Two decades on from a landmark treaty advancing the rights of African women, gender equality remains alive on paper, elusive in practice.
Magret Kawala of Mponela in Dowa district, central Malawi had always experienced the joys of motherhood and married life. But when she became pregnant while nursing a nine-month-old child Kawala's fortunes changed.
When it was confirmed that she was three months pregnant, her instinct told her she had to go for an abortion. She discussed the issue with her husband, but since surgical abortion in Malawi is illegal and only permissible when a pregnancy pauses a threat to a woman, the couple opted for a backstreet abortion.
"When we failed to procure an abortion at health facilities we decided to go for a backstreet abortion, which was administered by a local herbalist," Kawala tells African Arguments.
The concoction that the herbalist administered to her managed to terminate the pregnancy. But the worst was yet to come.
"I developed several complications, which in the end damaged my womb resulting in a surgery. My raptured uterus had to be removed to save my life," said Kawala.
Six years since the incident, the 47-year-old mother of three still vividly remembers the ordeal she suffered after her uterus was removed.
"When my husband knew my uterus was removed and that I could no longer give him any more children, he abandoned me and married another woman," said Kawala.
According to a 2015 Guttmacher Institute report on Abortion and Post-abortion Care almost one in every six pregnancies ends in abortion with post-abortion complications accounting for around 6 to 18 percent of maternal deaths.
While the Maputo Protocol sets the minimum age of marriage for girls at 18, and states that all marriages take place with the full consent of both parties, UNICEF estimates that 9 percent of girls in Malawi are married by 15 and one in two by the age of 18. Unintended pregnancies have been identified as a driver of child marriages, ultimately denying the girl child a right to education.
Sadly, these developments are happening two decades after the adoption of the Protocol, which heralded a new era in women's rights including the right to access comprehensive reproductive healthcare services and the right to a safe abortion.
In Malawi and elsewhere on the continent, girls and women are being denied a right to sustainable development and the right to a healthy and sustainable environment - some of the fundamental principles of the protocol.
As of April 2023, 43 out of 54 African countries had ratified the Maputo Protocol, but only a handful had reformed their abortion laws in line with the Protocol. This is despite the public health burden caused by unsafe abortions.
Dr. Chisale Mhango of the Malawi College of Medicine (MCM) says most unsafe abortions end in a Dilation and Curettage (D&C), a procedure that in most cases results in the woman losing her womb.
"About 53 percent of pregnancies in Malawi are unintended and around 60 percent of the induced abortions end in complications that require medical attention. In some instances, these women lose their wombs resulting in broken marriages," says Dr. Mhango. While the minimum cost of managing the effects of an unsafe abortion are estimated at an average of US$83 in Africa, an abortion procedure at a clinic would cost around US$63 according to various sources.
Despite being party to the Maputo protocol, cultural and religious beliefs continue to undermine women's rights including the right to sexual reproductive health, says Emma Kaliya, a renowned Malawian women rights activist.
"Culture and religion should not be tools to suppress women's rights. We cannot talk about the right to life when we subtract issues to do with unsafe abortions" says Kaliya.
While legalizing safe abortion remains a controversial debate in religious circles, Reverend Martin Kalimbe, chairperson of Religious Leaders Network for Choice, a grouping of religious leaders advocating for minority rights including maternal health, says that should not be the case.
"We understand the Bible differently. Even in Christ's days there were differences in the Church. At one point some Christians wanted all gentiles circumcised and the same can be said of the on-going debate on safe abortion," says Kalimbe.
According to MSI Reproductive Choices, giving women a right to comprehensive reproductive healthcare services also promotes the right of to life.
For example, MSI notes that in the Democratic Republic of Congo following the development Standards and Guidelines for Woman-Centered Comprehensive Abortion Care and investment in a new training curriculum for midwives, the country has witnessed significant progress in access to sexual and reproductive healthcare - and wider gender equality. In Ethiopia maternal mortality dropped from 31 to 1 percent since abortion was legalised in 2005, saving the lives of countless women and girls.
Dr Joan Oracha, Country Director for MSI Kenya told African Arguments that the Maputo Protocol remains a groundbreaking and invaluable tool for promoting reproductive health and gender equality in Africa. Despite its impact, she said, challenges persist.
"Inconsistencies in national laws and a lack of comprehensive implementation hinder access to safe abortion services and endanger women's lives across the continent," said Oracha.
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In Kenya, she said, while article 26(4) of the country's 2010 constitution provides for safe abortion by a qualified medical practitioner in cases of sexual assault, rape, incest and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother and foetus, persistent cultural taboos, deep-rooted stigma and inadequate healthcare resources mean the country still has the third highest global teenage pregnancy rate and alarming numbers of unsafe abortions each year.
"Despite the legislation being in place, many women are still risking life-threatening injury and even death to terminate their pregnancies alone. This anniversary is an opportunity to renew commitments to the protocol, improve access to safe abortion services and safeguard women's autonomy," he said.
Meanwhile as the Maputo Protocol reaches is second decade, the big question that remains is: how much longer to full equality?
Madalitso Wills Kateta is a freelance journalist and media consultant. Kateta specialises in gender, human rights, climate change, politics and global development reporting. He has written for publications such as Thompson Reuters Foundation, The New Humanitarian, African Arguments, Equal Times and others.
