Roe’s repeal has energized Africa’s anti-abortion movement

Demeke Desta will never forget what the wards were like. The scenes from the special hospital units in Ethiopia for women and girls who’d had unsafe abortions left an indelible mark on the 53-year-old physician’s mind. In the early 2000s, he saw scores of young women with life-threatening conditions, including sepsis, hemorrhaging, perforated uteruses and pelvic organ injury — all the results of back alley abortions.

Desta and his colleagues did their best to treat them, but by the time many arrived at the hospital, it was too late. “We tried to save so many lives,” he recalled, “but in most cases we were not able to.”

These were Desta’s early years as a physician, when one-third of all maternal deaths in Ethiopia could be linked to unsafe abortions. Thousands of women died each year. Under pressure to reduce the maternal mortality rate, the Ethiopian parliament passed a groundbreaking law loosening abortion restrictions for a variety of health conditions in 2005. The policy brought about a dramatic reduction in the number of deaths from unsafe abortions, and the bleak and overwhelmed hospital units that Desta remembers so vividly eventually shut down. The closure of the wards was “a success,” he explained. “I am a living witness that abortion care saves lives.”

But lately, Desta, who is now the Ethiopia program director for the global reproductive health nonprofit Ipas, worries that the dark days of those wards could become a part of Ethiopia’s reality again. That’s because the country’s abortion law is on shaky ground, thanks to the efforts of an emboldened anti-abortion movement buoyed by a court ruling halfway around the world: The U.S. Supreme Court’s historic 2022 decision to limit abortion rights in Dobbs v. Jackson Women’s Health Organization. 

The Dobbs ruling — which overturned Roe v. Wade, the landmark 1973 decision that established a constitutional right to abortion — marked an anomaly in the trajectory of global abortion policy making over the last 30 years, which has trended sharply toward liberalization. 

Since the ruling, there has been a wave of abortion-related policy shifts around the world. In France, lawmakers used Dobbs as the basis for a legislative proposal that would enshrine abortion rights in the French constitution. Mexico’s Supreme Court decriminalized abortion earlier this month, despite the country’s deep Catholic roots. There is mounting support for policies to protect legal access to the procedure in Argentina and Colombia.

Anti-abortion groups, meanwhile, see Dobbs as a signal that it may not be so difficult to roll back the gains made by abortion advocates. “The opposition has tasted blood in the water,” Lori Adelman, the acting executive director of Planned Parenthood Global, told me. In India, anti-abortion activists took to the streets of Delhi in the months after Dobbs, calling on the Indian government to repeal its 1971 law legalizing abortion. In Italy, pro-choice gynecologists are facing a fresh wave of harassment by an emboldened anti-abortion movement riding a post-Roe high. 

But nowhere has the anti-abortion movement been more energized by Roe’s overturning than on the African continent. While abortion is restricted across much of the region, those countries that have expanded access are now seeing a backlash.

In Kenya, opponents are already drawing on Roe’s reversal to challenge abortion policy. According to the international reproductive rights advocacy organization Fos Feminista, which recently published a report about Dobbs’ global impact, anti-abortion groups highlighted Dobbs as a reason to appeal a 2022 constitutional court decision in Kenya expanding abortion access. The ruling, which came out before Roe was overturned, affirmed abortion as a fundamental right in Kenya’s constitution, citing international jurisprudence on abortion, including Roe v. Wade. But opposition groups latched onto Dobbs as a reason to challenge the judgment, arguing that the judge who decided the case relied on “bad law” from the U.S. The decision is now stayed, pending appeal. “The fact that it was entertained is really worrisome to many that are working on the ground in Kenya,” said Kemi Akinfaderin, a global advocacy officer with Fos Feminista.

In Nigeria, the governor of the state of Lagos suspended policy guidelines about abortion care for life-threatening health conditions less than a month after Roe was overturned. Abortion opponents seized upon the U.S. Supreme Court’s decision, arguing that the governor should follow the ruling’s lead and revoke the provisions. In July 2022, he did. “The Dobbs decision has trickled down to Nigeria, and it’s very disappointing,” said Ijeoma Egwuatu, the communications director for the Nigeria-based reproductive health nonprofit, Generation Initiative for Women and Youth Network. 

For abortion opponents, the U.S. trajectory provides a possible model for reversing abortion gains.

“They are saying, ‘Dobbs is the wind we need behind our sails,’” Akinfaderin told me. “‘If we can do this in the U.S., we can do this anywhere else.’” For abortion advocates, it’s a glaring warning. “For the longest time, Roe has been seen as a gold standard,” Akinfaderin continued. “And so the fact that this can happen in the U.S. is a very clear indication to some in the feminist movement in Africa that it can happen here as well. These gains can be lost over time.”

Akinfaderin, who is based in Togo, believes that abortion opponents have strategically chosen where to focus their attention on the African continent. “They’re not making mistakes,” she explained. “They are targeting big countries, countries with political influence and countries with very strong religious communities.”

