DAKAR, Senegal — Between heavy lunches and poolside cocktails, the doctors and health experts who gathered at a fancy hotel here early this month to talk about reproductive health often brought up cultural taboos. Cultural taboos that hinder open discussion of H.I.V., cultural taboos that prevent the availability of contraceptives, cultural taboos that make abortions illegal in many African countries.

Every sub-Saharan African state already allows pregnant women to abort when their lives are in danger, and in recent years Benin, Chad, Ethiopia, Ghana, Mali, Swaziland and Togo have been working at expanding their laws to allow abortions in more circumstances.

Still, in all of sub-Saharan Africa, abortion is legal only in Cape Verde and South Africa. And the number of unsafe abortions on the continent is staggeringly high: every year, there are over six million unsafe abortions conducted in Africa, and about 30,000 women die from the procedure. Unsafe abortions are among the leading causes of death for women admitted to hospitals around much of the continent.



The solution to this problem is clear. Just two years after abortion became legal in South Africa, the number of deaths among pregnant women who underwent the procedure fell precipitously: by 90 percent between 1998 and 2001, according to the South African Medical Journal. But legalizing abortion won’t be easy. Even since 45 African countries signed the 2005 Maputo Protocol, pledging to relax their abortion laws, local health-care providers throughout the continent have refused to provide safe procedures or counseling.

The root of this resistance is more complex than any one entrenched stigma. Take Eunice Brookman-Amissah, a doctor who attended the conference in Dakar. Twenty years ago, she was a gynecologist in Ghana. One day, the 14-year-old daughter of a family friend whom she’d treated since the girl was 10, walked in, scared and asking for an abortion. The father was a much older man. Brookman-Amissah said she was shocked and turned the girl away, telling her she didn’t perform that type of procedure because she thought it was sinful. A few days later, Brookman-Amissah found out that the man had sent the girl to a witch doctor in the countryside and that the girl had died from a botched abortion.

Edgar Kuchingale, a doctor in Malawi who also attended the conference, told me that to this day prejudice, especially about immoral sexual behavior, remains a major hurdle. But for Brookman-Amissah, now vice president for Africa of Ipas, a reproductive-health nongovernmental organization, the problem mostly lies elsewhere: “It is not as if it is by custom that Africans are against abortion. Rather, it is the colonial laws that we need to get rid of.”

Many restrictive abortion laws in Africa date back to colonial codes, and the bigotry of the law has trickled through society. Mali’s law is based on the Napoleonic Code from 1810, which forbade abortion. Nigeria’s, one of the world’s most restrictive, dates back to a British provision from 1861.

Brookman-Amissah told me that she was changed by her patient’s death. Soon she became known at Ghana’s health ministry as the “abortion lady.” Working with Ipas, she started passing out vacuum-aspiration kits for post-abortion care to women who had given themselves procedures outside of hospitals.

Brookman-Amissah, who was Ghana’s minister of health from 1996 to 1998, had some success in decentralizing reproductive care to rural outposts and clinics and in training midwives and natural-birth attendants in performing abortions. Ghana’s maternal death rate dropped as a result, if only slowly: there were 451 deaths for every 100,000 live births in 2008, down from 740 deaths in 1990, according to The Ghanaian Journal.

The current laws urgently need abolishing or amending. After so many years of women’s health in Africa being dictated by governments, both domestic and foreign, it’s time African women be allowed to take the matter of their bodies into their own hands.

Travel for this post was supported by a grant from the Pulitzer Center on Crisis Reporting.