By Joyclyn Wea, gender reporter with New Narratives

• Access to abortion pills, costing as little as $5, has quietly expanded, helping some women access safe abortions and by-pass legal restrictions.
• As rights groups warn that unsafe abortions are driving the country’s high maternal death rate, legislators debate bill that would expand access to legal abortion.
• Religious leaders and conservative politicians strongly oppose the legalization of abortion, leaving the bill’s passage in the Senate uncertain.

D. was 18 and had just entered the 12^th grade in 2017 when she discovered she was pregnant. Like all teenage students, ambitious for a successful future – in her case as a banker – she feared having a baby would end her dreams. She also feared the shame it would bring to her mother who had worked hard selling potato greens in a local market to pay for her daughter’s education so she could have a better life.

D.’s sister’s boyfriend offered a solution. He told her there were now pills available that could end the pregnancy safely.

“He showed me the medicine,” D. recalled. She paid $20 for four small pills – two different medications – that came in a matchbox-sized package. Following the instructions she took one medication by mouth and waited 12-24 hours for signs the pregnancy had ended. Then she took the second medication which expelled the contents of her womb.

For D. it was a huge relief. She had heard many stories of women who had been forced to obtain abortions illegally. They often ended in tragedy. The identities of all women in this story are being withheld to protect them from stigma.

“There wasn’t any fever, pain, and I didn’t go to the hospital after,” she said.  

D.’s stories is part of a quiet revolution occurring across the world including in Liberia. Medicines are now offering women and girls safe alternatives for abortion. Liberian law only permits abortion in a few cases: rape, incest, fetal abnormality, or threats to maternal health. Getting permission requires written approval from at least two doctors, and cases involving sexual assault must be documented with evidence provided to the health minister, county attorney, or police. Performing an illegal abortion carries penalties of up to five years in prison.

The result has been that only wealthy women have been able to get safe abortions while thousands of poor women and girls are maimed or killed each year after resorting to dangerous methods, including inserting sticks and glass inside their wombs and drinking toxic chemicals. Liberia has one of the highest rates of maternal mortality in the world, and unsafe abortion is a major factor.

Another woman, T., had a very different experience. Discovering she was pregnant at age 15 and desperate to hide it from her parents, she sought an abortion from a man in the community who did the procedure quietly for $US50.

Seven years on T. suffers from constant pain. Doctors have told her she would not bear children. “The doctors to JFK and ELWA say the person didn’t do the work good and the money they are requesting, my father doesn’t have that money,” she said. “I can just be praying to God, asking God to forgive me.”

T. is one of thousands of Liberian women harmed every year in the quest to access abortion. A groundbreaking 2021 study by Liberia’s Ministry of Health in partnership with the Clinton Health Initiative revealed the staggering scope of unsafe abortion – more than half of all pregnancies were unintended, with one-third, or more than 38,000, ending in abortion.

“One in every three women who have induced abortions seeks help for complications at facilities. Of those, 75 percent had moderately severe complications,” according to the research.

The study documented 14,555 women who sought care for abortion-related complications in 2021 alone. Activists said the true numbers are far higher due to stigma and fear of legal repercussions that prevent women from seeking care. And because Liberia has one of the world’s highest rates of teen pregnancy – one in three girls is pregnant by the age of 18 – it’s a crisis being borne heavily by girls.

A medical abortion is a safe procedure that works by stopping the growth of the pregnancy and then causing the uterine lining to shed. The most common regimen involves taking two drugs — mifepristone and misoprostol. Mifepristone blocks progesterone, the hormone needed to support a pregnancy. Misoprostol causes cramping and bleeding to empty the uterus. The drugs were first approved in the United States 25 years ago, and nearly two-thirds of abortions in the U.S. are now carried out with medication.

“The pills cannot lead to death,” Dr. Su Mon Thaw, a medical professional who has worked in reproductive health in Liberia and overseas for years. “There will be bleeding, which is common in medical abortion, but they don’t leave any lasting effects. Without these medications, complications of unsafe abortion can be lethal.”

While some states in the United States have sought to ban them. Experts say in Liberia, they are legal through a loophole. If administered by the patient herself the act is not illegal. The medications, which cost between $5 and $20, are imported from certified manufacturers in India and Bangladesh through official channels regulated by Liberia’s Medicines and Health Products Regulatory Authority. They are available at many pharmacies.

