Abortion in Gabon

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In Gabon, abortion is only legal in the cases of risk to the mother's life, risk of birth defects, pregnancy from rape or incest, or if the mother is a minor in distress, up to ten weeks of pregnancy. Illegal abortions are punishable by prison or fines. Gabon has one of the highest rates of abortion in Sub-Saharan Africa.

Contents

Abortion was banned in Gabon under French colonial law, and later by a total ban in 1969. In the 1990s and 2000s, public concerns arose about unsafe abortions and teenage pregnancy, and certain therapeutic abortions were made legal. The current abortion law is from the penal code of 2019. The parliament of Gabon made the abortion law more permissive in 2021, but did not add legal grounds. In 2023, the government proposed easing restrictions further. The majority of people in Gabon believe abortion should be illegal. Research groups have advocated for legalization.

Gabon's high abortion rate is associated with its high rate of teenage pregnancy and low rate of birth control usage. Abortion complications are a common cause of maternal mortality, though the rate has decreased in the 21st century. Many people self-induce abortions using plants or using misoprostol, which is available over-the-counter. Post-abortion care patients often face stigma from providers. In the 21st century, initiatives have made post-abortion care safer in Libreville and educated midwives about procedures.

Legislation

Article 376 of the penal code of Gabon says abortion may be punished by up to five years of prison or a fine of 2 million CFA francs. [1] Article 377 says: [2]

Est punie d'un emprisonnement de deux ans au plus et d'une amende de 1.000 000 plus, ou de l'une de ces deux peines, la femme qui s'est procurée l'avortement à elle-même qui a tenté de se le procurer ou qui a consenti à faire usage des moyens à elle indiqués ou administrés à cet effet.
It is punishable by a prison sentence of up to two years and a fine of 1,000,000, or one of these two penalties, for a woman who has procured or attempted to procure an abortion for herself or who has consented to the use of these means administered to her to this effect.

The second paragraph sets the following exceptions: [2]

lorsqu'il a été prouvé que l'enfant conçu naîtra avec des malformations physiques graves ou incurables;
lorsque cette grossesse compromet gravement la vie de la mère;
lorsque la conception a eu lieu par suite de viol, inceste ou lorsque la mineure se trouve dans un état de détresse grave
when it has been proven that the conceived baby will be born with serious or incurable physical deformities;
when the pregnancy seriously compromises the life of the woman;
when the conception has occurred as a result of rape or incest, or when the minor is in a state of serious distress.

Article 378 sets a gestational limit of ten weeks and requires that an abortion be performed at a hospital by a physician. [2]

Gabon has a law limiting the dissemination of information about abortion, though there is an exception for medical professionals publishing information about legal abortion in journals. [3] Gabon has ratified the Maputo Protocol, which includes a right to safe abortion. [4]

History

Gabon's abortion ban was influenced by France's abortion ban from the French Penal Code of 1810. Gabon was under the jurisdiction of a 1939 law specifying that all means of abortion were banned and that the only ground for therapeutic abortion was a "grave risk to life". [5] A 1969 law completely banned abortion and birth control. [6]

In 1995, the government launched a sexual and reproductive health education program, funded by UNESCO. It came in response to demands for legal contraception and a rise in unsafe abortions and teenage pregnancies. The program conducted studies confirming high rates of teenage pregnancy. It distributed information on abortion, a taboo subject. In 1999, the parliament debated lifting the abortion ban. [6] Birth control was legalized by a women's health measure in 2000 that enacted a right to contraception. [4] A law from 2000 said physicians could permit abortions if they determined there was a risk of maternal death or fetal abnormality. [7] In 2001, the Health Ministry found that illegal abortions resulted in 28.8% of maternal deaths. In the 2000s, there were many reports of fetuses being dumped as garbage. The Gabonese Midwives Association attributed this to the high rate of unsafe sex among teenagers. [7]