Enter Ethiopia, the second-most populous country in Africa after Nigeria and the home to the headquarters of the African Union. The country has a distinctive history and cultural legacy. It is one of just two countries on the continent that successfully resisted colonization. (Liberia is the other.) Ethiopia is also home to a distinct Christian Orthodox tradition dating back to the 4th century. Orthodox Christians are the country’s largest and most influential religious group, making up more than 40% of the population. One-third of the population identifies as Muslim and nearly one-fifth as Protestant. Abortion remains controversial in the country — surveys show the majority of Ethiopians, including Orthodox Christians, oppose the procedure. 

The policy reforms in Ethiopia in 2005 legalized abortion in a variety of circumstances, including if a woman was a victim of rape or incest, if her life is in danger, if she has physical or mental disabilities or if she is a minor and is not ready to have a child. The changes had a dramatic impact. Today, deaths from unsafe abortions make up just 1% of maternal deaths in Ethiopia, compared to over 30% before the law went into effect. 

But Ethiopian reproductive health advocates worry that those advances are now in jeopardy. Over the last year, the country’s anti-abortion movement has coalesced around a concrete goal. “They are targeting the abortion law,” said Abebe Shibru, a longtime reproductive health advocate and the Ethiopia country director for the international health nonprofit MSI Reproductive Choices. “Now, anti-abortion groups are intensifying their movement and they are targeting policymakers, health providers — anyone who might have a strong stake in sexual reproductive health services.” Because of this momentum, Shibru continued, “this existing abortion law is very vulnerable.”

Much of this organizing has taken place behind the scenes, according to Shibru, as leading anti-abortion figures attempt to influence lawmakers, government officials and the general population. But a few public demonstrations from anti-abortion groups in recent months offer a glimpse into the movement’s goals and direction.

In July, thousands of people took to the streets in the town of Hawassa, Ethiopia, to speak out against abortion and LGBTQ rights. Nearly two dozen churches in the city opposed to abortion and same-sex marriage organized the demonstration, according to local media. Participants carried signs and chanted slogans about fetal rights and explained that the protest was organized to “save the youth” from the “dangers” of same-sex marriage and abortion.

Weeks before the protest, healthcare workers began catching glimpses of vans parked near abortion clinics in Addis Ababa. The cars, emblazoned with the slogan “Praying to end abortion in Ethiopia,” written in Amharic, were spotted repeatedly throughout the city in June, according to Desta, from Ipas. “Whenever a provider sees this car parked next to the clinic, or a woman sees this information when trying to access services from these clinics, they’re embarrassed, they are harassed,” he told me. It’s unclear who was behind this effort, but Desta believes it reflects a more confrontational strategy from the opposition post-Roe. 

“Before the decision, they were not boldly coming out in the media and talking about abortion. But now, they are in the media, on TV  and on social media,” Desta said. “They are very vocal, very organized, and boldly speaking out about abortion in Ethiopia.”

According to Desta and other observers, one group leading the charge to repeal Ethiopia’s abortion law is Family Watch International, a U.S.-based nonprofit that claims to be working to “protect and promote the family as the fundamental unit of society.” According to the Southern Poverty Law Center, it is an anti-LGBTQ hate group. The organization’s leader has compared same-sex marriage to drug addiction and argued that the “homosexual agenda is a worldwide attempt to justify behavior that is inherently destructive to both society and to the individual.” 

While headquartered in Arizona, the organization has long worked in Africa and maintains an active presence in Ethiopia with an office in Addis Ababa, according to interviews with several reproductive rights advocates working there. After Roe was overturned, Family Watch wrote on its website that the decision was a “historic victory for life and family.” The organization’s Africa chapter, it added, is “working to stop abortion being pushed abroad.” The group’s Africa director is Seyoum Antonios, a prominent Ethiopian physician who recently railed against “the LGBTQ, abortion, and child sexualization and transgender agenda of the European Union” in an August speech to the African Bar Association. 

As of now, Ethiopia’s law is still standing. The forces jeopardizing its survival may not ultimately succeed in toppling the policy, and the transnational anti-abortion coalition — though energized — still faces an uphill battle if it wants to reverse global trends in abortion policymaking.

But even without a change in the law, the opposition’s efforts already appear to be having tangible impacts on the country’s abortion landscape. Over the last year, Shibru and his colleagues have noticed that some healthcare workers in public clinics have ceased providing abortion services — a likely result of the amplified pressure campaign against them. Shibru told me that providers are facing harassment from “their friends, their families, and their communities.” He added, “​When you go into public facilities, we heard that this facility used to provide safe abortion, but not now. Because we used to get good support, but now no one is encouraging us.” 

Additionally, Shibru said that he and other reproductive health workers have documented an increase in the number of women seeking medical treatment for abortion-related complications over the last year. Fewer clinics offering services could cause women to seek out unsafe alternatives, Shibru explained, and medical care for procedures gone wrong. These scenarios, coupled with the abortion law’s shaky standing, fill Shibru with dread. 

“​​What does it mean if the law is reversed?” he asked. “We are going back 20 years. That means more maternal mortality. Hospitals will be occupied with abortion-related problems.The women in Ethiopia in danger.” Such a scenario, he continued, “will be a big moral crisis.”