Reproductive rights advocates have welcomed the arrival of the drugs. Titus Pakalah, who leads Sexual Reproductive Health and Rights Champions Liberia, recounted a recent case in West Point, Monrovia’s largest informal settlement, where a teenage girl died from complications after using a traditional practice known by the acronym “RPG” or “rocket propelled grenade” – a mixture of non-prescribed drugs, and nonalcoholic beverage, chili pepper extract and sediments from crushed bottles combined with sodium carbonate, according to a 2021 study.

“She was afraid because she feared that when she reported, her parent would beat her or even stop supporting her,” Pakalah said. “And that girl bled for one week, and she passed away.”

The public health bill, which includes the clause that would legalize abortion up to 14 weeks if performed by a doctor, would fundamentally change this landscape. Passed by Liberia’s House of Representatives in 2022, it was then blocked by senators who, in the run-up to the 2023 election, feared it would hurt their reelection bids in the face of a strong opposition campaign funded in part by American organizations.

The 2023 election brought 15 new lawmakers to the Senate, forcing advocates to restart their lobbying efforts. The bill’s passage is on a knife-edge. It requires a two-thirds majority to pass – or 20 votes. Of the 30 sitting senators, Pakalah estimated that 20 have expressed interest in the bill. Five remain opposed, while five others are seeking further consultation with their constituents.

Senator Darblah Varplah, who now chairs the Senate health committee, said the abortion provision has dominated discussions about a comprehensive health reform package that includes provisions for vaccination programs, biosecurity measures, occupational health standards, and environmental regulations.

Religious opposition has been fierce, with opponents arguing that abortion is morally unacceptable under any circumstances. The resistance extends beyond religious circles to include traditional leaders and conservative politicians who view abortion as contrary to cultural values.

Supporters of the law said pushing it through required courage unlike any other act of their political lives. Joseph Sonwarbi, a pharmacist and former chair of the House of Representatives, championed the passage of the bill to allow access to safe termination when failed pregnancies endanger the mother, but he says it cost him his seat.

“My own church turns against me, but God knows my heart. I don’t regret it because I was never born as a lawmaker,” he said. “As a medical person, my oath is my guide that I should save lives. I want to say this law is meant to save our population instead of going to the backyard, going to quack doctors who are doing those abortions in the kitchen, bathroom, bedroom, and other unhygienic places.”

“We are not compromising,” said Pakalah. “This bill seeks to really address women and children’s issues, health issues across Liberia. We should not look at this bill to think that when you put in resources, that is when it will pass. We must be able to humanize the conversation around this bill.”

Sub-Saharan Africa, which has the highest abortion case-fatality rate globally, resulting in 15,000 preventable deaths annually, according to reproductive rights organizations. The region also leads the world in maternal mortality, with unsafe abortion being a major factor. If passed, Liberia’s law would be among the most liberal in sub-Saharan Africa, where 92 percent of women of reproductive age live in countries with highly restrictive abortion laws, according to the Guttmacher Institute.

The contrast with other regions is stark. Most European countries allow abortion until at least the 10th week of pregnancy, with Sweden permitting procedures until the 18th week. Maternal mortality and unsafe abortions in those countries are extremely low.

Beyond legal barriers, Liberia’s healthcare system lacks the infrastructure to provide safe abortion services, even in legal cases. The country has one of the world’s lowest ratios of healthcare workers to population, with rural areas particularly underserved. Many healthcare facilities lack basic equipment for safe procedures, adequate blood supplies for emergencies, or trained staff capable of managing complications.

The economic impact of unsafe abortion extends beyond immediate healthcare costs. Women who experience complications often require extended hospital stays, face long-term health consequences that limit their ability to work, and may need ongoing medical care that their families cannot afford. For families already struggling with poverty affecting over 50 percent of Liberia’s population, experts say these costs can be devastating. The death or disability of a mother often plunges entire households deeper into poverty, affecting children’s education and nutrition.

Reproductive Rights Advocates Call for Greater Awareness Raising

D. was lucky. She learned about the abortion pills and avoided the dangerous alternative. She also learned how to avoid getting pregnant with five-year contraceptive implants that have saved her from having to go through the experience again.

Dr. Thaw would like to see more women and girls have access to that information and full family planning services. “Having safe abortion guidance would help a lot of young women. If they have access to safe abortion and a full understanding of family planning, that will save a lot of lives,” she said.

