Saheed Ibrahim
One of the contributory factors to maternal mortality and morbidity in Nigeria is unsafe abortion. WHO states that unsafe abortion is a leading but preventable cause of maternal deaths and morbidities. It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems.
In spite of this challenge, unsafe abortion remains one of the underreported issues in the Nigerian media. From the use of unverified methods to patronizing quacks by those in search of abortion, Saheed Ibrahim of The Hope newspapers tracked these stories.
Rape, Incest and Doubt of Motherhood
13yr-old Lara (not real name) was in the junior secondary school when she was betrayed by her blood relative – an uncle who was living with her family.
“He started by buying gifts for me. I thought it was a normal uncle-niece relationship because he was always around me but I did not know what his intentions were. We used to be home alone together whenever I return from school.
“So, on this particular day, I was home and he was in his room. He called me to see him in his room, which I did but before I knew anything, he forcefully had carnal knowledge of me”, Lara recounted her ordeal.
She discovered she was pregnant a month after she was raped.
Lara’s uncle begged her not to inform her mother of what happened between the two, but this did not stop her pain.When she took the drugs her mother got her from a chemist store in the neighbourhood,she started bleeding uncontrollably .
This incident put Lara, her mother and father in a terrible situation that caused a set back in her academics.
Going by a 2018 document released by the Nigerian government on national guidelines on safe termination of pregnancy for legal indications, Lara may not fall within the conditions in which a woman can legally seek abortion. Althoughthe guidelines stated that abortions can only be allowed when it is needed to save the life of a woman, it does not take into account if the consequences of the pregnancy would harm the woman’s safety, health and well-being.
The guidelines also listed, among others, obstetric and gynaecology conditions, maternal heart and vascular diseases, kidney diseases, cancer, blood diseases, psychiatric and other mental disorders as “conditions that may constitute a threat to the life of a woman who is pregnant, who could benefit from legal termination of pregnancy”
Even though Lara was depressed as a result of incest or rape, which is one of the conditions under which abortion is allowed under the 2018 national guidelines, she would need more than a feeling to get it done. She would need a qualified medical practitioner to establish this condition. Unfortunately, this is a tall order indeed owing to the fact that a vast majority of Nigerian women and girls find it difficult to discuss abortion and other sexual and reproductive health and rights issues in public.
It will be difficult for an adolescent like Lara and even many married women to go through the legal process of having an abortion.
Although it may seem the national guidelines on safe termination of pregnancy did not answer some questions, it is a departure from the decades-long penal and criminal codes which banned abortion in its entirety in both southern and northern Nigeria.
Couple’s unspeakable loss
In the quiet corners of Ondo city, a couple battled life challenges just like countless other Nigerians striving to put food on their table amidst the harsh economic realities brought about by fuel subsidy removal, soaring inflation rates, and the escalating prices of goods and services.
With two little ones to cater for, the thought of expanding their family further seemed like an overwhelming burden, given the economic strain they were already enduring. Yet, fate had other plans – the wife became pregnant.
Although, they realised their options were limited within the law, they sought for abortion in the back alley where an unskilled medical practitioner who allegedly performed dilation and curettage (D & C) on her, even in a standard medical facility with a skilled attendant, this method has since been replaced with Manual Vacuum Aspiration (MVA) by the WHO, which is the recommended surgical technique for abortion up to gestational age less than 12 weeks.
Unfortunately, what was anticipated to bring relief only ushered in an era of unimaginable suffering and pain.
Afterwards, the wife began to bleed profusely, writhing in agony. The pain became unbearable and she was rushed to the nearest hospital. Recognizing the gravity of her condition, the hospital referred her to the Obafemi Awolowo University Teaching Hospital (OAUTH) Ile-Ife in Osun State, southwest Nigeria.
There, it was discovered that the so-called doctor had punctured the woman’s uterus during the botched abortion attempt. Her womb was said to be decaying, necessitating its removal.
In the end, she took her last breath and, was pronounced dead.
Further investigation revealed that the husband was arrested by the police in Ondo. A close source in the Ondo state command of the Nigerian Police Force confirmed the case to The Hope Newspaper. A prosecutor also confirmed knowledge of the ugly development. The said doctor was on the run as of the time of writing this. Unconfirmed report had it that the husband sold his late wife’s phone to pay for the services of the quack doctor to have her undergo unsafe abortion.
This heart wrenching tale serves as a stark reminder of the debilitating effects of unsafe abortion and the need for contraceptive use by couples to prevent unintended pregnancy that could lead to unsafe abortion. Statistics show that 61% of women of reproductive age in Nigeria who want to avoid a pregnancy have an unmet need for modern contraception, according to estimates from the Guttmacher Institute.And of all unintended pregnancies in Nigeria, 48% ended in abortion.
Taming the ugly tide
It is estimated thatif all needs were met for contraceptive, maternal and newborn and abortion care in Nigeria, unintended pregnancies, abortions and unsafe abortion would drop by 80%, maternal deaths would drop by 61%, while newborn deaths would drop by 76%.
Adesegun Fatusi, a professor of public health and community medicine and founding President of the Academy for Health Development (AHEAD) Nigeria, said these unsafe abortion stories underscore the sad realities of many women and teenagers as situations leading to abortions are diverse.
He added that statistics show that married women seek abortion more than the unmarried ones because the former are more exposed to more sexual intercourse.
Fatusi said women would do anything possible to abort if they choose to,whether approved or unsafe methods, irrespective of the law.
He stressed the need to pay more attention to abortion and sexual and reproductive health and rights issues to avoid women and girls putting their lives at risk.
“Anyone that finds themselves in a situation where they did not plan to have pregnancy but have sex should take approved contraceptives to prevent pregnancy”, the public health expert recommended.
Has this inspired action?
As the Executive Director of UNFPA, Dr. Natalia Kanem stated, “We know the steep costs associated with unintended pregnancy, costs to an individual’s health, education and future, costs to whole health systems, workforces and societies.”
The media, non-governmental organizations, advocates and all stakeholders must understand that talking about abortion is not illegal and raising awareness about the consequences of unsafe abortion can also reduce maternal mortality in Nigeria and across the world.