Sierra Leone: Shifting tide on abortion law

The new government is responding positively to health workers and youth groups who have long called for a change in the 1861 law banning abortion except in exceptional circumstances.

A draft law which would make abortion legal under certain conditions, is currently waiting to be passed by parliament following the 17 November elections, according to Sas Kargbo, director of Reproductive Health at the Health Ministry.

"The present laws are outdated and violate the rights of the women of Sierra Leone," said Al Saccoh, coordinator of a youth network called the National Youth Coalition of Sierra Leone, adding that the current law contradicts international covenants on human rights that Sierra Leone has signed since 1861.

Campaigners say the unavailability of cheap and safe abortions is leading to severe health risks for women and girls and pushing up the maternal mortality rate.

Brima Kamara, advocacy manager at the Planned Parenthood Association of Sierra Leone, told IRIN: "Because there is no legal framework that gives women the right to choice governing abortion, the present law is killing women."

Sierra Leone has one of the world's highest maternal mortality rates: 890 women die for every 100,000 live births.

It is not clear how many women seek abortions in Sierra Leone each year as so many of them do so clandestinely, but reproductive rights NGO Marie Stopes International estimates at least 40,000 women and girls in Sierra Leone had abortions in 2011.

According to the UN Population Fund (UNFPA), some 250,000 children across the globe lose their mothers to abortion-related deaths.

Quacks

The problem is most women seeking an abortion will turn to uncertified doctors or quacks who perform cheap abortions, as few can afford the SL 200,000 (US$46) fee that a certified doctor would charge.

Methods used by quacks include giving women detergent to swallow, administering high doses of aspirin or antibiotics, or using native roots and herbs, according to Williamson Taylor, a gynaecologist at the Princess Christian maternity hospital in the capital, Freetown.

Taylor said he often tends to patients who have undergone botched abortions. Most of them arrive in a state of severe pain, or have heavy bleeding, or may have infections linked to perforations of the uterus, intestines or abdominal cavity.

"I have performed many surgical operations due to abortion complications in young girls," he told IRIN. "Cassava sticks and other objects that they use to abort a pregnancy are a very crude method and usually perforate the womb or the intestines."

Betty Ranney, a gynaecologist at the Médecins Sans Frontières-run Emergency Unit Hospital in Bo, in south-central Sierra Leone, told IRIN: "In the most severe cases the womb has to be removed altogether, to save the young girls' lives."

Some 4-10 percent of women who have a medical abortion will need to have a surgical procedure following it, to remove the remaining tissue, said Sarah Koroma, delivery manager at the Planned Parenthood Association clinic at West Street in Freetown. Uncertified doctors lack the training or equipment to do this.

But it is hard to find certified doctors who are willing to perform the procedure - many fear legal redress. "The present law does not favour us as qualified doctors. As such, there is constant fear. I perform abortion for humanitarian purposes where the life of the girl or woman is at dire risk. It's important that the present law is reformed to create accessibility to abortion services as a right, without fear," Taylor told IRIN.

Most cases require consent from the partner of the woman, or in the case of a minor, her parents, which puts off many would-be patients.

Reproductive health agencies will also perform abortions if the pregnancy is seen to put the life of the patient at risk. A nurse at one practice told IRIN: "It's not yet legal, so we do it within the parameters of the present law."

Pressure mounting

But pressure among many sections of society is mounting for a change in the law. Many doctors who have experienced first-hand the implications of unsafe abortions support a new law. "We have to give people choice. Sex is an unavoidable thing so we must make it safe for people who want to have an abortion in a country like Sierra Leone," said Taylor.

Ex-Minister of Health and Sanitation Zainab Hawa Bangura would not be pinned down, but told IRIN: "Improvements in laws and policies, and a more responsive approach to the reproductive health needs of women is needed in Sierra Leone."

In a recent county-wide Ministry of Health-led survey of health workers and legal professionals on attitudes to abortion, most respondents favoured a review of the law, calling for the government to liberalize abortion as part of its commitment to reduce maternal mortality rates.

However, many religious leaders are not in favour, and see imminent change as destroying the moral fabric of Sierra Leonean society. A group of Islamic clerics recently came forward to announce they would accept abortion if it took place within the first four months of pregnancy and if the mother's life was in danger.

Family planning

Legalizing abortion, however, is just one step in a much more complicated puzzle, say campaigners and health workers.

Access to family planning services remains very poor for youths, especially girls and women.

Sierra Leone has high teenage pregnancy rates due to poor education standards for girls; initiation rites into secret societies which make even young girls eligible for marriage; high levels of sexual violence; low access to contraception; and low awareness of family planning methods, according to reproductive rights agencies.

A number of agencies (including UNFPA, Marie Stopes, Planned Parenthood, and the UK Department for International Development) are trying to boost access to quality family planning services for Sierra Leoneans of all ages, across the country. UNFPA launched a family planning campaign in July 2012.

But while attitudes towards family planning are shifting, particularly among urban women, say health workers, they will not change their behaviour unless access to services becomes much more readily available. Too often health clinics remain under-stocked, particularly in rural areas.

"The use of contraceptives must be pushed aggressively in Sierra Leone to help reduce the huge number of young girls seeking abortions in secret," concluded Taylor.