AT just 16, Fatou Esther Jusu feared her life would fall apart after discovering she was pregnant. Abortion was—and remains—illegal in Sierra Leone. Desperate and terrified of her family’s judgment, she took misoprostol, a drug sold in local pharmacies that can induce abortion. It failed. A second attempt caused a miscarriage, and she collapsed from blood loss.
‘I went to the toilet… and the baby came out,’ she said. Hospitalised and afraid, she begged doctors to keep it secret. Now 21 and studying nursing, Jusu is channelling that trauma into activism, pushing for legal reform to protect others from the same fate.
‘Even though I made a mistake, this mistake is saving other people,’ she told the Associated Press (AP).
Sierra Leone is on the brink of potentially becoming only the second country in West Africa to decriminalise abortion. A long-contested bill, the Safe Motherhood Bill, could save thousands of lives—if it passes.
The cost of silence: thousands of unsafe abortions
Tens of thousands of women and girls in Sierra Leone attempt unsafe abortions each year. Abortion is criminalised in all circumstances under a colonial-era law. Health workers say they often perform life-saving procedures under different labels, such as treating incomplete miscarriages, to avoid legal repercussions.
According to the African Population and Health Research Centre, around 90,000 abortions occur annually in the country of 8 million. Approximately 10 percent of maternal deaths—already among the world’s highest—are due to unsafe terminations. Medics believe the real numbers are likely much higher.
Nurse Hawanatu Samura, known as ‘Nurse Awa’, sees the fallout every day. At the MSI Sierra Leone Reproductive Choices clinic in Freetown, she treats girls as young as 13 suffering from botched abortions—cases that often involve expired pills, wire hangers or harmful chemicals.
‘They go to any length,’ Samura told AP. ‘In Sierra Leone, people are afraid of the stigma … so they would prefer to die silently.’
From global outrage to national pushback
The proposed Safe Motherhood Bill was introduced by President Julius Maada Bio in 2022, shortly after the US Supreme Court reversed Roe v. Wade. ‘At a time when sexual and reproductive health rights are under threat globally, we are proud to lead with progressive reforms,’ he said.
Originally, the bill aimed to allow abortion up to 14 weeks. But religious opposition—particularly from Christian and Muslim leaders—forced amendments that now limit it to cases of rape, incest, life-threatening complications, or fatal foetal abnormalities.
Archbishop Edward Tamba Charles, head of Sierra Leone’s Inter-Religious Council, condemned the bill as ‘ungodly’ and contrary to public morality. Even some members of the ruling party, including MP Rebecca Yei Kamara, oppose it.
‘In our communities, children don’t get pregnant … they teach them how to grow up into womanhood,’ Kamara argued, claiming statistics are inflated.
Life and death decisions in the clinic
Healthcare workers continue to see the consequences of inaction. At MSI clinics, patients like a mother of six who ingested a traditional herbal mix often arrive too late. Samura recalled escorting her to hospital, where the woman died in the waiting room from septicemia.
‘Anytime I think of her, I wish the bill had been long passed,’ she said.
Over 20 percent of teenage girls in Sierra Leone become pregnant, according to the UN Population Fund. Many, like Jusu once was, suffer in silence.
Lawyer Nicky Spencer-Coker, who has been pushing for reform since 2015, asks: ‘If you aren’t listening to your doctors, then who are you listening to?’
A vote and a verdict still to come
The government expects the revised bill to go before Parliament in the coming weeks, though its future remains uncertain.
If passed, it would not only allow access to legal abortion in exceptional cases but also strengthen family planning services and complement broader gender reforms, including the recent ban on child marriage.
But if the bill fails, campaigners warn, the status quo will continue to claim lives. For many women in Sierra Leone, it’s not a political issue—it’s survival.
