Fatima* lives with her two children in a mud brick home on the outskirts of Lubumbashi, a city in the far south of the Democratic Republic of Congo, where the earth is colored red and mining industries rule the economy. Fatima, 31, used to have a husband, too, but he disappeared last year after she learned that she was pregnant with their third child. Birth control of any variety is not regularly used in the DRC.
"He saw he couldn't support another child, so he left me," Fatima told me one afternoon in May. She sat atop a white cloth under the shade of the yard's only tree. At her feet, her young children played indolently, exhausted by the noontime heat.
With Fatima's husband gone, her main source of income disappeared. She made money as a freelance house cleaner whenever she could, but those earnings weren't enough to feed her family. When Fatima was around three months pregnant, she decided she needed to end her pregnancy. "I wasn't scared because I had made up my mind that I was going to have an abortion," she said. "I had no choice. There was so much suffering. This one was a baby then," she added, pointing to one of her children, now a toddler. "I was going to have another baby. How was I going to feed these kids?"
Abortion is illegal in the DRC and has been since the country's colonial era. The abortion restrictions here are some of the harshest in the world: The procedure is allowed only in instances where the mother's life is threatened, with no exceptions for rape or incest. Anyone caught performing an abortion is subject to five to 15 years in prison, and any woman who voluntarily undergoes a termination faces five to 10 years.
This doesn't stop Congolese women from getting abortions secretly at their gynecologists' offices or with the help of a midwife. Only, Fatima didn't have a gynecologist—she couldn't afford one. But she was desperate. She remembered hearing older women from her neighborhood speak of how to induce a miscarriage using herbs and various plant roots, and decided her only option was to follow this do-it-yourself hearsay: She took a concoction of local herbs and stuck other herbs into her vagina. Within a day, she started to suffer from severe cramping and began bleeding heavily. Lying on the dirt floor of her home, Fatima thought she was going to die.
"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?"
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.
According to a Guttmacher Institute study published in 2016, approximately 13 percent of pregnancies in Middle Africa are terminated by abortion. This is despite the fact that abortion is prohibited in every country in the region, often without an explicit legal exception to save the mother's life. Copious research shows that banning abortion in a country does not prevent abortion from taking place—it just increases the likelihood that the procedures will be performed in unsanitary and unregulated conditions.
Last year, Cynthia's* 19-year-old daughter, Yvonne*, died from complications following an illegal abortion procedure. Speaking from her modest house near central Lubumbashi, Cynthia, a 60-year-old mother of eight, solemnly recounted the story of what had happened. Yvonne had been a shy student who struggled at school.
When Yvonne became pregnant in early 2016, at age 19, she didn't tell a soul, as far as Cynthia knows. Desperate, and lacking options, she took matters into her own hands. When Cynthia discovered her daughter hiding in her room suffering from a high fever, she immediately rushed her to the hospital. Yvonne stayed there for five days before she died.
"It hurt me so much to watch this happen to my daughter, because she shouldn't have died," Cynthia said, clutching the armrests of her sofa chair as if to brace herself against the tragedy.
Nationwide statistics for the number of illegal abortions that happen in DRC or the number of women who die from botched abortions are difficult to come by. Several international family planning groups that work in the country, including the United Nations Population Fund, told me they were not aware of such numbers existing. Still, "considerable numbers of clandestine abortions, especially among urban adolescents and single women, take place in the Democratic Republic of the Congo," according to the UN.
It's the poor who suffer the most, as they cannot afford to go to a gynecologist for a secret, safe abortion. That would cost between $200 and $250, and DRC is one of the poorest countries in the world.
"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."
"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," a police chief in Lubumbashi told Broadly. "We usually only hear about it when a woman dies or there are some major health repercussions." In other words, anti-abortion legislation is quite difficult to enforce.
And while it's impossible to know just how many women are deterred from seeking an abortion because the procedure is illegal, we do know that the law puts women trying to terminate their pregnancies in a much more precarious, and often life-threatening, situation. Jeannine Assani, the regional coordinator for ABEF, a Congolese family planning and reproductive health organization, regularly deals with the ramifications of the law. ABEF clinics treat women who've had health complications due to failed attempts to abort, and the organization provides support for families who've lost daughters, sisters, or wives to botched abortions.
I asked Jeannine if she wanted to see the anti-abortion law overturned in her home country. "Yes, abortion should be legal," she said matter-of-factly. "If a women does not want to be pregnant, it's better that we can just help her, and then maybe help her realize her dreams for her life as well."
* 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.