Silent cries, hidden wounds: Rwanda’s struggle to protect girls from unsafe abortions

By Telesphore KABERUKA

In the dimly lit corridor behind the maternity ward of a hospital in eastern Rwanda, the air is thick with urgency. Every few minutes, a nurse pushes a stretcher toward the small Post-Abortion Care (PAC) room, a place few talk about openly, yet one that silently carries the weight of Rwanda’s reproductive-health challenges.

Inside, the atmosphere is a mix of medical precision and emotional fragility. Some girls lie trembling, pale from blood loss. Others sit quietly, eyes fixed on the floor, bracing for the questions they fear: “How did this happen? Why didn’t you come earlier?” Many never answer.

A hidden crisis behind hospital walls

On a Wednesday morning, a 17-year-old girl (name withheld for protection) arrived unconscious after attempting to terminate a pregnancy with herbs recommended by a friend. “By the time she came, the infection had spread,” says Midwife Speciose Mukabutera, who has worked in PAC for 11 years. “We saved her, but we lose some. Most come too late because fear keeps them away.” Fear of parents, of teachers, of being shamed, of simply being seen entering a hospital.

“I thought my life was over”

Clarisse Niyonsaba was 18 when she discovered she was pregnant. Today, at 22, she reflects on the moment that changed her life.

“I didn’t tell anyone for months. I was scared… mostly because I knew nothing about pregnancy,” she says. “My school didn’t talk about it, and at home we never discuss such things.”

She attempted at-home methods to “end the problem” before complications forced her to seek help. Clarisse survived. Many do not.

The voices of those still in the shadows

At a youth center in Muhanga district, a group of teenage girls speaks candidly, on condition of anonymity.

A 16-year-old says: “When a girl gets pregnant, people blame her immediately. Even going to ask a nurse about contraception makes you look guilty.”

A 19-year-old, who once escorted her friend to a secret abortion attempt, adds: “Some girls decide between two fears: the fear of dying, or the fear of being seen entering a clinic. Stigma is stronger than danger.”

Beatrice Uwimana, a mother of three daughters, admits: “We grew up in silence, so we repeat silence. But now I see it is killing our children. They need conversations we were never given.”

When information fails, unsafe methods fill the gap

Healthcare professionals report that some girls use dangerous methods recommended on social media, by peers, or by untrained individuals. These include toxic herbs, sharp objects, or high-dose drugs bought clandestinely.

Dr. Jean Paul Uwimana, a gynecologist in Kigali, explains: “By the time many arrive, the uterus is perforated, or the infection has spread to the blood. These are preventable deaths. Post-abortion care exists. What is missing is early access, and trust.”

An adolescent-health expert from a national NGO, Carine Gihozo, echoes the concern: “Laws alone don’t change attitudes. Communities must understand that providing information is not promoting immorality; it is saving lives.”

Teachers also witness the consequences. At a secondary school in Nyagatare, a teacher who requested anonymity observes: “We see girls drop out suddenly. Weeks later, we hear whispers that one nearly died from complications. We need structured SRHR education, not fear-based silence.”

Experts and community members propose several solutions. “Building stigma-free youth corners, improving parental communication, strengthening school-based SRHR education, expanding youth-friendly digital platforms, and raising awareness about Rwanda’s legal provisions for safe abortion”, suggests Dr. Jean Paul Uwimana.

The legal and policy backbone behind the fight

Rwanda’s commitment to protecting women and girls is anchored in a strong legal framework. The 2012 Penal Code legalized abortion under specific circumstances, offering a pathway to safe services for victims of rape, incest, and for cases involving risk to the mother’s health or fetal anomalies. The National Policy on Reproductive Health (2019) reinforces these protections by mandating equitable access to information and services, while the Adolescent Sexual and Reproductive Health and Rights (SRHR) Strategy ensures that young people are not left behind. Post-abortion care is guaranteed at all public hospitals and health centers. These policies are designed not only to save lives, but to restore dignity.

“The real challenge lies in transforming the protections guaranteed by law into protections felt in everyday life, a shift that demands awareness, compassion, and the dismantling of stigma,” says Karahamuheto Jeff, a policy expert. “Yet laws and policies cannot shield girls from whispers, judgment, or the silence of families who refuse to speak about sexuality”, he adds.