As she lay, bleeding and feverish, Fatima knew she had to try to seek medical attention for the sake of her two children. She summoned enough strength to make the half-hour ride to a clinic in Lubumbashi, riding on the back of a bicycle taxi while hemorrhaging blood. When we spoke, she couldn't recall the clinic's name. It was far from a legitimate hospital, she said: a tiny structure down a back alley that may not have been run by licensed doctors. The medical staff was able to save her, but then when it came time to pay the $150 for treatment, Fatima didn't have the money.Until Fatima could convince a relative to pay the fee, three months later, the clinic held her hostage, she claims. At night, she slept chained to a cot; during the day, the clinic kept her youngest child as collateral while she searched for odd jobs. (According to a 2016 article published in Health and Human Rights Journal, DRC is one of the countries where "detention of women is a surprisingly common problem" for those who cannot pay for childbirth services at hospitals or clinics.)"I didn't feel great for a while after the abortion, but slowly after a few months, my health improved, and now I'm back to normal," Fatima said. She considers herself lucky, and understandably so: According to the World Health Organization, a woman in the developing world dies every eight minutes from complications related to an unsafe abortion procedure. The region of Middle Africa, which includes the DRC, is home to the highest percentage of unsafe abortions in the world.
"I had made up my mind that I was going to have an abortion. I had no choice… How was I going to feed these kids?"
"Most gynecologists perform abortions, but secretly," a Lubumbashi gynecologist, Francois*, told me during an interview in the garden of a local cafe. "Every abortion is illegal, but in our profession it's generally agreed upon that certain abortions are acceptable."Teenage rape victim seeking abortions fall into that category, he continued, especially cases where the rapist is HIV positive. Otherwise, as a devout Catholic, Francois prays about each abortion case that comes to his office and makes a decision according to his faith. For example, if a well-off couple asks him for an abortion and only has one other child, Francois will refuse. He will also refuse to terminate a pregnancy out of concern for his only safety: If a young woman comes into his office without the consent of her family or the father, he won't perform the procedure. If the family later discovers what he has done, he explained, they could go to the police.He knows this pushes women into more dangerous situations, but "I have to weigh the risk," Francois said. He knows of four medical professionals who have been jailed for performing abortions. The Prosecutor General in Lubumbashi told me that six abortion cases were prosecuted last year, which included both women who had gotten abortions and abortion providers.
"Most abortion cases happen, and they happen in silence. We usually only hear about it when a woman dies or there are some major health repercussions."
* Because abortion is a criminal offense in DRC, names have been changed to protect anonymity.This story was produced with the support of the International Women's Media Foundation's African Great Lakes Reporting Fellowship.