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Abortion in Liberia

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In Liberia, abortion is only legal in cases of rape, fetal impairment, or risk to the mother's physical or mental health or life, up to the 24th week of pregnancy.

Liberia's abortion law is from 1976. The Legislature of Liberia introduced a revision to the law in 2020 and began debating it in 2022. Supporters of the law have said it will reduce the high rate of unsafe abortions. Opponents have said it violates religious beliefs.

About 32% of women have had abortions, which Liberians call "spoiling the belly". Unsafe abortions are common and account for 15% of maternal deaths in the country. Self-induced abortions are common. Medical abortion is legally restricted. Post-abortion care is available from public and private facilities.

Legislation

Section 16.1 of the penal code of Liberia criminalizes abortion without a legal defense, and Section 16.3 sets the gestational limit at 24 weeks of pregnancy.[1] In 1976, Liberia legalized abortion in the cases of rape, incest, risk to the physical or mental health of the mother, or risk to the life of the mother or the fetus.[2] Police and judiciary investigations are required in the case of rape or incest, and medical exemptions require written agreement from two physicians.[3] The law defines that pregnancy begins after complete implantation.[4]

Proposed amendment (2022)

In February 2020, a revision to the Public Health Bill addressing abortion was introduced to the Legislature of Liberia.[5] The proposal would amend Section 16.3 to legalize abortion for socioeconomic reasons.[3] It would lower the limit for legal abortions to the eighteenth week of pregnancy. Deputy Health Minister Varfee Tulay said the limit would emphasize that the law intends to avoid maternal deaths rather than promote widespread abortions.[6] If passed, the law will be one of the most liberal in Africa.[7]

On 13 June 2022, a joint committee began debating it.[8] The debate was introduced by Augustine Chea of Sinoe County, who is chair of the Senate Health Committee and a member of the Senate Judiciary Committee. Speaking to the Women's Legislative Caucus as a proxy for President Pro Tempore Albert Tugbe Chie, Chea said his goal was to stop abortion being a criminal offense.[3] Both chambers passed the law. The proposal addressed sex education and family planning, as well as other major health issues, despite a public perception that there was a standalone bill about abortion.[7][5] A special session convened on 22 August 2023 and adjourned on 5 September after anti-abortion groups called for the legislature to reject the bill.[9] As of February 2024, the Senate is reviewing the law.[10] The Coalition for Democratic Change opposes the proposal.[11]

Advocates for legalizing abortion have cited high rates of illegal abortions in Liberia and the risk of complications. An anonymous group of senators told the Liberian Observer, "Don't you think it's finally time for a change? Yes. Having an illegal abortion may cause more deaths because it is done in backyard clinics and sometimes we throw our babies in dumpsites because most women can't even afford a daily meal or provide a good home for the children."[3] The Community Health Initiative, an advocacy group campaigning for the law, worked with the national government to form coalitions and led workshops with journalists to report on the topic.[10] The national not-for-profit organization Sister AID Liberia held media dialogues to discuss prevention of unsafe abortions.[12] Vice President Jewel Howard Taylor voiced support for the law in an interview with state broadcaster ELBC-FM.[7]

Many traditional and religious leaders believe abortion is against Christian teachings and local traditions.[10] Opponents have argued that prioritizing abortion rights ignored the rights of the unborn child.[3] Bishop Kortu K. Brown, former president of the Liberian Council of Churches, has been a vocal protestor.[7] His website StopLiberiaAbortionBill.com urges citizens to write to their representatives opposing the bill.[6] Members of Liberia's Religious Council criticized the Swedish Embassy and other organizations for advocating the legalization of abortion.[13] Swedish ambassador Urban Sjöström defended the country's support for legal abortion, and the embassy denied allegations of bribing lawmakers.[7][14] A member of the United States House of Representatives, Chris Smith, called for Liberian legislators to reject the bill and for the US Congress to investigate whether Joe Biden's administration had illegally advocated for legal abortion in Liberia.[15]

Prevalence

According to a report by the Ministry of Health, 38,779 abortions occurred in Liberia in 2021, equalling 30.7 per 1,000 women (of reproductive age), or 229 per 1000 live births.[10] The country's abortion rate increased from 28 per 1,000 women in 1990–1994 to 42 per 1,000 women in 2015–2019. In the latter period, 49% of pregnancies were unintended and 40% of unintended pregnancies resulted in abortion.[note 1][16] As of 2015, the only representative survey of abortion in Liberia is the 2007 Demographic and Health Survey, in which 6% of women, speaking face-to-face, reported having had abortions. Anecdotal evidence and statistical analysis indicate that 32% of women have had abortions.[17]

