Stigma and silence surrounded unsafe abortion in Africa until the International Conference on Population and Development in 1994. Up to five million unsafe abortions are performed in Africa every year, with young women disproportionately affected. This paper summarises the colonial origins of current abortion laws and efforts in the region to provide post-abortion care. Much as it helps to save lives, however, post-abortion care will not eliminate unsafe abortion. There is a need to do away with restrictive laws. The paper describes efforts in several countries to change the law, focusing on Kenya, where organised opposition to reforming the law has emerged and led to the arrest of three service providers. Regional bodies, including the African Union, have taken a stand on abortion within the wider context of safe motherhood and reducing maternal mortality, and advocacy for better abortion laws is increasing across the region. As more girls remain in school and the marriage age increases, the inadequate provision of family planning and abortion care will cause Africa to lose many young women through unsafe sexual activity, unwanted pregnancy, unsafe abortion, early childbearing and HIV infection. The time has come in Africa for a commitment to eliminate deaths and disability from unsafe abortion and respect women's right to decide the number and spacing of their children.