Unsafe abortion: Silent epidemic on the prowl in Nigeria

Nigeria’s abortion laws are some of the most restrictive in the world. In this article by SADE OGUNTOLA, experts say despite this, the unsafe abortion rate in the nation has reached an epidemic state and is contributing to Nigeria’s worsening maternal mortality rates.

 

IN most countries, large numbers of women every year become pregnant without planning or wanting to have a child at that time in their lives, and some may be more distressed than joyful under these circumstances.

This is the case in Nigeria where hundreds of thousands of women every year become pregnant without wanting to, and where many women with unwanted pregnancies decide to end them by abortion.

Unwanted pregnancy is at the very heart of why large numbers of both disadvantaged and advantaged women also seek treatment for abortion-related complications.

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Unfortunately, “55,000 unsafe abortions happen all over the world every day and 19 million unsafe abortions occur in developing countries every year,” Professor Adetokunbo Fabamwo, a consultant obstetrician and gynaecologist, Lagos State University Teaching Hospital (LASUTH), said.

Professor Fabamwo, the Chief Medical Director, Lagos State University Teaching Hospital (LASUTH) spoke at a two-day Population Reference Bureau (PRB) Safe Engage/Safe Journalist Training Workshop in Lagos.

In Africa, nearly half of all abortions happen in the least safe circumstances. The risk of dying from an unsafe abortion is the highest in Africa, where most are carried out by non-physicians.

Currently in Nigeria, “unsafe abortion contributes 13 per cent to all pregnancy-related deaths. About 610,000 unsafe abortions occur in Nigeria every year and half of the women that will die from it are young people or adolescents”, said Professor Fabamwo.

Paradoxically, in 2018, the Performance Monitoring and Accountability 2020 (PMA 2020) survey, the most recent family planning data for Nigeria and Lagos indicated that abortions by women between 15 and 49 years in Nigeria has risen to between 1.8 and 2.7 million annually.

The survey results had provided new insights into the characteristics of women who have abortions and the pathways leading to abortion within or outside the healthcare system in three countries, Nigeria inclusive.

Dr Funmi OlaOlorun, the co-principal investigator of the PMA 2020 survey, said likely abortions are higher among women who are in their 20s, have at least secondary education, and live in urban areas.

The survey, she said, which indicated that unsafe abortion is an equity issue, found 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.

Dr OlaOlorun stated that all together, 37 per cent underwent surgery to ultimately terminate their pregnancy, seven per cent used Mifepristone/ Misoprostol and the remaining 56 per cent used other or unspecified medications or traditional methods.

In addition, most public tertiary facilities provided postabortion care (92 per cent) and safe abortion services to save a woman’s life (83 per cent); lower level public facilities and private facilities were much less likely to do so.

Abortion is a controversial topic in Nigeria. But it is still done in secret and mostly by non-physicians because of many reasons, including family planning services being out of reach; rape, incest, ignorance and lack of resources to raise and support a/another child.

However, Professor Fabamwo quoted the World Health Organisation (WHO) estimate that indicated that between 10 and 50 per cent of women that undergo unsafe abortions in developing countries subsequently need medical care to manage their complications.

Complications of unsafe abortion include infertility, chronic pelvic pain, heavy and prolonged bleeding, womb perforation, infection, and digestive system discomfort.

Professor Fabamwo, however, stated that “Unsafe abortion continues to contribute needlessly to maternal mortality and morbidity in Nigeria, largely due to the consequences of a highly restrictive abortion law. Repeated attempts at liberalising the Nigeria Abortion Laws had failed despite a compelling case for it.”

“Continued and relentless advocacy should be maintained towards changing the law. Other safety nets like medical abortion should continue to be explored.”

For now, Professor Fabamwo declared that medical abortion is legal under the Lagos State Criminal Code if having the child is going to put the mother’s life and her physical health in danger.

According to him, under the code, “a medical doctor is not criminally responsible for performing in good faith, with reasonable care and skill a surgical operation on any person for his benefit, or on an unborn child for the preservation of the mother’s life and physical health, if the performance of the operation is reasonable, given the circumstances of the case.”

He declared that elective abortions were not usually done until the Ministry of Health’s circular of April 2019, adding, “now, for legally indicated cases, options of medical and surgical abortions are now available.”

Medical abortion is a procedure that uses medication to end a pregnancy. It does not require surgery or anaesthesia and can be started in a medical office or at home. It is most effective in the first trimester of pregnancy.

It is done to complete an early miscarriage or to end an unwanted pregnancy if there is a medical condition that makes continuing a pregnancy life-threatening. The pregnancy, of course, must be less than nine weeks.

However, medical abortion is not for women with certain medical conditions like bleeding disorders, heart disease, liver, kidney and lung disease as well as women on blood thinners or steroids.

Earlier, Ms Sybil Nmezi, founder and coordinator of Generation Initiative for Women and Youth Network (GIWYN), says Nigeria’s collapsing social, health and other support systems expose women to sexual violence, unwanted pregnancy, unsafe abortion and death.

Although women’s sexual and reproductive health is related to multiple human rights, including the right to life, health, privacy, education, the prohibition of discrimination, make an informed decision and be free from torture, she stated that Nigeria does not implement or enforce most of them.

According to her, messages such as “Only bad women have abortionsand contraceptive” or “A pregnancy is more valuable than the woman carrying it” must also be changed in the media.

Unfortunately, many people lack understanding of provisions under the law when women can assess abortion and this had contributed to the misconception on the illegality of abortion in Nigeria

Professor Ayodele Atsenuwa of Department of law at University of Lagos in an overview of the legal framework affecting abortion, stated that Nigeria’s abortion law is not as restrictive as many people presume since it still makes provisions for therapeutic abortion.

According to her, “there are criminal provisions against abortion, but abortion is lawful when the legal indication within the provisions of the law is satisfied.”

“It is important that our response to abortion should be based on the law. It is not that there are no instances when a woman can have a lawful abortion, the law is very clear.”

Professor Atsenuwa added: “That has always been in the law, even in the 1904 criminal code. There is a definition of what is the crime and anything that does not fit that definition is not the crime.”

“Defence is available, especially under the provisions of sections 297 of the criminal code and something similar is in section 201 of the criminal law of Lagos State.

“It is important that we disseminate information about when the law recognises that it is necessary to allow women to have access to safe abortion. It recognises that there are circumstances when it is in the best interest of the society to allow women have access to safe abortion.”