The OAU assembly mandated the African Commission on Human and Peoples' Rights (ACHPR) to develop such a protocol at its 31st Ordinary Session in June 1995, in Addis Ababa.

The states that have signed but not yet ratified are Burundi, the Central African Republic, Chad, Eritrea, Madagascar, Niger, Somalia, and Sudan.

Pope Benedict XVI described the reproductive rights granted to women in the Protocol in 2007 as "an attempt to trivialize abortion surreptitiously".

[9] In Uganda, the powerful Joint Christian Council opposed efforts to ratify the treaty on the grounds that Article 14, in guaranteeing abortion "in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus," is incompatible with traditional Christian morality.

[12] In Niger, the Parliament voted 42 to 31, with 4 abstentions, against ratifying it in June 2006; in this Muslim-majority country, several traditions banned or deprecated by the Protocol are common.

[13] Nigerien Muslim women's groups in 2009 gathered in Niamey to protest what they called "the satanic Maputo protocols", specifying limits to marriage age of girls and abortion as objectionable.