INDUCED abortion is illegal in Nigeria, except when performed to save a woman’s life. Both the penal code, which is generally applied in the country’s northern states, and the criminal code, which generally applies in the southern states, allow this exception and the regions specify similar criminal penalties for noncompliance.
Yet, pregnancy terminations are quite common and because they are often performed clandestinely or by unskilled providers, they are sometimes unsafe. A recent survey indicated that unintended pregnancy and abortion are experienced by women worldwide.
Dr Jonathan Bearak, a Senior Research Scientist at Guttmacher Institute, in a global overview on unintended pregnancies and abortion, stated that most abortions happen because the pregnancies are unwanted at the time of conception, or if they occurred earlier than desired, or what in public health is termed unintended.
He spoke during a special session on: ‘The Public Health Challenges of Unintended Pregnancies and Abortion: Global and National Dimension’, facilitated by a non-governmental organisation, Academy for Health Development (AHEAD), Ile-Ife, Osun State, in collaboration with Guttmacher Institute, New York, United States.
The session was part of activities of the fifth Scientific Conference of the Society for Public Health Professionals of Nigeria (SPHPN), held at the Lagos State University Teaching Hospital (LASUTH), Ikeja.
Bearak said between 2015 and 2019, 250 million pregnancies on average occurred yearly, adding that 121 million of these pregnancies were unintended (wanted later or not at all) and 73 million end in abortion each year.
The Guttmacher Institute’s new global estimates indicate that unintended pregnancy incidence among women aged 15 to 49 years are the lowest in high-income countries and higher in low- and medium-income countries. It was 34 per 1,000 in women aged 15 to 49 in high-income countries and 93 per 1,000 in women aged 15 to 49 years in low-income countries.
“Abortion rates are similar in countries where it is legal and prohibited. While the unintended pregnancy rate and abortion rate have reduced globally, unintended pregnancies ending in abortion and pregnancies ending in abortion have increased.
“In high-income countries with broadly legal abortion, unintended pregnancies ending in abortion and pregnancies ending in abortion have decreased, but rather had increased in a larger amount in counties which prohibited abortion, with wide variation in rates, including among countries in a region,” the report noted.
Professor of Community Medicine and Public Health, Adesegun Fatusi, who gave Nigeria’s specific estimates on unintended pregnancies and abortion, said unsafe abortion results in high level of maternal death and is the fourth leading cause of maternal death globally.
According to him, no fewer than 67,000 women die annually in Nigeria from pregnancy-related causes, with a record of at least 20 deaths daily across the country, adding that about 11 percent of deaths among mothers are due to abortion.
“That is worrisome. However, we do know from global data that deaths from abortion are due to unsafe abortion, because the statistics show globally that safe abortion does not necessarily lead to increased maternal mortality. The risk is not as significant. So, anytime we talk about abortion and death, we are practically talking about unsafe abortion.
“The proportion of deaths from abortion could be higher than what we are saying, because some of the figures on women who are bleeding in pregnancy can be due to abortion, but the women will not talk about it,” he said.
Professor Fatusi declared that global law had not been able to deter women who want abortion and to stem abortion, making it imperative to fully understand why abortion happens though unintended pregnancy is established as the major cause.
“By ensuring every woman that needs contraceptives can have the information, education, services and obtain the contraceptive, we can cut down the potential of abortion substantially. That is the starting point.
“A higher proportion of people who are affected by unsafe abortion in Nigeria are young women between the ages of 15 and 19 that do not have access to comprehensive sexual education and who do not have money to procure safe abortion,” he added.
Fatusi said abortion has a huge cost for the health system and, as such, the need to look at laws on the sexual and reproductive health of women and social norms and practices that discourage or deny people the opportunity to access contraceptives.
He stated: “If all needs are met for contraceptives, maternal, newborn and abortion care in Nigeria, unintended pregnancies would drop by 80 percent; abortion would drop by 80 percent; unsafe abortion would drop by 80 percent, maternal deaths would drop by 61 percent and newborn deaths would drop by 76 percent.
“It is interesting that if a woman is dying from abortion complications, our health service guideline says such a woman must access services, but if the woman wants access to safe abortion, she cannot.”
On his part, Dr Ejike Oji, a physician and chairman, Management Committee, Association for the Advancement of Family Planning, posited that the rates of unintended pregnancies and abortion are going up in Nigeria, leading to a rise in abortion-related deaths.
“Whether it is legal or not, women will want to terminate pregnancies they could not prevent. The greatest cause of infertility in Nigeria is complications of unsafe abortion. Often, we always push abortion as the fifth most commonest cause of pregnancy-related causes, but to me, it is second, following bleeding after childbirth,” he said.
Dr Oji said Nigeria needs to do more to stem abortion and ensure that gains made on family planning are not reversed in the country due to the stock-out of long-acting reversible contraceptives like implants.
“There are no implants across the country and this can lead to our modern contraceptive prevalence rate going down soon, with unintended pregnancies and abortion-related deaths going up. These are some of the gains of family planning services that are about to be reversed,” he said.
Country Director of Ipas Nigeria Health Foundation, Mr Lucky Palmer, decried the alarming rate of abortion and deaths as a result of unsafe abortion in the country, especially among adolescents and urged stakeholders and the government to stem the deaths.
“Within an hour, at least two women will die in Nigeria, so if we really must move forward, we must collectively pay attention to the health of women. We only need to amend the law and give authority to the health workers to provide the right care and treatment for women, including contraceptives.
“Abortion is a right of every woman that needs to be treated; it is not a social concept. Abortion is a low-hanging fruit that we can stop to ensure that Nigeria meets its MDG targets come 2030,” he added.
Country Director, MSI Nigeria Reproductive Health Choices, Mr Emmanuel Ajah, said the Guttmacher Institute’s new global estimates on abortion certainly had missed many that were not reported across the country and called for sincerity and support of government to drive sexual and reproductive health services.
“In some communities, especially in the North, we have poor human resources for health. So we need to make sure that even as we embark on task shifting, more people can be equipped to continue to provide health services.
“We need to ensure that all religious, traditional and social norms that continually impede the uptake of family planning services must be addressed. Our women should be able to make choices regarding their lives.
“If malaria drugs can be bought by the government and kept so that people can use them, I think family planning products should also be bought to make them available to women who need them, too,” Ajah said.
National Coordinator, African Youth and Adolescent Network on Population and Development, Elizabeth Alatu-Williams, asserted that many adolescents engage in unsafe sex leading to unintended pregnancies and, in the long run, unsafe abortion, as she stressed the importance of comprehensive sexuality education for the adolescents and young persons.
She said: “It is a form of education that empowers them with life skills around goal-setting, self-esteem, values, assertiveness, being able to make decisions for themselves, being able to say no to sex until when they know that they are ready and also being able to engage in safe sex if at all they have it or engage in sexual activities.”
Other participants at the conference enjoined the government, religious leaders, parents, teachers and other stakeholders to up the game and make safe spaces available for adolescents so they can make the right choices and be protected from death occasioned by unintended pregnancy leading to unsafe abortion.
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