While Abortion Rights Shrink in U.S., This Small Country Expanded Access

While Abortion Rights Shrink in U.S., This Small Country Expanded Access

COTONOU, Benin — When lawmakers in the West African nation of Benin met last year to consider whether to legalize abortion, they heard shocking testimony from Dr. Véronique Tognifode, the country’s minister of social affairs, about what she had seen during her years working as a gynecologist.

She recounted how she and her peers had struggled to save women who had tried to end their pregnancies by ingesting dubious pills or bleach, inserting sharp objects into their bodies or getting illegal abortions from the dangerous hacks known locally as “mechanics.”

The death toll was unacceptably high, she told them: One in five maternal deaths in Benin resulted from unsafe abortions, according to the government — more than twice the average on the African continent, which is the most unsafe region in the world to terminate a pregnancy.

“Young women and girls are getting abortions one way or another, and those ways are unthinkable,” said Dr. Tognifode, who is one of three gynecologists serving as senior officials in Benin’s government. “We can’t live with what we see in hospitals.”

A year after that testimony, Benin, with a population of 12 million, mostly Christians and Muslims, has become one of the few countries in Africa where abortion is broadly available.

Credit…Carmen Abd Ali for The New York Times

Legislators voted in October 2021 to decriminalize abortion under most circumstances, allowing it when a pregnancy is likely to cause a woman “material, educational, professional or moral distress.” Previously, abortion was allowed only in cases of rape, incest or fetal abnormalities, or if the mother’s life was at risk.

Unlike in several Latin American countries, where abortion was recently legalized in response to grass-roots feminist movements, in Benin, the law was changed after years of discreet lobbying by advocates and doctors. They also had support from the country’s president, politicians said.

A year after the law passed, some clinics have seen more women seeking abortions but fewer needing treatment for botched ones.

Benin’s move to expand the right to abortion ran counter to the direction taken in the United States, where states are tightening restrictions and the Supreme Court overturned Roe v. Wade, the 1973 decision that legalized abortion nationwide.

It also runs counter to most of Africa. About nine in 10 women in sub-Saharan Africa still live in countries with restrictive laws on abortion, according to the Guttmacher Institute, a nonprofit specializing in reproductive health.

Benin is one of only a handful of countries on the continent — including Cape Verde, Mozambique, South Africa and Tunisia — where abortions are broadly allowed.

The issue is under discussion elsewhere. Lawmakers in Liberia debated a bill in June that would legalize abortions in most circumstances, but the outcome is unclear. The government of Sierra Leone, which has one of the world’s highest rates of maternal mortality, has vowed to decriminalize abortions.

Advocates for abortion rights in Africa fear that the overturning of Roe v. Wade could hamper liberalization in Africa.

“Benin now recognizes what the U.S. denies, but the impact of the end of Roe v. Wade on Africa cannot be overlooked,” said Bilguissou Baldé, the director for Francophone Africa at Ipas, a nonprofit that promotes abortion rights.

Still, in Benin, many women now feel more at liberty to inquire about the procedure, health workers said, although the authorities have yet to provide official statistics on abortion rates.

“Women bluntly tell us, ‘I want to abort,’” said Serge Kitihoun, the director of medical services at the Beninese branch of the International Planned Parenthood Federation. “That would have been unthinkable years ago.”

One morning this past summer, a 21-year-old student arrived at a clinic in Cotonou, Benin’s largest city, for her second appointment in a week and told a counselor that she was four weeks pregnant. The student, Chantal, who asked to be identified by only her first name for fear of being stigmatized, said neither she nor her boyfriend were ready to be parents. She first wanted to finish her degree and start working.

“Without the pressure of my studies, and my parents who want me to focus on them,” she said, she and her boyfriend would be willing to have the baby. “But I just can’t right now.”