As the Senate reconvenes the fate of the public health bill remains uncertain. Senator Varplah expressed cautious optimism about its passage.

“A lot of people are inclined and have understood that this is mainly about protecting women. It’s not just about abortion in the minds of the people as terminating another life. Sometimes abortion is necessary to save a life and to bring up more lives,” she said.

For women like D. and T, the stakes could not be higher. Experts say their stories illuminate the human cost of a system that forces desperate choices in the shadows while political leaders debate laws that can change their lives in the halls of power.

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

In Liberia, 16% of all pregnancies end in abortion, according to a recent study conducted in Liberia between October 2021 and March 2022 by the Ministry of Health and its partners, Clinton Health Access Initiative, the African Population and Health Research Center, and the Guttmacher Institute. It revealed that the national abortion incidence for the year 2021 was 38,779.

By Siatta Scott Johnson, Contributing Writer

The revised Public Healthcare Law that will ensure the improvement in the lives of every Liberian, protection of rights to choose and make informed decision on their healthcare and have access to quality and gender response delivery is being discussed at the Liberian Senate.

Benefits

Liberians need to be aware that there are many benefits of the revised Public Health Law, including progress on protection for the people of Liberia. The revised law will guide service providers in service deliveries and against discrimination; it will prohibit street selling of drugs, including fake, expired, and unsafe medications; it will protect mentally ill people, regulate the sale and marketing of tobacco and breast milk substitute products. The revised law will also provide guidelines for the control and prevention of epidemics and diseases, improve access to safe abortion and post abortion care, regulate traditional medicines, and provide coordinating mechanisms between the communities and the health authorities in all counties.

Reduction of Maternal Mortality: Ensuring access to safe abortion services can significantly reduce maternal mortality rates. When women have access to professional and regulated healthcare providers, the risks associated with unsafe abortion procedures are minimized, leading to fewer maternal deaths.

 Prevention of Unsafe Abortion Practices: Legalizing abortion helps prevent women from resorting to unsafe and clandestine procedures, which often lead to severe health complications and or deaths. Unsafe abortions are a major contributor to maternal morbidity and mortality, and providing safe alternatives is crucial for public health.

Preventing Complications and Long-term Health Issues: Legalizing and regulating abortion helps prevent complications that may arise from unsafe procedures. By providing safe alternatives, the risk of long-term health issues, such as infertility and chronic health conditions, is minimized. This contributes to overall public health by reducing the burden on healthcare systems.

Family Planning and Healthier Child Spacing: Safe abortion services contribute to family planning efforts by allowing women to control the timing and spacing of their pregnancies. This can lead to healthier outcomes for both mothers and children, positively impacting

Psychosocial Well-being: Legal abortion services can contribute to the psychosocial well-being of women by reducing the stigma and shame associated with seeking abortion. This, in turn, can have positive effects on mental health, further promoting overall public health.

Increased Healthcare Efficiency: Ensuring access to safe abortion services allows healthcare resources to be allocated more efficiently. Treating complications from unsafe abortions can strain healthcare systems, whereas providing safe and legal services allows for better resource planning and allocation. This contributes to overall public health by reducing the burden on healthcare financing.

Addressing Reproductive Health Inequalities: Legal and safe abortion services can help address reproductive health inequalities and ensure that all women, regardless of socioeconomic status, have access to quality reproductive healthcare. This contributes to a more equitable distribution of healthcare resources.

There have been different opinions in the media by some religious and medical leaders claiming that Abortion is an attack on the unborn child, on mothers, and on societies; what a shame that these religious leaders would insinuate such. It is important to know that there are overwhelming evidence and facts in support of safe abortion.

While it is good to acknowledge the rights of others to express their views on all matters, it is also prudent to strongly disagree with the positions that continue to criminalize abortion, especially with the current burden on the health system in providing Post Abortion Care.

It is indeed a shame that religious leaders will hide behind the Bible and Quran to sentence women and girls to early death. Lack of access to safe abortion is akin to a death sentence.

Statistics

Between 2018 and 2019, the Health Management Information System of Liberia recorded a total of 15,844 cases requiring Post Abortion Care, reported at multiple health facilities. In 2021, the National abortion incidence recorded 38,779, while 8,461 induced abortion cases were reported.

