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.

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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 gestational limit is 24 weeks of pregnancy. 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, chair of the Senate Health Committee and member of the Senate Judiciary Committee. Speaking to the Women's Legislative Caucus as a proxy for President Pro Tempore Albert Tugbe Chie, Chea and 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] The Senate tabled its discussion after 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, or 229 per live birth. [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. [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 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]

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 women give 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.

<span class="mw-page-title-main">Abortion in the United States</span>

Abortion is a divisive issue in the United States. The issue of abortion is prevalent in American politics and culture wars, though a majority of Americans support continued access to abortion. There are widely different abortion laws depending on state.

The abortion debate is a longstanding, ongoing controversy that touches on the moral, legal, medical, and religious aspects of induced abortion. In English-speaking countries, the debate most visibly polarizes around adherents of the self-described "pro-choice" and "pro-life" movements. Pro-choice supporters uphold that individuals have the right to make their own decisions about their reproductive health, and that they should have the option to end a pregnancy if they choose to do so, taking into account various factors such as the stage of fetal development, the health of the woman, and the circumstances of the conception. Pro-life advocates, on the other hand, maintain that a fetus is a human being with inherent rights that 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.

<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">Abortion law</span> Laws that allow, prohibit, or regulate abortion

Abortion laws vary widely among countries and territories, and have changed over time. Such laws range from abortion being freely available on request, to regulation or restrictions of various kinds, to outright prohibition in all circumstances. Many countries and territories that allow abortion have gestational limits for the procedure depending on the reason; with the majority being up to 12 weeks for abortion on request, up to 24 weeks for rape, incest, or socioeconomic reasons, and more for fetal impairment or risk to the woman's health or life. As of 2022, countries that legally allow abortion on request or for socioeconomic reasons comprise about 60% of the world's population. In 2024, France became the first country to explicitly protect abortion rights in its constitution.

<span class="mw-page-title-main">Self-induced abortion</span> Abortion performed by a pregnant person themselves outside the recognized medical system

A self-induced abortion is an abortion performed by the pregnant woman herself, or with the help of other, non-medical assistance. Although the term includes abortions induced outside of a clinical setting with legal, sometimes over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, potentially more dangerous methods. Such practices may present a threat to the health of women.

<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.

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.

Abortion in Namibia is restricted under the Abortion and Sterilisation Act of South Africa (1975), which Namibia inherited at the time of Independence from South Africa in March 1990. The act only allows for the termination of a pregnancy in cases of serious threat to the maternal or fetal health or when the pregnancy is a result of rape or incest. This law has not been updated since, and attempts to liberalise it have been met with fierce opposition from religious and women's groups.

Abortion in Turkey has been legal on request since May 27, 1983. Abortion is legal up to 10 weeks of pregnancy, and in special circumstances the time threshold can be extended if there is danger to the woman's life or the life of the fetus. During the ten weeks, an abortion is allowed for the following reasons: the pregnancy threatens the woman's mental and/or physical health, the fetus would be physically or mentally impaired, if the conception occurred through rape or incest, and economic or social reasons. The woman's consent is required. If the woman is under the age of 18, then parental consent is required. If the woman is married, the consent of the husband is also required. Single women over the age of 18 can choose to have an abortion on their own.

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">Abortion-rights movements</span> Social movement advocating for legal access to abortion

Abortion-rights movements, also self-styled as pro-choice movements, advocate for the right to have legal access to induced abortion services including elective abortion. They seek to represent and support women who wish to terminate their pregnancy without fear of legal or social backlash. These movements are in direct opposition to anti-abortion movements.

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.

Abortion in the Central African Republic is prohibited by law unless the pregnancy is the result of rape. According to general medical practice, the medical procedure is only legal if the abortion will save the woman's life, though this is not explicitly stated in any law. Anyone who performs an abortion faces up to five years in prison and a fine, and physicians risk losing their medical licenses for up to five years.

As of 2022, abortion in Missouri is illegal, with abortions only being legal in cases of medical emergency and several additional laws making access to abortion services difficult. In 2014, a poll by the Pew Research Center found that 52% of Missouri adults said that abortion should be legal vs. 46% that believe it should be illegal in all or most cases. According to a 2014 Public Religion Research Institute (PRRI) study, 51% of white women in the state believed that abortion is legal in all or most cases.

Black maternal mortality in the United States refers to the death of women, specifically those who identify as Black or African American, during or after child delivery. In general, maternal death can be due to a myriad of factors, such as the nature of the pregnancy or the delivery itself, but is not associated with unintentional or secondary causes. In the United States, around 700 women die from pregnancy-related illnesses or complications per year. This number does not include the approximately 50,000 women who experience life-threatening complications during childbirth, resulting in lifelong disabilities and complications. However, there are stark differences in maternal mortality rates for Black American women versus Indigenous American, Alaska Native, and White American women.

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 offense. Its abortion law does not specify any grounds for legal abortion, but abortion might be permitted to save the life of the mother.

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. 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.
  6. 1 2 Karmo, Henry (30 November 2023). "Liberia: Lawmakers, Religious Leaders in Rigmarole over 'Abortion Law'". FrontPage Africa . Retrieved 12 July 2024.
  7. 1 2 3 4 5 6 "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. 1 2 3 4 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. 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.
  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). doi: 10.1186/s12978-019-0681-1 . ISSN   1742-4755. PMID   30764836.
  22. 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.
  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. PMID   37265831 – via African Journals OnLine.
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