Chantal’s abortion was legal under the new law because the pregnancy could cause her educational and economic distress, said the counselor, Clémentine Degnagni. Since the law was passed, her clinic, the Beninese Association for the Promotion of the Family, has gone from performing about 30 abortions a month to performing 50.

The parliamentary vote on the bill in Benin capped years of behind-the-scenes lobbying by abortion rights advocates. The health minister, Benjamin Hounkpatin, who is also an obstetrician-gynecologist, told advocates in 2018 that he was interested in improving access to abortion, according to Dr. Baldé of Ipas.

Twice last year, lawmakers gathered in a hotel outside Cotonou and heard presentations on the results of unsafe abortions from Dr. Tognifode, the minister of social affairs, and from other gynecologists and nurses.

Botched abortions leave hundreds of women infertile and kill at least 200 women annually in Benin — and that figure could be two or three times higher, Dr. Tognifode said. Studies have shown that restricting access to abortion has little effect on the number of women seeking abortions, and that it instead endangers women’s lives.

Dr. Tognifode said, “How many more bowels coming out of uteruses do we need?”

One lawmaker, Orden Alladatin, said in an interview that legislators had been shown images so “atrocious” that he was persuaded to support the bill.

Bishops of the Roman Catholic Church, which accounts for about a quarter of the population, sought to lobby against the bill, but they were told about it only on the eve of the vote, said the Rev. Eric Okpeitcha, the secretary general of the country’s bishops’ conference. “We tried to call on lawmakers to vote against it, but it was too late.”

“It’s just not in our culture,” Father Okpeitcha said of abortion. He argued that the criteria in the new law was too permissive and vague: “Material distress — who can define this?”

No referendums or surveys were conducted to gauge public opinion. Some lawmakers, including the president of Benin’s lower branch of Parliament, loudly opposed the bill.

Dr. Kitihoun, from the Planned Parenthood group, said he had lobbied lawmakers until the last minute, following some of them to the bathroom in the National Assembly building, as they took a break before the final vote.

After hours of debate, the Assembly voted unanimously in favor of the bill. Opponents had either left the building or claimed to have changed their minds. The vote count was never made public.

President Patrice Talon, 64, a businessman who made his fortune in the cotton industry, personally pushed for the law, according to Dr. Tognifode and Dr. Hounkpatin. Many saw the president’s support as consistent with his record of passing measures on women’s rights: strengthening sentences for sexual assault; criminalizing sexual contact between university professors and the students they teach; allowing mothers to give their family name to their children.

But critics say legislators had little choice but to get in line with a president who analysts say has become increasingly autocratic since he was elected in 2016, jailing political opponents and stifling press freedom.

Whether Beninese society is ready for legal abortion is another question. The country has brought down its birthrate in recent decades, to 4.7 births per woman, but it is religiously conservative — about half of the population is Christian of various denominations, and a quarter is Muslim.

Simon Séto, a surgeon and gynecologist in Abomey-Calavi, near Cotonou, said he had observed some hypocrisy around abortion. “The priest preaches with blind eyes,” he said, “but when their daughter or wife needs us, they know very well how to find us.”

The taboo around abortion, as well as the lack of psychological support, leaves women struggling with guilt and trauma, according to gynecologists and counselors.

In interviews with four women who recently had abortions, only one said she had felt comfortable telling a friend or a relative about it.

“Aborting is like being different. It’s like you’re not a saint anymore,” said Précieuse, 24, a student who received an abortion from a doctor who also required her to get a contraceptive implant.

Benin has an active youth association affiliated with the International Planned Parenthood Federation that is now leading sessions to promote awareness about contraception and the new abortion law.

On a recent afternoon on the outskirts of Abomey-Calavi, a group of seven young women, all training to be hairdressers, gathered to hear Aubierge Gloria Attinganme, a member of the youth group, explain that going to an unlicensed “mechanic” for an abortion could be fatal but that a new law had legalized most abortions.

It was the first that any of the women had heard about the law.

Flore Nobimé contributed reporting from Cotonou.

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