The current abortion rate is 30.7 abortions per 1,000 Women of Reproductive Age making the abortion ratio 229 abortions per 1,000 live births.

At present, 60% of reported abortion cases in 2021 were under unsafe conditions 10% of maternal deaths occur annually due to unsafe or backstreet abortion.

These figures significantly underrepresent the true burden due to the criminalization of abortion, leaving countless unreported cases and those who never made it to the facility alive. Please take a second and imagine the number of unreported cases and the ones that do not reach the health facilities alive.

Liberia currently has the 7th highest rate of maternal mortality in the world and the 3rd in Africa, with many women and girls dying from childbirth and related health complications. Liberia also has one of the highest rates of teenage pregnancy, with 30% of girls and young Liberian women, age 15 -19, already mothers or pregnant with their first child. This means that of every 3 girls, 2 become mothers by age 19!

Nationally, 52% of all pregnancies are unintended, indicating the high unmet need for Family Planning; 35% of unintended pregnancies end in abortion.

Only 15% of primary facilities can provide all post abortion care (PAC) signal functions; however, this increases to 65% if a vehicle is available for referral as a signal function requirement is excluded, indicating the lack of vehicles as a key bottleneck.

Liberia has also a high rate of sexual and gender-based violence. As per a 2019 stat, two out of every three rape cases are minors. In addition, limited accesses to comprehensive sexual health education and sexual health and reproductive services and commodities, including lack of access to safe abortion and post-abortion care, have resulted into women and girls dying. Between 2017 and 2018, statistics show that over 8,700 abortion cases were reported at health facilities in Liberia, and in 2021 over 2,600. These abortion cases were carried out in the least safe and most dangerous conditions, with 10% ending in deaths of young women and girls. Daily, hundreds of women desperately take matters into their own hands, seeking services from backstreet abortion service providers; some use self-induced procedures to terminate their own pregnancies, and this includes women and girls of all ages, professions, and socio-economic statuses.

Section 16.3.4 of the Liberian code of Law (Penal Law) currently allows self-abortion before 24 weeks of pregnancy. This law creates the possibility for women and other unqualified persons to use harmful substances like cassava stick, broken glass bottles mix with blue and pepper, herbs, etc., commonly referred to as RPG to begin the termination of pregnancy. This often leads to severe complications like infection, bleeding, organ/system failure, uterine damage, and a high financial burden on the family and state. Several available data in the country validate the worrisome nature of these unsafe abortion practices.

Liberia has one of the highest maternal mortality rates (742 per 100,000 live births) in the world, and four of the leading causes (hemorrhage, sepsis, unsafe abortion, and post-partum mental health) of maternal death are linked to the practice of unsafe abortion. As of now, medical abortion is safe with minimum health risk and reduces the burden of Post Abortion Care on the health system.

International Laws

The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), to which Liberia is a signatory, recognizes the rights of individuals, particularly healthcare providers, to refuse to perform certain medical procedures or services, based on their personal beliefs or moral convictions. Despite the fact that the convention recognizes the importance of freedom of thought, conscience, and religion, the convention also emphasizes that the exercise of conscientious objection should not undermine women’s rights to access essential reproductive health services.

Therefore, the state must not only ensure that conscientious objection remains a personal decision, rather than an institutional practice, it must guarantee access to safe abortion in public health facilities and ensure that adequate services are accessible and available, with non-objecting medical providers ready to carry out these services. It is also important to note that when laws restrict and criminalize abortions, they do not prevent abortion; instead, those laws end up pushing more women towards unsafe abortion practices, sometimes even leading to health complications and death.

If the Public Health Law is passed as it is, it helps to ensure that women have access to safe procedures in licensed medical health facilities, and this helps to improve women’s health and reduce maternal deaths related to unsafe abortion. It is essential to know that every woman should have the right to make informed decisions about her body, health, and future. Access to information empowers women to exercise their reproductive rights, allowing them to make informed choices in difficult circumstances. Making abortion safe provides an opportunity to address social and economic inequalities, by enabling women to make choices that align with their life goals and circumstances.

International Best Practices:

Countries that have ensured safe abortion services have demonstrated improved maternal health indicators and have upheld individual rights and autonomy. Emulating international best practices will contribute to Liberia’s progress towards achieving better healthcare outcomes.

