Recent research suggests that more than one in four adolescent girls in West and Central Africa become pregnant before eighteen, and contraceptive prevalence sits at under 20% regionally. These numbers do not emerge from a lack of legal frameworks. They emerge from frameworks that exist without enforcement and rights recognised without resources.
Even so, data from WHO suggest that despite a 40% decline since 2000, the region still accounts for 70% of global maternal deaths, with an estimated 178,000 mothers dying each year, many from preventable causes including unsafe abortion. These disturbing trends reveal not just a public health crisis, but a systemic failure to translate policy commitments into accessible, life-saving services for women and girls.
A Spotlight on Sexual and Reproductive Health and Rights Gaps in Central Africa
Within Central African countries, there is a pattern of legal recognition without effective delivery, where sexual and reproductive health and rights frameworks exist on paper but remain unevenly realised in practice. Cameroon provides a useful starting point for examining how sexual and reproductive health and rights are framed within national legal systems in Central Africa. Its experience sets the stage for a comparative look at neighbouring countries, where similar legal commitments diverge sharply in practice.
Cameroon has ratified the Maputo Protocol without reservations and permits abortion where the mother’s life or health is at risk or where pregnancy results from rape. Yet statistics from the WHO African Regional Fact Sheet indicate that contraceptive prevalence remains at just 18.8%. Additionally, there is little or no mandatory comprehensive sexuality education in schools, and emergency contraception is not guaranteed for rape survivors. Thus, Cameroon’s interpretative declaration on Article 14 of the Maputo Protocol raises questions about the depth of its commitment to reproductive health rights.
Like Cameroon, the Democratic Republic of Congo has also ratified the Maputo Protocol and developed a legal framework making Sexual and Reproductive Health and Rights information compulsory in schools. On paper, it sits ahead of most neighbours. In practice, decades of armed conflict and collapsed infrastructure have made those commitments theoretical. Humanitarian reports from key actors in the region, including WHO, suggest that less than 10% of primary health facilities across the region can provide basic post-abortion care. In a country where conflict has systematically targeted women’s bodies, the gap between what the law promises and what the state delivers is both an administrative failure and a humanitarian crisis.
Cameroon’s closest neighbour, the Central African Republic (CAR), is currently experiencing similar challenges, with disturbing gaps between legal commitments and lived realities. Figures from UNFPA West and Central Africa show that it has an adolescent birth rate of 229 per 1,000, the highest in the entire sub-region, and an early marriage rate of 68%. That changed partially in August 2025, when the CAR ratified the Maputo Protocol, a significant, if not long overdue,step. The Centre for Reproductive Rights confirms that its legal framework already permits abortion on relatively broad grounds and prohibits female genital mutilation FGM. However, the question remains one of implementation in a context where state authority barely extends beyond the capital.
Furthermore, it seems as though there has been a deliberate absence of sexual and reproductive health and rights policy in Chad. Records from UNFPA regional data shows that the country has an early marriage rate of 67% and a contraceptive prevalence of just 22.9%. Chad has not ratified the Maputo Protocol, has no mandatory sexuality education, no laws criminalising spousal rape, and no specific sexual harassment legislation. Access to services in Chad remains constrained, exacerbated by state fragility. These conditions make it difficult to reduce the issue of sexual and reproductive health and rights in Chad to policy weakness alone, instead indicating a deeper structural neglect of SRHR as a policy priority, with far-reaching implications for gender equality and public health outcomes
What the Law Leaves Out
The silences in the law are as consequential as its provisions. The Population Council GIRL Center Research Brief estimates that no Central African country mandates free or subsidised contraception, and none guarantees adolescents access to SRH services without marital restrictions, meaning unmarried girls are legally excluded from services in many contexts. The WHO African Region Fact Sheet further confirms that HPV vaccination programmes are absent in most Central African countries, and spousal rape remains unrecognised as a crime across much of the subregion. These are not oversights. They are choices.
The Maputo Protocol provides a binding regional framework. Still, ratification without domestication produces rights that exist only on paper, not in the clinics and communities where women and girls actually live. Three priorities emerge from the evidence: governments must move from ratification to implementation, embedding treaty commitments into national law and budgets; comprehensive sexuality education must be made mandatory in schools; and legal barriers restricting SRH services to unmarried women must be dismantled, recognising that reproductive rights are not a marital privilege but a human one. For the women and girls of Central Africa, the law has made many promises. It is long past time those promises were kept.
In conclusion, closing the SRHR gap in the Central African region requires more than goodwill; it requires action from governments, civil society, and international partners willing to move beyond declarations and into delivery.
• Governments and policymakers in countries like Chad must accelerate the ratification and implementation of the Maputo Protocol, translating ratified commitments into enforceable national laws and allocating real budget resources. Signing a treaty is not the same as building a hospital or ensuring a teenage girl can access contraception regardless of her marital status.
• Civil society organisations, women’s rights groups, community health advocates, and legal aid organisations must be recognised and properly funded as frontline actors, not afterthoughts. Their closeness to communities, particularly in conflict-affected rural areas of the Democratic Republic of Congo (DRC), the Central African Republic (CAR), and the English-speaking regions of Cameroon, where fragility is high, makes them essential in bridging the gap between policy and practice
• International donors must align their funding with the region’s most urgent needs, investing in community-level SRH services, sexuality education, and legal reform. The frameworks exist. The evidence is clear. What is missing is the political will to make those commitments real and a regional accountability system strong enough to hold governments to what they have already signed.
