There is a patient Dr Véronique Tognifode, a gynaecologist, will always remember. About eight years ago, Abosede*, a student, visited her clinic in tears. Pregnant with an unwanted baby, she asked for an abortion, but the law in Benin at that time permitted termination only in cases of rape or incest, or where the mother’s life was at risk or the unborn child had a serious medical condition.
Tognifode counselled her, telling her a baby was a blessing and that she would help her through the pregnancy. Tognifode felt Abosede took all this on board, and “she left in a calmer state, saying she would come back for prenatal appointments”.
Three weeks later, Tognifode was working on a ward at the local hospital when she reached a woman who had septicaemia, probably caused by a clandestine abortion. “It was the same young woman I had seen a few weeks before,” she says. “She had found her own solution in secret … I hadn’t completely recognised her because she was no longer in the same state but close to the other side, close to death.”
For Tognifode, this story – and there are countless others from gynaecologists around the country – illustrates why reform to the law in Benin was so crucial.
When abortion is illegal, says Tognifode, women resort to “unimaginable and inhumane methods” that are “completely mad, medically speaking”. They may ingest pills or bleach, or insert sharp objects into their vaginas, sometimes causing intestinal damage. Benin’s health minister, Benjamin Hounkpatin, estimates that unsafe abortions are responsible for one in five maternal deaths nationwide.
In 2019, Tognifode became the west African country’s minister of social affairs, and was instrumental in getting MPs to vote to legalise abortion in most circumstances in October 2021. She didn’t do it alone; two other ministers, also gynaecologists, were heavily involved, as were professional bodies and civil society organisations who lobbied for years for expanded abortion rights. They also had support from Benin’s president, Patrice Talon.
The move was in stark contrast to the US where, less than a year later, the supreme court overturned Roe v Wade, ending the nationwide right to abortion.
Abortion is now permitted in Benin if the pregnancy is “likely to aggravate or cause a situation of material, educational, professional or moral distress incompatible with the interests of the woman and/or the unborn child”. Abortions can be carried out up to 12 weeks after the absence of a period.
It is one of the most liberal laws in Africa. In sub-Saharan Africa, as of 2019, 92% of women of reproductive age live in countries with restricted abortion rights. In Africa, only São Tomé and Príncipe, South Africa, Mozambique, Cape Verde, Tunisia, Zambia and Guinea-Bissau have similarly liberal abortion laws. Sub-Saharan Africa has the highest abortion case-fatality rate in the world, amounting to 15,000 preventable deaths every year.
Progress is slow, however, and women’s rights activists and doctors are convinced that unsafe abortions are still being practised across Benin.
“Not everyone knows about this law,” says Dr Serge Kitihoun, director of medical services at the country’s branch of the International Planned Parenthood Federation. “It is written in French; not everyone speaks French. We must translate the law into the national languages so everyone can be informed. Those who don’t yet have the information certainly will be resorting to unsafe abortions.”
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Raïmath Moriba, president of Femmes engagées pour le développement, a non-governmental organisation, agrees that only people in large towns and cities know about the legal change. “Clandestine abortions are still happening,” she says. In areas where news of the law has not filtered through, “women don’t know about laws like this that have been voted in to protect them. There is still a lot of work to do.”
Moriba wants systems put in place where untrained people who perform or facilitate unsafe abortions are called out and punished.
Kitihoun believes awareness-raising workshops are needed, along with training for communities and healthcare professionals. There are doctors who refuse to carry out abortions because of religious reasons or because they have been brought up to believe it can’t be done, he says.
Prof Francis Dossou, president of the National Council of the Order of Physicians of Benin, told the BBC he would “make every effort to convince the pregnant woman to keep her pregnancy”.
“There is still resistance,” says Kitihoun. “If you modify the law, that’s not to say that 100% of the population is in agreement. We must continue to work to convince national opinion.”
When the law was being debated, the religious lobby was vocal. Catholic bishops of Benin said it would bring about “a culture of death”. Moriba says culture plays a huge role in views on abortion. “Beninese and African culture does not conceive that a woman can allow herself to be pregnant and then terminate the pregnancy. According to religious and spiritual teachings, it’s like taking the life of an individual.”
Benin is a country of about 13 million people, sandwiched between Togo and Nigeria. Christianity and Islam are the two dominant religions, but the country is also the birthplace of voodoo, which plays into many people’s beliefs. “We are a country of voodoo. In practically all families, there is this reality,” says Moriba.
A woman may legally go ahead with an abortion, but belief in karma or spirits can play on people’s minds.
Outside a family planning clinic in Cotonou, Benin’s largest city, Marie*, 24, tells in a barely audible voice of the abortion she had a week ago. She says she “didn’t have a choice”, her parents would have reacted badly and she isn’t in a financially secure position to bring up a child.
When the legal change was announced, she didn’t agree with it because of her beliefs as an evangelical Christian. “The abortion has touched me,” she says. “I still feel bad. I’ve asked God to forgive me. I will never do this again. If I could go back in time, I would keep the baby.”
She adds that she is also scared about the “spiritual” implications of her actions. She still plans to marry the father, but says she will practise abstinence until the wedding in 2025.
In his clinic across town, Kitihoun is “extremely happy” with a law that “allows us to work in peace. Now we can offer a service and save lives.”
*Names have been changed to protect identities
