In Senegal, abortions are carried out in secret since the practice is illegal and considered taboo. Torn between pain and fear, a young Senegalese woman narrates her experience. And an abortionist weighs in.
by Bineta Diagne, Dakar
Global report warns: Back-street abortions on the rise
A long-term fall in the global abortion rate has tapered off and the number of unsafe pregnancy terminations is rising worryingly, according to a report published by The Lancet two weeks ago.
Between 1995 and 2003, the number of abortions around the world for every 1,000 women aged between 15 and 44 fell from 35 to 29.
But in 2008, the rate was almost unchanged, at 28 per 1,000, due to a surge in abortions in developing countries.
The Lancet report also highlighted a dramatic increase in the proportion of unsafe abortions.
This rose from 44 percent of the total in 1995 to nearly one in two -- 49 percent -- in 2008, inflicting a traumatic toll in death and injury.
The UN World Health Organisation (WHO) defines unsafe abortion as a pregnancy termination performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards or both.
Around the world, unsafe abortions accounted for 220 deaths per 100,000 procedures in 2008 -- 35 times the rate for legal abortions in the United States -- and for nearly one in seven of all maternal deaths.
Each year, around 8.5 million women in developing countries encounter abortion complications that are so serious they need medical care.
“First, I went to a pharmacy and from there I was directed to a certain doctor,” she recounts. The doctor in question referred her to a private clinic. At the clinic, Fatoumata was torn between fear and pain. The doctors coldly questioned her: “They asked me: ‘Are you here for an abortion?’, ‘Are you married?’, ‘Do you have a boyfriend?’ and ‘Does your boyfriend agree with you having an abortion?’”
Fatoumata remained composed and explained that her partner did not know about her pregnancy and that she wanted to have an abortion. But the doctors persisted, trying to ensure that “I would not cause any complications, because it is a clinic and abortion is illegal.”
Then it was bargaining time. “I was asked to pay 70,000 CFA francs [~100 euros] for the procedure, plus 6,000 CFA francs [around 9 euros] for the ticket,” the young woman recalls. “I said no, I don’t have that much money, I have 50,000 CFA francs [~75 euros]... We finally agreed on 60,000 CFA francs [~90 euros].”
But they doctors were still not convinced and asked a few more questions. “The gynaecologist asked me why I wanted to do it,” recalls Fatoumata. “I answered that it was because I didn’t want a child at the moment.”
The gynaecologist then took her into a small operating room. “It was neat,” she noted. It was with a bitter voice that she narrated the rest of her experience. “I felt a lot of pain and she [the gynaecologist] told me ‘don’t scream too much otherwise people will know what you are doing here; you chose this, so be strong; everything will be fine.’ It was the most horrible ten minutes of my life,” says Fatoumata.
But the next moments were even more painful, according to the young woman. “She showed me what she had taken out my womb, probably to discourage me from having an abortion ever again.” Today, Fatoumata is healthy and well; shortly after the procedure, the gynaecologist gave her a prescription for antibiotics and other medications. “But there was no follow-ups,” says Fatoumata.
Mohamed, who prefers not to use his real name, is a doctor. He is meeting us by night, in a treatment room, to discuss this taboo subject. He has been performing abortions for more than twenty years, in strict anonymity and secrecy, because, in Senegal, a doctor faces between one and five years imprisonment and a fine between 20,000 and 100,000 CFA francs [between around 30 and 150 euros] for performing an abortion.
According to the penal code, a woman who has an abortion faces jail time ranging from six months to two years.
“I do it mostly for social reasons. Sometimes I want to help friends or relatives who find themselves in a difficult position with their families because of an unplanned pregnancy,” explains the doctor who is in his fifties. He sees “many young women” as well as “company executives who want to conceal the pregnancy of their mistresses”. Mohamed therefore operates “in secrecy”.
“After anesthetising the cervix,” he says, “I use special instruments to clean the uterus. It is a delicate procedure that lasts ten to fifteen minutes.” But the procedure also has some dangers, so he asks the women to come back two weeks later for an ultrasound test.
“I was very scared of having an abortion because I know many women who died from it. I was also scared of complications,” admits Fatoumata. “I just hope abortion will one day be legalised in Senegal.”