By the time the bleeding started, Mayeni, 25, was no longer afraid. Three months had passed. Months in which her boyfriend stopped answering his phone and, when she called him from another number, switched phones. In which her petite belly slowly began to swell and panic grew inside her. If her mother found out she was pregnant again, she would definitely kick her out. Where was she supposed to go then? In the twilight of the night, on the other side of the corrugated iron slum in Freetown, where Mayeni lives with her mother, sister and son, she tells in a whisper. About the friend who took her to a woman who could ‘help’ her. How he asked for an amount that Mayeni couldn’t possibly afford. How she begged and begged her. 100 Leones, about 7.50 euros, was all she had. About how bitter the sap of the plant tasted. And how then the bleeding started. She can retell it. With a dull voice and empty eyes, but still. Many young girls like her are less fortunate in Sierra Leone, where abortions are illegal and the death rate of pregnant women is one of the highest in the world at 1,120 deaths in 100,000 births. Some 10 percent of deaths, according to experts, are the result of quacks and traditional healers tucked away in proverbial alleys promising to terminate pregnancies. For years, activists and health care providers have been pushing for relaxation of the abortion ban. It dates back to the time when Sierra Leone was a British colony. But while other African countries slowly liberalized their abortion laws, Sierra Leone was one of the few to stick to the old rules. Now it seems that a big change is imminent. In Freetown, a new law is currently being written to broaden the right to abortion. Proponents hope that parliament will vote on it this month. It is still uncertain how far the new law will go. Will an abortion only be allowed if life is in danger? Also rape? Or under more circumstances? Doctors see cuts in the cervix from branches or other objects. “If the law is passed, it will be a game changer anyway,” says Felix Ikenna , almost solemnly. The doctor sits in his bright white-lit office in downtown Freetown, his hands resting on his desk in front of him. Ikenna is affiliated with Marie Stopes , an NGO working worldwide for the right to safe abortion and birth planning. In Sierra Leone, he runs several clinics where, among other things, complications after illegal abortions are treated. Ikenna has seen everything there. The bleeding due to incorrect medication, sometimes so heavy that blood transfusions are necessary. infections. Cuts in the cervix from branches or other objects that have been used. Sometimes they come too late. One thing is clear, says the doctor, who, like most NRC speaks with, chooses his words carefully. “The current ban is not helping.” First try It was President Julius Maada Bio who started the change in July. Standing on a podium at a sexual health and rights conference in Freetown, he announced his government “unanimously” supported a new law to make motherhood safer in his country. With the option of abortion as part of that. “At a time when sexual and reproductive health rights for women are either being destroyed or threatened, we are proud that Sierra Leone can lead the way in progressive reform,” said Bio, in an unveiling reference to the United States, where since the destruction of ‘Roe v. Wade’ by the Supreme Court just the opposite happens. That statement did not come out of nowhere. In recent years, officials from the Ministry of Health and a coalition of women’s rights organizations have worked closely together to frame a law that would pass. Well, because an earlier attempt in 2015 failed. That year, parliament twice voted overwhelmingly in favor of a ‘safe abortion’ law, which enshrined the right to an abortion for up to 12 weeks. But the president at the time refused to sign. “There was a lot of pressure from religious leaders,” says Fodie Paul Oniel Kamara. The 55-year-old activist is one of the leading voices in Sierra Leone fighting for more self-determination for women. “They absolutely disagreed.” The law was very ambitious, he admits. But he also said little had been done to prepare people. When Kamara got involved in another effort the following year, he decided to do things differently. “We have gone to every chiefdom , to every district and have held consultations everywhere. With the women, traditional leaders, religious.” Hear their concerns, their objections. The imams and priests were especially unequivocal. Then he tested his theory. What if the daughter of someone from your church was raped and now pregnant, what would you advise? And if it was your own child? The closer Kamara got, the less certain the answers became. What also helped their campaign was the arrival of a new government in 2018 and a president for whom reducing maternal mortality became a key theme. The day Bio was on stage, Kamara was in the audience. With a hefty headache, he jokes. “I screamed that loud.” Danger Sierra Leone, with its 8.3 million inhabitants, is one of the world’s poorest countries. Decades of brutal civil war completely eroded the already weak health care system. By the end of 2002, clinics had been destroyed and doctors had fled. Then in 2014 came an Ebola epidemic. How much deeper you now go into the provinces, how big the shortages are still. On equipment, personnel, on blood for transfusions. At the same time, the number of teenage pregnancies is sky-high at 30 percent. While giving birth in such a scenario is already a risk, illegal abortions are even more so. Also read this interview with doctor and abortion activist Rebecca Gomperts Her mother never found out, Mayeni says. That is why she does not want her surname in the newspaper (it is known to the editors) and her eyes always shoot up when voices are heard nearby. If her boyfriend had taken his responsibility at the time, she would never have gone to that traditional healer, she says softly, her thin arms wrapped tightly around the boy, her first, who is fast asleep on her lap. The bleeding continued for three days. On the advice of the woman she wore diapers, sanitary pads were not enough. She did not dare to go to the hospital. Who knows what would happen there. In a small room in a large maternity hospital in Freetown, a nurse throws her hands in the air. The table next to her is barely visible under all the paper files, boxes full of medicines piled in the corner. She puts her glasses on her forehead and rubs her eyes. They come to this department almost every day, she says. Sometimes they are still teenage girls, sometimes mothers with five children. With all kinds of complications. While other African countries slowly liberalized their abortion laws , Sierra Leone was one of the few to stick to the old rules. Photo Melina Mara / Getty Images That is the impact of the current ban, says the sister, who is not allowed to speak and therefore remains anonymous. “People are dying. Young people. And it creates a high workload for us.” Like a number of colleagues in her department, she has even been trained to perform abortions using vacuum aspiration. Officially to remove the remaining tissue after a lot of work. But not only then, let them gently hint. ,,If a woman comes to us and asks for it, we help her. Here it is safe.” NRC hears similar stories elsewhere. In a small hospital on the outskirts of the capital, a doctor says that despite the ban, he also helps women who want an abortion. “I see it as my duty,” he says firmly. “I am convinced that this is how I save lives.” He also wishes to remain anonymous. Not out of fear of the police (“Believe me, they too will come to me with their children”), but of his strict Muslim father. He wouldn’t talk to him anymore. The difficult thing, says the doctor, is that teenage girls do not know that they can also knock on the door of hospitals like his. “Given the current law, I can’t shout that from the rooftops.” The law that is now being written about must do something about it. This “Safe Motherhood and Reproductive Rights Act” is about a lot. About the right to birth care, contraception and sexual education. And abortion. Where to get it, who is authorized to do it. And with sanctions for the (so-called) doctors and pharmacies who do not comply with this. The fact that this law is a lot broader than in 2015, helps to convince opponents, says activist Kamara. But, he admits, this law will not go as far as then. He cannot – and may not – say much yet, but the most likely scenario is this: an abortion will soon be allowed when the health of the mother or fetus is in danger, in the case of rape or incest. He would have preferred to see abortion become accessible to everyone, says Kamara. But you have to start somewhere. “This is the hardest part, getting a law through.” After that, the activist says with a grin that betrays a plan, they can work on amendments. About this story For this story, NRC spoke to several healthcare providers – doctors and nurses – as well as organizations involved in abortion and women’s rights in Sierra Leone. Due to the sensitivity of the subject, the religious taboo and the risk of persecution, some of them wished to remain anonymous. Their names and institutions are known to the editors. A version of this article also appeared in the newspaper of October 11, 2022