Africa: Challenges of Culture and Conscience

In Biblical times, the Prophet Hosea lamented, “[M]y people die for lack of knowledge.” In the 21st century, African women are dying for lack of knowledge, but also in the name of religion.

In my life as an African woman, a physician and former minister of health in Ghana—and more recently in my work as an advocate for sexual and reproductive rights—I have seen too many African women die a senseless and painful death

because they were unable to realize their reproductive rights.

Thousands of African women die every year from preventable pregnancy-related causes because religious leaders prevent politicians and policymakers from passing laws and implementing services needed to save them. The African Union’s latest Maternal Newborn and Child Health Status Report shows that most countries in Africa have seen reductions in maternal mortality, although the average rate remains exceedingly high at more than 500 deaths per 100,000 live births, amounting to 56 percent of total global maternal mortality.

Women’s Role in Reproduction

Patriarchy derives from some men’s need to control women’s ability to procreate. In most African traditional patriarchal societies, children belonged to the man, each child increasing his immortality. Hence, the practice of polygamy ensured that the man had as many children as he could afford, whereas the woman was only there to produce children.

But we also know that in African traditions, older women cared for pregnant women and the traditional midwives knew how to assist them in childbirth. Women had supreme power in this area of procreation or reproductive health, and it was women who decided when it was time to have another child.

Among the Maasai of Kenya, older women in the community decided whether a pregnancy should be terminated for several reasons, including incest and rape. (It is not clear if the woman had a say in this matter.) In other societies, a woman who wanted to end a pregnancy for whatever reason went to the community abortionist, who was often also the traditional midwife.

Colonization of the continent introduced Christianity—mostly in sub-Saharan Africa—and Islam in Western and Northern Africa. And the imposition of colonial laws, including very restrictive abortion laws, in all African countries immediately turned what had been a legal but very private women’s affair into one of crime and punishment, and created the stigma that still contributes to so many unsafe or deadly abortions over the years.

Religious leaders, both Muslim and Christian—and especially from the Catholic church—have yet to recognize women’s competence as moral decision makers for their own reproductive health.

The Influence of Religion on Women’s Reproductive Health

Family planning was prohibited by law in Francophone Africa by the French anticontraceptive law of 1920. This was as a result of French Catholic influence and a mistaken interpretation of the Quran as being against modern contraception. It was only after the International Conference on Population and Development in 1994 that a Reproductive Health Model Law for the subregion was developed.

Thousands of African women die every year from preventable pregnancy-related causes because religious leaders prevent politicians and policymakers from passing laws and implementing services needed to save them.

In Ghana in the mid-1990s, the contraceptive prevalence rate was generally low. It was even lower among Muslim women, who were stuck in the vicious cycle of more children and increased poverty and lack of quality (or any) education for these children. As minister for health at the time, I conducted several meetings and seminars with Muslim religious leaders, guiding them to finally accept that contraception was not prohibited by the Quran. Stickers and billboards were produced that pronounced, “Islam is not against abortion.” Though use of contraceptives subsequently increased markedly among Muslim women, due to long-standing stigma they preferred injectable methods, which left no telltale marks. They lacked the autonomy to openly practice contraception.

Evidence shows that most Catholic women in the region practice modern contraception against the teachings of the church, but perhaps under a heavy burden of guilt. A 1993 survey in Benin found that 59 percent of the total number of abortions were by practicing Catholic women.

Reproductive Rights

A woman can only exercise conscience and autonomy in reproductive health issues when she has choices and opportunities.

The African Union’s Maputo Protocol, established in 2005, is the only international human rights treaty that explicitly allows for abortion—albeit not for the reasons women need or want to have abortions, a result of tough negotiations with religious and fundamentalist groups. The abortion provisions in the Protocol do not allow for choice, but if all ratifying nations would fully implement these, some deaths and injury would be averted.

Subsequently, Africa’s health ministers, under the auspices of the African Union, approved the Maputo Plan of Action for Sexual and Reproductive Health and Rights, which included a call for expanded access to contraception and a review of restrictive abortion laws and safe abortion services. In January 2016, the African Commission launched a continent-wide campaign to decriminalize abortion in Africa. Thus, the standards have been set at the highest international and regional political level, but there is need for implementation at country level.

Religion and Governments

Even though only a few African states are expressly religious countries—mostly in Muslim North Africa—governments and political leaders seem to be held captive by religious leaders, who exert a lot of influence on issues pertaining to SRHR.

In several health policy meetings, I have pleaded that, as custodians of the health of all people, including those of different beliefs and nonbelievers, our decisions should be guided not by religious dogma and personal beliefs, but by sound scientific evidence.

When African women get to know and understand their reproductive rights and governments cast off the spell of religious influence, I believe that then African women will be in a position to exercise freedom of conscience and autonomy.