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. 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.

Contents

Liberia's abortion law is from 1976. The Legislature of Liberia introduced a bill to legalize abortion in 2020. The legislature began debating the revision in 2022 after it was introduced by Senator Augustine Chea. Pro-abortion advocacy groups have said it will reduce the high rate of unsafe abortions. Religious leaders have opposed it, saying it violates fetal rights. As of 2024, the bill is being debated.

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] A 1976 law permits 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 and specifically does not apply to actions taken to prevent pregnancy. [4] [5]

History

In July 1976, an amendment to the penal code received presidential approval, which included Section 16.3 on abortion. [6] Liberia legalized the abortion pill mifepristone before 1996. [7]

Proposed amendment (2022)

In February 2020, a revision to the Public Health Bill addressing abortion was introduced to the Legislature of Liberia. [8] The proposal would amend Section 16.3 to legalize abortion for socioeconomic reasons. [3] It would lower the limit for legal abortions to the fourteenth 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. [9] If passed, the law will be one of the most liberal in Africa, where a vast majority of women live in places with restrictive laws. [10]

On 13 June 2022, a joint committee began debating the bill. [11] The debate was introduced by Augustine Chea of Sinoe County, who was 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] The House of Representatives 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. [10] [8] 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. [12] As of February 2024, the Senate is reviewing the law. [13] The Coalition for Democratic Change opposes the proposal. The party's Secretary General, Jefferson Tamba Koijee, argued that the bill would threaten population growth. [14]

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. [13] The national not-for-profit organization Sister AID Liberia held media dialogues to discuss prevention of unsafe abortions. [15] Vice President Jewel Howard Taylor voiced support for the law in an interview with state broadcaster ELBC-FM. [10]

Many religious and traditional leaders believe abortion is against Christian teachings and local traditions. [13] 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. [10] His organization, the Campaign to Stop Abortion in Liberia, urges citizens to write to their representatives opposing the bill. [9] Members of Liberia's Religious Council criticized the Swedish Embassy and other organizations that funded activism supporting legal abortion. [16] Swedish ambassador Urban Sjöström defended the country's support for legal abortion, and the embassy denied allegations of bribing lawmakers. [10] [17] [18] A Republican 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. [19]

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. [13] 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] [20] 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 as of 2013. [21]

In Liberia, abortion is referred to as "spoiling the belly" or "taking the belly". [22] 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. [22] 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. [23] Some have drunk water mixed with ground glass or an herb known as "Christmas leaf". [10] 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. [24] Septic abortions are a common cause of tetanus. [25]

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. [26] 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. [22] Liberia's standard treatment guidelines include misoprostol for post-abortion care and haemorrhage treatment. [26] 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. [27]

Notes

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

Related Research Articles

Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of all pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently "induced miscarriage". The unmodified word abortion generally refers to an induced abortion. The most common reasons given for having an abortion are for birth-timing and limiting family size. Other reasons reported include maternal health, an inability to afford a child, domestic violence, lack of support, feeling they are too young, wishing to complete education or advance a career, and not being able or willing to raise a child conceived as a result of rape or incest.

The abortion debate is a longstanding and contentious discourse that touches on the moral, legal, medical, and religious aspects of induced abortion. In English-speaking countries, the debate has two major sides, commonly referred to as the "pro-choice" and "pro-life" movements. Generally, supporters of pro-choice argue for the right to choose to terminate a pregnancy. They take into account various factors such as the stage of fetal development, the health of the woman, and the circumstances of the conception. By comparison, the supporters of pro-life generally argue that a fetus is a human being with inherent rights and intrinsic value, and thus, cannot be overridden by the woman's choice or circumstances and that abortion is morally wrong in most or all cases. Both terms are considered loaded words in mainstream media, where terms such as "abortion rights" or "anti-abortion" are generally preferred in order to avoid bias.

<span class="mw-page-title-main">Maternal death</span> Aspect of human reproduction and medicine

Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.

<span class="mw-page-title-main">Unsafe abortion</span> Termination of a pregnancy by using unsafe methods

An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both. An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention. About 25 million unsafe abortions occur a year, of which most occur in the developing world.

