As the Nigerian Army rescues more and more women and girls from their Boko Haram kidnappers, the women are coming back to their homes traumatized, ill, and, in lots of cases, pregnant. Many of the women saw their husbands, brothers, and other male family members killed before they were taken and forced into "marriages" with their kidnappers, and then were repeatedly raped over the course of months. By the time the Nigerian Army finds them, some have already given birth and land in internally displaced persons (IDP) camps with children in tow. Some of the pregnant girls and new mothers are children themselves.

The Lagos-based newspaperVanguard reported that of the 234 women and girls rescued earlier this month by the Nigerian Army, at least 214 are pregnant, and media outlets across the world picked up that claim. According to Ratidzai Ndhlovu, an in-country representative of the United Nations Population Fund (UNFPA), that figure is incorrect — the 234 girls are in a camp in the eastern city of Yola and are still being evaluated by health workers, who have not yet released figures on the number of pregnancies. There are 214 other girls and women, some recovered Boko Haram kidnap victims and others not, who are pregnant in an IDP camp in Borno. Confusion about location and numbers aside, all parties agree that of the hundreds of women and girls rescued from Boko Haram, and the hundreds more the Nigerian government hopes to recover, many will be pregnant and will need extensive medical and psychological care.

Governments and international organizations are stepping up to help, offering antenatal care, family planning services, and treatment for malnourishment. Media stories about the rescued women and girls abound. But despite the fact that a story about pregnant rape survivors — potentially hundreds of them — is making headlines across the globe, almost no one in media, in government, or on the NGO circuit is talking about the need for abortion.

A small handful of advocates for global women's rights say that's an unconscionable omission. There are legal obstacles, but they say there's an established framework for providing abortions to rape victims in Nigeria. The problem is lack of political will.

"There's enough international work and policy that has gone into addressing the exact issue we are faced with right now that it should be a no-brainer for international donors like the U.S. government, like UNFPA, to be going into Nigeria and helping these girls access safe abortions, for the ones who want and choose that," Serra Sippel, president of the Center for Health and Gender Equity (CHANGE), an organization that advocates for a human-rights-based foreign policy that centers on the rights of women and girls, told Cosmopolitan.com. "There are resources, there's policy in place, it's just a matter of being compassionate and providing these services. I'm beside myself that nobody's talking about this."

According to mental health experts, rape survivors are best served when they are able to make their own decisions about their bodies and their care. Particularly important, experts say, is survivors' ability to regain control over their bodies, their lives, and their choices — and that includes the right to exercise a full range of reproductive choice.

"If there's any sort of return to normalcy, there needs to be engagement with the woman about what she can do to reclaim her life," Bea Arthur, a therapist who often works with victims of violence, told Cosmopolitan.com. "Telling someone they can't have a choice extends that trauma and denies them their own humanity, integrity, and basic human self-respect."

Some women who are impregnated by rape, Arthur says, decide to give birth because it gives them a sense of purpose and helps them to feel that something positive came out of such a terrible experience. Others want nothing more than to not be pregnant. And when women are barred from safe abortion services, some go to extreme lengths — even attempting or committing suicide — to avoid bearing a child conceived in rape. Forcing women to go one way or another and not letting them have say over their own bodies after those bodies have endured sexual violation can re-traumatize them, Arthur says. Women who are raped in war and bear children may be especially vulnerable to depression, post-traumatic stress, and other mental health issues, with studies indicating that large numbers of them experience severe negative psychological consequences, especially if they face stigma or isolation within their communities.

That's already the case with some of the women and girls raped by Boko Haram members, UNFPA's Ndhlovu says. Ndhlovu says she heard a report of at least one young girl who gave birth to the baby of her Boko Haram rapist and wanted nothing to do with the child; counselors, fearing she may harm the baby or herself, removed the child from her care and placed it in an orphanage until the young mother becomes capable of safely caring for it — if that ever happens.

On its face, it seems obvious why the rescued Nigerian women wouldn't have abortion access: Abortion is illegal in most of Nigeria except to save the pregnant woman's life. Still, despite being illegal, abortion remains common, with some 760,000 procedures performed in Nigeria every year — a higher abortion rate than that of the U.S. The clandestine nature of illegal abortion makes it hard to track rates of death and injury, but experts estimate that as many as 34,000 women die of unsafe abortion in Nigeria every year. Even the most conservative estimates say some 3,000 women lose their lives because they could not access safe abortion services.

With abortion outlawed, NGOs and other governments have cover to stay silent on safe abortion for the rescued girls and women. But Nigeria is also a signatory to the Maputo Protocol, an African Union treaty instrument delineating the rights of women, including the right to abortion in cases of rape, incest, or where pregnancy would pose a danger to the woman's physical health, mental health, or life. If Nigeria abided by its treaty obligations, the pregnant girls and women would have the right to end their pregnancies if that's what they wanted. The kidnapping of the Chibok girls, who inspired the #BringBackOurGirls campaign, happened more than a year ago, and advocates knew that many of the thousands of women and girls kidnapped by Boko Haram would be sexually abused and raped by their captors. That many of the girls would come back pregnant was obvious even then.