Réseau d'Afrique centrale pour la santé reproductive des femmes (Réseau GCG; transl. Central African Network for Women's Reproductive Health) is a group that has advocated for the decriminalization of abortion. It was founded in 2009 by Aimée Patricia Ndembi Ndembi, Gail Pheterson, Justine Mekuí, and Marijke Alblas. It influenced the government's decision to ease abortion restrictions in 2019. [8] Since 2019, the Social Sciences Research Institute of Omar Bongo University has held an annual conference about the prevalence of unsafe abortion. [9]

In March 2021, a law was proposed to the Parliament of Gabon that would increase the gestational limit, remove the requirement of approval from a physician, and expand the grounds to include distress that is not "serious". The law did not add legal grounds; Prime Minister Rose Christiane Raponda said, "It is not yet the right time." [10] It was proposed alongside gender equality bills, which gave women the equal right to initiate divorce and removed the legal requirement that women obey husbands. Raponda said, "The legal changes aim to tackle the issues of violence and discrimination that women face in our society." [11] The law was adopted on 14 May. [12]

In June 2023, under the administration of Ali Bongo Ondimba, the Council of Ministers of Gabon approved a draft law that would permit abortion if the pregnancy caused distress to the woman, had a risk of fetal deformities, or resulted from rape or incest. The law would amend Law 006/2020 and Law 042/2018 of the penal code. [13] The director of the NGO Sensibilisation-Santé-Sexualité called it a "sigh or relief". [14] The law faced opposition from religious leaders. [15] A 2024 survey by Afrobarometer found that 56% of Gabonese believe women who receive abortions should be imprisoned. [1]

Many Facebook pages advertise illegal abortions. Gabon Media Time wrote in 2024 that these pages offer abortions up to eight months of pregnancy, some of which use unspecified abortifacents, for prices between 28,500 and 138,500 francs. The publication said there was an "alarming silence from authorities" on the subject. [16]

Prevalence

In 2015–2019, 57% of pregnancies in Gabon were unintended, and 37% of unintended pregnancies resulted in abortion, equaling 21,100 abortions. Between 1990–1994 and 2015–2019, the unintended pregnancy rate went down by 23% and the share of unintended pregnancies resulting in abortion increased. [17] Gabon's rate of termination of pregnancy is one of the highest in Sub-Saharan Africa, compared to the regional average of about 16%, as of the early 2020s. [18] [19] Abortion is stigmatized, and women who receive abortions face ostracism from society. [20]

Gabon's high rates of unwanted pregnancies and abortions are affected by its low rate of birth control usage. [18] The rate increased from 14% in 2000 to 19% in 2012. [21] Although birth control has been legal since 2000, it is not widespread. In 2010, only 11.5% of contraception used modern methods. [4]

Gabon's maternal death rate is one in eighty-five reproductive-aged women, as of 2019. People in Gabon anecdotally report abortion complications to be a frequent cause of death. [4] Between 2000 and 2012, the Demographic and Health Survey reported decreases in both overall maternal mortality and abortion mortality. [22]

As of 2017, women in their twenties have the highest abortion rate, and abortion rates are not correlated with marital status or whether the woman lives in an urban area. Unlike in most countries, women who have given birth have a higher abortion rate. [23] A 1995 study focused on Libreville found that 19% of women have ever had abortions, of which 46% made the decision to abort on their own. A 2002 qualitative study in the rural Ngounié Province found that motives for abortion include lack of support from the father, lack of financial support, contraceptive failure, and fear of parents' reactions. Women in the study got information about abortion from social groups. [24]

Plants are traditionally and commonly used for self-induced abortions. This method is used by adolescents, who view it as a discreet and low-cost strategy, and by older women who wish to limit their births. Abortions are induced by vaginally inserting objects such as papaya roots, cassava leaves, or ndolé, or by ingesting lemon, ginger, grass, salt, bleach, permanganate or quinine. [4] [24] A self-report study found that 40% of self-induced abortions in Gabon result in complications of varying degrees. Reports of self-induced abortions without complications influence women's decisions to do the same. [4]

