The African Coalition for Research and Communication on Abortion: Shifting power, building capacity, defending rights

Background

Unsafe abortion remains an important, yet preventable, cause of maternal mortality and morbidity in Africa. Those already marginalised by poverty, geography, age, or other forms of social exclusion bear this burden most acutely. A range of barriers limiting access to safe and comprehensive abortion care continue to exist throughout the entire African region. These include restrictive, complex or conflicting laws, policies and regulations surrounding abortion services and products; limited provider and public knowledge of the policy and legal environment and/or safe points of care; insufficient coverage and/or poor quality of services and products for both comprehensive abortion care and post-abortion care; and pervasive and persistent abortion stigma, inhibiting communication on abortion and the provision of care.

Addressing these substantive challenges requires multi-pronged, well-resourced and strategic action. Central to this is the availability of good data and high-quality, policy-relevant evidence. While a small but important body of research on abortion in Africa exists – including a small number of population representative abortion incidence and safety studies (many now dated), and a growing number of evaluative, clinical or social studies – the evidence base remains limited.

Conducting and promoting abortion research can be challenging for a range of reasons including stigma, legal restrictions, policy ambiguity and resultant fears of criminalisation. This is compounded by low prioritisation of abortion and wider reproductive health research, diminishing scientific funding for public health as well as limited demand for evidence from policy-makers and/or legislators. These factors may discourage early-career researchers in the region from focusing on abortion. They can also find it challenging to openly share findings or have their data and insights accessed and acted upon. This situation is further exacerbated by the growing and alarming pushback of sexual and reproductive rights, choice and bodily autonomy occurring globally.

Consequently, there is a lack of publicly available data and research on abortion throughout the African region, resulting in underestimates of abortion incidence and severity. More specialised tools and methodologies are needed, as well as adequate resourcing for nationally representative surveys – costly yet crucial for high level policy decision-making.

These factors have shaped the abortion research ecosystem on the continent, resulting in studies on abortion being primarily designed and led by institutions from outside the region. This international leadership may include decisions on the nature and locus of the study, grant management (and linked research agenda-setting), the technical and academic leadership on the study and/or first authorship. There is though, a positive shift unfolding with notable abortion research capacity strengthening efforts leading to a growing number of trained researchers in the region. This positive trajectory must continue so that research agendas on issues pertinent to Africa are set and led by scientists and research users from the region.