Liberia’s New Health Law Among Most Liberal in Africa for Abortion

--- But faces hurdle in Senate

When Teta graduated from high school in 2015, she had big plans: attend college and become a medical doctor. But when the then-17-year-old discovered she was pregnant, that bright future was cast into doubt.

The father of the unborn child, her boyfriend of four years, denied the baby was his. Afraid of the shame and disgrace that would come with being an unwed teenage mother, Teta sought an abortion.

“I was scared and confused,” said Teta. “I had no plans of becoming a mother at age seventeen, my family and everybody looked up to me.”

Teta said a friend helped her obtained a herb, commonly known as “Christmas leaf”. They boiled it into a tea that she drank. Over a few days Teta suffered indescribable pain as her body expelled the fetus. 

“The whole place I was sitting was bloody. I bled. I bled. I thought I was going to die.”

Like most African countries, Liberia has firm restrictions on abortion. It is illegal for a health worker to execute an abortion except, in cases of rape, incest, fetal abnormality or risk to the woman’s physical or mental health. Two physicians must certify medical exceptions and evidence of rape and incest must be provided to the health minister, a county attorney or police. Illegal abortion is punishable with up to five years in prison. The law’s backers say that means safe abortion is available to wealthy women, leaving the poor with only dangerous options. 

Liberia’s new public health law, which was passed by the House of Representatives in 2022, is currently being debated in a special session by the Senate, where it is facing a barrage of opposition from abortion opponents. A provision in the bill, which contains a range of other public health elements, would make abortion legal up to 18 weeks of pregnancy as long as it is done by a doctor. The original version of the bill made it 24 weeks, but lawmakers revised it to 18 weeks.

The Ministry of Health worked with health law experts in the U.S. and U.K. to draft the law after a major country-first survey released in April by the Ministry in partnership with the Clinton Health Access Initiative and others found unsafe abortions caused shocking outcomes for young women and the health system.

The study found more than half of all pregnancies in Liberia in 2021 were unintended. Thirty five percent – or more than 38,000 - ended in abortion. Alarmingly, more than six in every ten women who had an abortion had moderate to severe complications. One in ten abortions resulted in death or “near misses”. Activists say the number is likely far higher because stigma means few women admit to undertaking abortions. 

Unsafe abortions are a major contributor to Liberia’s “very high rate of maternal mortality,” according to a 2020 report by the World Health Organization. It was one of just eight African countries that ranked that high. 

“We all know that abortion is taking place—illegal abortion, that is killing millions of girls. People are dying,” said Vice President Jewel Howard Taylor defending the bill in a recent interview on ELBC, the state broadcaster. “So, the government decided that we should put in place some safety regulations for abortion, that you can go to the hospital for abortion. The law is trying to make abortion safe.”

The law has been welcomed by health providers and women’s rights activists. 

“If abortion is decriminalized, Liberia would have solved a public health crisis,” said Atty. Mmonbeydo Nadine Joah, Founder and Executive Director of the nonprofit Organization for Women and Children in an email.

Women like Teta ingest harmful substances or try to clear the fetus from their wombs with sticks, clothes hangers, boiled herbs and laundry detergent. 

Teta said she bled for three weeks. She has not seen a doctor since the abortion, but sometimes suffers extreme pain that she treats with a pain killing medicine.

30-year-old Markanah, another survivor, said she drank water mixed with ground glass to abort her eight-week-old pregnancy in 2020. Markanah said she felt bad but had no choice because the father was a married man who begged her to abort “to save his marriage from trouble.”

“I bled and bled,” said Markanah. “I thought I was going to die.”

Markanah has also not seen a doctor since the abortion. Experts warn women who survive are often left with lifelong injuries, severe bleeding, damage to internal organs, and barrenness.

“There are a lot of unimaginable things that women do to themselves just to get rid of pregnancy,” said Dr. Fokape Duyenku, a gynecologist at the Japanese Maternity Center in John F. Kennedy Hospital, one of Liberia’s largest referral health centers. He underscored the claim by other experts that unsafe abortion is unnecessarily draining Liberia’s already overstretched health resources.

The Center received 211 unsafe abortion cases in 2022. Dr. Duyenku said as many as one in every five required major surgery. 

