Sierra Leone debates decriminalizing abortion as women and girls endanger their lives

FREETOWN, Sierra Leone (AP) — When she got pregnant at 16, Fatou Esther Jusu was terrified that it would derail her future.

Abortion is illegal in Sierra Leone. Fearing judgment from her family, she took friends’ advice and bought misoprostol, a drug whose uses include abortion, from a local pharmacy. It didn't work. Desperate, she tried again and miscarried.

“I went to the toilet… and the baby came out,” she said. She fainted and was taken to a hospital, where she pleaded with doctors not to tell her parents.

Now 21, Jusu considers herself lucky. One friend died after taking an expired version of the medication.

With those experiences in mind, the nursing student is mobilizing others in support of a bill that would decriminalize abortion in the West African country.

“Even though I made a mistake, this mistake is saving other people,” Jusu said.

Sierra Leone could become the second country in West Africa to decriminalize abortion, which health workers say would significantly improve the safety of pregnant women, decrease the number of preventable deaths and bring an end to the current colonial-era law.

Tens of thousands of women and girls attempt to self-terminate their pregnancies every year in Sierra Leone, where abortion is illegal in all circumstances.

Supporters of the bill say unsafe abortions account for around 10% of maternal deaths. Healthcare workers are known to perform terminating procedures when the situation is “incompatible with life” of the woman, usually in the case of “incomplete” abortions. Because abortion is illegal, they cite other reasons for the termination.

Sierra Leone’s President Julius Maada Bio pointedly introduced the Safe Motherhood Bill after the U.S. Supreme Court overturned Roe v. Wade in 2022, stripping away women's constitutional protections for abortion.

“At a time when sexual and reproductive health rights for women are either being overturned or threatened, we are proud that Sierra Leone can once again lead with progressive reforms,” Bio said.

If approved, the bill would have been West Africa's most progressive legislation on abortion, allowing the procedure for up to 14 weeks.

But Sierra Leone since then has been torn apart by debate. Following opposition from religious leaders, the bill has been amended and now limits abortion to cases of life-threatening risk, fatal fetal abnormalities, rape or incest.

The government says it expects a vote in parliament in the coming weeks. It is not clear whether it will be approved.

An estimated 90,000 abortions are performed annually in Sierra Leone, a country of more than 8 million people, according to research by the African Population and Health Research Center. About 10% of the country's maternal deaths — affecting 717 of every 100,000 births — are due to unsafe abortions, the center said.

Health workers say the true number is likely much higher.

Due to cost and stigma, many women and girls resort to unsafe methods like expired medication, laundry detergent, hangers or sharp instruments.

On a recent morning at a clinic run by the MSI Sierra Leone nonprofit, dozens of women and girls waited nervously for consultations with nurse Hawanatu Samura.

MSI offers “post-abortion care,” including terminations in cases of “incomplete” miscarriage, often when people have tried and failed abortions themselves. The nonprofit is the largest individual service provider of family planning services in the country.

If patients want an abortion, “they go to any length,” Samura said. She often sees damage caused by unsterilized instruments, leading to severe hemorrhages, especially in underage girls.

Over 20% of girls between 15 and 19 in Sierra Leone get pregnant, according to the U.N. Population Fund, one of the highest teenage pregnancy rates in the world.

Samura said a 13-year-old — already mother to a 10-month-old — recently arrived with severe pain after secretly taking unidentified pills to try to abort her pregnancy.

“In Sierra Leone, people are afraid of the stigma … so they would prefer to die silently,” she said. The patient did not understand her body, Samura said, and her dead fetus resulted in dangerous septicemia.

The clinic has at least one such case a month, the nurse said.

Many women and girls who have had abortions fear speaking out, and the push for the bill in Sierra Leone has been led by women’s rights groups and medical professionals.

“If you aren’t listening to your doctors, then who are you listening to?” said lawyer and advocate Nicky Spencer-Coker. She has fought for reproductive rights alongside a coalition of women’s rights organisations since 2015.

At the time, parliament unanimously passed a first version of a bill allowing abortions for up to 12 weeks. But then-President Ernest Bai Koroma blocked the bill amid pressure from anti-abortion and religious groups.

Some Muslim and Christian leaders have denounced the current bill as “ungodly” and “hellish.” Archbishop Edward Tamba Charles, head of the country's Inter-Religious Council, said it contradicts citizens' “religious values and sensibilities.”

