Towards Progressively Reforming Abortion law and the Health Care System in Sierra Leone
By Abdul Tejan-Cole
With high rates of infant and maternal mortality compounded by a high incidence of teenage pregnancy, it is hardly surprising that the abortion debate in Sierra Leone has recently become heated. Parliament’s overwhelming support for the “Safe Abortion Bill’ and the President’s decision not to give the Bill his assent but to send it back to Parliament for further review has provoked intense debate between groups in support of and those opposing safe abortion access . The uncertainty surrounding the Bill leaves a lot to be desired, especially considering the origins of abortion law in Sierra Leone.
Abortion was outlawed in Sierra Leone by dint of the country’s colonial legacy/heritage. Sections 58 and 59 of the Offences Against the Persons Act 1861 made it unlawful for any ‘woman being with child’ with intent to procure her own miscarriage to unlawfully administer to herself any poison, using any instrument or other noxious thing. It is also unlawful for the woman to cause any person to do the same. The penalty at the discretion of the court ranged from a term imprisonment not exceeding 2 years with or without hard labour or in solitary confinement to life imprisonment. Although this law was not expressly enacted by the Sierra Leone Parliament. It was however applicable as a result of another law that made all statues of general application in England before January 1, 1880, applicable in Sierra Leone.
Today, although the United Kingdom has amended the provisions of this law to make abortion permissible in certain circumstances, the 1861 law has been left in situ in Sierra Leone. Despite its existence, the law is honoured more in its breach than in its observance.
The debate on the legalization of abortion is thus in my view a few decades too late. Whether or not the Safe Abortion Bill is enacted, abortion will continue to be carried out in Sierra Leone. Law enforcement agencies lack the capacity to enforce the current law and as such will continue to turn a blind eye to the implementation of this anachronistic law. Hence, Parliament must not miss this opportunity to bring the law in in line with what obtains in reality.
The fact that abortion is commonly performed in the country is incontrovertible. Those who can afford it would go to private hospitals. In a country where poverty is rife – almost a quarter of all children in Sierra Leone are malnourished and the results from the 2011 Sierra Leone Integrated Household Survey (SLIHS) indicate that poverty rate is about 52.9% - most cannot afford the cost charged by private doctors so they end up going to quack ‘doctors’ and undergo unhygienic and perilous abortions in clandestine places. Unsafe abortion practices undermine the health rights of women and girls. As it is, Sierra Leone has the dubious distinction of having one of the highest rates of maternal and infant mortality in the world. World Bank statistics shows that in 2011, 102 infants per 1,000 live births died before reaching the age of one year. In 2015, the number was estimated at 87 per 1,000 live births. Maternal mortality statistics are worse. In 2011, 1,580 per 100,000 live births died from pregnancy-related causes while pregnant or within 42 days of pregnancy termination. In 2015, there was a slight reduction to 1,360.
The recent decision by government to exclude pregnant girls from mainstream schools will increase the desperation of girls and their parents to get abortion at all cost. The lame explanation given for this policy - namely to protect "innocent girls” from negative influences – reinforce stigma by blaming and shaming pregnant girls. To avoid discrimination and provide themselves with a modicum of opportunity to succeed in a society and culture that discriminates against them, young girls will be left with Hobson’s choice.
A 2013 study by UNICEF entitled ‘Sierra Leone: An Evaluation of Teenage Pregnancy Pilot Projects in Sierra Leone’ pointed out that teenage pregnancy and motherhood was the second most prevalent child abuse practice in Sierra Leone. According to the report, it constitutes a national and community-wide problem, with a prevalence of 68 percent pregnancy rate among sexually active teenage girls, with a mean age of 15, and 28 percent of teenage boys having caused a pregnancy. While sexually active teenagers had frequent sex (49 percent in the last few months and 44 percent in recent weeks), slightly more than one-third (35 percent) had ever used a condom. Only a small percentage (9.2 percent) of the girls between 15 and 19 who had more than one sexual partner during the last twelve months reported to have used condom the last time they had sex. Moreover, even though about 64 percent of the females between the ages of 15 and 19 know HIV can be transmitted from mother to child, only around 7 percent of sexually active girls within this age group have been tested for HIV and know their results. To compound this, there is a low contraceptive prevalence rate of only 8%.
The alarming rate of teenage pregnancy which was exacerbated during the Ebola epidemic prompted the First lady of Sierra Leone to intensify her work aimed at reducing teenage pregnancy and the Government to launch a ‘National Strategy for the Reduction of Teenage Pregnancy.’
Rather than arguing about the rationale for legalization, the real debate should shift to how we can reduce teenage pregnancy and the extremely high incidence of infant and maternal mortality rates. Decriminalizing g abortion will make a difference and should definitely be the progressive way to go. The current Bill allows for abortion to be performed during the first 12 weeks using WHO guidelines and up to 24 weeks if pregnancy poses risk to the pregnant woman’s health, fetal abnormality, rape, incest or felonious intercourse. But legalization alone, will change very little. In spite of Ghana’s fairly liberal abortion law, unsafe abortion remains common and is the second most common cause of maternal mortality, accounting for 11% maternal deaths.
Accessibility and affordability remain the main challenges why pregnant women don’t go to hospitals. WHO statistics show that close to 74% of babies in Sierra Leone are born at home. Almost 23% in public hospitals and 2.5% in private hospitals. In 2010, Sierra Leone granted pregnant women, new mothers, and young children free health care. Whilst some progress has been made, as Ebola showed recently, there is an urgent need to improve access to safe and quality health services, and narrow the equity gap for the most vulnerable and marginalized populations. Without major transformations in our health care system, we will not be able to put the quack doctors out of business and they will continue to kill our sisters and mothers.
Abdul Tejan-Cole is the Executive Director of Open Society Initiative for West Africa (OSIWA)