BILL ii

Supplement to the Sierra Leone Gazette Vol. CLXIV, No. 8

13.Accounts and audit.
dated 16th February, 2023
14.Financial year.
15.Annual report.
THE SAFE MOTHERHOOD AND REPRODUCTIVE
HEALTH CARE ACT, 2023 PART V-MISCELLANEOUS
16.Regulations.
ARRANGEMENT OF SECTIONS 17.Repeals

Section.

PART 1–PRELIMINARY
1. Interpretation
2. Object of Act.

PART II - ADMINISTRATION OF ACT

3.Responsibility of Minister.
4.Safe motherhood and reproductive health facilities and services.

5.Reporting requirement.
6.Support to vulnerable women and children.
7.Confidentiality.

PART III - RIGHT OF ACCESS TO SAFE MOTHERHOOD AND REPRODUCTIVE

HEALTH CARE
8.Right to safe motherhood and reproductive health care.

9.Requirement for informed consent.

10.Right to accept or refuse.
11.Protection from discrimination.

PART IV - FINANCIAL PROVISIONS

12.Funding for safe motherhood and reproductive health care services.
18 No. The Safe Motherhood and Reproductive Health Care Act 2023
MEMORANDUM OF OBJECTS AND REASONS

The purpose of this Act is to provide for safe motherhood and reproductive health
care throughout Sierra Leone, to set the standards of sexual and reproductive
health care, to provide for the right to make decisions regarding safe motherhood
and reproductive health and to provide for other related matters.

The Act is divided into 5 parts-

Part I - makes provision for the definition of words used in the Act and states the
object of the Act.

Part II - vests the administration of the Act on the Minister responsible for health
and to facilitate access to the highest attainable standard and quality safe
motherhood and reproductive health care services throughout Sierra Leone.

Part III - deals with the right of access to safe motherhood and reproductive health
No. 2023
care.

Part IV - contains finance and accounting provisions. Sierra Leone

Part V - contains miscellaneous provisions including the power to make regulations
and repeal. A BILL ENTITLED
Short title.
THE SIERRA LEONE PUBLIC TRANSPORT AUTHORITY
MADE this day of, 2023 ACT 2023

DR. AUSTIN DEMBY Being an Act to provide for safe motherhood and reproductive
Minister of Health and Sanitation health care throughout Sierra Leone, to set the standards of safe
FEBRUARY motherhood and reproductive health care, to provide for the right to
FREETOWN make decisions regarding safe motherhood and reproductive health
and to provide for other related matters.

[ ] Date of
commencement.
ENACTED by the President and Members of Parliament in this
PRINTED AND PUBLISHED BY THE GOVERNMENT PRINTING DEPARTMENT, SIERRA LEONE. present Parliament assembled.
GAZETTE NO. 8 OF 16TH FEBRUARY, 2023.
2 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 3