In Liberia, abortion is referred to as "spoiling the belly" or "taking the belly".[18] Backstreet abortions are commonly available. Some providers are nurses who use speculums and syringes, some use knives or sharp bones, and others use remedies such as herbs, ground avocado, or chalk. A 2013 study of six counties of Liberia found that over 10% of women had undergone unsafe abortions.[18] The most common demographics recorded to have unsafe abortions are young women, students, and people who have previously been pregnant. Risks include sepsis, which accounts for 15% of maternal deaths in Liberia, and haemorrhage.[19] Septic abortions are a common cause of tetanus.[20]

Many young women have performed self-induced abortions by vaginally inserting cassava, chalks, or an herb mixture known as "rocket-propelled grenade". This sometimes results in fatal sepsis.[21] Some have drunk water mixed with ground glass or an herb known as "Christmas leaf".[7]

Liberia has no government-supported training for abortion providers. Medical abortion is provided by private organizations that import registered abortion pills, but distribution is legally restricted.[22]

Public and private facilities such as Planned Parenthood offer post-abortion care. Some unsafe abortions result in severe pain or the need to remove the uterus.[18] Liberia's standard treatment guidelines include misoprostol for post-abortion care and haemorrhage treatment.[22] Most cases of unsafe abortion requiring surgery are referred to the John F. Kennedy Maternity Center in Monrovia, the only tertiary medical facility in the country. The center's exploratory laparotomy surgeries have a fatality rate of 22.4%, as of 2022. Delays in treatment contribute to the fatality rate, caused by cost of travel, fear of legal or social ramifications of abortion, or time taken by primary care.[23]

Notes

  1. ^ This equates to 19.6% of all pregnancies in this period being unintentional pregnancies resulting in abortion.

