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Abortions are legal in much of Africa. But few women may be aware, and providers don't advertise it

Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, poses for a photo in Accra, Ghana, Tuesday, March 19, 2024. Efua sought an abortion at a health clinic but worried the procedure might be illegal. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Efua spoke to the AP on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country. (AP Photo/Misper Apawu)

ACCRA, Ghana (AP) — When Efua, a 25-year-old fashion designer and single mother in Ghana, became pregnant last year, she sought an abortion at a health clinic but worried the procedure might be illegal. Health workers assured her abortions were lawful under certain conditions in the West African country, but Efua said she was still nervous.

“I had lots of questions, just to be sure I would be safe,” Efua told the Associated Press, on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country.

Finding reliable information was difficult, she said, and she didn't tell her family about her procedure. "It comes with too many judgments,” she decided.

More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. And despite the expanded legality of the procedure in places like Ghana, Congo, Ethiopia and Mozambique, some doctors and nurses say they've become increasingly wary of openly providing abortions. They're fearful of triggering the ire of opposition groups that have become emboldened since the U.S. Supreme Court’s 2022 decision overturning the nationwide right to abortion.

“We are providing a legal service for women who want an abortion, but we do not advertise it openly,” said Esi Asare Prah, who works at the clinic where Efua had the procedure — legal under Ghana's law, passed in 1985. “We’ve found that people are OK with our clinic providing abortions, as long as we don’t make it too obvious what we are doing.”

The Maputo Protocol, a human rights treaty in effect since 2005 for all 55 countries of the African Union, says every nation on the continent should grant women the right to a medical abortion in cases of rape, sexual assault, incest, and endangerment for the mental or physical health of the mother or fetus.

Africa is alone globally in having such a treaty, but more than a dozen of its countries have yet to pass laws granting women access to abortions. Even in those that have legalized the procedure, obstacles to access remain. And misinformation is rampant in many countries, with a recent study faulting practices by Google and Meta.

“The right to abortion exists in law, but in practice, the reality may be a little different,” said Evelyne Opondo, of the International Center for Research on Women. She noted that poorer countries in particular, such as Benin and Ethiopia, may permit abortions in some instances but struggle with a lack of resources to make them available to all women. Many women learn of their options only through word of mouth.

Across Africa, MSI Reproductive Choices — which provides contraception and abortion in 37 countries worldwide — reports that staff have been repeatedly targeted by anti-abortion groups. The group cites harassment and intimidation of staff in Ethiopia. And in Nigeria, MSI’s clinic was raided and temporarily closed after false allegations that staffers had illegally accessed confidential documents.

“The opposition to abortion in Africa has always existed, but now they are better organized,” said Mallah Tabot, of the International Planned Parenthood Federation in Kenya. She noted that a significant amount of money backing anti-abortion efforts appears to have come from conservative American groups — and severalreports have found millions in such funding from conservative Christian organizations.

The spike from opposition groups is alarming, said Angela Akol, of the reproductive rights advocacy group Ipas.

“We’ve seen them in Kenya and Uganda advocating at the highest levels of government for reductions to abortion access,” she said. “There are patriarchal and almost misogynistic norms across much of Africa. ... The West is tapping into that momentum after the Roe v. Wade reversal to challenge abortion rights here.”

Congo, one of the world's poorest countries, introduced a law in 2018 permitting abortions in the first 14 weeks of pregnancy in cases of rape, incest, and physical or mental health risks to the woman.

Even so, pamphlets aimed at women who might want an abortion use coded language, said Patrick Djemo, of MSI in Congo.

“We talk about the management of unwanted pregnancies," he said, noting that they don't use the word abortion. "It could cause a backlash.”

Accurate language and information can be hard to find online, too. Last week, a study from MSI and the Center for Countering Digital Hate found that Google and Meta — which operates Facebook, Instagram and WhatsApp — restricted access to accurate information about abortion in countries including Ghana, Nigeria and Kenya.

The study said the tech giants banned local abortion providers from advertising services while approving paid ads from anti-abortion groups pushing false claims about decriminalization efforts as part of a global conspiracy to “eliminate” local populations.

Google didn't respond to a request for comment on the study. Meta said via email that its platforms “prohibit ads that mislead people about services a business provides” and that it would review the report.

Opondo, of the international women's center, said she's deeply concerned about the future of abortion-rights movements in Africa, with opponents using the same tactics that helped overturn Roe vs. Wade in the U.S.

Yet, she said, for now it's “still probably easier for a woman in Benin to get an abortion than in Texas.”

For Efua, information and cost were obstacles. She cobbled together the necessary 1,000 Ghana cedis ($77) for her abortion after asking a friend to help.

She said she wishes women could easily get reliable information, especially given the physical and mental stress she experienced. She said she wouldn't have been able to handle another baby on her own and believes many other women face similar dilemmas.

“If you're pregnant and not ready," she said, "it could really affect you mentally and for the rest of your life.”

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Cheng reported from London.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, poses for a photo in Accra, Ghana, Tuesday, March 19, 2024. Efua sought an abortion at a health clinic but worried the procedure might be illegal. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Efua spoke to the AP on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country. (AP Photo/Misper Apawu)
Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, poses for a photo in Accra, Ghana, Tuesday, March 19, 2024. Efua sought an abortion at a health clinic but worried the procedure might be illegal. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Efua spoke to the AP on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country. (AP Photo/Misper Apawu)
Pictured is the room at MSI Ghana in Accra, Tuesday, March 19, 2024, where Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, had an abortion. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Efua spoke to the AP on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country (AP Photo/Misper Apawu)
Pictured is the room at MSI Ghana in Accra, Tuesday, March 19, 2024, where Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, had an abortion. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Efua spoke to the AP on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country (AP Photo/Misper Apawu)
Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, poses for a photo in Accra, Ghana, Tuesday, March 19, 2024. Efua sought an abortion at a health clinic but worried the procedure might be illegal. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Pictured is the room at MSI Ghana in Accra, Tuesday, March 19, 2024, where Efua, a 25-year-old fashion designer and single mother in Ghana who became pregnant in 2023, had an abortion. More than 20 countries across Africa have loosened restrictions on abortion in recent years, but experts say that like Efua, many women probably don't realize they are entitled to a legal abortion. Efua spoke to the AP on condition that only her middle name be used, for fear of reprisals from the growing anti-abortion movement in her country (AP Photo/Misper Apawu)