PART I – PRELIMINARY feeding, nurturing care, infection prevention,

Interpretation. assessment of health problems, recognition and
1 In this Act unless the context otherwise requires - response to danger signs, timely and safe referral
"adult" means a person aged 18 years and above; when needed and offered both in the health facility
and at home;
"basic emergency obstetric and new born care"
includes the administration of parenteral antibiotics
"family planning" means the ability of individuals and
or anticonvulsants, administration of intravenous
couples to anticipate and attain their desired number
fluid, using vacuum extractor or forceps to assist
of children and the spacing and timing of their births;
vaginal birth, manual removal of a placenta, removing
the products of conception following a miscarriage
"gender-based violence" means harmful acts directed
or termination of pregnancy;
at an individual based on their gender, and rooted in
"basic obstetric care" means routine care provided for gender inequality, the abuse of power and harmful
women during pregnancy, childbirth and post-natal norms;
period for positive maternal and neonatal outcome;
"health" means a state of complete physical, mental
and social well-being and not merely the absence
"child" means a person below the age of 18;
of disease or infirmity;
"confidentiality" means the right of patients to keep
their records private and represents physicians' and "health care provider" means an individual health
medical professionals' moral and legal obligations professional or a health care facility or organisation
in handling patients' sensitive medical and personal licensed to provide health care diagnosis and
information; treatment services including medication, surgery
and medical devices;
"contraceptive method" means the intentional
prevention of conception through the use of various "infertility" means failure to achieve a pregnancy after
devices, sexual practices, chemicals, drugs, or 12 months or more of regular unprotected sexual
surgical procedures; intercourse;
"emergency obstetric care" means care provided to
treat and save the life of a woman experiencing a "information, education, communication for sexual
complication of pregnancy or childbirth; and reproductive health" means a public health
approach aiming at changing or reinforcing health-
"essential new born care" means care for all babies in related behaviours to promote safe motherhood and
the first days after birth and involves immediate reproductive health through communication
care (delayed cord clamping, thorough drying, methods and principles;
assessment of breathing, skin-to-skin contact, early
initiation of breastfeeding), thermal care, "Minister" means the Minister responsible for Health;
resuscitation when needed, support for breast milk
4 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 5

"new-born" or "neonate" means a child up to 28 days planning, prenatal, delivery and postpartum care, in
of age; order to achieve optimal health for the mother, foetus
and infant during pregnancy, childbirth and
"privacy" means the right to maintain and respect postpartum;
space, including personal space (physical privacy),
personal data (informational privacy), personal "sexual health" means a state of physical, emotional,
choices including cultural and religious affiliations mental and social well-being in relation to sexuality
(decisional privacy), and personal relationships with that requires a positive and respectful approach to
family members and other intimates (associational sexuality and sexual relationships, as well as the
privacy); possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and
"quality" means the degree to which health care violence;
services for individuals and communities - "sexual and reproductive health" means a state of
(a) are safe, timely, effective, efficient, equitable complete physical, mental and social well-being in
and patient centred; all matters relating to the reproductive system where
people are able to have a satisfying and safe sex life,
(b) increase the likelihood of desired health the capability to reproduce and the freedom to decide
outcomes; and if, when, and how often to do so;
(c) are consistent with current professional "sexual and reproductive health services" means health
knowledge; care offered, arranged, or furnished for the purpose
of preventing pregnancy, maternal health, neonatal
"reproductive cancer" means cancers that occur in the health, terminating a pregnancy, managing
reproductive organs and includes cancers in the pregnancy loss, or improving maternalhealth and
breast, cervix, uterus, vulva, endometrium or ovaries; birth outcomes; and includes, but not limited to:
"reproductive health" means a state of complete care for preconception; contraception, maternity care
physical, mental and social well-being and not merely (ANC, Intrapartum, Postnatal, EmONC), termination
the absence of disease or infirmity, in all matters of pregnancy, infertility, STI Management,
relating to the reproductive system and to its reproductive cancer, fistula and other reproductive
functions and processes; health care;

"responsible adult" means a person aged above 21 or "termination of pregnancy" means a procedure or
a Healthcare provider acting in the best interest of process of ending a pregnancy.
the patient or client;
"unsafe termination of pregnancy" means a procedure
"safe motherhood" means initiatives, practices, for terminating an unintended pregnancy carried out
protocols and service delivery guidelines structured either by persons lacking the necessary skills or in
to give mothers high- quality gynaecological, family an environment that does not conform to minimal
medical standards, or both.
6 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 7

"vulnerable women and children" means women, (c) develop standards to be maintained in the
children and persons belonging, or perceived to provision of safe motherhood and
belong, to groups that are in a disadvantaged reproductive health care services throughout
position or marginalised. Sierra Leone including -

