‘Clear and promising’ opportunities for expanding abortion care in francophone West Africa

Tuesday, March 29, 2016

woman smiling

With a new report concluding there is “a vast unmet need” for safe, induced abortion care in francophone West Africa, Ipas is stepping up work with national and international partners to expand comprehensive abortion care (CAC) service delivery and access in the region.

According to the report, Comprehensive Abortion Care Needs and Opportunities in Francophone West Africa: Situational Assessment Results (also available in French), there are more than 1.8 million unsafe abortions in West Africa each year. The report recommends and outlines specific ways that governments, health officials, community groups and others can develop strategies and mobilize resources to significantly expand programs providing safe, induced abortion.

Working in partnership with international and in-country agencies, Ipas conducted the situational assessment in March-May 2015.  It was part of a larger planning project funded by the William and Flora Hewlett Foundation and supported by the French government. The assessment initially looked at the entire francophone West Africa region but subsequently focused on four countries—Benin, Burkina Faso, Senegal and Togo— based on a set of criteria that indicated positive movement on CAC.

 “Ipas has long been concerned about the lack of access to comprehensive abortion care and contraceptive care for women in francophone Africa,” says Katherine L. Turner, Ipas senior health systems advisor and francophone Africa manager. “We are greatly encouraged by the results of the assessment, which show there are clear and promising opportunities to expand services to the women who need them and are entitled to them by law.”

As part of the assessment, Ipas researchers interviewed government officials, health-care providers, lawyers and civil society leaders to gain an understanding of the current state of abortion policy, research, and services and opportunities for expanding CAC service delivery and access. They also conducted focus-group sessions with women to get their perspectives on abortion and carried out mystery-client visits to pharmacies to assess provision of misoprostol for abortion-related care.

Increasing leadership and commitment in the region

The planning project strategies have focused on increasing leadership and commitment, strengthening partnerships and mobilizing resources for comprehensive abortion and contraceptive care. Key activities include stakeholder meetings in Benin and Togo and an Ipas-led francophone study tour for six country delegations to Ghana, which provides a legally and culturally relevant example of a successful national comprehensive abortion care and contraceptive services program.

Ipas also has invited more than 20 organizations—including IntraHealth International, IPPF, Médecins du Monde, Pathfinder, PSI, the Ouagadougou Partnership Coordination Unit and others—to participate in a Francophone Networking Group to increase coordination and collaboration on sexual and reproductive health and rights activities in the region. Future activities will include a regional priority-setting workshop, country-level planning and ongoing resource mobilization. 

Powerful barriers to care

To date, abortion-related efforts in francophone West Africa have mostly focused on postabortion care; few have concentrated on the provision of safe, induced abortion. Even though most countries have legal provisions for abortion—such as to protect the life and health of the woman and in cases of rape, incest and fetal abnormalities—in many countries these laws have not been translated into actual services for women.  Among the concerns cited in the report and by those interviewed:

  • In Benin, the Ministry of Health has issued standards and guidelines on safe abortion service delivery, but “this progressive document was never fully disseminated and remains poorly known throughout the health system.”
  • In Burkina Faso, more than a quarter of all maternal deaths are attributed to unsafe abortion—an extremely high proportion when compared to the global rate of 13 percent. Provider stigma and fear of prosecution are major barriers for women seeking safe, legal abortion care.
  • In Senegal, abortion is only legal when three physicians agree that an abortion is necessary to save the life of the woman. This means that comprehensive abortion care is severely restricted, and even postabortion care is not available at all levels of the health system, due to lack of trained providers, lack of proper equipment and other challenges.
  • In Togo, a 2007 reproductive health law authorizes abortion for several indications.  However, provisions for implementation have not been elaborated and the health system has not developed or implemented service delivery standards and guidelines to offer abortion care for women who are eligible under the law.
  • Throughout the region, there are strong cultural, religious and political opponents to comprehensive abortion care—in addition to other barriers, such as stigma and lack of awareness of the legality of abortion. The report quotes one physician in Benin, an ob/gyn who works with the Ministry of Health, saying that even the country’s well-educated, urban residents are not familiar with the abortion law.

Next steps

Despite the significant challenges, the report concludes there is the opportunity for “truly transformative change” in women’s reproductive health in francophone West Africa.

“The women in this region have been neglected for far too long,” says Turner. “We need to get comprehensive abortion care out of the law books and into facilities and communities.”

To that end, Ipas is stepping up efforts to engage with ministries of health, nongovernmental partner agencies, youth organizations and others to increase commitment to implementing comprehensive abortion care to the fullest extent possible.

As outlined in the report, this will include steps to:

  • Engage with governments to increase their commitment and engage with donors to increase their support for comprehensive abortion care programs in francophone African countries;
  • Collaborate with in-country and international research partners and institutions to prioritize areas for further research, including strategic assessments that will estimate abortion incidence and costs of unsafe abortion and assess women’s and youth perceptions;
  • Implement comprehensive abortion care and contraceptive care in all levels of the health system, in a way that is integrated within broader sexual and reproductive health programs;
  • Promote understanding of local abortion laws and support the legislative and ministry of health processes for implementing those laws;
  • Partner with local organizations to conduct community sensitization activities to increase understanding of the legal indications for abortion and advocate for increased access to comprehensive abortion and contraceptive care.

The capacity and commitment to comprehensive abortion and contraceptive care in the region is already increasing. As one member of the Togolese delegation on the study tour affirmed, “I will support the ministry of health to develop an advocacy program in favor of safe abortion care.”