FREETOWN, Sierra Leone – For nearly two years, Sierra Leone’s Safe Motherhood and Reproductive Health Care Bill has been stuck in a political and social tug-of-war that has little to do with the technical business of passing a health law. 

Instead, the country is wrestling with who gets to define reproductive health in the country: Parliament, doctors, women, religious leaders, families, and so on. 

The Bill was introduced in Parliament on 17 December 2024. Health Minister Dr Austin Demby motivated the reforms, saying that 82% of illegal abortions resulted in complications and teenagers accounted for a significant proportion of maternal deaths.  Demby also advocated for better support for pregnant schoolgirls and greater choice about unwanted pregnancies.

But the Bill was met with an immediate outcry from religious leaders. The Speaker then referred it to Parliament’s Legislative Committee for further consultation. 

At a stakeholder meeting hosted by President Julius Maada Bio in January 2025, the President conceded that his Cabinet had approved the legislation but called for Parliament to engage more with religious and other parties. 

By March 2025, Parliament noted simply in relation to the Bill: “Further consultation to be held.” 

Over a year later, in July 2026, civil society groups, health professionals, and MPs are still asking Parliament to fast-track it. The Bill is being kept alive, but it is not allowed to move.

Conservatives woo First Lady

The political climate surrounding the Bill has become more complicated by the staunchly anti-abortion Trump administration resuming control of the United States government in January 2025. 

In late December 2025, Sierra Leone and the Trump administration signed a bilateral aid agreement in terms of the America First Global Health Strategy. The US will contribute $129 million to assist the country’s various health concerns while Sierra Leone will invest $44 million.

First Lady Fatima Maada Bio has also become the subject of intense focus for conservative anti-abortion campaigners, particularly from the US.

Fatima Bio has long been a public champion of girls’ rights, reproductive health, and gender equality.  In 2024, during the We Are Equal campaign in Angola, she stated: “Our bodies should no longer be defined, limited, and violated just because men or society can.” 

But conservatives have intensified efforts to engage with the First Lady since the introduction of the Safe Motherhood Bill.

In June 2025, the Church of Jesus Christ of Latter-day Saints (Mormons) hosted a conference on “Strengthening Families” in Freetown, and invited the Office of the First Lady to collaborate, with the First Lady giving a keynote address.

According to the church, First Lady Bio “has had multiple interactions with the Church, including visiting Church headquarters in Salt Lake City in 2024 and hosting Elder D Todd Christofferson of the Quorum of the Twelve Apostles in her home in 2025”.

Also attending the conference were US anti-rights groups including Family Watch International (FWI), led by Sharon and Greg Slater from the same church. FWI has been campaigning against abortion for more than two decades in Africa, and both Slaters also addressed the conference.

Mariama Zumia Zombo, MP, told Health Policy Watch that she had been heavily influenced against the Safer Motherhood Bill by the Strengthening Families Conference. 

“I am strongly religious. Even though I have a public health background, I am against abortion,” she said. 

Meanwhile, Valerie Huber, a key ally of US President Donald Trump and one of the drivers of the global anti-abortion Geneva Consensus Declaration (GCD), has held several meetings with the First Lady.

Huber, one of the architects of the GCD and its chief negotiator in Africa, heads the Institute for Women’s Health (IWH).

First Lady Bio described their meeting in March, as a “transformative conversation” that “explored meaningful opportunities for collaboration”.

Yesterday, I had the pleasure of meeting and engaging in a transformative conversation with Valerie Huber, President and Founder of the Institute for Women’s Health, who previously served as the U.S. Special Representative for Global Women’s Health at the U.S. Department of… pic.twitter.com/EtDzwHI2OW

— H. E. Fatima Maada Bio (@FirstLadyBio) March 27, 2026

Health law that became an abortion debate

The first mistake is to call the proposed legislation an “abortion bill.” It covers so much more, including maternal and newborn care, family planning, reproductive health information, adolescent services, protection for vulnerable women and children, emergency care, and setting standards for reproductive health services. 

But abortion has taken the lion’s share of the public conversation. The Bill proposed to legalise abortion up to 14 weeks for any reason, and even later if the continued pregnancy would endanger the life of the pregnant woman or girl, in the case of rape or incest, or a severely malformed foetus.

The government’s main motivation for decriminalising abortion is to reduce maternal mortality. The country has made significant progress, moving from the highest maternal mortality rate in the world in 2000 – 1,682 deaths per 100,000 births – to 354 deaths by 2023, a reduction of 79%. 

But this is still about three maternal deaths per day, with unsafe abortions accounting for around 10% of these deaths, as well as severe complications. There is also a very high rate of teen pregnancy.