Object 2. The object of this Act is to- (i) the number of trained health care
of Act. professionals required to provide safe
(a) provide a framework for the protection and motherhood and reproductive health
advancement of safe motherhood and services in a health facility;
reproductive health rights for every person;
(ii) the type and quantity of diagnostic and
therapeutic equipment required by a
(b) create an enabling environment for the
health facility in order to provide safe
reduction of maternal and child morbidity and
motherhood and reproductive health
mortality; and
services effectively; and
(c) ensure access to quality safe motherhood (iii) the quality of medical supplies for
and reproductive health care services treatment of the complications arising
throughout Sierra Leone. in the delivery of safe motherhood and
reproductive health services;
PART II - ADMINISTRATION OF ACT
(d) promote research and innovation in the field
Responsibility 3. (1) The Minister responsible for health shall, in order to of safe motherhood and reproductive health;
of Minister.
facilitate access to the highest attainable standard and quality safe
motherhood and reproductive health care services, - (e) carry out sensitization programmes on family
planning methods and services;
(a) formulate and implement a comprehensive
national strategy and plan of action to (f) put in place mechanisms to -
promote the realisation of the right to safe
motherhood and reproductive health care (i) enhance access to family planning,
services throughout Sierra Leone; information, counselling and services in
designated safe motherhood and
(b) provide the necessary mechanisms and reproductive health care facilities;
infrastructure to facilitate access to
(ii) improve the education, training and
preventive, promotive, curative,
skills of health professionals including
rehabilitative, palliative sexual and
allied health professionals to ensure
reproductive health services throughout
effective delivery of quality safe
Sierra Leone;
motherhood and reproductive health
care services throughout Sierra Leone;
and
8 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 9

(g) establish linkages and networks with local (c) adolescent friendly health services;
and international developmental partners and
organisations to mobilise and source for (d) prevention and treatment of HIV and other
funding to promote the realisation of the right sexually transmitted infections;
to safe motherhood and reproductive health
and the delivery of effective safe motherhood (e) prevention, detection, and management of
and reproductive health care services. sexual and gender-based violence;

Safe 4. (1) The Minister shall, for the attainment of his (f) prevention, detection, and management of
motherhood responsibility under section 3, - reproductive cancers;
and
reproductive
health care (a) designate public and private safe (g) provision of information, counselling and
facilities and motherhood and reproductive health care services for -
services. facilities;
(i) family planning, including modern
(b) authorise private safe motherhood and contraceptives;
reproductive health care facilities,
(ii) prevention and treatment of obstetric
(c) provide preventive, promotive, curative, fistula;
rehabilitative, palliative, safe motherhood and
reproductive health care services throughout (iii) reproductive health and wellbeing;
Sierra Leone.
(iv) subfertility and infertility.
(2) The safe motherhood and reproductive health care
services to be provided under subsection (1), include - (h) Safe termination of pregnancy services
where -
(a) pre-conception care;
(i) the continued pregnancy will endanger
(b) support during a pregnancy, comprising - the life of a pregnant woman or
adolescent girl;
(i) antenatal, childbirth and postnatal care;

(ii) immunisation and treatment of other (ii) the termination of pregnancy is

conditions; necessary to prevent injury to the
physical or mental health or social
(iii) basic and emergency obstetric care; and wellbeing of a pregnant woman or
adolescent girl;
(iv) essential and emergency new-born
care;
10 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 11

(iii) there is malformation of the foetus (d) mentally challenged.

which will affect its viability or
incompatibility with life; or (2) The Minister, in order to protect and support
vulnerable women and children shall provide -
(iv) the pregnancy is a result of sexual
penetration, rape or incest; (a) free or reasonably low priced safe
motherhood and reproductive health care
(i) prevention and treatment of - services for vulnerable women and children;

(ii) complications of unsafe termination of (b) emergency medical services for vulnerable
pregnancy; and women and children.

