Rwanda and Nigeria Still Struggle with Abortion Stigma, Despite Laws
Aimable Twahirwa and Abiodun Jamiu (Lead Writers)
When Francine Nyiramahirwe, 22, decided to consult a health professional to terminate her pregnancy at a private clinic in Nyanza, a district in Southern Rwanda, she was immediately arrested and charged with murder. In 2015 Nyiramahirwe was indicted and sentenced to 15 years in jail after taking the drug Misoprostol at 18 weeks of pregnancy.
Misoprostol is known to be an effective pill for terminating a pregnancy, with a success rate of over 80% for women who are between 10 to 13 weeks pregnant,
“When I was raped in 2015, I didn’t have any other option rather than to terminate [the] pregnancy. I wanted to pursue my academic programme,” she explained, adding that her social science studies have been disrupted following her imprisonment.
The arrest occurred before the Rwandan government revised its penal code in August 2018. Previously the code imposed prison sentences on anyone having an abortion or assisting someone to terminate a pregnancy without a court order. Under the new law, abortion is allowed in cases of rape, forced marriage, incest, or instances where the pregnancy poses a health risk to the mother or the foetus. Nyiramahirwe was released from jail following the full decriminalization of abortion in Rwanda.
While some healthcare providers remain uncertain about their rights and responsibilities in providing abortion care, activists stress that addressing these knowledge gaps through capacity-building, guidelines, and awareness campaigns is essential.
“Understanding of rights and responsibilities among healthcare providers regarding abortion care is a complex issue influenced by legal, cultural, and institutional factors,” Dr Tom Mulisaal, commenting on the current situation in Rwanda, stated.
Dr Mulisa is the Executive Director at the Great Lakes Initiative for Human Rights and Development (GLIHD), a non-governmental organisation (NGO) is committed to advancing human rights in Rwanda and the Great Lakes region.
According to Dr Jean Pierre Ndayisenga, a lecturer at the University of Rwanda, explains that many women, including pregnant ones, prefer to self-manage their abortions outside the formal healthcare system due to a lack of accurate information. Dr Ndayisenga conducted a study examining the factors that influence young Rwandan women to seek abortion care outside the formal healthcare settings.
“The majority of these women from rural settings are using medications that they acquired informally,” he said. Without proper medical supervision, women may not receive appropriate instructions for the use of medications, leading to incorrect dosages or adverse side effects.
Abortion can be performed at all health facilities, including health centres and clinics in Rwanda, following the publication of an order of the Minister of Health published in the Official Gazette in April 2019. However, Dr Mulisa, noted that one key challenge is that some healthcare providers may not fully understand the scope of the legal changes or the steps to follow when approving and providing abortion care. “Some providers [still] refuse to offer abortion services on moral or religious grounds, which can further limit access,” he said.
Complications remain
The 2020 Rwanda Demographic Health Survey revealed that the number of underage pregnancies rose from 17,337 to 19,832 between 2017 and 2020.
While the rate of medical abortions continues to increase in Rwanda, some medical doctors have also reported complications during abortions, especially heavy bleeding because of uterine perforation.
Another challenge is that while Rwanda’s legal framework now permits abortion under certain circumstances, activists point out that cost-related barriers still limit access for many, especially marginalised groups such as women and girls in low-income settings.
Rwanda’s Mutuelle de Santé, a community-based health insurance, is one of the country’s most widely used health insurance schemes. However, abortion services are not explicitly covered, even when provided legally.
Stigma, cultural and religious beliefs still hinder safe abortions in Nigeria
Growing up in a Muslim household in Nigeria, Salmat Ibrahim was taught that abortion was an unforgivable sin. For years, she held to this belief but was shocked when she learnt that her mother had secretly helped her elder sister terminate her pregnancy at an unregistered medicine store. “I was angry; angry at her, at the people who helped her. All I could think was that what they did was wrong, and I frowned at it every chance I got.”
Faced with a pregnancy in her third year of university and at the risk of incurring her religious father’s wrath, Salmat, now 23, was left with difficult decisions to make. Her boyfriend, who was 25 years old at the time, encouraged her to terminate the pregnancy, and she found herself torn between a personal crisis and the fear of going against her family’s beliefs.
The following day, they travelled to the Apete area of Ibadan, Oyo State, where she was introduced to a grey-haired man who led her into a private room within a makeshift shop. For the next 15 minutes, she endured agonising pain as she lay through the procedure, “It [was] the worst moment of my life. I bled for over two weeks after the evacuation and was only told to buy [some drugs] to ease the pain” she said
In Nigeria, abortion remains illegal. Sanctions can go as high as 14 years imprisonment. The laws only allow for abortion when the pregnancy is deemed to be a danger to the life of the woman. Many women huddled under the cover of secrecy to terminate their pregnancies often face complications, and in extreme cases, death. Recent statistics show that there are at least 6,000 abortion-related deaths recorded in the country annually.
Seeing the trend of abortion-related deaths, young women like Elizabeth Enu-Akan and Dasola Tewogbade are using social media to dispel common myths about abortions. Nigeria has an active number of TikTok users, amounting to 23.84 million. Its combination of short, engaging videos captures mostly young people seeking entertainment, community, and a sense of identity.
Dasola had visited a health facility in the Ife area of Osun state after experiencing an episode of painful periods. However, at the facility, despite writhing in unbearable pain, the health workers only watched and assumed she had had an abortion, “and they punished me for that,” she recalled.
In April 2019, Dasola started FIGURE to shift culture and demystify abortion stigma. On Facebook, she also runs a private group with over 4,100 members, including men, where she educates members on birth control and abortion care.
Elizabeth on the other hand, would appear in costumes and post short educational videos. She employs this tactic to pique the interest of the country’s teeming young population on the platform and to sustain engagement.
A post she made clarifying safe and unsafe abortions went viral and had women swarming to understand the implications, spurring the reality of the unending culture of silence women contend with. She would go on to start the Network for Safeguarding Women’s Health and Rights later.
Little efforts, big impact
An estimated 47% of Nigerians are poor, and Esther Emmanuel who works as a teacher, earning N25,000 monthly, and her partner were not ready to bear the financial responsibility that comes with having a child.
During this uncertainty, she met Dasola on Facebook. She attended some of her live sessions and had private conversations with her before booking an appointment with a doctor who provided her with professional advice about her choices.
“I did it and I think it is the best decision I have ever taken. Her perspective made me realise there’s nothing wrong with having abortions, especially when one isn’t ready or financially stable enough to care for a child,” she said matter-of-factly. “It is better that kids are not born than subjecting them to this cruel world where people only judge abortion but don’t care about the life of the kids that are brought forth,” she explained.
However, their interventions have not been without hiccups. They grapple with social exclusion from their immediate communities. Scaling their activities offline to bridge the digital divide, especially in rural, underserved communities where misconceptions about abortion and stigma are still rife, has been a key impediment. “Being a voice for Abortion rights condemned me to social and cultural isolation and excommunication, and I personally struggle with that often,” Dasola noted.
Amina Muhammed, a sexual reproductive rights advocate, believes the country’s restrictive laws on abortion reflect a broader misunderstanding of women’s reproductive rights, adding that “abortion is a basic human right. It is, however, deeply concerning that individuals without a uterus feel entitled to make life-altering decisions that affect women.”
She adds that education and awareness campaigns targeting lawmakers are “crucial, alongside increasing women’s representation in government, particularly in legislative roles. This would create policies that genuinely reflect women’s realities and needs.”
