By Kemi Olatunde
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September 28 is recognized as the international safe abortion day, a day aimed at promoting access to legal and safe abortion. Access to safe abortions is one of the factors identified as critical to achieving SDG 3.1, the reduction of maternal mortality rate.
According to a United Nations report in 2013, unsafe abortions are a “leading cause of maternal deaths”. The report further warned that “it is likely that the number of unsafe abortion will continue to increase unless women’s access to safe abortion and contraception – and support to empower women (including their freedom to decide whether and when to have a child) – are put in place and further strengthened.”
One out of every seven global maternal deaths occurs in Nigeria. Nigeria’s maternal death ratio was estimated at 512 deaths per 100,000 births each year. The NDHS report also stated that for every 1,000 live births, five women die during pregnancy, after childbirth and two months after childbirth.
SDG goal 3.1, to reduce maternal mortality ratio to less than 70 per 100,000 live births by 2030, currently seems hard-to-reach for Nigeria and unsafe abortions, among other things, is a factor impeding Nigeria’s progress.
Abortion is illegal in Nigeria, permitted only when it is medically recommended to save a woman’s life. Abortion is a felony, and though governed by two separate laws in Nigeria, one for Northern Nigeria contained in the penal code and the other for Southern Nigeria contained in the criminal code, the punishments are similar.
Up to a fourteen-year jail term for a doctor who performs abortion and 7 years for the woman on which it is performed.
Unfortunately, this has not stopped illegal abortions in Nigeria. Most of these are unsafe because they are done in secret, by unskilled providers or both
The estimated abortion rate in Nigeria is 33 per 1,000 women between ages 15-49, 1.25 million induced abortions occurred in 2012 with one in seven pregnancies ending in abortions. They are married and/or sexually active and they want to space their births or stop childbearing, but are not using contraceptives.
Among sexually active unmarried women, 22 percent have an unmet need. In 2012, about one-fourth of Nigeria’s 9.2 million pregnancies were unintended. More than half (56 percent) of these unintended pregnancies ended in an induced abortion; 32 percent ended in an unplanned birth and 12 percent in a miscarriage.
According to the data from 2012, the South-South region had the highest rate of abortions in Nigeria, while North-East has the second highest rate of abortion. Southwest and North-central have the lowest rate of abortion in Nigeria.
Guttmacher data reveals that 285,000 women have complications from unsafe induced abortions and only 212,000 women in 2021 went to a health facility for treatment of complications from induced abortions.
The main reason for abortions in the country is the desire for smaller family and the non-use of contraceptives. Religious beliefs and cultural beliefs have greatly influenced access to abortion in some regions including Nigeria.
There have been several conversations about legalizing abortion in Nigeria, with proponents emphasizing the loss of life to unsafe abortions as a fundamental reason for legalizing it.
Consultant, Obstetrician Gynaecologist, UNIMED Teaching Hospital, Akure complex, Dr. Olumide Akadiri stated that abortion has two classes which are spontaneous and induced abortion, noting that it is illegal as there are punishment for practitioners who carry it out.
He affirmed its high rate which according to him is above 50 percent according to the records of Ante Natal Clinic in the facility.
Describing Family Planning which is available in all government health facilities as a way of unwanted pregnancy prevention, he stressed the need for all to embrace it as there are various methods to choose from.
Speaking extensively, he said; “induced abortion can be divided into medical indication or illegal abortion/unsafe abortion that is the abortion done by an unskilled person or done in an inadequate environment.
“There are certain medical indication which are legal procedures for termination of pregnancy that is between 0 and 24 weeks. Anything after that is not an abortion as the baby is fit to live.
“There can be medical indication for a baby to be terminated that is if it will constitute harm to the mother or if the baby has gross congenital malformation which isn’t compatible with life. Aside this, it isn’t allowed under the Nigerian Law.
“Spontaneous abortion on the other hand is miscarriage which can either be threatened or incomplete abortion. There is also missed abortion where the baby dies inside the mother without pain or bleeding.”
According to him, complications of induced abortion which could be early or late complication includes; excessive bleeding, perforation of the uterus which leads to internal bleeding which may require operating intervention, infection, infertility, chronic pelvic pain, ectopic pregnancy and death.
Medical Director of a private clinic in Akure, Dr. Victor Adefesoye while speaking extensively noted that a large number of quacks who are not medically oriented engage in unsafe abortion and called on proper implementation of the law on perpetrators of the act in order to reduce high death rate.
His words; “A study was jointly conducted by the Society of Gynaecologists and Ministry of Health in Nigeria in 2015 and the number of women who engaged in unsafe abortion was 59 to 1000 women due to high rate of unintended pregnancy between the ages range of 15 and 49 years.
“According to the study, the figure accounted for a high number of deaths yearly which is about 20,000, hence, it is so high in Nigeria.
“Abortion is the termination of a pregnancy process before it becomes term. It has been estimated that a normal pregnancy lasts between 36 and 40 weeks within three trimesters each of which is associated with different activities and occurrences in the development of the child. Abortion can occur in any stage of pregnancy.
According to him, factors responsible for spontaneous abortion includes; chromosomal disorder in baby, genetic codding in baby, cervical inconsistency, infection, hormonal factors, Diabetes Mellitus, severe Hypertension, Tyroid malfunction and mother’s social cultural factor such as smoking, alcohol intake and drug abuse among others.
He noted that the law allows abortion to be carried out only when the pregnancy becomes a threat to the mother, stating that other forms of induced abortion is criminal.
Responsible factors for induced abortion according to Adefesoye includes; unwanted pregnancy, poverty, lack of information on modern contraceptive use, indiscriminate sex especially by young girls and rape among others.
He called on pregnant women to register early for Ante Natal Clinic in health facilities for relevant medical advise to safeguard the pregnancy so as to prevent the occurrence of spontaneous abortion.
He also called on all to embrace modern contraceptive methods to reduce death rate from abortion, adding that there should be improvement in sex education among adolescent to enable them play safe during sexual engagement to prevent abortion.
In his concussion, he stressed the need to uphold and implement the law in checkmating the activities of health workers engaging in criminal abortion in order to reduce the death rate from abortion.
Provost, Ondo State College of Health Technology, Akure, Dr. Felix Olawoye on the contrary stated it isn’t low according to available data within his environment.
According to him; I will like to use Nigerian students as a case study to justify my assertion that abortion is on the lower side.
“Most of the students of higher institutions have imbibed the habit of using contraceptive of different types (post coital, pills, implants, injectable etc) to put pregnancy at bay. Invariably, abortion cannot be procured in the absence of pregnancy. However, the side effects of these contraceptives are enormous which range from primary infertility, debilitating diseases and sexually transmitted diseases.”
