The death of a mother-of-six from a botched abortion at an unlicensed clinic 10 years ago is one Reverend Patricia Sheerattan-Bisnauth will never forget.

It had been almost two decades since Guyana passed ground-breaking abortion reform legislation, yet no public hospitals offered terminations and doctors were not licensed to carry them out.

“Women were still dying of abortions gone wrong,” Patricia tells the BBC.

“They were using home remedies, bush medicine, unlicensed doctors. The law may have been passed but it took many years for it to be implemented. For me, it was an urgent cause.”

Today, Guyana remains one of few countries in the Caribbean to allow terminations upon request.

Most are beholden to colonial-era laws – backed by religious leaders – outlawing them in all but the most extreme circumstances.

Despite this, clandestine abortions are prevalent.

As a minister in the Christian Church, Patricia may seem an unlikely campaigner for legal reform.

“We are all talking about life, and we are for life. There are too many abortions; we want to address the issues that create them. Decriminalising abortion will bring it out of the darkness and lead to a reduction because people are educated and don’t have repeat ones,” she explains.

Patricia is working alongside regional women’s health charity Aspire to change the law in two Caribbean nations.

Aspire is spearheading legal action in Dominica and Antigua and Barbuda to overturn the 19th-Century Offences Against the Person Act, which stipulates a 10-year prison sentence for a woman who ends a pregnancy. The only exception is when her life is at risk.

When Brianna (not her real name) fell pregnant at 19 in Dominica, she was faced with a difficult choice. A college student with limited funds, she knew she was neither financially nor emotionally ready to become a parent.

Seven years on, the memory of the secret termination she underwent remains acutely painful.

Brianna and her partner had been taking precautions.

“We used contraception most of the time and I was on birth control too. We were both really young and bringing up a child wasn’t something we could have done then,” she explains.

Brianna decided ending the pregnancy was her only option.

“It was a frightening situation. I had no idea where to go and I didn’t want to get into trouble by just walking in somewhere and asking,” she recalls.

Eventually she found a private doctor willing to carry out the procedure, but at more than $600 (£465) – about an average month’s salary in Dominica – the cost was steep.

A nurse took pity on her and loaned her the money.

“I was really scared. I wasn’t well versed on how it would work or what would happen to me. I had to lie to get the time off work. And at the doctor’s, they hid me in a room by myself.

“I felt really isolated, like I was doing something wrong,” she says.

Brianna’s story is far from unique.

A study carried out by Aspire indicates that in Antigua, almost three in four women will have a termination by their mid-40s – practically all of them carried out clandestinely.

Aspire’s founder Fred Nunes – who played a key role in changing the law in Guyana in the 1990s – says he is fighting to “eliminate unsafe abortions”.

He argues that current laws are unconstitutional, an affront to women’s bodily autonomy, and disproportionately affect the poor.

“The women who have the power to change the law have no need to, because they can walk into a doctor’s office and have a safe abortion,” he says.

“The women who have a need to change the law are the poor, the young and the vulnerable. That is why we have to intervene, to end the silence and provoke social justice.”

Prosecutions for covert abortions in the Caribbean are rare, but not unheard of. Aspire cites a handful of cases where women, and the healthcare provider helping them, have been charged in the last decade.

In Dominica, a young woman’s death in May 2023 was blamed on a self-administered termination after police found a foetus buried at her home.

Still, campaigners know they will have a battle on their hands.

The Christian Church plays a key role in Caribbean society and religious leaders have spoken out vehemently against the matter, which is due to come before Antigua’s High Court in September.

The Antigua and Barbuda Evangelical Alliance has condemned what it calls a “deliberate erosion of our moral code… under the cloak of advancing human rights”.

Spokesman Pastor Fitzgerald Semper told the BBC: “We’re directly opposed to any changes in the law. As a church, we believe life is sacred and only God should determine when life should end.

“The current law says that if the mother’s life is endangered, then abortion is permitted, and we stand in agreement with that. There should be nothing added or taken away from the legislation.”

With the church wielding such power, abortion is a delicate area to navigate politically and many Caribbean governments have been reluctant to broach the issue. In Antigua, the government has sidestepped the debate by pledging to leave the matter in the hands of the courts.

“Politicians are scared of the church,” Mr Nunes says.

“In the last few decades in the Caribbean, membership has declined in mainline established churches and risen in evangelical, right-wing dogmatic churches – and those are extremely hostile to women’s rights.

They’ve made it almost impossible to approach improving the law.”

Alexandrina Wong, of Antigua-based campaign group Women Against Rape, wants to see the “archaic” legislation removed, while retaining some restrictions such as term limits.

“We’ve seen women who’ve become pregnant after being raped and their mental state has been affected considerably. They must not be denied the right to choose,” she adds.

Brianna thinks better sex education in schools would alleviate the prevalence of abortion.

Aspire’s study also indicates very low rates of contraception in the region; 80% of pregnancies are said to be unplanned.

“A lot of teenage pregnancies are because youth are just not educated about sex,” she says.

Stigma surrounding abortion means Brianna has kept her own termination largely to herself.

“Even though many people know someone who did it, people still get shunned. It’s a very religious community and people think it’s taking a life,” she says.

“But to expect a woman to go ahead with a pregnancy when she’s not capable of taking care of a child physically, financially or emotionally is unfair on her and the child. I feel that’s worse than an abortion.

“Unless someone has been in that situation, they can’t understand the psychological warfare it can cause.”