Sierra Leone debates decriminalizing abortion as women and girls endanger their lives

FREETOWN, Sierra Leone (AP) - When she got pregnant at 16, Fatou Esther Jusu was terrified that it would derail her future.

Abortion is illegal in Sierra Leone. Fearing judgment from her family, she took friends' advice and bought misoprostol, a drug whose uses include abortion, from a local pharmacy. It didn’t work. Desperate, she tried again and miscarried.

"I went to the toilet... and the baby came out," she said. She fainted and was taken to a hospital, where she pleaded with doctors not to tell her parents.

Now 21, Jusu considers herself lucky. One friend died after taking an expired version of the medication.

With those experiences in mind, the nursing student is mobilizing others in support of a bill that would decriminalize abortion in the West African country.

"Even though I made a mistake, this mistake is saving other people," Jusu said.

Sierra Leone could become the second country in West Africa to decriminalize abortion, which health workers say would significantly improve the safety of pregnant women, decrease the number of preventable deaths and bring an end to the current colonial-era law.

Tens of thousands of women and girls attempt to self-terminate their pregnancies every year in Sierra Leone, where abortion is illegal in all circumstances.

Supporters of the bill say unsafe abortions account for around 10% of maternal deaths. Healthcare workers are known to perform terminating procedures when the situation is "incompatible with life" of the woman, usually in the case of "incomplete" abortions. Because abortion is illegal, they cite other reasons for the termination.

Sierra Leone's President Julius Maada Bio pointedly introduced the Safe Motherhood Bill after the U.S. Supreme Court overturned Roe v. Wade in 2022, stripping away women’s constitutional protections for abortion.

"At a time when sexual and reproductive health rights for women are either being overturned or threatened, we are proud that Sierra Leone can once again lead with progressive reforms," Bio said.

If approved, the bill would have been West Africa’s most progressive legislation on abortion, allowing the procedure for up to 14 weeks.

But Sierra Leone since then has been torn apart by debate. Following opposition from religious leaders, the bill has been amended and now limits abortion to cases of life-threatening risk, fatal fetal abnormalities, rape or incest.

The government says it expects a vote in parliament in the coming weeks. It is not clear whether it will be approved.

An estimated 90,000 abortions are performed annually in Sierra Leone, a country of more than 8 million people, according to research by the African Population and Health Research Center. About 10% of the country’s maternal deaths - affecting 717 of every 100,000 births - are due to unsafe abortions, the center said.

Health workers say the true number is likely much higher.

Due to cost and stigma, many women and girls resort to unsafe methods like expired medication, laundry detergent, hangers or sharp instruments.

On a recent morning at a clinic run by the MSI Sierra Leone nonprofit, dozens of women and girls waited nervously for consultations with nurse Hawanatu Samura.

MSI offers "post-abortion care," including terminations in cases of "incomplete" miscarriage, often when people have tried and failed abortions themselves. The nonprofit is the largest individual service provider of family planning services in the country.

If patients want an abortion, "they go to any length," Samura said. She often sees damage caused by unsterilized instruments, leading to severe hemorrhages, especially in underage girls.

Over 20% of girls between 15 and 19 in Sierra Leone get pregnant, according to the U.N. Population Fund, one of the highest teenage pregnancy rates in the world.

Samura said a 13-year-old - already mother to a 10-month-old - recently arrived with severe pain after secretly taking unidentified pills to try to abort her pregnancy.

"In Sierra Leone, people are afraid of the stigma ... so they would prefer to die silently," she said. The patient did not understand her body, Samura said, and her dead fetus resulted in dangerous septicemia.

The clinic has at least one such case a month, the nurse said.

Many women and girls who have had abortions fear speaking out, and the push for the bill in Sierra Leone has been led by women's rights groups and medical professionals.

"If you aren't listening to your doctors, then who are you listening to?" said lawyer and advocate Nicky Spencer-Coker. She has fought for reproductive rights alongside a coalition of women's rights organisations since 2015.

At the time, parliament unanimously passed a first version of a bill allowing abortions for up to 12 weeks. But then-President Ernest Bai Koroma blocked the bill amid pressure from anti-abortion and religious groups.

Some Muslim and Christian leaders have denounced the current bill as "ungodly" and "hellish." Archbishop Edward Tamba Charles, head of the country’s Inter-Religious Council, said it contradicts citizens’ "religious values and sensibilities."

Sierra Leone’s current president has faced opposition from his own party members, including lawmaker Rebecca Yei Kamara.

"In our communities, children don't get pregnant ... they talk to them, they teach them how to grow up into womanhood," she said, and accused supporters of the bill of exaggerating the country’s abortion statistics.

Government officials have called the bill a necessary response to the reality of high numbers of deaths among pregnant women.

"The number of girls that die every year ... that's the demonstration of people's will," Chernor Bah, the information minister, told The Associated Press.

Officials also say the bill is needed to strengthen gender reforms in Sierra Leone, which include last year's ban on child marriage.

The bill also would allow wider access to family planning and reproductive health services. Activists fear those will be lost if the bill fails.

Both sides in the debate have accused each other of being sponsored by foreign governments.

Some conservative U.S. media have framed the bill in Sierra Leone as a "Biden-backed push" for abortion rights in Africa.

The U.S. embassy in Freetown denied involvement in the bill.

Sierra Leone’s Inter-Religious Council has cited the recent changes on abortion access in the U.S. as reference points in their position papers opposing the bill.

Meanwhile, the reality for some pregnant women and girls remains harrowing.

Many healthcare practitioners told the AP they want the bill to pass so they can save lives without fear.

Samura the nurse recalled a mother who had traveled for hours in agony to the capital after drinking a concoction given to her by a traditional healer. Samura accompanied the patient to a hospital to seek treatment for a distended abdomen, severe septicemia and anemia.

The mother of six died in the waiting room.

"Right there on the couch .... everybody was crying," Samura said. "Anytime I think of her, I wish the bill had been long passed."