But since the Nigerian Army began its high-profile rescues of some of the girls and women kidnapped by Boko Haram, there's been no public pressure by high-profile NGOs or governments to push the Nigerian government to allow abortion services for rape survivors. In part, that's because NGOs on the ground are stretched incredibly thin. UNFPA, one of the leading groups serving the girls and women, is handling this crisis in triage mode, Ndhlovu says. Their top priorities have been getting the girls and women mental health counseling, and delivering reproductive health packages to the camps, which include things like STI and HIV tests, family planning tools, and safe delivery kits. They've also delivered "dignity kits," which Ndhlovu says serve the purpose of restoring a sense of humanity and normalcy.

"Let them look good," she said. "Let them have what they need when the time comes for them to go through menstruation. Soap, perfume, packets to wash their things in."

But there are more women and girls in the camps than anticipated, and many of them are arriving pregnant or facing serious mental or physical health issues.

"We underestimated," Ndhlovu said. "Everybody is shocked by the numbers that are now coming back and going into the camps. Some of them are coming from the north of the country, coming from the neighboring countries, running away. But they have no homes to go to, so they're going to camps. The need for these services is so huge because there are so many people crowded in camps, and there's no room."

Ndhlovu says UNFPA is taking a holistic look at the needs of the girls and women, within serious budget constraints. They bought 600 culturally appropriate dresses, she says — the rescued women had been living in the forest for months with just one dress, turned threadbare and filthy by the time they made it to the camps. And the psychological care on offer is structured around helping the girls and women reacclimatize to normal life, especially if they're treated as oddities or damaged goods in their own communities.

"We are trying to give them a certain power over their suffering and what they went through so that they develop some level of individual resilience, so that they can meet the challenges which are likely to come," Ndhlovu said. "If these girls are getting stigma even among their own friends who also came from the forest, what more are they going to get when they go out into the community? That's something that we need to prepare them for."

As for adding abortion services to the roster, Ndhlovu says, "We have not yet had that discussion at UNFPA."

"When you look at our resource constraints at the moment because of the influx and the underestimation, the package of services we are offering right now is so huge we are overwhelmed," she said. "I don't see myself trying to take on something additional when we are struggling to cope with the package that we already have to deal with. If I can deliver the services that we want to give right now, I would be the happiest person. But to tell you the truth, we are so resource-constrained it's impossible."

It's not just unsafe illegal abortion that kills Nigerian women; having children in Nigeria can be a risky endeavor too. Nigeria has one of the highest maternal mortality rates in the world, with women there facing a 1 in 13 chance of dying while pregnant or in childbirth. And 2,300 children under the age of 5 die in Nigeria every day.

NGOs are ready to help the rescued women and girls have safe births — but birth is the only pregnancy outcome they're mentioning. Without the Nigerian government giving the OK, the women and girls won't have the option to end their pregnancies, unless they seek out illegal and often dangerous procedures.

The United States and NGOs could change that, Sippel says, noting that the U.S. government already has a presence in Nigeria, funding family planning and post-abortion care for women injured by clandestine abortions. They could, she says, put pressure on the Nigerian government to bring its laws into accord with the Maputo Protocol and offer resources for rape survivors to obtain a full range of reproductive health care services.

But instead, "what the U.S. government does is allow the extreme politicization of abortion in the United States to dictate how they're responding in this kind of crisis, which to me is unconscionable," Sippel said.

American dollars can never pay for elective abortions because of the Helms Amendment, a 1973 law restricting abortion funding abroad. American money can fund abortions if the pregnant woman is a rape victim, or if the pregnancy will endanger her life or her health, but because contentious American abortion politics have created what Sippel calls a "chilling effect" when it comes to abortion funding abroad, Helms is often interpreted as a blanket ban on abortion funding. That leaves women in some of the most under-served parts of the world vulnerable. It also compromises NGOs — the UNFPA, for example, lost funding under President George W. Bush, after pressure from American anti-abortion organizations. Funding was restored under President Barack Obama, but another anti-abortion executive could mean funding gets pulled again — and so the UNFPA may be hesitant to loudly demand abortion access for the Nigerian women.

"It would be brilliant if UNFPA actually partnered with the U.S. government and provided these services, to demonstrate to the world that they're not going to be pushed around, that the politics of an extreme group in the United States are not going to dictate how they respond to an international crisis impacting women and girls," Sippel said. "This is a moment in time, and time is running fast. We know there is a certain period of time where we need to be able to get safe abortion access to these girls."

Boko Haram has kidnapped thousands of girls and women, and those who have been rescued are just a fraction of the total number — the Chibok girls, for example, are still missing. The rescued women and girls who are currently pregnant will almost surely not be the last, and it's their rights and interests, some advocates say, we should be prioritizing.

"Part of our U.S. foreign policy is about restoring dignity and justice," Sippel said. "Providing safe abortion services is an important piece of that for these girls and women."

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Jill Filipovic
senior political writer

Jill Filipovic is a contributing writer for cosmopolitan.com. She is the author of OK Boomer, Let's Talk: How My Generation Got Left Behind and The H-Spot: The Feminist Pursuit of Happiness. A weekly CNN columnist and a contributing writer for the New York Times, she is also a lawyer.