In early July, Sierra Leone’s Cabinet unanimously approved the decision to draft a bill on safe motherhood and reproductive health, which, when passed, will provide access to sexual and reproductive health services across the country. The Cabinet paper detailing the decision provides a broad outline of issues to be covered in the bill. Among other provisions, the legislation will confer a constitutional right to safe abortion, reduce barriers to accessing the health system and eliminate barriers related to obtaining family planning services and contraception.
The bill responds to the dire health consequences of unsafe abortions in Sierra Leone. Under a colonial-era law dating back to 1861, abortions are illegal except when a woman’s life is at risk. These abortions often result in complications that require treatment in health facilities, where about 1 in 5 women treated present with clinically moderate or severe complications that require attention from high-skilled health providers. In addition to the health implications, this also results in higher costs of care and extended periods of admission. Unfortunately, many women experiencing complications from unsafe abortions delay seeking care due to fears of prosecution under the current law, and because the health system’s capacity to address these complications remains inadequate.
As a result, unsafe abortions account for 9-12 percent of the country’s high maternal mortality rate, which a 2019 demographic and health survey by Statistics Sierra Leone put at 717 per 100,000 live births. A World Health Organization estimate shows even higher rates, at 1,120 deaths per 100,000 live births. Sierra Leone also has a high unmet need for contraception as well as one of the highest adolescent pregnancy rates globally. Together, these contribute to high rates of unintended pregnancies, estimated at 88 per 1,000 women of reproductive age, which in turn drive unsafe abortions and maternal mortality.