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unsafeabortioncovid19With the advent of the COVID-19 pandemic, it is anticipated that women would be at greater risk of socio-economic impacts. Women’s rights to sexual and reproductive health care should still be respected in the context of COVID-19, however due to the urgency of the pandemic, the provision of such health services and potential to engage in diverse policy debates has been impacted. Globally, 210 million women become pregnant annually and 80 million of these are unplanned, resulting in 46 million of these pregnancies being terminated due to a myriad of reasons including economic pressures and health reasons. In Africa, predominantly, there is little to no legislation on the termination of pregnancy, only three countries, South Africa, Cape Verde and Tunisia have passed termination legislation. Nineteen million unsafe abortions are performed annually globally, with 97% of these taking place in the developing world. It is also estimated that 90% of all abortions carried out in Africa are unsafe.

Abortions are deemed unsafe when it does not meet the regulatory standards and are not performed by a trained health professional in a sterile environment. The lack of reproductive health and sexual rights in Africa is detrimental to African women and girls in all aspects. In Africa, unsafe or backstreet abortions are commonplace, with streets filled with posters advertising such services or in other instances nurses or other healthcare professionals freelancing as abortion clinics after-hours. The nature of the business is inherently murky, operating on the fringes and outside the lines of the law, criminalizing women and young girls for making decisions about their own bodies.  This places women in danger when seeking termination services, and subsequently face the highest risk of death during pregnancy termination in the world. Sub-Saharan Africa’s maternal mortality is estimated at 200 000 deaths a year, approximately 68% of all maternal deaths per year worldwide.  

COVID-19 has made an already dangerous and difficult situation worse; with many countries imposing strict lockdown measures, clamping down on the movement of people and calling for strict home confinement in an effort to curb the spread of the deadly Coronavirus. The virus has led to a decrease in supply of essential sexual and reproductive health services and products like condoms, sanitary towels, and contraceptives as well as reduced access to healthcare services.  

In Africa, COVID-19 places a heavier strain on already fragile healthcare systems that are underfunded, understaffed and largely on the brink of collapse due to other diseases like Ebola in Sierra Leonne or malaria in some Nigerian states. Years of austerity measures and health care budget cuts leave many state funded facilities in dire straits on a normal day. With COVID-19, many would not be able to access a test or a respirator when and if needed. Albeit that activists have called for the health sector to continue to prioritize access to sexual and reproductive health care services, we have witnessed a stringent prioritization of COVID-19 cases across Africa.

The World Health Organization (WHO) has warned that the Coronavirus pandemic would result in 7 million unintended pregnancies due to reductions in routine health services and access to contraceptives. The poorest women in African societies will bear the brunt of these conditions, they are more likely to turn to the least safe measures of termination and home remedies out of sheer desperation. The food security crisis brought on by the Coronavirus will add more complexity to the strain on women as they are mostly placed in charge of meal provision for the family. The economic and mental strain of providing for an infant may push women to take risky decisions, that lead to more extensive health problems or death. Therefore, triggering added complexities to a post-COVID-19 environment amplifying and deepening existing inequalities and gender power dynamics. This has largely been described as a preventable pandemic.

In Africa, 93 % of women of reproductive age (15-44) live in countries with restrictive termination laws. Countries like Angola, Egypt and Senegal prohibit abortions all together. Here, no explicit legal exception is allowed, and abortions are prohibited under any circumstances. Many countries allow for abortions under special medical conditions such as to save a mother’s life or preserve her physical or mental health. The prevalence of unsafe abortions is associated with restrictive abortion laws, poor quality health services and low community awareness. Of the three countries (Cape Verde, South Africa, and Tunisia) allowing termination without restriction as to reason, women continue to face obstacles such as distance to local clinics, stigmatizing by health care professionals and cultural or religious hurdles. The poorest women with the fewest resources are most likely to experience complications due to unsafe abortions. Countries where abortion laws are restricted have high unofficial rates of baby dumping. Even where abortion laws are permitted like in South Africa, it is estimated that up to 3 000 babies are abandoned annually, many after failed abortion attempts. The current situation will see more women turn to backstreet abortions, as they cannot access contraceptives or the multiple trips to their local clinic for a termination of pregnancy.

Due to the stay-home restrictions an increase in pregnancy rates is expected, as people have more time to engage in sexual activity and less access to regular contraceptive methods such as condoms and contraceptives. Some countries in Africa have high rates of HIV/AIDS infections, and this too may increase due to the lockdown measures. Seeking immediate medical attention for exposure drugs and ARVs may also be curbed and have negative long-term impacts on the lives of millions and the economy. The rate of gender-based violence (GBV), sexual violence included, has also spiked globally since countries have imposed lockdown measures. This trend was foreseeable as hundreds of young girls were raped in Sierra Leone during the Ebola pandemic teenage pregnancy increased by 65% during the pandemic. The spillover effects of the Coronavirus could result in an additional 56 700 maternal deaths over the next six months in 118 low- and middle-income countries globally.

The massive shift of resources (administrative and medical staff, medical supplies, and financial support) responding to the pandemic is undisputedly necessary, but sexual and reproductive health services should continue as routinely as possible or even increased during such times. The coronavirus has placed the hard-won advances on women’s rights in the past decade at risk, even more so in Africa, where the bulk of the world’s most vulnerable population resides. These advances have been the result of collaborative work by civil society organizations who play a dual role of implementors and watchdogs. The UN reports that as a direct result of the pandemic, 47 million women and girls will fall below the poverty line, bringing the total of poor women to 435 million by 2021. The Sustainable Development Goals (SDGs) have been formulated as an opportunity to transform the lives of women and girls globally; but the impact of COVID-19 has been severe in reversing SDG gains, which disproportionally impact women and girls. In Africa, these consequences are even more dire due to lack of state budgets and gross mismanagement. Women will also be left out of recovery plans as they predominantly operate in the shadow or informal economies in Africa; leaving women and girls with an increased burden of weaving society back together in recovering from COVID-19.

Riska Koopman is currently working as an NGO consultant focused on issues of Gender, Economic and Tax Justice. Riska is passionate about intersectional feminist activist deeply interested in Africa's growth, development and role in the world. She holds BA and BCom Hons degrees from the University of Stellenbosch. Her views do not necessarily reflect those of the IGD.

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