References

  1. ^ "Offenses Against the Family, Chapter 16: Penal Law - Title 26 - Liberian Code of Laws Revised". Legal Information Institute. Retrieved 17 July 2024.
  2. ^ Cook, Rebecca J.; Dickens, Bernard M. (July 1978). "A decade of international change in abortion law: 1967-1977". American Journal of Public Health. 68 (7): 644. doi:10.2105/AJPH.68.7.637. eISSN 1541-0048. ISSN 0090-0036. PMC 1653985. PMID 665881.
  3. ^ a b c d e Sonpon, Leroy M., III (13 June 2022). "Liberia: Senate Debates Abortion Rights Legalization". Liberian Observer. Archived from the original on 13 June 2022. Retrieved 11 July 2024.{{cite news}}: CS1 maint: multiple names: authors list (link)
  4. ^ Banwell, Suzanna S.; Paxman, John M. (October 1992). "The search for meaning: RU 486 and the law of abortion". American Journal of Public Health. 82 (10): 1400. doi:10.2105/AJPH.82.10.1399. eISSN 1541-0048. ISSN 0090-0036. PMC 1695867. PMID 1415870.
  5. ^ a b Tweh, Ethel A. (23 August 2023). Browne, Jonathan (ed.). "Senate Pro-Tempore Chie clarifies abortion bill". The New Dawn Liberia. Retrieved 11 July 2024.
  6. ^ a b Karmo, Henry (30 November 2023). "Liberia: Lawmakers, Religious Leaders in Rigmarole over 'Abortion Law'". FrontPage Africa. Retrieved 12 July 2024.
  7. ^ a b c d e f "Liberia: Liberia's New Health Law Among Most Liberal in Africa for Abortion". Liberian Observer. 1 September 2023. ProQuest 2859970858 – via ProQuest.
  8. ^ "Liberia's parliament prepares bill to expand access to abortion". Africanews. 17 June 2022. Retrieved 11 July 2024.
  9. ^ "Senate tables public health law debate". The New Dawn Liberia. 6 September 2023. Retrieved 11 July 2024.
  10. ^ a b c d Teh, Lewis S. (19 February 2024). "Unsafe abortion threatens women's health". The New Dawn Liberia. Retrieved 12 July 2024.
  11. ^ Teh, Lewis S. (18 September 2023). "CDC opposes bill on abortion". The New Dawn Liberia. ProQuest 2865897845 – via ProQuest.
  12. ^ Peters, Lincoln G. (20 March 2024). "SALI aims to mitigate Liberia's 38,000 illegal abortion". The New Dawn Liberia. Retrieved 12 July 2024.
  13. ^ "Liberia: 'Abortion Would Lead to 40,000 Deaths'". Liberian Observer. 21 August 2023. Archived from the original on 25 August 2023. Retrieved 11 July 2024.
  14. ^ "Sweden Defends Support for Legalizing Abortion in Liberia". Liberian Observer. 21 July 2023. 2840636703 – via ProQuest.
  15. ^ Koinyeneh, Gerald C. (12 July 2023). "Congressman Smith Calls on Liberian Senate to Reject Pro-Abortion Bill". FrontPage Africa. Retrieved 11 July 2024.
  16. ^ "Country Profile: Liberia". Guttmacher Institute. 2022. Retrieved 11 July 2024.
  17. ^ Moseson, Heidi; Massaquoi, Moses; Dehlendorf, Christine; Bawo, Luke; Dahn, Bernice; Zolia, Yah; Vittinghof, Eric; Hiatt, Robert A.; Gerdts, Caitlin (5 September 2015). "Reducing under-reporting of stigmatized health events using the List Experiment: results from a randomized, population-based study of abortion in Liberia". International Journal of Epidemiology. 4 (6). Oxford University Press: 1951–1958. doi:10.1093/ije/dyv174. ISSN 1464-3685. PMC 5156336. PMID 26342584.
  18. ^ a b c Thomas, Katherina (21 April 2017). "'Spoiling the Belly': The Dangers of Backstreet Abortions in Liberia". The New Humanitarian. Retrieved 12 July 2024.
  19. ^ Ndyanabangi, Bannet; Livingstone, Maybe; Gobeh, Woseh; Logan, Gorbee G.; Atukunda, Laura (December 2021). "Unsafe abortion – A Risk factor for maternal mortality in Liberia - An analysis of the characteristics of unsafe abortion clients and risk factors for maternal morbidity and mortality". African Journal of Reproductive Health. 25 (6): 43–50. doi:10.29063/ajrh2021/v25i6.5 (inactive 17 July 2024). JSTOR 27233196. PMID 37585819 – via JSTOR.{{cite journal}}: CS1 maint: DOI inactive as of July 2024 (link)
  20. ^ "Validation of maternal and neonatal tetanus elimination in Liberia, 2011". Weekly Epidemiological Record. 87 (18). World Health Organization: 169–176. 4 May 2012. ISSN 0049-8114. PMID 22574353.
  21. ^ Tarr-Attia, Christine K.; Boiwu, Grace Hawa; Martínez-Pérez, Guillermo (14 February 2019). "'Birds of the same feathers fly together': midwives' experiences with pregnant women and FGM/C complications - a grounded theory study in Liberia". Reproductive Health). 16 (18): 18. doi:10.1186/s12978-019-0681-1. ISSN 1742-4755. PMC 6376772. PMID 30764836.
  22. ^ a b Grossman, Amy; Prata, Ndola; Williams, Natalie; Ganatra, Bela; Lavelanet, Antonella; Läser, Laurence; Asmani, Chilanga; Elamin, Hayfa; Ouedraogo, Leopold; Rahman, Md. Mahmudur; Conneh-Duworko, Musu Julie; Tehoungue, Bentoe Zoogley; Chanza, Harriet; Phiri, Henry; Bhattarai, Bharat; Dhakal, Narayan Prasad; Ojo, Olumuyiwa Adesanya; Afolabi, Kayode; Kabuteni, Theophista John; Hailu, Binyam Getachew; Moses, Francis; Dlamini-Ngeketo, Sithembile; Zulu, Thembi; Rehnström Loi, Ulrika (11 April 2023). "Availability of medical abortion medicines in eight countries: a descriptive analysis of key findings and opportunities". Reproductive Health. 20 (58): 58. doi:10.1186/s12978-023-01574-3. PMC 10091522. PMID 37041543.
  23. ^ Odunvbun, Williams O.; Kollie, Jewel T. (1 April 2022). "The burden of surgical complications from unsafe abortion treated at the John F. Kennedy Maternity Center (JFKMC), Monrovia, Liberia". Malawi Medical Journal. 34 (1): 43–48. doi:10.4314/mmj.v34i1.8. eISSN 1995-7262. ISSN 1995-7270. PMC 10230577. PMID 37265831.
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