Fanella Bola lay against the perimeter walls of a hospital in Sierra Leone and cried at the thought of going through with her pregnancy. The 17-year-old had been turned away from almost every hospital in the capital city of Freetown, where abortion is illegal.
As she dried her tears and prepared to trudge home, the schoolgirl was approached by a market woman who said there was another way.
“She took me to a pharmacy at Lumley,” Bola told The Telegraph, referencing a neighbourhood in the city. “I bought a pill called misoprostol which easily aborted the baby as it was only three weeks old.”
Misoprostol is a drug to treat stomach ulcers but it can also be used to abort foetuses by making the uterus contract. Elsewhere, it is sold as an effective abortion pill, but in Sierra Leone it is unwittingly dished out to pregnant girls over the counter who claim they have stomach problems.
Although Bola survived the ordeal, thousands of girls in the tiny West African country put their lives at serious risk by taking misoprostol without medical advice and at the wrong stages of their pregnancy.
‘Some insert sharp objects into their uterus’
“They do it without doctors or nurses,” said Ellen Lema Allieu, a doctor at the Aberdeen Women’s Center in Freetown. “Sometimes it fails and we have to rush them to the hospital. If the girl has been pregnant for more than 20 weeks, they often experience severe abdominal pain and bleeding. Some of them die because of septicemia when the foetus is dead, but we are not able to expel it.”
For these women, some of whom have been raped by close family members, taking unprescribed medicine is just one method to secretly abort their babies in a country which is facing a teenage pregnancy and abortion “epidemic,” medical professionals say.
According to government data, there were 91,494 abortions in Sierra Leone last year despite an 1861 abortion law which makes it illegal to terminate pregnancies, unless the mother’s life is at risk.
Doctors at Marie Stopes, an international abortion clinic, told The Telegraph that young girls were using the caveat in the colonial-era law to force medical professionals to perform abortions.
“Some drink rat poison and others insert sharp objects into their uterus,” they said, talking on condition of anonymity. “They get themselves into such a bad state that when they come here, they know that we will have to operate on them. Many of them die.”
Unsafe abortion attempts account for up to 10 per cent of maternal deaths in Sierra Leone, which has the third-highest rate of maternal fatalities in the world, at 1,120 deaths per 100,000 births in 2017.
Previous attempts to reform Sierra Leone’s abortion law have been blocked by pressure from Christian and Muslim groups in the extremely conservative African country.
In 2015, a bill passed by lawmakers to allow abortions up to 12 weeks of pregnancy was blocked by the then president, Ernest Bai Koroma, after a huge backlash from anti-abortion groups. The current president, Julius Maada Bio, announced in July that his government would draft and submit a new bill to parliament, buoying hopes that abortion will soon be decriminalised.
However, many observers remain sceptical that the president will introduce the controversial bill before elections in June next year, by which time hundreds of girls could have died.
‘Rape leading to teenage pregnancy is a big problem’
“It will be very difficult for it to be passed at this stage,” said Daniel Kettor, executive director of the Rainbo Initative, a charity for survivors of sexual violence. “Parliamentarians do not want to lose their seats because of this bill. Most people look at abortion from a cultural and religious perspective. They do not think about what happens if a person gets raped.”
The Rainbo Initiative is one of several charities based in Freetown that deals specifically with sexual violence and rape. The executive director said that rape is a key reason why there are so many unwanted pregnancies in Sierra Leone. Around one sixth of the women who seek help at the Rainbo Initiative are pregnant from rape, according to records kept by the charity.
“In 2020, we had 3,339 sexual assault cases; 559 of the girls were pregnant,” Kettor said. “In 2021, we had 2,966 sexual assault cases; 537 of the girls were pregnant. And so far this year we have had 1,439 sexual assault cases and 204 of the girls were pregnant.”
Most of the girls who come to the Rainbo Initiative have been raped and impregnated by close family members including fathers, uncles and brothers. They are advised by the charity to go through with the pregnancy, due to the current abortion law. Some of the girls, who are between the ages of 10 and 18, have picked up serious diseases like HIV and hepatitis B.
“Rape leading to teenage pregnancy is a big problem, it’s a big concern,” said Kettor. “That’s why the president declared a state of emergency in 2020 against sexual assault and rape. We are suffering a teenage pregnancy epidemic.”
One of the major problems is overcoming a culture of silence where the community and family prefer to brush rape cases under the carpet. Survivors also face a considerable stigma, making it harder for them to speak up and seek justice. In reality “most rape cases do not get reported,” Kettor said.
Some credit the high levels of sexual violence to Sierra Leone’s brutal civil war in the 1990s and early 2000s. The collective trauma of the 11-year conflict, which saw widespread atrocities and rape used as a weapon of war, may have been passed down through the generations.
Amanda Clemens, communication officer at Don Bosco, a Freetown-based charity for street kids, said that young girls who turn to prostitution to escape poverty is another reason for high levels of teenage pregnancies.
“We have a lot of girls and minors who come in as commercial sex workers,” she said. “Often, they have been abused and there is little or nothing done for them. Most of the girls don’t know who impregnated them and if they do, they know the father will not take care of the child.”
Don Bosco runs four refuge centres across Freetown for vulnerable girls and boys. It was set up in the aftermath of the war to rehabilitate child soldiers who had lived through horrific experiences. Clemens said that out of the 40 children who are temporarily housed at each centre, an average of five of the girls will give birth to unwanted babies at any one time.
The children are given medical treatment and therapy for around a month. After that, they are encouraged to rejoin their families – which sometimes means sending them back to their abusers.
In a country with a weak justice system, a major problem is holding the perpetrators to account. Don Bosco is working with the family support unit (FSU), a branch of the police, to instruct officers on how to properly collect evidence when crimes are reported.
“We have noted that while awareness of sexual abuse has risen in Sierra Leone, a lot of the cases have been thrown out of court because there is no proper evidence or documentation,” Clemens said.
The government has made recent improvements in this area by significantly increasing the prison sentence for rape.
In 2019, it introduced legislation which sets a 15-year minimum sentence for rape – previously the maximum sentence for sexual crimes. It has also launched a widespread awareness campaign, setting up ‘Girls Clubs’ in government schools across the country which teach young women how to react to sexual abuse.
At the Aberdeen Women’s Center in the capital city, Rebecca Larsson, the country director, despairs at the lack of resources in the donor-funded institution to deal with the sheer number of teenage pregnancies.
“Last year we delivered 660 teenage babies here,” she said, at Sierra Leone’s second busiest maternal unit in the country. “It puts huge pressure on our meagre resources.”
Bola, who used misoprostol for an abortion, reports that she is pregnant again and this time wants to keep the baby. She believes what she did was “a sin” and therefore thinks the government should not legalise abortion.
“The government has got to stop the bill because the creator does not like the killing of these babies.” But should abortion remain illegal, young women like Bola will continue to put their lives on the line. Not all will be so fortunate to survive.
