February 3, 2023

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As abortion rights shrink in the US, this small country has expanded access

COTONOU, Benin – When lawmakers in Benin, West Africa, met last year to consider whether to legalize abortion, they heard shocking testimonies from Dr. Véronique Tognifode, the country’s social affairs minister, on what she had seen during her years working as a gynaecologist.

She shared how she and her colleagues had fought to save women who had tried to terminate their pregnancy by taking dubious pills or bleach, inserting sharp objects into their bodies, or obtaining illegal abortions from the dangerous hackers who worked before Locally known as “mechanics”.

The death toll is unacceptably high, she told them: one in five maternal deaths in Benin is due to unsafe abortions, according to the government – more than double the average on the African continent, which is the world’s most unsafe region to terminate a pregnancy pregnancy.

“Young women and girls are having abortions one way or another, and that way is unthinkable,” said Dr. Tognifode, one of three gynecologists serving as senior officials in the Benin government. “We cannot 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 widely available.

dr Véronique Tognifode, Benin’s social affairs minister, shared with lawmakers her experiences as a gynecologist trying to save women dying from illegal, botched abortions. Credit…Carmen Abd Ali for The New York Times

Lawmakers voted in October 2021 to decriminalize and legalize abortion in most circumstances when pregnancy is likely to cause a woman “material, educational, occupational or moral hardship.” Previously, abortion was only allowed in cases of rape, incest, or fetal abnormalities, or when the mother’s life was in danger.

Unlike several Latin American countries, where abortion was recently legalized in response to grassroots feminist movements, the law in Benin was changed after years of discreet lobbying by lawyers 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 requesting abortions but fewer requiring treatment for botched abortions.

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

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

Benin is one of just a few countries on the continent – including Cape Verde, Mozambique, South Africa and Tunisia – where abortion is widely legal.

The topic is discussed elsewhere. Liberian lawmakers debated a bill in June that would legalize abortion under most circumstances, but the outcome is unclear. The government of Sierra Leone, which has one of the highest maternal death rates in the world, has vowed to decriminalize abortion.

Abortion law advocates in Africa fear that repealing Roe v. Wade could hinder liberalization in Africa.

“Benin now recognizes what the US denies, but the impact of the end of Roe v. Wade on Africa are unmissable,” said Bilguissou Baldé, director for Francophone Africa at Ipas, a non-profit organization that campaigns for abortion rights.

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

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

One morning last summer, a 21-year-old student showed up 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. Student Chantal, who asked to be identified by just her first name for fear of stigma, said neither she nor her boyfriend were ready to become parents. She wanted to finish her studies and start working.

“Without the pressure of my college and my parents wanting me to focus on them,” she said, she and her boyfriend would be ready to have the baby. “But I can’t right now.”

Counselor Clémentine Degnagni said Chantal’s abortion is legal under the new law because the pregnancy could cause her academic and economic problems. Since the law was passed, her clinic, the Beninese Family Promotion Association, has increased from around 30 to 50 abortions a month.

Benin’s parliamentary vote on the law ended years of behind-the-scenes lobbying by abortion rights activists. Health Secretary Benjamin Hounkpatin, who is also an obstetrician-gynecologist, told lawyers in 2018 that he was interested in improving access to abortion, according to Dr. Baldé of Ipas.

Twice in the past year lawmakers gathered at a hotel outside of Cotonou and heard presentations on unsafe abortion results from Dr. Tognifode, the Minister for Social Affairs, and other gynecologists and nurses.

Botched abortions leave hundreds of women infertile and kill at least 200 women a year in Benin — and that number could be two or three times higher, said Dr. Tognifode. Studies have shown that restricting access to abortion has little effect on the number of women who want an abortion and instead puts women’s lives at risk.

dr Tognifode said, “How many more guts from the uterus do we need?”

One lawmaker, Orden Alladatin, said in an interview that lawmakers were shown such “cruel” images that he was persuaded to support the law.

Bishops from the Roman Catholic Church, which makes up about a quarter of the population, tried to lobby against the bill, but they were only informed on the eve of the vote, said Rev. Eric Okpeitcha, the general secretary of the state bishops’ conference. “We tried to urge 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 were too permissive and vague: “Material need – who can define that?”

No referendums or polls were conducted to gauge public opinion. Some lawmakers, including the president of Benin’s lower parliament, vocally opposed the bill.

dr Kitihoun, of the Planned Parenthood group, said he stood up for lawmakers up to the last minute, following some of them to the restroom in the National Assembly building when they were taking 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 published.

President Patrice Talon, 64, a businessman who made his fortune in the cotton industry, said Dr. Tognifode and Dr. Hounk godmother personally installed for the law. Many saw the president’s support consistent with his record of passing measures on women’s rights: tightening penalties for sexual assault; criminalizing sexual contacts between university professors and the students they teach; Mothers are allowed to give their children their family names.

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

Whether Beninese society is ready for legal abortions is another question. The country has brought its fertility rate down to 4.7 births per woman in recent decades, but it is religiously conservative – about half the population are Christians of various denominations and a quarter are Muslims.

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

The taboo surrounding abortion and the lack of psychological support leave women struggling with guilt and trauma, according to gynecologists and counselors.

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

“Having an abortion is like being different. It’s like you’re not a saint anymore,” said Précieuse, 24, a student who had an abortion by a doctor who also prescribed her birth control implants.

Benin has an active youth association affiliated with the International Planned Parenthood Federation, which now runs meetings to promote awareness of 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 they had become an unlicensed ” Mechanic” should go for one. Abortion could be deadly, but a new law has legalized most abortions.

It was the first time either woman had heard of the law.

Flore Nobimé contributed to the coverage from Cotonou.