MRS Sherifat Haruna, a mother of one, was thrown into a dilemma when her 14-year old niece with hearing deformity was impregnated by her husband during the lockdown to stop the spread of COVID-19. She was torn between asking her to abort, retain the baby in the home or give it for adoption after delivery. Either of these solutions comes with several challenges.
Mrs Nike Azeez’s dilemma is different. She got pregnant after robbers came to her house and raped her. The husband couldn’t stop them because they threatened to kill him. It was weeks after when she discovered that she was pregnant.
Many Nigerian women, including adolescents, daily face similar situations, including different forms of sexual violence like rape, sexual abuse and violent acts against sexual integrity, including female genital mutilation and obligatory inspections for virginity. They are left with reproductive health, physical, social, psychological and mental health consequences.
Findings from a National Survey carried out in 2014 on Violence Against Children in Nigeria confirmed one in four females reported experiencing sexual violence in childhood with approximately 70 per cent reporting more than one incident of sexual violence. In the same study, it was found that 24.8 per cent of females’ ages 18 to 24 years experienced sexual abuse prior to age 18 of which 5.0 per cent sought help, with only 3.5 per cent receiving any services
Unfortunately, its reproductive health consequences such as sexual dysfunction, unwanted pregnancy which may result in unsafe abortion and death, sexually transmitted infections, including HIV/AIDS, and genital injuries and gynaecological complications like bleeding and urinary tract infections are better imagined than felt.
“A high percentage of pregnancy that results from sexual violence ends up in abortion” Lucky Palmer, the country director, Ipas Nigeria, noted.
This was at a three-day Ipas media training for journalists on women’s sexual reproductive health and rights and global gag rule. It is an international non-profit advocacy group that is focusing on improving and expanding women’s sexual and reproductive rights.
Mr Palmer declared, “The environment is not favourable for women of Nigeria to seek safe sexual and reproductive health within the law. For instance, abortion is only allowed when the life of the woman is at risk.
“A critical question is, when is the life of the woman at risk? Is it when she is ill? Is it psychological or a physical situation we are talking about? These are the questions we should ask so that our laws could be a little bit more inclusive and allow doctors to serve their clients in a better way.”
Howbeit, in 2017, between 1.8 and 2.7 million unsafe abortion occurred in the country, in about 41.1 per 1000 females aged 15 to 49. The most affected are adolescent girls due to restrictive abortion laws, poor access to information on contraception access and use, access to safe abortion services and shortage of trained staff and equipment.
Women’s sexual and reproductive health is a fundamental right that is recognised by the World Health Organisation and it is to ensure the right of women freely and without coercion, violence or discrimination, to have control over and make decisions concerning their own sexuality, including their own sexual and reproductive health.
However, Mr Palmer stated that the global gag rule (GGR) which restricts the ability of non-American NGOs receiving funding from the US providing services or restricting the type of services that they provide under sexually and reproductive health and rights, is impeding this in Nigeria and many other countries.
“The law says that they are not allowed to provide abortion services, counselling or referrals regarding abortion or to conduct a public campaign on abortion access. However, it does not prohibit abortion counselling or referrals in cases of rape, incest or life endangerment,” Palmer added.
The U.S remains the single largest donor country to global health efforts, including maternal and child health, HIV prevention and treatment, malaria and Zika programmes. Therefore, any decision they make to support global health is expected to have far-reaching impacts on sexual and reproductive health and other health initiatives across the world.
The global gag rule, a US policy first implemented in 1984 but reinstated by US President Trump, is imposed on virtually all global health assistance. The non-American NGOs are forced to certify to not use their own private funds to provide abortion services, counselling or referrals regarding abortion, advocate for abortion law reforms in their country or conduct a public campaign on abortion access to retain US funding.
Unfortunately, the global gag rule has also indirectly restricted these NGOs’ provision of other public health services, including HIV/AIDS-related care, tuberculosis, family planning services and other communicable diseases.
Dr Abiola Akiyode-Afolabi, Women Advocates Research & Documentation Centre (WARDC), Lagos declared “it has precluded alliances of NGOs essential for solving public health crisis.”
She said numerous statistics attest to the adversity of GGR on health and human rights of women, given the 70 per cent of the world’s one billion poorest people.
According to her, “Though the Global Gag Rule was meant to target abortion providers, it has terrible consequences for the health and lives of poor women and their families in ways that have nothing to do with abortion.
“The Global Gag Rule affects family planning, HIV services, maternal and child health, and even malaria services. And in no place does the policy reduce abortions. In fact, the irony is that this policy leads to more unwanted pregnancies.
“The rule will put thousands of international healthcare workers in the difficult position of deciding whether to continue to offer family planning care that includes abortion at the expense of a critical funding stream. It has led to unsafe abortions and a major cause of maternal mortality and kills tens of thousands of women every year.
“Paradoxically, family planning organizations have found that a country’s abortion rate does not closely correlate with whether abortion is legal or easily accessible. Twenty million of the 46 million abortions performed annually worldwide occur in countries with highly restrictive abortion laws.”
Dr Steven Lemadoro, a consultant obstetrician and gynaecologist, stated that conditions many women pass through are heartbreaking despite women’s reproductive health rights that are entrenched in universal human rights.
He declared: “A lot of the time, issues on sexual violence, including rape and incest, oftentimes result from the things that we do. We do not ensure that at all times that women have the right to make decisions over their own bodies, including sexual and reproductive health, and that the right should be protected.”
Dr Lemadoro said the non-domestication and implementation of many conventions the government was a signatory to ensure that women’s sexual and reproductive health and rights are protected was a limitation to women’s wellbeing.
The expert added that liberalizing abortion law in Nigeria does not force anybody to offer abortion services or to access it, but only gives the benefit of choice to women that may want it.
“We are talking about the need for the government to tinker with it; protect those who object while allowing those who desire such services to be able to access them in safe and confidential settings. Unsafe abortion remains a major contributor to maternal mortality in Nigeria,” he added.
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