Safe Motherhood Bill: Justifying Murder by Saving the Mother!

By Jia B Kangbai

I am for pro-life, and I also support women to determine their health outcomes only if is based on sound clinical evidence or medical opinion. Much has been said about the Safe Motherhood Bill; here are my submission to this national debate based on my 18 years public health background:

1.            Abortion is not the leading cause of maternal mortality (MM) in countries (including Sierra Leone) with high maternal mortality rate (MMR) – severe hemorrhage and infections (sepsis) during or after child birthing, HBP (pre-eclampsia and eclampsia), complications from child birthing are the four leading causes of MM. In fact, unsafe abortion only ranks as the fifth cause.

2.            Ninety-eight percent of abortion mortality is due to unsafe and criminal abortions which are performed by quacks and most often in non-clinical environments. So, the noise connecting abortion and MM is not abortion but where it is performed and who performed it. Like all clinical operations, including surgeries, there is always a miniscule probability of failure mostly based on who performed it and where it was done.

3.            Majority of unsafe abortions are committed by desperate women hence the term: Desperate Abortion. The trigger for majority of Desperate Abortions is unwanted pregnancy and not based on clinical evidence or medical opinion. An SSS1 girl is more likely to commit unsafe abortion leading to her death compared to a married woman because she is desperate for her status not to be identify both at home and school.  

4.            The Safe Motherhood Bill as it stands empowers the woman to make a family decision without the consent of her partner – such an empowerment has the potential of undermining traditional family value in Sierra Leone. I agreed that this contention issue deals more directly with the affected woman, however, the decision to have or not to have a child should come from both parties.

5.            In public health, anytime a system tries to offer as free through a public health policy without duly following Health-Belief Model Theory (HBMT) will boomerang. In the early 2000, an attempt by the West (USA, Canada and Britain) to ‘legalize hard drugs’ by selling small portion of medical cannabis to their youths has today led to a global drug pandemic simply because with an easy access to medical cannabis people increase their demand for it, leading to a reduction of the effect of the drug anymore in their system. The ultimate route now left is to go for a higher impact drugs like Ecstasy, Kushe etc.

6.            The HBMT believes that individuals make changes in behavior (in this case unprotected SEX) on their perception of the severity of the potential health problems. So, if a girl/woman perceive having unprotected sex can lead to unwanted pregnancy that has a high tendency leading to death, that girl/woman would either abstain or use contraceptives. The Safe Motherhood Bill as it stands offers a negative feedback loop system to the HBMTB.

7.            Interestingly even in the US, not all states have legalized abortion and those that have do so based on sound clinical and medical opinions and findings: currently about 26 States are either totally against or severely limiting abortion, while few others have it being debated in various legal systems. 

8.            The way out for this Bill is to fine tune some of its clauses to capture its good elements. Not all abortions are due to unwanted pregnancies that have the high chances of death. A good number of the pregnancies that occur are needed but during their process complications occur placing the life of both the mother and or unborn child on high risk of death – such pregnancies require clinical-decision based abortion. Such an abortion must be certified by a clinician backed by the laboratory results and decision processes that were followed to arrive at such conclusions. Sierra Leone should not be rushed into arriving at the conclusion to make abortion free and legal perhaps because of foreign pressure. Most of the elective-specific abortion procedures done in the West are purely clinical-decision based abortion, while those that had to do mostly with unwanted pregnancies, are being done in backstreet abortion clinics like in Third World Countries often with severe consequences including death.

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More about the Author

Jia Bainga Kangbai is a USA States Department William Fulbright Fellow and a Germany DAAD Fellow

Jia did his PhD at the University of Munich, Germany and his MPH (Epidemiology and Biostatistics) at the University of Kentucky

His interest is applying Machine and Deep Learning and AI in solving medical problems. He has recently shift focus on health system strengthening.