Accra, Ghana——

When Efua, a 25-year-old fashion designer and single mother in Ghana, became pregnant last year, she sought an abortion at a medical clinic but feared the procedure might be illegal. Health workers assured her that abortion was legal under certain conditions in the West African country, but Efua said she was still nervous.

“I have a lot of questions, just to make sure I’m safe,” Efua told The Associated Press, on the condition that only her middle name be used out of fear of retaliation against her country’s growing anti-abortion movement.

Finding reliable information was difficult, she said, and she didn’t tell her family about her surgery. “It comes with too much judgment,” she decided.

More than 20 countries in Africa have loosened restrictions on abortion in recent years, but experts say many women, like Efua, may not realize they have the right to have a legal abortion. Even as abortion legality continues to expand in places like Ghana, Congo, Ethiopia and Mozambique, some doctors and nurses say they are growing wary of offering abortions openly. They worry about angering opposition groups, which have become emboldened since a 2022 U.S. Supreme Court ruling struck down abortion rights nationwide.

“We are providing legal services to women who want abortions, but we are not publicizing abortions,” said Esi Asare Prah, who works at a clinic that performs abortions in Efua, according to Ghana 1985 A law passed in 2006 made abortion legal. “We’ve found that people are comfortable with our clinic providing abortion services, as long as we don’t make it too obvious what we do.” “

The Maputo Protocol is a human rights treaty that has been in force for all 55 countries of the African Union since 2005. It stipulates that every country on the African continent should grant women the right to protect themselves against rape, sexual assault, incest and situations that endanger the survival of humanity. the right to medical abortion. The mental or physical health of the mother or fetus.

Africa is the only country in the world with such a treaty, but more than a dozen countries have yet to pass laws allowing women to have abortions. Even in those countries that have legalized the procedure, barriers to access remain. Misinformation is rampant in many countries, and a recent study criticized the practices of Google and Meta.

“Legally there is a right to abortion, but in practice the reality may be a little different,” said Evelyn Opondo of the International Center for Women’s Studies. She noted that poorer countries in particular, such as Benin and Ethiopia, in certain Abortion may be permitted in some circumstances, but lack of resources prevents it from being available to all women. Many women only learn about their options through word of mouth.

Across Africa, MSI Reproductive Choices, which provides contraceptive and abortion services in 37 countries around the world, reported that staff were repeatedly targeted by anti-abortion groups. The organization cited harassment and intimidation of Ethiopian staff. In Nigeria, MSI clinics were raided and temporarily closed following false accusations that staff illegally obtained confidential documents.

“African pro-life voices have always been there, but they are better organized now,” said Marla Talbot of the International Planned Parenthood Federation in Kenya. She noted that much of the funding supporting anti-abortion efforts appears to be coming from conservative U.S. groups — — Some reports have found that conservative Christian organizations have provided millions of dollars in such funding.

Angela Akol of reproductive rights advocacy group Ipas said the surge in opposition groups was alarming.

“We’re seeing them in Kenya and Uganda advocating at the highest levels of government to reduce access to abortion,” she said. “patriarchal, almost misogynistic norms exist across much of Africa… In the wake of the reversal of Roe v. Wade, the West is using the momentum to challenge abortion rights here.”

Congo, one of the world’s poorest countries, introduced a law in 2018 that allows abortion within the first 14 weeks of pregnancy in cases of rape, incest and threats to a woman’s physical or mental health.

Even so, brochures aimed at women who might want an abortion still use coded language, said Patrick Djemo of MSI Congo.

“We talk about the management of unwanted pregnancies,” he said, noting they don’t use the word abortion. “That could cause a backlash.”

Accurate language and information can also be difficult to find online. Last week, a study by MSI and the Center to Counter Digital Hate found that Google and Meta (which operates Facebook, Instagram and WhatsApp) restricted access to accurate information about abortion in countries including Ghana, Nigeria and Kenya.

The study said tech giants banned advertising from local abortion providers while approving paid ads from anti-abortion groups that promoted false claims about decriminalization efforts as part of a global conspiracy to “erase” local populations.

Google did not respond to a request for comment on the study. Meta said by email that its platform “prohibits ads that mislead people about the services a business provides” and that it will review the report.

International Women’s Center’s Opondo says she is deeply worried about the future of abortion rights movement in Africa as opponents use the same tactics used in the US to overturn Roe v. Wade

However, for now, she said, “it’s probably still easier for women to get an abortion in Benin than it is in Texas.”

For Efua, information and cost were barriers. After asking friends for help, she scraped together the 1,000 Ghanaian cedis ($77) needed for the abortion.

She said she wanted women to have easy access to reliable information, especially given the physical and mental stress she experienced. She said she couldn’t raise another child on her own and believed many other women faced similar struggles.

“If you’re pregnant and you’re not ready,” she said, “it can really affect you mentally and for the rest of your life.”