Amid the high risks of unsafe abortions for women and girls in Sierra Leone, discussions are underway to decriminalize the procedure.
At 16, Fatou Esther Jusu feared her pregnancy would derail her future. Desperate, she turned to misoprostol, a drug often used for abortions, but it failed. On her second attempt, she miscarried alone in a bathroom, later waking up in a hospital where she begged doctors to keep her secret.
Now 21, Jusu considers herself fortunate. A friend who took an expired version of the drug didn’t survive. These experiences drive her advocacy for a bill that could decriminalize abortion in Sierra Leone, a country where it remains illegal in all circumstances.
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Sierra Leone is on the verge of becoming only the second West African nation to legalize abortion, a move that health experts say could drastically reduce preventable maternal deaths. Unsafe abortions account for about 10% of maternal fatalities, though the true toll is believed to be much higher. Many women resort to life-threatening methods, including expired medication, household chemicals, or unsterilized instruments.
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According to an AP report, President Julius Maada Bio introduced the Safe Motherhood Bill in 2022, shortly after the U.S. Supreme Court overturned Roe v. Wade. “At a time when sexual and reproductive health rights for women are being threatened, Sierra Leone is proud to lead with progressive reforms,” he said.
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Initially, the bill proposed allowing abortion up to 14 weeks, making it the most liberal abortion law in West Africa. However, intense opposition from religious groups led to amendments restricting access to cases of life-threatening risk, fatal fetal abnormalities, rape, or incest.
The bill now faces fierce debate. Some Christian and Muslim leaders call it “ungodly,” while medical professionals argue it is necessary to curb maternal deaths. Advocates stress that if lawmakers won’t listen to doctors, they should at least consider the 90,000 illegal abortions estimated to occur annually in Sierra Leone.
Healthcare workers witness the consequences firsthand. Nurse Hawanatu Samura regularly treats young girls suffering complications from unsafe abortions. She recalls a 13-year-old mother who attempted a self-induced abortion with unidentified pills. The dead fetus inside her body caused life-threatening septicemia.
“In Sierra Leone, people are so afraid of stigma, they’d rather die in silence,” Samura said.
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Opposition also comes from within the president’s own party, with some lawmakers claiming the country’s abortion statistics are exaggerated. Meanwhile, global politics have complicated the debate. The bill has been framed in conservative U.S. media as a “Biden-backed push” for abortion in Africa, a claim the U.S. embassy denies.
Despite these obstacles, activists remain determined. Lawyer Nicky Spencer-Coker, a longtime reproductive rights advocate, urges lawmakers to put women’s lives above politics. “If you aren’t listening to your doctors, then who are you listening to?” she asks.
For healthcare workers like Samura, the stakes are painfully clear. She remembers a woman who traveled hours seeking care after ingesting a toxic herbal mixture to induce an abortion. By the time she arrived at a hospital, she was beyond help.
“She died right there in the waiting room,” Samura said. “Anytime I think of her, I wish the bill had passed long ago.”
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