Eunice Brookman-Amissah

Abortion risks in Sub-Saharan Africa and beyond

Sub-Saharan Africa has the highest number of abortion-related deaths worldwide, with 185 maternal deaths per 100,000 abortions. Alarmingly, over 75 per cent of all abortions in this region are unsafe, a significantly higher percentage than the global 45 per cent average. Even when safe abortion services are available, many health organisations in the region rely on US government funding to run their programmes. Unfortunately, this funding is subject to the policy known as “The Global Gag Rule”, instated during conservative US presidential administrations to withhold aid from organisations providing or discussing abortion services, even if they’re legal in their countries. While not in effect during the Biden administration, the policy’s chilling effect on ministries of health further impedes abortion access across the region.

While abortion access is especially perilous in Sub-Saharan Africa, women’s reproductive rights are at risk worldwide. Of the 55 million abortions that take place globally each year, approximately 25 million are unsafe. Recent regressions in legal protections for women’s reproductive rights are likely to worsen these figures. For example, in 2020, Poland issued a near-total ban on abortions. Similarly, in 2022, the Supreme Court of the United States overturned its previous decision in Roe v. Wade, effectively eliminating the federal right to abortion.

There is no medical reason why abortion should be unsafe. Instead, the safety of abortions is almost always tied to its legality. These illegal and unsafe abortions can have severe consequences for women’s sexual and reproductive health, including increased risks of maternal mortality, worsened physical and mental health and significant financial hardships given the high price of clandestine abortion and the resulting medical complications. Conversely, safeguarding reproductive rights allows women to realise their full potential, improving their educational outcomes by reducing rates of teen pregnancy and enhancing their participation in the labour market.

From medical director to safe abortion advocate

It is with this context in mind that Eunice Brookman-Amissah set out to improve African women’s access to safe abortions 30 years ago. However, this was not always her mission, as Brookman-Amissah began her career as a physician in the UK and Ghana. Due to her conservative upbringing, she initially held anti-abortion views. However, when one of her regular patients, a 14-year-old girl, tragically died from an unsafe abortion after Brookman-Amissah denied her care, a profound transformation took place. From that moment, she dedicated her career to safeguarding women’s access to safe abortions across Africa.

In the early 1990s, when Brookman-Amissah began her work on safe abortion access, the term abortion was highly stigmatised. During this period, she was known to spend hours outside of Ghana’s Ministry of Health offices trying to donate abortion kits created by Ipas, an international organisation focused on expanding safe abortion access. Brookman-Amissah later served as Ghana’s Minister of Health (1996-1998), providing her with a platform to improve women’s reproductive health in Ghana and beyond. She then served as Ghana’s Ambassador to the Netherlands (1998-2001), where she deepened her understanding of the lifesaving and career-enhancing advantages of the Netherlands’ elective abortion policies.

Brookman-Amissah’s early involvement with Ipas was pivotal to her career. In 2001, she became Ipas’ Vice President for Africa, a position she held until she retired from the organisation in 2014. In this position, she led the Ipas Africa Alliance for Women’s Reproductive Health and Rights in Nairobi, Kenya. Leveraging her experiences as a physician, government official and diplomat, her work at Ipas centred on addressing the root causes of unsafe abortions and finding viable solutions at the national and regional levels.

Brookman-Amissah’s fearless pursuit of safe abortion access has resulted in multiple threats to her life. In 2006, she was targeted by an extremist anti-abortion group based in the US, Human Life International, that called for her to be eliminated. As a result, Brookman-Amissah required constant security – at home, in her office and while travelling. A similar threat came in 2016 when she received an anonymous phone call from somebody claiming to have been hired to assassinate her. None of these threats deterred her mission to end the needless deaths and disabilities of women from unsafe abortions in Africa.

Advancing safe abortion access through collaboration

Brookman-Amissah dedicated years to sensitising national and regional government officials, lawyers, judges, healthcare workers, journalists, women’s rights activists, religious leaders and young people to the importance of reproductive health services. These years-long processes enabled her to build a coalition of key stakeholders in support of abortion law reforms throughout Africa.

Her work was significantly bolstered by the adoption of the Maputo Protocol by the African Union. The protocol was enacted in 2005 to advance women’s rights and gender equality across Africa and is the first human rights document to explicitly recognise the right to abortion as a human right. Brookman-Amissah led the dissemination of the protocol across Africa to ensure women’s reproductive rights were not only protected on paper but also in practice.

Throughout her career, Brookman-Amissah organised multiple regional conferences on the topic of safe abortion access. At a conference she convened for African policymakers in 2003, the World Health Organisation unveiled its inaugural technical and policy guidelines on safe abortion—a document that has been critical to global safe abortion initiatives ever since. Brookman-Amissah’s efforts also led The International Confederation of Midwives (ICM) to change its stance on abortion. Following discussions between Brookman-Amissah, Ipas and African midwives, ICM acknowledged the role of midwives in providing safe abortion care in 2014, paving the way for African midwives to conduct safe abortions and provide family planning services. This development has been pivotal in improving women’s health outcomes in areas with limited access to doctors.

Brookman-Amissah’s dedication to educating and engaging with diverse actors has led to the implementation and expansion of legal indications for abortion across Africa. In 2006 and 2008, Brookman-Amissah and Ipas partnered with the Ghanaian and Zambian Ministries of Health to improve the implementation of the countries’ existing abortion laws. She also initiated processes leading Mozambique, Sierra Leone, Benin, Eswatini and Kenya to reform their abortion laws. As a result of these efforts, abortion is now legal up to 12 weeks of gestation in Mozambique and Benin; Sierra Leone overturned its colonial-era law criminalising abortion; Eswatini allows abortion to save women’s lives and preserve their health; and Kenya expanded its indications for legal abortion. The process of sensitising and educating stakeholders in Malawi is ongoing.

Despite her retirement from Ipas in 2014, Brookman-Amissah continues to engage in her mission to reduce abortion-related maternal mortality in Africa through consulting and providing training to the next generation of SRHR activists. Brookman-Amissah, a remarkable advocate for women’s reproductive rights in Africa, exemplifies resilience and determination. Her unwavering commitment to advancing safe abortion access in the face of mounting challenges has left an indelible mark on the continent and beyond. Brookman-Amissah’s collaborative spirit and single-focused dedication have transformed the SRHR field and made Africa a more inclusive and safer place for women and girls.