Misoprostol (under the brand name Cytotec) is an approved over-the-counter drug for stomach conditions. [24] Women wishing to perform medical abortions can buy the drug at low costs from market vendors, pharmacists, and physicians. It is usually self-administered without the use of mifepristone. [4]

Post-abortion care

Access to post-abortion care (PAC) is limited by stigma. [25] Out of fear of legal repercussions, women who terminate pregnancies often avoid medical treatment unless complications occur. Women seeking PAC for may face mistreatment from providers who suspect them of illegal induced abortion. [4]

Libreville Hospital is the largest maternal hospital in Gabon. It treats 650 PAC patients annually, as of 2014. [21] A 2009 study found that PAC patients at the hospital faced wait times of up to 24 hours and that abortion complications caused 25% of maternal deaths at the hospital. [26] A subsequent initiative introduced manual vacuum aspiration (MVA) to the hospital, replacing dilation and curettage (D&C), in line with WHO guidelines. By 2012, PAC procedures had lower wait times and complication rates. [27] In 2013, it introduced long-acting reversible contraceptives (LARC) and DMPA injections, which were taken up by 25% of patients. Women with children were more likely to choose LARC methods. [21] In 2014, a program introduced misoprostol regimens. [22]

Réseau GCG was founded with the goal of educating the public about PAC in Gabon, Cameroon, and Equatorial Guinea. In the following ten years, GCG trained 500 providers in MVA, misoprostol regimens, and post-abortion IUD insertion, leading to a reduction in maternal mortality. [8] [4] It has collaborated with the Gabon Association of Midwives. [28]

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons given for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

<span class="mw-page-title-main">Misoprostol</span> Medication to induce abortion and treat ulcers

Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. It is taken by mouth when used to prevent gastric ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAID). For abortions it is used by itself or in conjunction with mifepristone or methotrexate. By itself, effectiveness for abortion is between 66% and 90%. For labor induction or abortion, it is taken by mouth, dissolved in the mouth, or placed in the vagina. For postpartum bleeding it may also be used rectally.

<span class="mw-page-title-main">Self-induced abortion</span> Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

Unintended pregnancies are pregnancies that are mistimed or unwanted at the time of conception, also known as unplanned pregnancies.

A medical abortion, also known as medication abortion or non-surgical abortion, occurs when drugs (medication) are used to bring about an abortion. Medical abortions are an alternative to surgical abortions such as vacuum aspiration or dilation and curettage. Medical abortions are more common than surgical abortions in most places around the world.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

In Benin, abortion is legal on broad socioeconomic grounds up to twelve weeks of pregnancy.

<span class="mw-page-title-main">Abortion in Kenya</span>

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

Post-abortion care (PAC) is treatment and counseling for post-abortion women. It includes curative care, such as treating abortion complications, as well as preventative care, such as providing birth control to prevent future unwanted pregnancies. Post-abortion care reduces morbidity and mortality associated with abortion.

In 2005, the Ethiopian Parliament liberalised the abortion law to grant safe abortions to women in specific circumstances.

Abortion is illegal in Tanzania except to preserve the life of the mother. Under the Tanzanian penal code, health practitioners who perform illegal abortions may receive sentences of up to 14 years in prison, while those who procure abortions for themselves may be sentenced to up to seven years in prison.

In Zambia, abortion is legal if the pregnancy would threaten the mother's life or physical or mental health or those of existing children, or if it would cause a birth defect. Zambia has one of the most permissive abortion laws in Africa, though its restrictions limit access. The Termination of Pregnancy Act, passed in 1972, legalizes abortion if approved by medical professionals. It requires signatures from three doctors, including one specialist. Amendments to the bill and medical guidelines clarify that the law allows the consideration of situations such as pregnancy from rape, as well as socioeconomic factors.

In Malawi, abortion is only legal to save the life of the mother. Abortion is a felony punishable by prison. Malawi's abortion law is one of the strictest in the world.