Sierra Leone's current president has faced opposition from his own party members, including lawmaker Rebecca Yei Kamara.

“In our communities, children don’t get pregnant … they talk to them, they teach them how to grow up into womanhood,” she said, and accused supporters of the bill of exaggerating the country's abortion statistics.

Government officials have called the bill a necessary response to the reality of high numbers of deaths among pregnant women.

“The number of girls that die every year … that’s the demonstration of people’s will,” Chernor Bah, the information minister, told The Associated Press.

Officials also say the bill is needed to strengthen gender reforms in Sierra Leone, which include last year’s ban on child marriage.

The bill also would allow wider access to family planning and reproductive health services. Activists fear those will be lost if the bill fails.

Both sides in the debate have accused each other of being sponsored by foreign governments.

Some conservative U.S. media have framed the bill in Sierra Leone as a “Biden-backed push” for abortion rights in Africa.

The U.S. embassy in Freetown denied involvement in the bill.

Sierra Leone's Inter-Religious Council has cited the recent changes on abortion access in the U.S. as reference points in their position papers opposing the bill.

Meanwhile, the reality for some pregnant women and girls remains harrowing.

Many healthcare practitioners told the AP they want the bill to pass so they can save lives without fear.

Samura the nurse recalled a mother who had traveled for hours in agony to the capital after drinking a concoction given to her by a traditional healer. Samura accompanied the patient to a hospital to seek treatment for a distended abdomen, severe septicemia and anemia.

The mother of six died in the waiting room.

“Right there on the couch …. everybody was crying,” Samura said. “Anytime I think of her, I wish the bill had been long passed.”

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A woman walks past a b illboards promoting the Safe Motherhood Bill on Wilkinson Road, Freetown, Sierra Leone, Wednesday, 12 March, 2025. (AP Photo/Caitlin Kelly)

Nurse Isha T Kamanda consults a pregnant patient at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

Nurse Isha T Kamanda consults a pregnant patient at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

Nurse Isha T Kamanda holds a positive pregnancy test at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

Mariama Soriba undergoes a procedure for a contraceptive implant at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

A patient is cared for at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

Medical equipment at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

A pregnant patient consults with urse Isha T Kamanda at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

Fatou Esther Jusu, an activist and nurse on the issue of reproductive health and rights, poses at headquarters of feminist group Purposeful in Freetown, Sierra Leone, Thursday March 3, 2025. (AP Photo/Caitlin Kelly)

Hawanatu Samura or "Nurse Awa" instructs a patient to take medication ahead of an evacuation procedure at the Marie Stopes Sierra Leone Reproductive Choices clinic in Freetown, Sierra Leone, Thursday March 3, 2025. (AP Photo/Caitlin Kelly)

A healthcare worker sorts through medication for post-abortion care, family planning and other reproductive health concerns at the Marie Stopes Sierra Leone Reproductive Choices clinic in Freetown, Sierra Leone, Thursday, March 3, 2025. (AP Photo/Caitlin Kelly)

Women wait for consultations at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

A Marie Stopes Sierra Leone Reproductive Choices staff use a megaphone to announce their family planning services in the community, weaving through the stalls of the Luma market in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

Archbishop Edward Tamba Charles of the Inter-Relgious Council poses in his office in Freetown, Sierra Leone Thursday, March 3, 2025. (AP Photo/Caitlin Kelly)

School girls walk home past a mural from women's organisation "Plan International" reading "My Body, My Choice, My Rights" in Freetown, Sierra Leone Thursday, March 3, 2025. (AP Photo/Caitlin Kelly)

Mariama Soriba undergoes a procedure for a contraceptive implant at the Marie Stopes Sierra Leone Reproductive Choices clinic in Njagbahun, Sierra Leone, Saturday, March 5, 2025. (AP Photo/Caitlin Kelly)

ANCHORAGE, Alaska (AP) — A pilot and two children survived on the wing of a plane for about 12 hours after it crashed and was partially submerged in an icy Alaska lake, then were rescued after being spotted by a good Samaritan.

Terry Godes said he saw a Facebook post Sunday night calling for people to help search for the missing plane, which did not have a locator beacon. On Monday morning, about a dozen pilots — including Godes in his own airplane — headed out to scour the rugged terrain for the missing plane. Godes headed toward Tustumena Lake near the toe of a glacier and spotted what he thought was wreckage.

