Safe and legal abortion access for survivors of rape and incest in West and Central Africa: A comparative case study analysis of key barriers.

Despite legal provisions allowing for abortion in cases of rape and incest, survivors in West and Central Africa still face many access barriers. Understanding these obstacles is vital for their rights and health. This study looked at barriers to safe and legal abortion services for survivors of sexual violence in five West and Central African countries. We did a comparative case study in Benin, Burkina Faso, Cameroon, Côte d'Ivoire, and Togo. Data collection included documentary analysis, 164 semi-structured interviews with institutional actors, civil society members, community leaders, and sexual violence survivors, along with 14 focus group discussions and a multi-level analytical framework. We applied a four-phase collaborative qualitative thematic analysis. This helped us identify barriers at macro (policy), meso (organisational), and micro (individual) levels. The analysis reveals how interconnected barriers restrict access. At the macro level, obstacles include unclear laws, missing regulations, and bans on abortion-related communication. Meso-level barriers feature inconsistent institutional practices, unprepared health facilities, and poor coordination. Micro-level challenges involve limited awareness of legal rights, widespread social and religious stigma, and informal conscientious objection practices. For survivors seeking to end the pregnancy, these barriers lead to unsafe abortion or forced continuation of pregnancy. Legal provisions alone do not guarantee survivors' access to safe and legal abortion. Coordinated efforts are needed to address legal, institutional, and social obstacles, transforming legal rights into real access and reducing unsafe abortion practices.