São Tomé and Príncipe: São Toméans Strongly Support Women's Reproductive Autonomy, Sexuality Education, and Broad Access to Contraception

19 May 2026
Afrobarometer (Accra)
By Maame Akua Amoah Twum and Kamal Yakubu

Most say pupils who get pregnant should be allowed to stay in school.

Key findings

  • Overwhelming majorities of São Toméans say women should be able to decide for themselves whether and when to marry (88%) as well as when to have children and how many children to have (85%).
  • Women are more likely than men to assert women's autonomy in choices about marriage (91% vs. 86%) and childbearing (89% vs. 81%).
  • More than eight in 10 São Toméans (84%) say pupils who get pregnant or have children should be allowed to continue their schooling.
  • Almost nine in 10 (88%) endorse the teaching of sex education in school.
  • A large majority of citizens say contraceptives should be made available to anyone who is sexually active regardless of marital status (81%) and age (73%).
  • More than three-fourths (77%) of São Toméans see terminating a pregnancy as "sometimes" or "always" justifiable if the woman's life or health is at risk.
  • Majorities say abortion can be justified in cases of rape or incest (69%), if the woman is economically unable to care for a child (57%), and if the pregnancy is unwanted "for any reason" (57%).

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Sexual and reproductive health and rights (SRHR) are central to the well-being and empowerment of women and girls in São Tomé and Príncipe. However, despite government efforts supported by international partners to strengthen reproductive health services and expand sexuality education, significant challenges persist. Adolescent pregnancy remains high, uptake of family planning is limited, and access to safe abortion services continues to be constrained (Carvalho et al., 2020; Vasconcelos, Bandeira, Sousa, Pereira, & Machado, 2022a).

Adolescent pregnancy is a major public health concern across Africa, where an estimated 33% of girls give birth before age 18 and 3.5% before age 15 (Kassa, Arowojolu, Odukogbe, & Yalew, 2018). São Tomé and Príncipe reflects this regional pattern. National adolescent pregnancy prevalence rose from 22.8% in 2009 to 27.3% in 2014, and one in five hospital deliveries involved mothers aged 19 or younger (Vasconcelos et al., 2022a). Moreover, adolescent pregnancies in São Tomé and Príncipe are associated with adverse birth and perinatal outcomes such as foetal distress and increased need for neonatal resuscitation compared to older mothers (Vasconcelos et al., 2022b).

Although São Tomé and Príncipe adopted a relatively progressive legal framework following its ratification of the Maputo Protocol, moving from a complete prohibition against abortion to permitting abortion on request, access to safe abortion services remains limited (Center for Reproductive Rights, 2020). Evidence points to continued gaps in reproductive health services and family planning. A hospital-based study found that 13.4% of pregnant adolescents had previously had an abortion, while 30% were in their second or third pregnancy (Vasconcelos et al., 2022a). Another study reported that more than half (51%) of pregnant adolescent girls had considered terminating their pregnancy (Carvalho et al., 2020). A special question module in Afrobarometer's Round 10 survey (2024) explores the opinions and experiences of São Toméans related to sexual and reproductive health and rights.

Findings show that a majority of São Toméans support the autonomy of women in choices about marriage and reproduction. Most also endorse the teaching of sex education in schools and believe that schoolgirls who become pregnant should have the right to pursue their education. Majorities are open to making contraceptives available to anyone who is sexually active regardless of age or marital status, though substantial minorities disagree.

Most citizens consider abortion justifiable if the pregnancy threatens the woman's life or health or resulted from rape or incest. More than half hold the same view if the woman is economically unable to care for a child or if the pregnancy is unwanted "for any reason."

Maame Akua Amoah Twum Maame Akua is the communications manager at Afrobarometer

Kamal Yakubu Kamal Yakubu is Afrobarometer's capacity building manager (advanced Track).

Read the original article on Afrobarometer.

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