Religious objections

The Inter-Religious Council of Sierra Leone (IRCSL) is a powerful group of Christian and Muslim leaders who are opposed to abortion. 

The council asserts that life starts at conception and that abortion runs counter to religious teaching and Sierra Leone’s social and cultural values. The IRCSL has also questioned some of the health statistics used to justify reform. 

Religious leaders and other parties have made representations to Parliament’s Legislative Committee, and a pattern has followed: consultation, compromise, more consultation, and no finalisation.

In January 2025, Catholic Archbishop Edward Tamba Charles, president of the Inter-Religious Council, rejected government claims that the council had already backed the Bill’s proposals. 

He said it was “premature” to comment because amendments were still being considered.

To accommodate religious objections, the government has sought to narrow the most controversial provisions as much as possible. 

By January 2025, the government proposed to restrict access to safe abortion to situations where the life or physical safety of the pregnant woman or girl is at risk, the foetus is not viable, or the pregnancy is a result of sexual violence. 

Religious leaders were given another chance to review the amendments. But the compromise, in short, did not win the argument.

Parliament is divided

At President Bio’s stakeholder meeting in January 2025, Abdul Marray Conteh, chair of Parliament’s Legislative Committee, said that the committee had received 18 position papers, 16 supporting and two opposing the Bill. 

Parliament had also held meetings to go through the religious leaders’ concerns “line by line,” he said. 

Conteh also confirmed in an online TV interview that the Bill is still pending in Parliament, refuting allegations that it had been surreptitiously tossed out. 

However, he did not clearly state whether it would be passed soon. 

But if the majority of position papers submitted supported the Bill, why is consensus so elusive? The answer seems to lie not in the number of position papers but in the political weight of those that oppose it. 

In April 2025, Daniel Brima Koroma, deputy leader of the opposition All People’s Congress (APC) made it clear that the Bill would not be passed into law in the next three years “while MPs with Christian values were in Parliament”. 

Koroma added that legislation regarding motherhood must be appropriate to Sierra Leone’s cultural, traditional, and religious context. 

Women’s advocates decry the delay

Purposeful, one of the country’s leading feminist organisations, points out that Sierra Leone has spent more than a decade debating the issue. Back in 2015, the Safe Abortion Bill was passed by Parliament but never introduced into law after religious opposition. 

In June 2025, Dr Ramatu Bangura, co-CEO of Purposeful, wrote in the national media that the Bill it would save lives.

“Without a comprehensive law on reproductive health, our medical professionals and facilities are left vulnerable, girls and women are denied clarity on their rights, and policy remains subject to politics, not public health,” said Bangura.

Bangura also lamented that Sierra Leone has “become a battleground for rights”. 

“Local far-right civil society and religious groups, with the support of far-right American evangelicals, have taken a stand against the passage of the Safe Motherhood Bill, further endangering the lives of Sierra Leonean girls and women,” she warned.

“If policymakers truly want to strengthen families and protect women, then they need to pass legislation that allows us to have the reproductive healthcare that we need and end the pandemic of sexual and gender-based violence that is prevalent in our beloved country.”

So what now?

The answer cannot be another endless round of consultations. Parliament needs to publish the current version of the Bill, including every substantive amendment made since December 2024, and the recommendations received from religious leaders and other stakeholders. 

The Legislative Committee should make clear what is still unresolved. If consultation is the reason for delay, Parliament should tell which consultation is still outstanding, with whom, and why it has taken so long. 

Last month, a coalition of MPs, women’s groups and health professionals meeting in Makeni again called for the Bill to be fast-tracked. 

The meeting, hosted by the Girl Child Network, Marie Stopes Sierra Leone, and Purposeful, also urged the government to act against misinformation about the Bill.

Catherine Zainab Tarawallie, MP, told the meeting that the legislation contains crucial provisions intended to safeguard women and girls during pregnancy and childbirth, according to news outlet Sierraloaded.

A new point of contention is whether women need the consent of their spouses to terminate their pregnancies. This might be the most convincing indication that the Bill isn’t merely waiting for Parliament. It is also waiting for Sierra Leone to decide how far it is prepared to go in reconciling faith, family, individual rights and public health.

Purposeful’s Bangura warns against “allowing religious zealots to hold sway over politicians and policymakers who have a duty to make decisions in the best interest of the most marginalised among us”. 

This country has already spent years debating the question. At some point, consultation has to end, and legislation has to begin.

However, the law alone will not save women and girls. Sierra Leone needs trained health workers, medicines, referral systems, blood supplies, functioning emergency services and money to implement whatever Parliament eventually approves.

Image Credits: Ministry of Health, Sierra Leone, Ministry of Health, Sierra Leone, Church of Jesus Christ of Latterday Saints, Office of the First Lady, Sierra Leone.