Demeke Desta will never forget what the wards were like. The scenes from the special hospital units in Ethiopia for women and girls who’d had unsafe abortions left an indelible mark on the 53-year-old physician’s mind. In the early 2000s, he saw scores of young women with life-threatening conditions, including sepsis, hemorrhaging, perforated uteruses and pelvic organ injury — all the results of back alley abortions.

Desta and his colleagues did their best to treat them, but by the time many arrived at the hospital, it was too late. “We tried to save so many lives,” he recalled, “but in most cases we were not able to.”

These were Desta’s early years as a physician, when one-third of all maternal deaths in Ethiopia could be linked to unsafe abortions. Thousands of women died each year. Under pressure to reduce the maternal mortality rate, the Ethiopian parliament passed a groundbreaking law loosening abortion restrictions for a variety of health conditions in 2005. The policy brought about a dramatic reduction in the number of deaths from unsafe abortions, and the bleak and overwhelmed hospital units that Desta remembers so vividly eventually shut down. The closure of the wards was “a success,” he explained. “I am a living witness that abortion care saves lives.”

But lately, Desta, who is now the Ethiopia program director for the global reproductive health nonprofit Ipas, worries that the dark days of those wards could become a part of Ethiopia’s reality again. That’s because the country’s abortion law is on shaky ground, thanks to the efforts of an emboldened anti-abortion movement buoyed by a court ruling halfway around the world: The U.S. Supreme Court’s historic 2022 decision to limit abortion rights in Dobbs v. Jackson Women’s Health Organization.