For every three women who give birth at the James N. Davies Memorial Hospital in Monrovia, another woman is treated for complications after an unsafe abortion. Since January, the maternity hospital in Jacob Town has treated 281 women who have either tried to abort the baby themselves or paid someone else to do it.
“They take a stick and insert it into the uterus where the baby sits. They open it up with the sharpened stick. Sometimes while doing it, the stick breaks inside and stays there. Sometimes you can even see pieces of chalk left inside,” says Dr Torsou Jallabah, the Medical Director at the hospital. “It is very grave, in most cases it is a 50/50 chance of survival. They can even die from it. If it is rotted up, all that can be done is a hysterectomy, so they will never have children again.”
Dr Jallabah sees at least one woman, who’s tried to have her baby aborted, come into the hospital every day. Betty, not her real name, has been here since Sunday. She sits on top of a small hospital bed dressed in a dark sweater, with a pair of purple socks on her feet and a colorful lappa tied around her waist. She looks very frail and her weak voice can hardly be heard.
I just started bleeding small, small. But yesterday I finished cooking so it was getting late and I decided to close the window,” says Betty, as she holds her arms loosely around her stomach. “As soon as I passed behind the house, I pushed the window and I just felt this sharp pain and felt hot stuff coming down from me. I went in the room and took off my clothes and I was bleeding and it was coming thick, thick.”
Betty paid twenty US dollars for an abortion three weeks ago and has been bleeding ever since. The public maternity hospital only caters to emergency cases and is free of charge, which is why Betty chose to come here. “I was just bleeding plenty. Myself I was afraid.”
Betty, who looks more like a teenager than a woman, says she is 26 years old. She explained that she is in college and has no money to raise a child right now, so she felt it was right to abort the pregnancy. And Betty is not alone. One in ten women under the age of 34 has had an abortion according to the first study of its kind in Liberia. And Government authorities are warning that most of those were illegal. The Ministry of Health interviewed 326 women from Bomi, Grand Bassa, Lofa, Montserrado and Nimba counties and found that more than 30% of women with unwanted pregnancies have undergone abortions.
“Unsafe abortion is still a problem in our society,” says Dr. Saye D. Baawo, the Director of Family Health at the Ministry of Health and Social Welfare. “They usually end up in death or in complications that lead to lifelong problems like infertility.”
Dr. Baawo says unsafe abortion is very serious both in the urban and rural areas and cuts across all tribal groups. Although nationwide statistics aren’t yet available, he says young women and teenagers are far more likely to be at risk, increasing the maternal mortality rate in the country. This is something Dr. Jallabah sees first hand at the James N. Davies Memorial hospital every day. “It’s a grave problem because most of them that come are teenagers. They don’t go to renowned hospitals or registered medical practitioners. All of the time, they come with complications.”
More than 90% of Africans live in countries where abortion is restricted. In Liberia, abortion is only legal when a licensed physician believes the pregnancy would substantially risk the mental or physical health of the mother. It is also legal if the unborn child has any serious mental or physical defects or if the pregnancy resulted from rape. However, very few women know this option is available to them. And if they did, a licensed practitioner who would be willing to carry out an abortion is almost impossible to find.
“When a young girl decides to go to a quack to carry out an abortion, the instruments may not be sterile so the girl is exposing herself to HIV because that abortionist may have used that instrument on many people,” says Dr. Baawo as he explains the dangers of unsafe abortions. “It is a blind procedure. You insert the instrument through the cervix but you do not know how far to put it . The person can pull the intestine into the uterus and then you have problems there. If it is not done well, the person can bleed to death. If it is successful and the girl survives, there is a possibility there can be an infection and then she can become infertile. “
The United Nations (UN) Millennium Development Goals, adopted by 189 nations, include the goal of improving maternal health and the specific target of reducing the maternal mortality rate by three-quarters between 1990 and 2015. Dr Baawo says, at the moment, Liberia will not reach this target. “With what the Ministry of Social Health and Welfare has put in place over time, we are sure that although we may not reach the target, we will make significant progress towards reducing maternal mortality in Liberia.”
However, he says the government is aware of the problem of unsafe abortions. “We are training our health workers on how to address unsafe abortions,” he says. “The Ministry of Health has been strengthening the county health teams. So in terms of addressing unsafe abortion, which is one of the causes of maternal mortality, we are making sure we are strengthening the comprehensive emergency obstetric and neonatal services in the county.”
While the government is focusing on how to reduce the rates of maternal mortality and prevent women from having unsafe abortions, Dr Jallabah at the James N. Davies Memorial Hospital says he is worried that the high number of unsafe abortion cases he sees is just the tip of the iceberg.
“It is actually an alarming problem. This is just one hospital. But I really believe it is the same elsewhere,” he says. “I think it’s very, very, very serious. With the number of abortions we see at this hospital, how much more in Greater Liberia? We don’t have these kinds of hospitals there but we know we have our young females there. “
For Betty, recovering in Jacob Town, her experience is one she never wants to go through again. Doctors managed to save her life and unlike many other women, she will be able to have children again. She is one of the lucky ones. “I just want to tell girls that they should not be in the habit of doing (unsafe) abortion because it is not good,” she says. “Me myself, I was just afraid.”