The cover of this excellent online book, created by Rutgers in the Netherlands and co-funded with the European Union, says it all: women face a maze when trying to get a safe abortion. In that maze, they get stuck between their rights and the women-destroying reality in their countries. But it isn’t just safe and legal abortion they were unable to access, they were often also victims and survivors of sexual violence as well, from which the unwanted pregnancy they ended up with really came, and from which they desperately needed to escape.
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The study reveals a huge gap between rights on paper and lived realities. It is the first systematic, comparative study in the region. And it is about a preventable crisis that often kills.
Every year, around 25 million unsafe abortions occur worldwide (WHO). The consequences are devastating. Over 20,000 women and girls die and many more live with lifelong physical or medical complications. Women, girls, communities and health systems also bear high social and financial costs. These
outcomes are not inevitable. They result from gender inequality, stigma and restrictive legal frameworks that limit access to safe, timely care. While entirely preventable, unsafe abortion remains a leading cause of maternal mortality in countries with restrictive abortion laws; where abortion is broadly legal, most abortions are safe.
In West and Central Africa, the risks are especially high. In 2029, an estimated 2.3 million unsafe abortions were performed in West Africa and 1.1 million in Central Africa, making these regions among the riskiest in the world for women and girls to experience unintended pregnancy.
Behind these statistics are countless individual stories of women and girls who became pregnant through sexual violence, including rape and incest, and were denied safe options as permitted by law. Victim-survivors of sexual violence are routinely failed by inadequate law implementation, incomplete policies, inaccessible services and profound information gaps. Many do not even know they have a legal right to a safe abortion. At every turn, they face stigma, discrimination and blame for circumstances beyond their control.
When a young woman in West or Central Africa becomes pregnant after rape or incest, her path should lead to care, safety and support. Instead, too often, she finds herself trapped in a maze: an exhausting obstacle course of stigma, silence, procedural delays, often resorting to an unsafe abortion. This is despite the fact that all countries have legal provisions in place to allow these adolescent girls and young women to access safe and legal abortion on these grounds if they do not wish to continue with the pregnancy.
Laure’s experience is not an exception. This study documents the maze many women and girls face when they fall pregnant in the aftermath of sexual violence. It investigates why, despite legal reforms and international commitments, victim-survivors of sexual violence in five countries in five countries in West and Central Africa – Benin, Burkina Faso, Côte d’Ivoire, Togo and Cameroon – are often still denied the safe abortion care they are entitled to.
Many unsafe abortions occur among adolescents and young women. These are not abstract figures. They are lived realities: girls and women who had no other option than forced to drink unsafe concoctions, seek clandestine providers, or suffer lifelong injuries and preventable deaths.
This comparative research, conducted by Rutgers and CERRHUD in cooperation with partners in the region and by young researchers, brings together victim-survivors’ testimonies, provider experiences and legal and policy analysis. It sheds light on how laws and commitments unravel in practice for women and girls. It shows how four exclusion mechanisms – lack of accountability, procedural complexity, information gaps and patriarchal stigma – systematically erode rights.
The study also highlights pathways forward. From Benin’s groundbreaking reform to grassroots innovations, change is possible. With political will and investment, governments can turn evidence into action and ensure every woman’s path leads to a safe choice.
Unsafe abortion in West and Central Africa
Women and girls in Sub-Saharan Africa face some of the highest risks of unsafe abortion globally. An estimated 42% of pregnancies are unintended, and approximately 37% of these end in abortion. Restrictive laws and pervasive stigma mean that 77% of abortions are unsafe, contributing to an estimated 185 deaths per 100,000 abortions—around 15,000 deaths annually in sub-Saharan Africa alone.
Adolescents are particularly vulnerable due to low contraceptive use, limited sexuality education, unequal gender norms, and exposure to sexual violence.2,3,4 Sexually active adolescents have the highest abortion rates among women of reproductive age but rarely have access to legal or safe services, often resulting in severe complications or death.
In West and Central Africa, 85% – 88% of abortions are less safe or unsafe. Central Africa (including Cameroon) has the highest abortion-related mortality in sub-Saharan Africa (≈260 deaths per 100,000 abortions), followed closely by West Africa (≈225 deaths per 100,000 abortions).
Sexual and gender-based violence
Gender-based violence affects one in three women in sub-Saharan Africa (UNFPA). Sexual and gender-based violence is also widespread in humanitarian contexts, and has lasting health and social consequences, including unintended pregnancies. Although accurate data on pregnancies resulting from sexual violence are limited, available studies reveal an alarming reality. In Cameroon, a 2008 study found that 24% of girls and women who were raped became pregnant because of the rape.
Pregnancies resulting from rape or incest often end in unsafe abortions, whereas others are carried to term due to lack of choice. Studies in Cameroon and Burkina Faso have shown that pregnancies resulting from rape are highly likely to result in clandestine abortions, even though legislation officially allows abortion in such cases. In conflict
situations in Africa, clandestine abortions among victim-survivors of sexual violence are also very common. Access to safe and legal abortion after rape and incest, although possible on paper, remains very limited and understudied.
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