5.2. Trends in legal, Policy and Institutional Reform

5.2.1. Legal Reforms

Over the Decade, countries in West Africa implemented legislative reform on SRH, maternal health and HIV/AIDS. Some countries sought to increase women’s access to sexual and maternal health by implementing universal medical coverage and addressing health care service costs. In Gambia, the 2010 Women’s Act guarantees women’s right to health, including SRH, and the enjoyment of health care and services. This includes the right to decide the spacing of children and to choose any method of contraception (Section 31).1284 In Burkina Faso, Decree No. 2016-311 guarantees free access to health care to pregnant women and children aged under five (Article 1) and free cervical and breast cancer testing and care for all women (Article 2).1285 Furthermore, Decree No. 2019-40 establishes free family planning services.1286 In 2019, the Malian president declared that primary care for, among others, pregnant women (including childbirth) and family planning would be free.1287 In Togo, the 2011 Law on Health Care guarantees free health care to freelancers and those in the informal sector, which is made up mostly of women.1288 The Sierra Leonean Free Health Care Initiative, launched in 2010, provides universal access for the most vulnerable groups and targets pregnant women and lactating mothers.

Regarding laws on abortion, in 2015 the Parliament in Sierra Leone overwhelmingly passed the Safe Abortion Act, which increases women’s access to safe and legal abortions. The Act permits abortion during the first 12 weeks of pregnancy, and until week 24 in cases of rape or health risks to the foetus.1289 In other countries, the situation has not improved; abortion is prohibited except in limited cases. In Côte d’Ivoire, the 2019 Penal Code, Article 426, sentences every woman who procures or tries to procure an abortion to jail (from six months up to two years) and a fine ranging from FCFA 50,000 to FCFA 500,000 (approximately US$ 90 -904 as of 4 July 2021) .1290 The only exceptions are to save a woman’s life or in the case of rape (Article 427). Also, incitement to abortion, notably through public discourse, can result in imprisonment from six months to three years (Article 428).1291 In Burkina Faso, abortion is permitted under the 2018 Penal Code only if continuing with the pregnancy endangers the life of the mother or if there is a high probability that the future newborn will suffer from a disease or infirmity of a severe nature diagnosed as incurable (Article 513-13). Abortion is permitted up to 14 weeks in cases of incest or rape (Articles 513-13 and 513-14).1292 In Guinea, under Article 265 of the 2016 Penal Code, abortion is allowed in cases of necessity to safeguard the woman’s life, rape, incest and severe conditions for the foetus.1293

Several countries have also enacted legislation that protects the rights of persons living with or affected by HIV. In Côte d’Ivoire, the Law of 11 July 2014 on Prevention, Protection and Repression in the Fight against HIV and AIDS promotes effective prevention and care and research strategies and programmes on HIV and AIDS. It ensures that the rights of people affected by HIV are respected, protected and fulfilled.1294 Article 9 states that testing is systematically proposed to pregnant women and future spouses. Article 26 guarantees the right to all persons infected with HIV to benefit from the state, including access to prevention, treatment, care and support services in the best possible conditions. Further, the Law contains a section on women and girls’ rights. Among others, women must receive information on preventing HIV transmission to their children, before, during and after pregnancy (Article 41).1295 In Ghana, the AIDS Commission Act 938 includes a section dedicated to non-discrimination towards persons living with or affected by HIV or AIDS and calls for the full enjoyment of the rights and freedoms enshrined in the Constitution (Section 28). The Act also guarantees the right of persons living with or affected by HIV to SRHR (Section 36).1296

5.2.2. Policy and Institutional Reforms

Since 2010, countries across the region have also implemented programmes and policies to ensure that SRH care and family planning are accessible and meet all women’s needs. Many countries have adopted policies addressing access to contraceptives. At the London Summit on Family Planning in 2012, Liberia pledged to increase its contraceptive prevalence rate from 10% in 2015 to 20% in 2021.1297 The 2014–2018 National Plan for Family Planning in Mali responded to the unmet need for family planning and sought to achieve a contraceptive prevalence of 15% by 2018.1298 In Niger, the Action Plan on Family Planning 2012–2020 aimed to increase the percentage of women using a contraceptive method to 50% by 2020.1299