Rwanda takes a giant step on abortion, but more needs doing

The government of Rwanda recently revised the penal code to expand access to safe abortion services, which demonstrates the country’s continued commitment to ensure compliance with the Maputo Protocol.

By passing the revisions, Rwanda has taken a critical step toward upholding women’s fundamental human rights, particularly with the removal of the requirement to obtain a court authorisation and have two doctors sign off, which will contribute to ensuring that women and girls do not resort to unsafe abortions.

It is also commendable that the revised law allows minors to legally obtain safe abortions. These revisions will help reduce the high rates of maternal mortality and morbidity that arise from unsafe abortions.

This is the second time that Rwanda has revised its penal code. The first revision made significant strides by expanding the grounds for abortion, specifically by ensuring that the country was in compliance with its minimum obligations under international and regional human-rights law. Yet at the same time, the law imposed obstructive administrative barriers that prevented women from obtaining access to legal abortions.

For example, women who had become pregnant as a result of rape, forced marriage or incest still had to seek written approval from the court.

Furthermore, the law mandated that anyone performing a legal abortion must be a licensed medical doctor and consult with another physician before the procedure. These restrictions created significant barriers for women and girls, which cost them money, time, and dangerous delays in getting critical healthcare.

The most recent revisions have removed those barriers and expanded abortion access. While this is a welcome move advancing women and girls’ reproductive health and rights, more needs to be done.

Rwanda’s national data on abortion, published in 2012 by the Guttmacher Institute, showed that an estimated 60,000 abortions are carried out annually, almost all of which are unsafe.

Furthermore, the publication found half of all abortions in Rwanda are performed by untrained individuals and are considered to be high-risk. An estimated 34 per cent of abortions are provided by traditional healers, and 17 per cent are induced by the women themselves.

The revised penal code comes with some burdensome regulations, which continue to hinder women and girls from fully exercising their reproductive rights. For example, it legalises abortion for minors, but only if they are accompanied by a parent or legal guardian and present a birth certificate.

If there is a disagreement among the guardians about the request for abortion, the law states that the view of the minor will prevail; however, requiring an adolescent to obtain permission is problematic for several reasons.

First, there is an intense social stigma around adolescents’ sexuality, which is intricately and comprehensively woven into Rwanda's social fabric and can prevent adolescents from discussing their pregnancy with their parents.

Second, the law failed to take into consideration those adolescents who have neither parents nor legal guardians. And last, it failed to acknowledge Rwanda's extremely low 10 per cent birth-registration rate, which makes it difficult for many to present a birth certificate.

As a result, adolescents will continue to be forced to seek unsafe abortions or carry their pregnancies to term, affecting the possibility of their pursuing any educational and professional goals.

Access to safe abortion is further limited by restrictions on which medical professionals are legally able to provide the service.

The penal code prohibits mid-level health professionals, such as nurses, clinical officers and mid-wives, from providing abortions, which severely restricts access to the service, particularly for low-income women and women living in rural areas, who are more likely to have access to these types of providers than doctors.

Due to the shortage of doctors in Rwanda, mid-level providers are already responsible for providing a significant portion of healthcare in the country, including delivery care.

Furthermore, the World Health Organisation has stated that mid-level providers can safely provide first-trimester abortion services. Prohibiting them from doing so can severely restrict women from obtaining an abortion, forcing them to incur increased cost of care or resort to unsafe methods.

Although revisions to the penal code are a step in the right direction – affirming the importance of a woman's access to safe and legal abortion – it is clear that more needs to be done. Women of all ages must be empowered to make their choices, unimpeded.

Evelyne Opondo is senior regional director for Africa at the Centre for Reproductive Rights. E-mail: [email protected]. Tom Mulisa is executive director of the Great Lakes Initiative for Human Rights and Development. E-mail: [email protected]