<span class="mw-page-title-main">Abortion in South Africa</span>

Abortion in South Africa is legal by request when the pregnancy is under 13 weeks. It is also legal to terminate a pregnancy between weeks 13 and 20 if the continued pregnancy would significantly affect the woman's social or economic circumstances, poses a risk of injury to the woman's physical or mental health, there is a substantial risk that the foetus would suffer from a severe physical or mental abnormality, or the pregnancy resulted from rape or incest. If the pregnancy is more than 20 weeks, a termination is legal if the foetus' life is in danger, or there is a likelihood of serious birth defects.

Abortion has been legal in India under various circumstances with the introduction of the Medical Termination of Pregnancy (MTP) Act, 1971. The Medical Termination of Pregnancy Regulations, 2003 were issued under the Act to enable women to access safe and legal abortion services.

Abortion in Uruguay is legal on request before twelve weeks of gestation, after a five-day reflection period. Abortion has been legalized in Uruguay since 2012. Uruguay is one of only four countries in South America where abortion is legal on request; the other three are Argentina, Guyana and Colombia.

The Dominican Republic is one of 24 countries in the world and one of six in Latin America that has a complete ban on abortion. This complete ban includes situations in which a pregnant person’s life is at risk.

<span class="mw-page-title-main">Health in Liberia</span>

Liberia is one of the poorest countries in the world. Civil wars have killed around 250,000 people and displaced many more. The wars ended in 2003 but destroyed most of the country's healthcare facilities. Recovery precedes proceeds, but the majority of the population still lives below the international poverty line. Life expectancy in Liberia is much lower than the world average. Communicable diseases are widespread, including tuberculosis, diarrhea, malaria, HIV, and Dengue. Female genital mutilation is widely practiced. Nearly a quarter of children under the age of five are malnourished and few people have access to adequate sanitation facilities. In 2009, government expenditure on health care per-capita was US$22, accounting for 10.6% of totaled GDP. In 2008, Liberia had only one doctor and 27 nurses per 100,000 people. It was ill-equipped to handle the outbreak of Ebola in 2014 and 2015.

Abortion in Uganda is illegal unless performed by a licensed medical doctor in a situation where the woman's life is deemed to be at risk.

<span class="mw-page-title-main">Abortion in Kenya</span>

Abortion in Kenya is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for women in Kenya.

Abortion in Georgia is illegal after detection of embryonic cardiac-cell activity, which typically begins in the fifth or sixth week after the onset of the last menstrual period (LMP), two to three weeks after implantation. Although this law was ruled unconstitutional by a Georgia superior court judge on September 30, 2024, it remains in effect while the state appeals the ruling.

In 2005, the Ethiopian Parliament liberalised the abortion law to grant safe abortions to women in specific circumstances.

Abortion is illegal in Tanzania except to preserve the life of the mother. Under the Tanzanian penal code, health practitioners who perform illegal abortions may receive sentences of up to 14 years in prison, while those who procure abortions for themselves may be sentenced to up to seven years in prison.

In Sierra Leone, abortion is a criminal offence. Its abortion law does not specify any grounds for legal abortion. It is unclear whether abortion is permitted to save the life of the mother, as a British judicial decision allowing such abortions is untested in Sierra Leone. Abortion is covered in the country's medical code of ethics, but there is no government training for providers. Prosecution of abortion is uncommon.

In Zambia, abortion is legal if the pregnancy would threaten the mother's life or physical or mental health or those of existing children, or if it would cause a birth defect. Zambia has one of the most permissive abortion laws in Africa, though its restrictions limit access. The Termination of Pregnancy Act, passed in 1972, legalizes abortion if approved by medical professionals. It requires signatures from three doctors, including one specialist. Amendments to the bill and medical guidelines clarify that the law allows the consideration of situations such as pregnancy from rape, as well as socioeconomic factors.

In Malawi, abortion is only legal to save the life of the mother. Abortion is a felony punishable by prison. Malawi's abortion law is one of the strictest in the world.

In Madagascar, abortion is illegal in all circumstances. The abortion law punishes receiving or assisting in an abortion with imprisonment or fines. It is one of the only countries with a total abortion ban. Abortion has been illegal since the French colonial era, influenced by attitudes favoring increased births. In 2017, the government rejected a proposal to legalize therapeutic abortion. A bill allowing abortion in the case of rape was proposed by Member of Parliament Masy Goulamaly in November 2021 but was withdrawn by the parliament.