In Madagascar, abortion is illegal in all circumstances. The abortion law punishes receiving or assisting in an abortion with imprisonment or fines. It is one of the only countries with a total abortion ban. Abortion has been illegal since the French colonial era, influenced by attitudes favoring increased births. In 2017, the government rejected a proposal to legalize therapeutic abortion. A bill allowing abortion in the case of rape was proposed by Member of Parliament Masy Goulamaly in November 2021 but was withdrawn by the parliament.

In Senegal, abortion is illegal unless the life of the mother is in danger. A medical exception requires a medical certificate. Senegal is one of the only countries whose criminal code completely bans abortion. Receiving an abortion is punishable by fines and prison. Abortion was banned in the colonial era. In 1967, an exception was made in the case of threat to life. In 2005, the National Assembly declared that women have a right to post-abortion care. Activists wanted this law to legalize abortion in the cases of rape or incest, but failed. In 2013, a group of NGOs called the Task Force formed with the goal of aligning Senegal's abortion law with the Maputo Protocol, which it had signed in 2004. The National Assembly considered a bill in 2024 that would guarantee legal access to medical abortion. International organizations have called for abortion law reform. Domestically, religious families and organizations influence widespread opposition to abortion due to Islamic beliefs.

In Togo, abortion is only legal in the cases of pregnancy from rape or incest, risk to the mother's health or life, or risk of birth defects. The law requires abortion to be performed by a doctor.

<span class="mw-page-title-main">Abortion in Africa</span>

In Africa, abortion is subject to various national abortion laws. Most women in Africa live in countries with restrictive laws. Most countries in Africa are parties to the African Union's Maputo Protocol, the only international treaty that defines a right to abortion. Sub-Saharan Africa is the world region with the highest rates of unsafe abortions and abortion mortality. Most abortions in the region are unsafe. The region has the highest rate of unintended pregnancy, the primary motive for abortion. The most likely women to have abortions are young, unmarried, or urban. Post-abortion care is widely available.

In Lesotho, abortion is illegal unless the pregnancy poses a risk to life or health.

In Guinea, abortion is illegal unless the pregnancy poses a threat to the life or health of the pregnant woman or fetus, if it resulted from rape, or if the pregnant woman is a minor. Illegal abortions are punishable by fines and prison. Legal abortions require approval from doctors in the case of therapeutic abortion or ethics committees in the case of abortion from rape. The conditions for legal abortion are debated. Women's rights activists and journalists have advocated for reform.

In Mauritius, abortion is only legal in the cases of risk to life, risk to physical or mental health, risk of fetal impairment, pregnancy from rape, or pregnancy of a minor. Legal abortions must be approved by three physicians or by a police report, and they must be approved by an adult if performed on a minor. Illegal abortions are punishable by fines or prison.