For Nawai Kaiser, founder of the Rural Women Rights Structure in Bong County, the bill is the result of more than a decade of lobbying. For her, it is personal. 

“We want to legalize abortion to save our young girls that are dying from unsafe abortion,” said Kaiser, who lost her fourteen-year-old daughter to an unsafe abortion in 2011. “My daughter got pregnant. She was just hiding it from us and complaining about different things. We found all her inside parts were damaged, everything was rotten.”

Kaiser said she started her organization after her daughter’s death, so as not to “allow another child to die like mine.”

Kaiser’s organization is a member of the Amplifying Rights Network, a coalition of ten civil society organizations in the field of sexual reproductive health and rights advocating for the legalization of abortion. The Network insists that abortion is a human rights issue and that if there is no law on safe abortion, no one can stop unsafe abortion.

Some lawmakers have focused on the impracticality of the existing law. Representative Joseph Somwarbi, Chair of the House Committee on Health, who campaigned for its passage in the House, argued that without blood tests and scanners available in a medical facility, it is impossible for women to establish whether there is fetal abnormality as required by the current law. 

“Conditions that justify abortion, such as fetal abnormalities of the fetus can be clearly observed around the 18 weeks with the level of advancement of technology,” said Somwarbi. A screenshot of a cell phone

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The law is facing powerful opposition from religious organizations in Liberia that are pushing senators to reject it. 

“If we want to fix things, let’s fix it well. We should not fix things haphazardly,” said Rev. Christopher Toe, Secretary General of the Liberia Council of Churches, which is urging senators to block the bill until more public awareness and discussion takes place. “When people are educated and the people themselves say okay based on our education, we move forward with this, then we can move forward with it.” 

“Legalizing abortion is giving license to too many killings,” said Bishop Kortu K. Brown, a former president of the Liberia Council of Churches (LCC). “Life is of God. We as a country are supposed to sustain life.”

But not all religious leaders are opposed to the law. Fr. Michael Sei, the rector of the St. Thomas Episcopal Church, disagreed with his colleagues. In a WhatsApp call from the U.S., he said the challenges required a new approach. 

“We have to adjust ourselves into contemporary time to meet up with the present challenges,” said Sei. “What if it was their child maybe raped by an armed robbery, or a child raped on the street by someone who has a mental illness? Will they allow that child to be born? Let us be careful on those things how we go about cherry picking what are those things he will do, and to be more Jesus than what Jesus has in the bible written. You know we should be able to be considerate, we should be able to empathize with people who are going through these kinds of situations on a daily basis. By doing that medical abortion does not mean that you will not be a Christian; you are saving life as well.”

The debate has been muddied by misinformation campaigns that have included unsubstantiated allegations that international embassies have been bribing lawmakers to pass the bill. The Swedish embassy was forced to issue a denial.  

“Swedish development cooperation never accepts any form of corruption, including giving and receiving bribes,” said the embassy in a Facebook post. 

The government needs the support of two thirds of senators if the bill is to be passed. It is not clear how many votes it currently has. In addition to the abortion provision, the bill includes important provisions devoted to “biosecurity and biosafety, improvements in occupational health, provisions on foods and other products for infants and young children, a new chapter on alternative medicine, a new provision for emergency treatment and many others,” according to a statement by Albert Chie, Senate President Pro-Tempore. The government may decide to strip the abortion provision from the bill in order to see it passed.  

If it passes, Liberia’s law would be one of the most liberal in sub-Saharan Africa. In 2019, 92% of women of reproductive age lived in countries with “highly restrictive” abortion rights, according to the Guttmacher Institute, a research and policy organization promoting sexual and reproductive rights. Sub-Saharan Africa has the highest abortion case-fatality rate in the world, amounting to 15,000 preventable deaths every year.

In most European countries, abortion is legal until at least the 10th week of pregnancy. In Sweden, it is legal until the 18th week. In the United States, abortion was legal at any stage of pregnancy from 1975 until last year, when the Supreme Court overturned an earlier ruling. It is now legal in half the U.S. states. 

This story was a collaboration with New Narratives as part of the “Investigating Liberia” project. Funding was provided by the Swedish Embassy in Monrovia. The funder had no say in the story’s content.