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.