References

  1. 1 2 Obanga Makeesi, Iris (2 October 2024). "Afrobarometer : 56% des Gabonais favorables à l'emprisonnement des femmes pratiquant l'avortement" [Afrobarometer: 56% of Gabonese in favor of imprisonment of women who practice abortion]. Gabon Media Time. Retrieved 21 October 2024.
  2. 1 2 3 Boukika, Pharel (5 November 2019). "Gabon : le gouvernement légalise l'avortement". Gabon Media Time. Archived from the original on 25 September 2020.
  3. ↑ Ambast, Sanhita; Atay, Hazal; Lavelanet, Antonella (February 2023). "A global review of penalties for abortion-related offences in 182 countries". BMJ Global Health. 8 (3): e010405. doi:10.1136/bmjgh-2022-010405. ISSN   2059-7908. PMC   10030558 . PMID   36941005.
  4. 1 2 3 4 5 6 7 8 9 Ndembi Ndembi, Aimée Patricia; Mekuí, Justine; Pheterson, Gail; Alblas, Marijke (2019). "Midwives and Post-abortion Care in Gabon: "Things have really changed"". Health and Human Rights. 21 (2): 145–156. ISSN   1079-0969. JSTOR   26915384. PMC   6927380 . PMID   31885444.
  5. ↑ Knoppers, Bartha Maria; Brault, Isabel; Sloss, Elizabeth (1990). "Abortion Law in Francophone Countries". The American Journal of Comparative Law. 38 (4): 889–922. doi:10.2307/840616. ISSN   0002-919X. JSTOR   840616. PMID   11659448.
  6. 1 2 Khouri-Dagher, Nadia; Simard, Tony (March 1999). "Gabon: Breaking the Silence". UNESCO Sources. Vol. 110. UNESCO. p. 15. Retrieved 23 October 2024.
  7. 1 2 "Illegal abortions cause one in four pregnancy-related deaths". IRIN News . 27 December 2004. Retrieved 23 October 2024.
  8. 1 2 Berer, Marge; Hoggart, Lesley (December 2019). "Progress toward Decriminalization of Abortion and Universal Access to Safe Abortions: National Trends and Strategies". Health and Human Rights. 21 (2): 79–83. PMC   6927373 . PMID   31885438.
  9. ↑ Obiang Nze, Ismael (17 June 2022). "Gabon: les chercheurs se penchent sur le phénomène inquiétant des IVG" [Gabon: researchers examine the worrying phenomenon of abortions]. le360 Afrique (in French). Retrieved 21 October 2024.
  10. ↑ Asala, Kizzi (28 March 2021). "Gabon wants more equality between men and women". Africanews . Agence France-Presse . Retrieved 19 October 2024.
  11. ↑ "Gabon introduces laws to promote gender equality, relax abortion rules". Reuters . 26 March 2021. Retrieved 19 October 2024.
  12. ↑ Mondjo Mouega, Morel (19 May 2021). "Gabon: adoption de la réforme sur l'élargissement du droit à l'IVG" [Gabon: reform adopted to extend the right to abortion]. Gabon Media Time. Retrieved 21 October 2024.
  13. ↑ Kengue, Esther (28 June 2023). "Gabon : l'interruption volontaire de grossesse pour les femmes en détresse désormais prise en charge" [Gabon: abortion for women in distress is now taken care of]. Gabon Media Time. Retrieved 21 October 2024.
  14. ↑ "Gabon: le Conseil des ministres valide un décret autorisant l'avortement dans certains cas" [Gabon: the Council of Ministers approves a decree authorizing abortion in certain cases]. Radio France Internationale (in French). 3 July 2023. Retrieved 21 October 2024.
  15. ↑ L.R.A. (9 July 2024). "Avortement - Traditionalistes et religieux : c'est non !" [Abortion: It's a no from the traditionalist and religious]. L'Union. Retrieved 21 October 2024.
  16. ↑ Lembet, Henriette (6 August 2024). "Gabon : apologie de l'avortement sur la toile sous le regard silencieux des autorités judiciaires" [Gabon: Glorification of abortion on the web under the silent gaze of judicial authorities]. Gabon Media Time. Retrieved 21 October 2024.
  17. ↑ "Country profile: Gabon". Guttmacher Institute . 2022. Retrieved 19 October 2024.
