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In Sub-Saharan Africa (SSA), 89% of unintended pregnancies occur among women with an unmet need for modern contraceptives. Often, such unwanted and unplanned pregnancies end in unsafe abortion. SSA has the highest estimated proportion of abortions that are unsafe in the world, which contributes to the region’s high maternal mortality.

On 27 October 2021, the African Institute for Development Policy (AFIDEP) and the Guttmacher Institute engaged African Parliamentarians on SSA’s reproductive health needs at the 13^th Network of African Parliamentary Committees of Health (NEAPACOH) meeting. The session, titled ‘Meeting Sexual and Reproductive Health Needs in Sub-Saharan Africa: A Focus on Preventing Unsafe Abortion’ was moderated by Dr. Eliya Zulu, Executive Director at AFIDEP.

The Guttmacher/AFIDEP session featured a presentation on regional trends on incidence, legality, and safety of abortion in SSA based on a Guttmacher report released in January 2021. The presentation was delivered by Dr. Susheela Singh, distinguished scholar and Vice President for Global Science and Policy Integration at the Guttmacher Institute. She highlighted the cost and benefits of fully investing in sexual and reproductive health services, relevant to the parliamentary committees of health, pointing to the need for policymakers to address the problem.

Trends on incidence, safety, and legality of abortion in SSA
An estimated 255 million women (92% of women) in SSA live in countries with highly or moderately restrictive abortion laws. Available evidence shows that there is no correlation between abortion legality and abortion incidence. In fact, countries that have the most liberal laws or the broadest criteria have some of the lowest abortion rates. Globally, abortion incidence is statistically the same for countries with restrictive abortion laws and for those with liberal laws. During the NEAPACOH meeting, Dr. Zulu asserted this, noting that, “removing legal restrictions does not really increase the rate of abortion.”

Weighing in on the consequences of unsafe abortion, Dr. Jotham Musinguzi, Director General of Uganda’s National Population Council stated that in many SSA countries, medical care for complications from unsafe abortion puts pressure on already fragile health services and systems.

Dr. Musinguzi encouraged African members of parliament to push for legal reforms on sexual and reproductive issues in the region, including the ratification of the Maputo Protocol, an international human rights instrument established by the African Union. He further reminded NEAPACOH participants of the commitment countries made at the International Conference on Population and Development (ICPD) in 1994 to provide safe abortion within the context of the country’s laws, which the Maputo Protocol also speaks to.

What can be done to reduce the burden of unsafe abortion in SSA?
Improving reproductive health care—including abortion-related care benefits women, families, and societies. In her presentation, Dr. Singh identified the following steps for national policy stakeholders to consider:

• Prevent unintended pregnancy: expanding access to modern contraception will go a long way to help prevent unintended pregnancies and associated unsafe abortions.
• Full implementation of the abortion law under the Maputo Protocol: so that all women who qualify for a legal abortion are able to obtain one. Evidence shows that legality alone does not ensure the availability of, and access to, quality abortion services.
• Expand the reach of post-abortion care services to all women: women are likely to seek an abortion when they have a pregnancy they really do not want. Continued investment in improving post-abortion care is necessary to mitigate the harm caused by unsafe abortions.
• Reduce the need for post-abortion care by improving the safety of abortions: this will require sustained collaboration from all stakeholders to implement legal criteria that, at a minimum, meet the grounds in the Maputo Protocol.
• Disseminate accurate information on how to use misoprostol: in countries with limited legal grounds, the effects of unsafe abortion can be minimized by promoting initiatives that have worked elsewhere. The use of misoprostol is one such example.

The AFIDEP/Guttmacher session on reproductive health was one of two preliminary sessions held ahead of the main NEAPACOH meeting which took place on 28 and 29 October 2021. The other session, also led by AFIDEP was jointly facilitated by the NEAPACOH secretariat and experts from the International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA). The session, on TB and lung health, was a follow-up from the 2020 NEAPACOH meeting where IMPALA presented emerging evidence on TB and Lung Health to parliamentarians, and how these issues could be addressed in their countries.

Under the theme ‘Sustained programs for the achievement of ICPD goals and the SDGs: Role of Parliamentarians’, the main NEAPACOH meeting focused on sharing experiences of countries’ achievements and lessons in implementing the October 2019 NEAPACOH commitments and Kampala Call to Action amidst the COVID-19 pandemic.

During the close of the NEAPACOH meeting on 29 October, Dr. Zulu had an opportunity to provide an overview of the key messages from the presentation on SSA’s reproductive health needs. His summary emphasized the readiness of AFIDEP and Guttmacher to support African Parliamentarians by providing well-packaged evidence for them to advocate for the issue of preventing unsafe abortion.

Additionally, the chairperson of NEAPACOH, Hon. Moshoeshoe Fako appealed to the Parliamentarians to advocate moving from unsafe abortions in their countries. Dr. Fako committed to driving efforts against unsafe abortion, promising to talk to the various Committees of Health to advance the joint venture towards preventing unsafe abortions.

The 13^th annual NEAPACOH meeting was hosted by the Partners in Population and Development Africa Regional Office (PPD-ARO), with AFIDEP among the co-convening partners.

About NEAPACOH
NEAPACOH is an annual meeting of the Network of African Parliamentary Committees of Health. It  aims to facilitate sharing of lessons-learned and experiences on how African parliamentary committees of health can more effectively address health challenges in their respective countries. The meeting also provides a platform for the committees to develop concrete commitments and actions to champion and address critical health challenges.