(iii) obstetric fistula; 7. (1) A safe motherhood and reproductive health care Confidentiality.
provider shall ensure that -
(j) appropriate referral services for emergencies
and other safe motherhood and
(a) registers and records are kept confidential;
reproductivehealth care services; and
and
(k) prevention and treatment of childhood (b) all necessary steps are taken to ensure that
illnesses. the identity of a patient is not accessible to
unauthorised persons.
(3) Notwithstanding subsection (2), a person shall not
be forced, threatened, enticed or allured to obtain a safe motherhood (2) The responsibility to keep information and records
and reproductive health service under this Act against his wish. on safe motherhood and reproductive health care services
confidential under subsection (1) shall not apply where such
Reporting 5. A safe motherhood and reproductive health care facility information is required by -
requirement. providing safe motherhood and reproductive health care services
under subsection (1) of section 4, shall submit monthly summary (a) the Minister or his authorised designate -
report of its activities and programmes to the Minister.
(i) when carrying out his duties under
Support to 6. (1) The Minister shall, subject to this Act, take such this Act; and
vulnerable measures as may be necessary to protect and support vulnerable
women and
children. women and children in need of safe motherhood and reproductive (ii) for research and statistical purposes;
health care services, who are -
(b) a person in charge of -
(a) in distress;
(b) neglected by family or relatives; (i) a public safe motherhood and
reproductive health facility; or
(c) victims of sexual assault; or
12 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 13

(ii) an authorised safe motherhood and (2) A person shall, in the access of safe motherhood and
reproductive health facility, when reproductive health care services, be -
carrying out his duties under the Act;
(a) treated with dignity and respect;
(c) a person who is acting pursuant to a court
order; (b) accorded respect of privacy and
confidentiality;
(d) the Registrar of a health professional
regulatory body or member of staff (c) protected from harm, ill-treatment and all
authorised by him, conducting an forms of violence including physical, verbal
investigation of an alleged misconduct or and psychological;
negligence; or
(d) protected from economic and sexual
(e) a person to whom the information relates exploitation.
consents that the matter be disclosed.
(3) A safe motherhood and reproductive health care
(3) A safe motherhood and reproductive health care provider who contravenes subsections (1) or (2) commits an offence
provider who contravenes subsection (1) commits an offence and is and is liable on conviction to a fine not less than 5, 000.00 Leones or
liable on conviction to a fine not less than 5, 000.00 Leones or imprisonment for a term not exceeding12 months and may be subjected
imprisonment for a term not exceeding12 months and may be to other disciplinary measures.
subjected to other disciplinary measures. Requirement
9. (1) A safe motherhood and reproductive health care for informed
PART III - RIGHT OF ACCESS TO SAFE MOTHERHOOD AND provider shall provide safe motherhood and reproductive health consent .
REPRODUCTIVE HEALTH CARE care services to a person who has given their informed consent.

Right to 8. (1) A person shall have the right of access to - (2) Informed consent shall, for purposes of subsection
safe
motherhood (1), be obtained, in the case of-
and (a) the highest attainable level of safe
reproductive motherhood and reproductive health (a) a minor, from persons with parental
health care
careservices without bias or discrimination responsibility or a responsible adult acting
based on gender, age, sex, marital in the best interest of the minor;
status,socio-economic status, physical or
other disabilities, geographical location, (b) A person with cognitive disability, with the
ethnicity, religious belief, tribe, political consent of a responsible adult;
affiliation, education level or other status;
(c) an emergency, including -
(b) safe motherhood and reproductive health
information, education and counselling.
14 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023 15

(i) loss of consciousness; (2) A safe motherhood and reproductive health care
provider who contravenes subsection (1) commits an offence and is
(ii) incapacitation; or liable on conviction to a fine not less than 5, 000.00 Leones or
imprisonment for a term not exceeding12 months and may be
(iii) other life-saving intervention, from a subjected to other disciplinary measures.
responsible adult.
PART IV - FINANCIAL PROVISIONS
(3) A safe motherhood and reproductive health care
provider who contravenes this section commits an offence and is 12. (1) The activities of the Ministry in relation to safe Funding for
liable on conviction to a fine not less than 5, 000.00 Leones or safe
motherhood health care services shall be financed by funds motherhood
imprisonment for a term not exceeding12 months and may be consisting and reproductive of - and
subjected to other disciplinary measures reproductive
health care
(a) monies appropriated by Parliament to the services.
Right to 10. (1) A person shall have a right to express choices and Ministry for the purposes of providing safe
accept or preferences in respect of diverse safe motherhood and reproductive
refuse.
motherhood and reproductive health care
health care services and procedures. services;