  18. 1 2 Seidu, Abdul-Aziz; Ahinkorah, Bright Opoku; Ameyaw, Edward Kwabena; Hubert, Amu; Agbemavi, Wonder; Armah-Ansah, Ebenezer Kwesi; Budu, Eugene; Sambah, Francis; Tackie, Vivian (23 July 2020). "What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys". PLOS ONE . 15 (7): e0235329. Bibcode:2020PLoSO..1535329S. doi: 10.1371/journal.pone.0235329 . ISSN   1932-6203. PMC   7377410 . PMID   32702035.
  19. ↑ Adde, Kenneth Setorwu; Dickson, Kwamena Sekyi; Ameyaw, Edward Kwabena; Amo-Adjei, Joshua (28 August 2021). "Contraception needs and pregnancy termination in sub-Saharan Africa: a multilevel analysis of demographic and health survey data". Reproductive Health. 18 (1): 177. doi: 10.1186/s12978-021-01227-3 . ISSN   1742-4755. PMC   8403371 . PMID   34454510.
  20. ↑ Sippel, Daniel; Marckmann, Georg; Atangana, Etienne Ndzie; Strech, Daniel (10 July 2015). "Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals". PLOS ONE . 10 (7): e0132374. Bibcode:2015PLoSO..1032374S. doi: 10.1371/journal.pone.0132374 . ISSN   1932-6203. PMC   4498757 . PMID   26161655.
  21. 1 2 3 Mayi-Tsonga, Sosthène; Obiang, Pamphile Assoumou; Minkobame, Ulysse; Ngouafo, Doris; Ambounda, Nathalie; de Souza, Maria Helena (30 March 2014). "Introduction of postabortion contraception, prioritizing long-acting reversible contraceptives, in the principal maternity hospital of Gabon". International Journal of Gynecology & Obstetrics . 126 (S1): S45-8. doi: 10.1016/j.ijgo.2014.03.012 . ISSN   0020-7292. PMID   24745694.
  22. 1 2 Mayi-Tsonga, Sosthène; Minkobame, Ulysse; Mbila, Arielle; Assoumou, Pamphile; Diop, Ayisha; Winikoff, Beverly (14 August 2014). "Première expérience de l'utilisation du Misoprostol comme soin après avortement (SAA) à Libreville, Gabon" [First experience of the use of misoprostol as post-abortion care in Libreville, Gabon]. The Pan African Medical Journal (in French). 18 (301): 301. doi: 10.11604/pamj.2014.18.301.4309 . ISSN   1937-8688. PMC   4247897 . PMID   25469194.
  23. ↑ Chae, Sophia; Desai, Sheila; Crowell, Marjorie; Sedgh, Gilda; Singh, Susheela (29 March 2017). "Characteristics of women obtaining induced abortions in selected low- and middle-income countries". PLOS ONE . 12 (3): e0172976. Bibcode:2017PLoSO..1272976C. doi: 10.1371/journal.pone.0172976 . ISSN   1932-6203. PMC   5371299 . PMID   28355285.
  24. 1 2 3 Hess, Rosanna F. (January 2007). "Women's Stories of Abortion in Southern Gabon, Africa". Journal of Transcultural Nursing. 18 (1): 41–48. doi:10.1177/1043659606294191. ISSN   1043-6596. PMID   17202528.
  25. ↑ Eyegue, Sophie (23 March 2023). "Au Gabon, même les soins post-avortements, pour sauver la vie des femmes, sont mal vus" [In Gabon, even post-abortion care to save women's lives is frowned upon]. Ouest France (in French). Retrieved 21 October 2024.
  26. ↑ Mayi-Tsonga, Sosthene; Oksana, Litochenko; Ndombi, Isabelle; Diallo, Thierno; de Sousa, Maria Helena; Faúndes, Aníbal (2009). "Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon". Reproductive Health Matters. 17 (34): 65–70. doi:10.1016/S0968-8080(09)34465-1. ISSN   0968-8080. JSTOR   40647447. PMID   19962639.
  27. ↑ Mayi-Tsonga, Sosthène; Assoumou, Pamphile; Olé, Boniface Sima; Ntamack, Jacques Bang; Meyé, Jean François; Souza, Maria Helena; Faúndes, Anibal (November 2012). "The contribution of research results to dramatic improvements in post-abortion care: Centre Hospitalier de Libreville, Gabon". Reproductive Health Matters. 20 (40): 16–21. doi:10.1016/S0968-8080(12)40670-X. ISSN   0968-8080. JSTOR   41714973. PMID   23245404.
  28. ↑ "Avortement : lutter contre la mortalité maternelle" [Abortion: fighting against maternal mortality]. L'Union (in French). 3 October 2024. Retrieved 21 October 2024.
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