Articles of Protection:

The UN-appointed panel drew specific attention to article 16, which “protects women’s rights to decide freely and responsibly on the number and spacing of their children”, adding that unsafe abortion is a leading cause of maternal mortality. The Public Health Law will be a win-win situation for our women in Liberia.

Finally, it is imperative that policymakers and the Liberian government critically consider the broader implications of restrictive abortion laws and prioritize the health and rights of Liberian women.

By ensuring that abortion is safely practiced, Liberia can take a significant step towards promoting women’s rights, gender equality, engendering public health and subsequently instilling public confidence.

We believe in fostering a society that respects diverse opinions while prioritizing the welfare of all citizens. Let us come together to engage in open, evidence-based conversations, keeping in mind the best interests of Liberian women and the overall well-being of our nation.

My final thoughts

Remember, Access to Safe Abortion is Healthcare. Unsafe abortion is a leading but preventable cause of maternal deaths and diseases. It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems. Lack of access to safe, timely, affordable and respectful abortion care is a critical public health and human rights issue.

Decades of research and evidence from countries where women have access to safe abortion show that safe abortion services reduces maternal mortality and contributes to overall better reproductive healthcare outcomes.

Background

Liberia’s amended Public Health Law (Title 33 of the Liberian Code of Law Revised) which includes a provision on abortion currently being debated before the Liberian Senate for passage into law, would ban abortions after 18 weeks of gestation. The current penal law (Title 26 – Liberian Code of Laws Revised, chapter 16), however, allows abortions up to 24 weeks gestation (about 6 months of pregnancy). Although it is a step in the right direction, more could be done. We disagree with the proposed legislation and believe that there is a better solution to this divisive issue. Therefore, we propose that 12 weeks gestation, the first trimester of pregnancy, as the cut off point for elective abortions. This gives a woman sufficient time to confirm that she is indeed pregnant and address all issues relating to her pregnancy… whether impregnated through incest (human sexual activity between family members or close relatives), rape, or other criminal acts …that would legally support her desire to safely obtain an abortion.  

Only seven nations including the U.S. permit nontherapeutic or elective abortion-on-demand after the twentieth week of gestation.  According to the March 19, 2018, Mississippi, United States, Gestational Age Act, Bill 1510, seventy-five percent (75%) of all nations do not permit abortion after twelve (12) weeks gestation, except (in most instances) to save the life and to preserve the physical health of the mother. 

Trend analyses conducted by a team of researchers at the National Public Health Institute of Liberia, on maternal and other major causes of death in Liberia, between 2018 to 2022, indicated that, the leading causes of maternal mortality in the country are, post-partum hemorrhage (PPH) at 38% of all maternal deaths; eclampsia/pre-eclampsia at 14%; followed by sepsis; obstructed labor; and, abortion, the fifth most common cause of maternal death. Globally, unsafe abortions cause 8–11% of maternal deaths, predominantly in low and middle-income countries, where the most restrictive access policies are concentrated, and socioeconomic factors further affect access to care (Lancet Global Health, 2018). Consequently, abortion is a subject that attracts substantial attention and is widely deliberated around the world (Liberia included) in all spectrums: public health, medical, political, social, religious, and legal. 

Our proposal to restrict abortions to 12 weeks of pregnancy in Liberia is based on statistical data in the Liberia Demographic and Health Survey of 2019/2020 (DHS 2019/20) which indicates that Liberia is among countries with the highest maternal and newborn mortality rates (MNMR) in Sub-Saharan Africa. The DHS also indicates a decline of maternal mortality rates (MMR) in 2013, from 1072 maternal deaths per 100,000 live births to 742 maternal deaths per 100,000 live births.   That is, for every 1,000 births in Liberia, about seven women die during pregnancy, during childbirth, or within 42 days postpartum, from causes other than accidents or violence. With such a disproportionally high MNMR, affecting primarily women in households with substantial socioeconomic inequalities, catastrophic health expenditures remain pervasive. Therefore, if access to abortion education and nontherapeutic abortion or, abortion-on demand is readily available and affordable, we believe that more women would choose abortion in the first trimester (12 weeks) when it is safer, as opposed to later in the second trimester (13-16, or 16- 24 weeks), when the risks of complications or even death, is much greater.    

