In Sierra Leone, where abortion is illegal under all circumstances, many women face significant challenges when dealing with unintended pregnancies. At sixteen, Fatou Esther Jusu became pregnant and feared the repercussions on her future. Due to the strict laws and fear of judgment from her family, she resorted to using misoprostol, obtained from a local pharmacy, in an attempt to terminate her pregnancy. When the initial attempt was unsuccessful, she tried again, eventually resulting in a miscarriage. After fainting, she was taken to a hospital but pleaded with the doctors to keep her condition a secret from her parents. Now 21 and studying to become a nurse, Jusu is advocating for a legislative change to decriminalize abortion in hopes of saving others from similar predicaments.
Sierra Leone could potentially become the second country in West Africa to alter its stance on abortion. Proponents of the bill argue that it would significantly enhance the safety and well-being of expectant mothers, reduce preventable deaths, and abolish outdated colonial-era legislation. Currently, women and girls in the country, numbering tens of thousands annually, attempt self-induced abortions due to the prevailing legal restrictions. Supporters contend that unsafe abortions account for approximately 10% of maternal mortality. Healthcare workers sometimes perform these procedures citing reasons other than abortion due to the legal constraints. Following the overturning of Roe v. Wade by the U.S. Supreme Court in 2022, Sierra Leone’s President Julius Maada Bio introduced the Safe Motherhood Bill.
Bio emphasized the progressive nature of Sierra Leone’s stance amidst global regression in women’s sexual and reproductive rights. Should it be ratified, the bill would represent the most liberal abortion policy in West Africa, allowing termination within fourteen weeks of pregnancy. However, due to increased opposition from religious circles, amendments to the bill now restrict abortions to specific scenarios such as life-threatening conditions, fatal fetal abnormalities, rape, or incest. Parliament is expected to vote on the bill soon, although its approval remains uncertain.
Research by the African Population and Health Research Center indicates about 90,000 abortions occur annually in a nation populated by over 8 million people, with unsafe procedures contributing significantly to maternal deaths—roughly 717 per 100,000 births. Many opt for hazardous methods, including expired medication and improvised tools, due to cost factors and social stigma. The MSI Sierra Leone clinic often manages post-abortion care, assisting women and girls who face complications stemming from untrained or self-administered abortion attempts. A significant portion of pregnancies, over 20%, occur among teenagers aged 15 to 19, among the highest rates globally.
Stigma associated with abortion discourages many from seeking proper medical care, leading to life-threatening situations. A 13-year-old mother recently sought help at MSI after ingesting pills for abortion, unaware of the perilous effects. Nurse Hawanatu Samura at MSI frequently encounters young patients suffering severe medical complications from using unsafe methods. Despite these dangers, the ongoing debate in Sierra Leone is underscored by opposing views on tradition and morality. Many religious leaders have vigorously opposed the bill, labeling it as contrary to the nation’s values. The Inter-Religious Council remains a vocal critic, emphasizing traditional norms over legislative changes.
The issue has also been politically contentious, with figures in President Bio’s circle expressing dissent. Conversely, government officials argue for the bill’s necessity in addressing maternal death rates and reinforcing recent gender reforms, such as a ban on child marriage. The legislation aims to improve access to family planning and reproductive health services, critical to women’s rights and health.
Amidst intense discussions, arguments of foreign influence have surfaced on both sides. While some factions in Sierra Leone attribute external sponsorship to opposition groups, opposition figures cite shifting U.S. abortion laws as a basis for their stance. Meanwhile, agony persists for many women in Sierra Leone who continue to face life-threatening circumstances due to existing abortion laws. Health professionals, like Samura, hope for legislative change to provide services without fear of reprisal and save lives. Remembering a mother’s tragic death from unsafe abortion methods at a hospital spurs such advocates to persist in their calls for reform.