Is abortion a family planning method?

MRS Deborah Haruna (not real name), a mother of two, found out that she was pregnant a few weeks after her husband returned after working  in The Gambia for three years.

Deborah, a secretary with a small law firm in Kaduna, found it hard to tell her husband that she was pregnant, especially when he came back with no money or job waiting for him in Nigeria.

“I had no choice than to heed my friend’s advice to terminate the pregnancy in a nearby clinic. I had assumed it was my safe period when we had sex.”she recounted.

The Adeleyes, with four children, also relied on safe period to prevent pregnancy. Initially, its failure did not matter since their family was small. After four children, the couple resorted to abortion to regulate their family.

“My husband always asks that I go for abortion. He tells me that even my friends do the same once they become pregnant. Once I suggested that I go for a family planning method, he said it will make me grow very fat and that it is only for bad women,” said Mrs Kemi Adeleye.

Ironically, many women resort to illegal abortion in planning their families. Some of these women, due to unconfirmed information, avoid available family planning methods, but see abortion as a way out of an unwanted pregnancy.

Is abortion a family planning method? Why is illegal abortion commonly used by many women to regulate fertility, even when its complications when done in an unsafe way can be life threatening?

In 2018, PMA2020 conducted a survey to produce updated and expanded estimates of abortion-related indicators. The survey was led by the Centre for Research Evaluation and Resources Development (CRERD) and Bayero University, Kano.

The PMA2020 study, implemented by local universities and research organisations in 11 countries, provided new insights into the characteristics of women who have abortions and the pathways leading to abortion within or outside the healthcare system.

The programme in Nigeria involved states of Lagos, Kano, Kaduna, Rivers, Nasarawa, Anambra and Taraba.

Dr Funmi OlaOlorun, the co-principal investigator of the PMA2020 survey, who spoke at a 2-day Population Reference Bureau (PRB) Safe Engage/Safe Journalist Training Workshop in Lagos, said the annual number of abortions for women of reproductive age in Nigeria in 2017 rose to between 1.8 and 2.7 million.

Howbeit, prior to this study, estimates that relied primarily on facility-based abortion complication data indicated that there were approximately 33 abortions per 1,000 women ages 15 to 49 in Nigeria in 2012— approximately 1.25 million abortions annually. The majority of these abortions would be considered unsafe [Unsafe abortions can be further classified into less safe and least safe abortions].

Paradoxically, the PMA2020 survey recorded that more than six out of 10 abortions were considered least safe, and 11 per cent of women experienced complications for which they sought post abortion care at a health facility.

Also, women living in rural areas, women with no formal education, and women who are poor were the most likely to have the least safe abortions.

Howbeit, Dr OlaOlorun, said traditional contraceptive methods is still in use in 10 to 15 per cent of cases, based on PMA2020 survey, with many people still using withdrawal, periodic abstinence and safe period methods to plan their families. Unfortunately, none of these is 100 per cent protective against pregnancy.

Even some health workers say they do not allow their wives to use modern contraception. One of the reasons given by a health worker was that his wife had excessive bleeding with IUD once, and he had said ‘no more!’. This may be one of the reasons why the use of withdrawal method is still high.

Dr OlaOlorun added, “the truth is family planning tends to be a sensitive topic to talk about. That is where the conversation on abortion should start, because no woman will want to put her life at risk if she can prevent that pregnancy right from the beginning.”

“We know that family planning methods sometimes fail when they are not used consistently and correctly. But, failure rates are generally low. So, any conversation about abortion that leaves family planning out is not complete, and it is not a conversation that is seeking for a solution to abortion.”

Mrs Stella Akinso, Oyo State team Leader of the Nigerian Urban Reproductive Health Initiative (NURHI), corroborated that many Nigerian women still resort to illegal abortion as a means of child spacing, despite availability of safe family planning methods.

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She declared, “the two are totally different. Abortion is the termination of a pregnancy that has happened before the 28 weeks whereas contraceptives or family planning is preventing that pregnancy from happening at all in the first instance.”

According to her, most women who refused to use modern family planning methods due to myths and misconceptions on family planning tap into loop holes in the Nigerian abortion law that allows abortion when it pertains to their physical health.

Akinso stated that many women resort to illegal abortion as a family planning method because access to family planning services is still low in Nigeria, if the woman cannot afford the money to buy the contraceptive when at the clinic, discouragement by myths and misconceptions about family planning, lack of spousal permission, providers’ attitude and stigma.

She declared, “young people do not go to family planning clinics because the centres are not youth friendly. They are not attractive to young people.  Studies show that youths end up getting more unsafe abortions than other age groups. It is also this age group that run away from contraceptives.”

Mrs Akinso said NURHI was tackling barriers to youths accessing family planning services by training health workers and youths to ensure that if they are sexually active, they should use a contraceptive method to prevent pregnancy, rather than resort to abortion when it occurs.

“Abortion has its own complications. Even if its complication is not life threatening, it might give them some kind of morbidity that they will live with for life,” she added.

Akinso said even at clinics where youths patronise for illegal abortion, talks with them to provide family planning services fall on their deaf ears because they see it running them out of business.

She also stressed the need for government to ensure that reproductive health rights of women, including young girls, be fulfilled.

According to her, “individuals have the right to the number of children they want; space their children or to have sex or not to. It is entrenched in the reproductive rights, which is also part of human rights.

“It is also entrenched in many conventions that Nigeria is a signatory to like the International Conference on Population and Development and the Beijing women’s conference. They all need to be implemented to the letter.”