PHOTO: The Author
By Siatta Scott Johnson
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.
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.