Safe abortion is life-saving healthcare: A call to action

By: Mumbi Mugo, Program Officer and Elizabeth Alukudo, Associate Program Officer

On the 2025 International Safe Abortion Day, commemorated on 28 September, we join women, girls, and human rights defenders across Africa and the globe in reaffirming a simple truth: safe abortion is life-saving healthcare.

As we reflect on progress made, and the road still ahead, we are reminded of the transformative potential of the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, more widely known as the Maputo Protocol. Adopted by the African Union in 2003, the Protocol remains one of the most progressive and comprehensive legal instruments for the promotion and protection of women’s rights globally, particularly in the realm of sexual and reproductive health and rights (SRHR).

The power of the Maputo Protocol

Article 14 of the Maputo Protocol is especially significant. It explicitly guarantees women the right to:

• Control their fertility

• Decide whether to have children, how many, and when

• Choose any method of contraception

• Access to sexual and reproductive health education and services

Critically, it also makes the Maputo Protocol the first and only binding international human rights treaty to explicitly guarantee access to safe abortion under specific conditions. These include:

• When the pregnancy endangers the mental or physical health of the mother

• When the life of the mother or fetus is at risk

• In cases of sexual assault, rape, or incest

The article also mandates access to comprehensive reproductive health services, including antenatal care, safe delivery, and family planning.

To date, 46 out of 55 African Union Member States have ratified the Maputo Protocol. However, nine — Burundi, Chad, Egypt, Eritrea, Madagascar, Morocco, Niger, Somalia, and Sudan,have yet to do so. Ratification alone is not enough: the Protocol calls on States to combat all forms of discrimination against women and to uphold their rights to reproductive healthcare, adequate housing, and a healthy, sustainable environment.

Reservations that undermine rights

While some countries have ratified the Maputo Protocol, many have done so with reservations, particularly to Article 14(2)(c), the clause guaranteeing access to safe abortion under specific conditions.

These reservations limit the Protocol’s impact and hinder the realization of women’s reproductive rights. Article 2(d) of the Vienna Convention on the Law of Treaties define a reservation as:

“A unilateral statement… made by a State… whereby it purports to exclude or to modify the legal effect of certain provisions of the treaty in their application to that State.”

Despite some progress since 2003, implementation of Article 14 has been inconsistent. In some countries, reservations to Article 14(2)(c) of the Maputo Protocol remain in place. These reservations limit the full realization of women’s reproductive rights under the Protocol and can create uncertainty around the scope of legal protections available. 

Removing such reservations would be a critical step toward creating coherent, rights-based legal frameworks that support women’s health and well-being, and enable healthcare providers to deliver care without fear or ambiguity.

The cost of inaction

Currently, Africa accounts for 70% of global maternal deaths. These preventable deaths are compounded by persistent gaps in access to sexual and reproductive health and rights (SRHR) services, which are essential to safeguarding the lives and dignity of women, children and adolescents.

Among the most devastating outcomes is the prevalence of unsafe abortion, which continues to claim the lives of thousands of African women and girls each year. According to the World Health Organization, nearly half of all abortions globally are unsafe, with Sub-Saharan Africa bearing the highest burden. The Guttmacher Institute estimates that three-quarters of all abortions in the region are unsafe, making it one of the leading and preventable causes of maternal death.

The tragedy is not that abortion exists. The tragedy is that safe abortion is denied.

Removing barriers to access

Despite legal allowances in some contexts, many women and girls across Africa continue to face significant obstacles in accessing safe abortion care. These challenges often stem from restrictive laws, unclear penal code provisions, and systemic gaps within healthcare systems. Even where abortion is legally permitted, lack of clarity and persistent stigma can lead to confusion, inaction, or fear of legal consequences for both those seeking care and those providing it.

What needs to change

On this International Safe Abortion Day, Equality Now calls on African governments to take immediate and concrete action:

1. Lift reservations to Article 14(2)(c) of the Maputo Protocol

Remove legal and procedural obstacles that prevent the full implementation of the Protocol’s reproductive rights provisions.

2. Reform national laws to eliminate vague or restrictive abortion provisions

Establish clear, rights-based legal frameworks that ensure access to safe abortion care.

3. Recognize safe abortion as essential public healthcare

Ensure abortion is provided without stigma, fear, or discrimination, and is accessible regardless of geography or socio-economic status.

4. Strengthen healthcare systems and train providers

Support the delivery of abortion and post-abortion care in line with World Health Organization guidelines.

5. Invest in comprehensive sexuality education and contraceptive access

Prevent unintended pregnancies and expand reproductive choices through education and access to contraceptives.

Safe abortion saves lives. It is a matter of public health, human rights, and justice. We stand united with those demanding that no woman or girl should ever lose her life for lack of access to a safe medical procedure.