Legal 

Liberia is swamped with controversies on abortion rights aimed at legislating an amended public health law (Title 33 of the Liberian Code of Law Revised). Public health authorities believe this is an effort to make the law fully compatible with contemporary public health issues and norms. The old Title 33 has been in effect since 1976, over four decades, without any revision, rendering it obsolete. 

The current penal code of Liberia, Title 26 – Liberian Code of Laws Revised chapter 16 – legalizes abortion up to 24 weeks gestation.  However, the proposed revised public health law would only allow legal abortions up to 18 weeks gestation, thereby reducing the period a woman can choose to legally have an abortion from 24 to 18 weeks. Although this amendment is somewhat welcoming, we disagree with legislating abortion at 18 weeks, proposing instead, 12 weeks as a reasonable option. At 12 weeks gestation, a woman is in her first trimester and can recognize and address all the pertinent issues of her pregnancy… whether through incest, rape, or other criminal acts …that would legally support her desire to safely obtain an abortion and avert the possible risks, even death, of an elective abortion at 18 to 24 weeks gestation. The revised Title 33 has been passed in the House of Representatives. It is now before the Senate for concurrence, where public hearings are being held, involving stakeholders consisting of public health experts, medical and legal experts, religious leaders, pro-life advocacy groups and reproductive rights advocates. 

Abortion is illegal in general terms, including in the penal code of Liberia, which makes it a crime after twenty-four weeks of pregnancy, however, it can legally be performed under certain medical conditions. Restrictive abortion laws affect women as well as their families, due to the long-term economic and health costs of rearing a child under difficult socioeconomic conditions. Research from the Lancet found that “ensuring women’s access to safe abortion services does lower medical costs for health systems” (Lancet Global Health, 2018). Similarly, international law has always viewed abortion rights within a medico-legal paradigm, the notion that legal and medical control would guarantee safe abortions. 

Meanwhile, on June 24, 2022, we witnessed the reversal of Roe vs. Wade, a landmark decision of the U.S. Supreme Court, of 1973, which ruled that the Constitution of the United States generally protected a woman’s right to choose to have an abortion. However, in its historic and far-reaching decision in June 2022, the U.S. Supreme Court overturned Roe vs. Wade, declaring that the constitutional right to abortion, upheld for half of a century, was no longer in existence. The Supreme Court held “The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives” (597 U. S. ____ (2022). 

In the Liberian situation, the Supreme Court did not rule on the Abortion Law.  The legislators, the elected representatives of the people, decided to amend the law based on the recommendations or influence of local public health officials. The Senate should now exert leadership by concurring with the House of Representatives to pass the amended Title 33, The Public Health Law of Liberia. This should include the provision on abortion by reducing the legal cut off point to 12 weeks gestation.

Considering that many low- and middle-income countries derived their abortion laws using Roe vs. Wade, it leaves reproductive health programs vulnerable in these countries, because they are funded by US aid. This aid, comes through critical USG programs including, the U.S. President’s Emergency Plan for Aids Relief (PEPFAR), a US flagship program that supports HIV/AIDs programs, mainly in Africa (politico.com/news, 2023). A child, born by a woman affected by HIV and full blown AIDS, is compromised at birth, by having HIV or AIDS. Therefore, these reproductive health and abortion programs are essential. Consequently, conservative republicans who are pro-life, are threatening not to renew the 5 years funding to PEPFAR, accusing the Biden Administration of using PEPFAR dollars to support abortion.

 Religion

Over eighty percent of the country is Christian and around fourteen percent is Muslim (DHS 2019/20). In this light, the Liberian legislators invited many stakeholders to the public hearings…bishops, imams, and pastors… who gave their perspectives on abortion. The religious community expressed apprehension over the moral and ethical implications of the abortion law. They vehemently opposed the existing law and any amendment to it …indicating that every life, from conception to the developing fetus to natural causes of death, is sacred and should be protected. From the vantage point of religious leaders, abortion ends the life of the fetus, undermines the dignity of the unborn and disregards the moral fabric of the society.

Although religious rights are paramount in Liberia, the religious community should assert all efforts to create awareness for sexual and reproductive rights, educate young people on these rights, provide intrinsic leadership and psychosocial counseling in their places of worship.

The Public Health Case for abortion rights 

Reproductive Rights: 

There is a strong correlation between low education among young women, poverty, unintended pregnancies, unsafe abortion, and maternal deaths. In Liberia, forty-seven percent of young women with no education have begun childbearing, as compared with twenty percent of those with a senior high school education. Similarly, forty-two percent of young women are among the poorest people in the country who have begun childbearing, compared with ten percent of those among the wealthiest, according to DHS 2019/20. 