(2) Notwithstanding the generality of subsection (1), a (b) monies given to the Ministry by way of gifts,
woman or adolescent girl shall have the right to determine, on her endowments, bequest, grant or other
own behalf, matters relating to - contributions by persons and organisations
for the purposes of providing safe
(a) family planning including - motherhood and reproductive health care
services;
(i) the number and spacing of her children;
(c) all other monies which may, from time to time,
(ii) whether to continue with or terminate a accrue to the Ministry for the purposes of
pregnancy; providing safe motherhood and
reproductive health care services.
(b) choice of companion during maternity
(2) The funds to the Ministry under subsection (1) shall
care, labour or delivery.
be applied only for the purposes of providing safe motherhood and
Protection reproductive health care services approved in the budget of the
11. (1) A person shall not be discriminated against in the
from Ministry.
discrimination. access to safe motherhood and reproductive health care services
on grounds of origin, religion, race, ethnicity, age, sex, occupation,
13. (1) The Ministry shall keep proper books of account and Accounts
sexual identity, physical or health condition, disability, marital status, and audit.
other records in relation to the activities, property and finances of
pregnancy, creed, state of reproductive morbidity, personal
the Ministry under subsection (1) of section 12, in a form approved
relationship or any other status.
by the Auditor- General, and shall prepare in respect of each financial
year of the Ministry Finance an annual financial statement which
shall include -
16 No. The Safe Motherhood and Reproductive Health Care Act 2023 No. The Safe Motherhood and Reproductive Health Care Act 2023
17
(a) balance sheet accounts; 14. The financial year of the Ministry shall be the same as the
Financial
financial year of the Government of Sierra Leone. year.
(b) income and expenditure accounts; and

(c) source and application of funds.

15. (1) The Minister shall lay copies of the annual report on Annual
the performance of its functions, in relation to the provision of safe report.
(2) The accounts of the Ministry kept under subsection
motherhood and reproductive health care services during that year
(1) shall, not later than 3 months after the end of each financial year,
and on its policy and programmes, before Parliament
be audited by the Auditor-General or an auditor appointed by him.
(2) The annual report submitted under subsection (1),
shall include the accounts and annual financial statement prepared
(3) For the purposes of subsection (2), the Auditor-
under section 11 and the report of the audit thereon.
General or the auditor appointed by him, shall be entitled to have
access to all books of account, vouchers and other financial records
(3) The Ministry shall make copies of the annual report
of the Ministry and to require s u c h
available to all stakeholders once it has been laid before Parliament.
information and explanation thereon as he may think fit.
PART V -MISCELLANEOUS
(4) The Ministry shall provide the Auditor-General or the
auditor appointed by him with all necessary and appropriate facilities
16. The Minister may, by statutory instrument, make Regulations.
for the examination of the accounts and records of the Ministry.
regulations, for the effective carrying out of the provisions of this
Act.
(5) The Auditor-General or an auditor appointed by him
shall submit to the Minister, a report on the audited accounts and the
17. (1) Sections 58 and 59 of the Offences against the Person Repeals
financial statements referred to in subsection (1) and shall, in his
Act are hereby repealed.
report draw attention to -
(2) Paragraphs (b) and (c) of subsection (1) of section 35
(a) any irregularities in the accounts;
of the Pharmacy and Drugs Act are hereby repealed.
(b) any matters that are likely to adversely affect
the activities of the Minister in relation to the
provision of safe motherhood and
reproductive health care services under this
Act; and

(c) any other matter which, in his opinion,

ought to be brought to the notice of the
Minister.