In the Gambia, abortion is illegal except to save the life of the mother or to prevent birth defects. Abortions in the Gambia have high rates of mortality and complications. Abortions are common among adolescents. There is a stigma surrounding extramarital pregnancy and abortion.

In Gabon, abortion is only legal in the cases of risk to the mother's life, risk of birth defects, pregnancy from rape or incest, or if the mother is a minor in distress, up to ten weeks of pregnancy. Illegal abortions are punishable by prison or fines. Gabon has one of the highest rates of abortion in Sub-Saharan Africa.

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. 1 2 3 4 5 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. ↑ Cook, Rebecca J.; Dickens, Bernard M. (Autumn 1981). "Abortion Laws in African Commonwealth Countries". Journal of African Law. 25 (2): 69. doi:10.1017/S0021855300012559. ISSN   1464-3731. PMID   12288246.
  6. ↑ Annual Review of Population Law. Vol. 1977. United Nations. 1977. p. 16 – via HeinOnline.
  7. ↑ Klashtorny, Natalie (Fall 1996). "Ireland's Abortion Law An Abuse of International Law". Temple International and Comparative Law Journal . 10 (2): 437 – via HeinOnline.
  8. 1 2 Tweh, Ethel A. (23 August 2023). Browne, Jonathan (ed.). "Senate Pro-Tempore Chie clarifies abortion bill". The New Dawn Liberia. Retrieved 11 July 2024.
  9. 1 2 Karmo, Henry (30 November 2023). "Liberia: Lawmakers, Religious Leaders in Rigmarole over 'Abortion Law'". FrontPage Africa . Archived from the original on 30 November 2023. Retrieved 12 July 2024.
  10. 1 2 3 4 5 6 Mehnpaine, Tina S. (1 September 2023). "Liberia's New Health Law Among Most Liberal in Africa for Abortion". Liberian Observer . ProQuest   2859970858 . Archived from the original on 5 September 2023.
  11. ↑ "Liberia's parliament prepares bill to expand access to abortion". Africanews . 17 June 2022. Archived from the original on 17 June 2022. Retrieved 11 July 2024.
  12. ↑ "Senate tables public health law debate". The New Dawn Liberia. 6 September 2023. Archived from the original on 7 September 2023. Retrieved 11 July 2024.
  13. 1 2 3 4 Teh, Lewis S. (19 February 2024). "Unsafe abortion threatens women's health". The New Dawn Liberia. Retrieved 12 July 2024.
  14. ↑ Teh, Lewis S. (18 September 2023). "CDC opposes bill on abortion". The New Dawn Liberia. ProQuest   2865897845 . Archived from the original on 26 September 2023.
  15. ↑ Peters, Lincoln G. (20 March 2024). "SALI aims to mitigate Liberia's 38,000 illegal abortion". The New Dawn Liberia. Archived from the original on 28 March 2024. Retrieved 12 July 2024.
  16. ↑ "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.
  17. ↑ "Sweden Defends Support for Legalizing Abortion in Liberia". Liberian Observer . 21 July 2023. ProQuest   2840636703 – via ProQuest.
  18. ↑ Mehnpaine, Tina S. (22 August 2023). "Liberia: Swedish Embassy Denies Bribing Liberian Senators to Legalize Abortion". Liberian Observer . Archived from the original on 25 August 2023. Retrieved 30 July 2024.
  19. ↑ Koinyeneh, Gerald C. (12 July 2023). "Congressman Smith Calls on Liberian Senate to Reject Pro-Abortion Bill". FrontPage Africa . Retrieved 11 July 2024.
  20. ↑ "Country Profile: Liberia". Guttmacher Institute . 2022. Retrieved 11 July 2024.
  21. ↑ 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.
  22. 1 2 3 Thomas, Katherina (21 April 2017). "'Spoiling the Belly': The Dangers of Backstreet Abortions in Liberia". The New Humanitarian . Retrieved 12 July 2024.
  23. ↑ 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.
  24. ↑ 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 1 November 2024). JSTOR   27233196. PMID   37585819 – via JSTOR.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  25. ↑ "Validation of maternal and neonatal tetanus elimination in Liberia, 2011" (PDF). Weekly Epidemiological Record . 87 (18). World Health Organization: 169–176. 4 May 2012. ISSN   0049-8114. PMID   22574353. Archived from the original (PDF) on 22 October 2014.
  26. 1 2 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.
  27. ↑ 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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