According to the World health Organisation (WHO)report, between 2010 and 2014, about 56 million induced–safe and unsafe– abortions occurred worldwide, Nigeria inclusive. Though the rate was higher in developing regions than in developed areas, around 25 million unsafe abortions were estimated to have taken place yearly with about eight million carried out in the least- safe or dangerous conditions with its attendant 4.7 to 13.2 per cent needless and avoidable maternal deaths, which stakeholders agreed must end. ROLAND OGBONNAYA writes
Amongst Nigeria women today, there are many factors that lead to unintended pregnancies. It could be economical and the family cannot accommodate any baby in the family, as a result of rape, which is now rampant, or a product of incest and largely because of lack of family planning. All of these could lead to having unintended pregnancy.
Reproductive health experts believe that unintended pregnancies are those that are mistimed, unplanned or unwanted at the time of conception. Sexual activities without the use of contraception through choice or coercion are also the predominant cause of unintended pregnancies. Universally, no fewer than 38 per cent of pregnancies (about 80 million pregnancies) were unintended in 1999. Experts further agreed that while unintended pregnancies are the main reason for induced abortions, not all result in abortions or unwanted children, but explained that it has been linked to numerous maternal and child health problems.
However, the fact remained that in Nigeria, some of these unintended pregnancies end in abortion and most times, due to lack of information it equally end in unsafe abortion and needless maternal death. Rising cases of abortions, most of them unsafe, the danger they pose to the health of the affected women and approaches to reduce them was the focus of the Safe ENGAGE Lagos State Journalists Training, which took place in Lagos recently. The programme was organised by PRB Safe ENGAGE in collaboration with the Network of Reproductive Health Journalists of Nigeria (NRHJN). Participants unanimously agreed that it was time to end the needless deaths arising from unsafe abortion.
Data from the Guttmacher showed that 1.8 to 2.7 million abortions occurred annually in the Nigeria. This is the situation even though abortion is highly restrictive in Nigeria. Existing law prohibits abortion from being done, except to save the life of a woman whom pregnancy threatens. There has been a line of argument that a woman has the choice to abort or not to abort a pregnancy and in a position where should does not want to go ahead with the pregnancy for whatever reason, she should be provided with the facility and service.
Abortions are safe if they are done with a method recommended by the WHO that is appropriate to the pregnancy duration and if the person providing or supporting the abortion is trained. Such abortions can be done using tablets (medical abortion) or a simple outpatient procedure. Unsafe abortion occurs when a pregnancy is terminated either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.
The people, skills, and medical standards considered safe in the provision of induced abortions are different for medical abortion (which is performed with drugs alone), and surgical abortion (which is performed with a manual or electric aspirator). Skills and medical standards required for safe abortion also vary depending upon the duration of the pregnancy and evolving scientific advances.
According to the WHO, they are less safe, when done using out-dated methods like sharp curettage even if the provider is trained or if women using tablets do not have access to proper information or to a trained person if they need help.
Abortions are dangerous or least safe when they involve ingestion of caustic substances or untrained persons use dangerous methods such as insertion of foreign bodies, or use of traditional concoctions. Women, including adolescents, with unwanted pregnancies, often resort to unsafe abortion when they cannot access safe abortion due to restrictive laws and stigma.
According to a PMA 2020 Abortion Survey Result conducted in 2018 in Nigeria, and presented at the PRB Safe Engage training programme, in 2017, the annual incidence of likely abortions in Nigeria was 41.1 per 1,000 women between the ages of 15 to 49 — nearly 1.8 million abortions. When including information related to the experience of respondents’ closest confidants, the number of likely abortions in Nigeria rose to 2.7 million, the report stated.
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.
The survey also discovered that women living in rural areas, women with no education, and those who are poor were the most likely to have the least safe abortions. At the same period, most public tertiary facilities provided post abortion 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.
Ironically, there have been numerous factors constituting barriers to accessing safe abortion, which includes restrictive laws. Nigeria’s abortion laws make it one of the most restrictive among countries. Nigeria’s criminal law system is divided between the northern and southern states of Nigeria. The Criminal Code is currently enforced in southern states and the abortion laws are expressed within sections 228, 229, and 230. Section 228 states that any person providing a miscarriage to a woman is guilty of a felony and up to 14 years of imprisonment. Section 229 states that any woman obtaining a miscarriage is guilty of a felony and up to imprisonment for seven years. Section 230 states that anyone supplying anything intended for a woman’s miscarriage is also guilty of a felony and up to three years of imprisonment.
The Penal Code operates in northern states, with abortion laws contained in sections 232, 233, and 234. The sections of the Penal Code parallel the Criminal Code, besides the exception for abortion with the purpose of saving the life of the mother. The Penal Code’s punishments include imprisonment, fine, or both. Apart from the restrictive laws, there is also the problem of poor and none-availability of services, high cost, stigma, conscientious objection of health-care providers and unnecessary requirements, such as mandatory waiting periods, mandatory counselling, provision of misleading information, third-party authorisation, and medically unnecessary tests that delay care.
Deaths and injuries are higher when unsafe abortion is performed later in pregnancy. The rate of unsafe abortions is higher where access to effective contraception and safe abortion is also limited or unavailable. Since abortion is illegal in Nigeria, many women resort to unsafe abortion methods, leading to abortion-related complications and thereby increasing mortality and morbidity rates in the country.
According to research done by the Guttmacher Institute, an estimated 456,000 unsafe abortions are done in Nigeria every year. In a similar joint study carried out by the Society of Gynecologists and Obstetricians of Nigeria and Nigeria’s Ministry of Health, estimates of women who engage in unsafe abortion were put at about 20,000 each year. Research also revealed that only physicians perform 40 per cent of the abortions with improved health facilities while non-physicians perform the remaining percentage.
While there have been protests in respect of liberalisation of abortion laws and promotion of women’s rights, some state governments like Lagos have seen the need to take a second look at the statue book and need to carry out a review. In 2015 The Violence Against Persons Prohibition Act (VAPP) was passed into law. This act, even though many states in the country have not replicated it, is meant to provide sexual assault and relationship violence survivors with aid.
This act is also helping women get the contraceptives they need to prevent unwanted pregnancy, the leading cause for abortions. Despite the combined and continued efforts of various Nigerian and international advocacy groups, only a woman whose life is endangered can undergo a legally performed abortion today even when unsafe abortion accounts for 40 per cent of maternal deaths in Nigeria, making it the second leading cause of maternal mortality in the country.
The need for increased access to safe abortion practices in Nigeria is very apparent. There are several different methods used to try and ensure a healthy and safe approach to abortions, but Nigeria hasn’t always been able to keep up with the costs of these medical advances when considered that many of the issues surrounding unsafe abortion focus on adolescents.
“As adults, we really make a difference when we talk to young ones. In fact, teens often see it as the biggest influence in their decisions about sex and maturity when it comes to their sexuality. Teens who report having good information with an informed adult about sex are more likely to delay sexual activities, become faithful and committed partners,” a healthcare provider said recently.
Adding her voice on the need to end needless morbidity and mortality arising from unsafe abortion, Sybil Mmezi, founder and coordinator of Generation Initiative for Women and Youth Network (GIWYN), said the way out is to empower women and provide them with basic information that could guide them on decision making. For instance, she said GIWYN has a hotline, which clients call for counselling on Reproductive health (RH) issues.