The DHS 2019/2020 report indicates further that, sixty percent of pregnancies resulting in live births in a span of 5 years were wanted at the time of conception; thirty-three percent were mistimed, meaning that, women wanted to have children later, and eight percent were not wanted at all. When you combine women who want to get pregnant later, and women who do not want to get pregnant at all, it constitutes a gigantic forty percent. Hence, ensuring general education for all women, providing reproductive health and family planning services, would avert unintended pregnancies and mitigate unsafe abortions. 

The Government of Liberia and health authorities need to bolster the activities of the Planned Parenthood Association of Liberia, an organization responsible for providing quality sexual and reproductive health services, including family planning services, across the country. Family planning is hailed as one of the greatest public health achievements of the last century (Amy Tsui et. al, 2010). It lowers the number of unplanned pregnancies and abortions and saves lives. Current contraceptive use in Liberia is twenty-four percent of married women and forty-five percent of sexually active unmarried women, who currently use a modern method of contraception, according to the DHS 2019/20. 

Conclusion – in the current discourse, we proffer the following recommendations:

1. Any abortion laws in Liberia should consider 12 weeks gestation, the first trimester of pregnancy, as the cut off point for elective abortions. This gives a woman sufficient time to confirm that she is indeed pregnant and address all issues relating to her pregnancy… whether impregnated through incest, rape, or other criminal acts …that would legally support her desire to safely obtain an abortion. The health risk of an abortion is directly related to how, when, where and by whom the procedure is performed. Therefore, health authorities should setup safe abortion clinics with trained providers, equipment, logistics and supplies. Because of intrusive legal restrictions and stigma, many young teenage girls and women seeking abortions in Liberia, often resort to clandestine procedures, where safety cannot be assured.  Even in the case of a justified abortion, providers should be reminded that continuing an unwanted pregnancy could induce considerable mental anguish for the mother, if the pregnancy resulted from rape, incest, or other felonious intercourse, or the fetus was found to have a genetic defect that could result in a child, born with grave physical or mental defects.

• When a woman is not pregnant, it’s improbable that she will die from pregnancy related causes, thus prevention of unwanted pregnancies is essential. When considering abortion, whether justified or unjustified, the Government of Liberia should guarantee women’s reproductive rights by ensuring that reproductive health and family planning services are readily available and accessible for women of child-bearing age. Liberian women need to be better able to avoid unintended pregnancies, the root cause of most abortions. Making a wider range of modern contraceptive methods available, strengthening access to emergency contraception, and improving family planning services, would potentially lower the rate of unintended pregnancies, and alleviate unsafe abortions, thereby significantly reducing maternal mortality.

• The general population should be informed and educated on the amended abortion law. This extends to medical professionals, the religious community, the judiciary, and law enforcement officials, who need to know and understand fully the legal criteria for the provision of abortion services.  The law should allow abortions up to 12 weeks of pregnancy.   Any abortion beyond that period, would be a criminal offence. 

Correspondence authors: Tolbert Nyenswah, LLB, MPH, DrPH is an international recognized legal scholar and global public health expert, a faculty member in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Prior to joining the Bloomberg School, he was Deputy Minister, Assistant Minister, Ministry of Health of Liberia, and Director General of the National Public Health Institute of Liberia. He’s credited and decorated as Ebola hero/czar for leading Liberia’s successful and unprecedented Ebola response as Incident Manager. 

Co-author: Mardia Stone, MD, MPH is a senior consultant and advisor in the Division of Global Psychiatry at the Boston University School of Medicine/Boston Medical Center. A global public health expert, she is formerly a WHO consultant in emergency preparedness and response, an Ebola Response Team Coordinator, senior and technical advisor to the Incident Manager of Liberia’s Ebola response and the National Public Health Institute of Liberia. Dr. Stone is also a retired obstetrician/gynecologist.

Disclaimer: This Op-ed is written in our personal capacity and is independent of our affiliation with our institutions, Johns Hopkins University and Boston University School of Medicine/Boston Medical Center.  

Data in this Op-ed are the most current available and, unless otherwise noted, are drawn from the Liberia Demographic and Health Survey 2019/2020