“It kind of broke my heart to see that, but as I got closer down and lower, I could see that there's three people on top of the wing," he told The Associated Press on Tuesday.

After saying a little prayer, he continued to get closer and saw a miracle.

“They were alive and responsive and moving around," he said, adding they waved at him as he approached.

The missing Piper PA-12 Super Cruiser, piloted by a man with two immediate juvenile family members aboard, flew Sunday on a recreational sightseeing tour from Soldotna to Skilak Lake on the Kenai Peninsula.

The three were rescued on the eastern edge of Tustumena Lake on Monday by the Alaska Army National Guard after Godes alerted other pilots searching for the plane that he had found it. Another pilot, Dale Eicher, heard Godes' radio call and alerted troopers since he was closer to Skilak Lake and figured he had better cell reception. He was also able to provide the plane's coordinates to authorities.

“I wasn’t sure if we would find them, especially because there was a cloud layer over quite a bit of the mountains so they could have very easily been in those clouds that we couldn’t get to,” Eicher said. But he said that finding the family within an hour of starting the search and finding them alive "was very good news."

The three survivors were taken to a hospital with injuries that were not considered life-threatening, Alaska State Troopers said.

“They spent a long, cold, dark, wet night out on top of a wing of an airplane that they weren’t planning on," Godes said.

He said there were many miracles at play, from the plane not sinking, to the survivors being able to stay perched atop the wing, to the three surviving the night in temperatures dipping into the 20s (subzero Celsius).

“It's a cold dark place out there at night,” he said.

The plane was mostly submerged in the lake with only the wing and the top of the rudder exposed above the ice and water, Godes noted.

Alaska is a state with few roads, leaving many communities to rely on small airplanes as the preferred mode of transportation.

Last month, in western Alaska, 10 people died when a small commuter plane that was overweight by half a ton crashed into sea ice in the Norton Sound, near Nome on the state’s western coast.

Five years ago, a deadly midair collision near the Soldotna airport claimed the lives of seven people, including an Alaska state lawmaker.

The Alaska Army National Guard dispatched a helicopter from its base in Anchorage to rescue the three people on Monday morning.

The initial plan was to use a hoist to pull the three up and off the wing, but it proved to be too dangerous as the the smallest girl was being buffeted and blown around by the wind created by the helicopter, said Lt. Col. Brendon Holbrook, commander of the guard’s 207th Aviation Regiment. So, instead the helicopter hovered to the side of the plane's wing and pulled the three people on board.

He said his personnel reported the two girls were surprisingly dry but the adult male had been in the water at some point. “We don't know to what extent, but he was hypothermic,” Holbrook said.

Holbrook said he was told the three people had basic clothing one would wear in Alaska on small planes without very good heating systems, but nothing sufficient to keep a person warm outside in winter-like temperatures with cold winds blowing on the lake.

“It was literally the best possible scenario and outcome,” Holbrook said. "Ultimately, the crew of that airplane were lucky because from what my guys told me, that plane was in the ice with the tail refrozen and if that tail hadn’t refrozen, it would have sunk.”

There is no indication why the plane crashed. The National Transportation Safety Board said Tuesday that it is investigating with the Federal Aviation Administration.

The 60,000-acre (24,200-hectare) Tustumena Lake is situated about 80 miles (130 kilometers) southwest of Anchorage and has been described by the Alaska Department of Fish and Game as “notorious for its sudden, dangerous winds.”

Conditions around the lake — with nearby mountains, a glacier and gusty winds — can cause havoc for both boats and planes. The body of water is the largest freshwater lake on the Kenai Peninsula .

“Even under what would be considered a benign or relatively weak pressure gradient, the terrain helps turn the winds around, and occasionally they get a little squirrelly," said Michael Kutz, a meteorologist at the National Weather Service in Anchorage.

Godes agreed that the area is always windy, and fresh water can kick up with the wind and turn into waves.

“Then just the way it’s placed right there at the heel of that, or at the toe of that glacier where you’ve got mountains on both sides, you know, just a few miles to the west, you’ve got Cook Inlet running back and forth with huge temperature and tidal swings every day. It’s just a recipe for chaos and for turbulence," he said.

This photo provided by the Alaska National Guard shows an airplane partially submerged into the ice of Tustumena Lake at the toe of a glacier on Monday, March 24, 2025, near Soldotna, Alaska. (Alaska National Guard via AP)