Unsafe Abortion and Maternal Deaths in Nigeria

Despite the concerted efforts by the federal and state governments to reduce the embarrassingly high maternal mortality rate of 570 per 100,000 live births in the country, the role of unsafe abortions has continued to threaten their efforts. Martins Ifijeh writes

Mrs. Zainab, a 44-year-old business woman never envisaged she will lose her only daughter, Ola, in an early age. She had wanted her to read law in the university after her secondary education, get a good job and then bring sunshine to the family, because she was a very brilliant child, but all of that became tall wishes that never saw the light of day. No thanks to unwanted pregnancy at the age of 17.

Ola, despite being surrounded by parents who were ready to give her the best of education even with their lean resources, would slip through the hemmed alleys in the house to meet her boyfriend who was staying in her neighbourhood in Agege, a Lagos suburb. Mrs.

Zainab never knew her daughter was already seeing a man until the unexpected happened.

She had barely reached her shop one Saturday morning when she received a call from the house that Ola was bleeding profusely. Zainab rushed home only to see her daughter reeling in pain, with blood stains all over her body. “At the first glance, I knew what was happening to her must be pregnancy related. We immediately took her to a nearby clinic where it was confirmed that the harm to her body was due to abortion she had done to terminate a pregnancy.

Ola knew everyone in the house would be disappointed in her if they know she has been impregnated, so she connived with her boyfriend to terminate it. First, she drank large quantity of spirits (ogogoro), caffeine, mixture of lime,aluminum and potassium sulphate (popularly called alum), tetracycline mixed with gin, different herbs, and several other substances prescribed by her peers and boyfriend. None of these worked.

Oblivious of the consequences of the various concoctions she was putting into her body, Ola and her boyfriend then decided to see an abortionist, who did a D and C (dilation and curettage) on her for N5,000. But the clean up wasn’t done properly as part of the fetus was still left in her uterus, while there were perforations in her womb too.

According to Ola, who mustered her last strength to explain to her mother, noted that that was the beginning of her troubles. “Ola told me since the abortion, she had been having intense abdominal pain, dizziness, weakness and a whole lot until she finally broke down.”

The doctor whom Zainab rushed Ola to for help tried all he could to evacuate the fetus, but the damage had been done. The uterus was infected, there were several perforations in her womb, a 3cm small bowel defectand free air in the abdomen. Ola was discharged after five days, but a week later, she died. The infection had probably eaten deep into her, no thanks to the quack abortionist she and her boyfriend visited.

Unlike Ola, Favour was lucky to still be alive despite going through six different abortions in her five years of relationship with her boyfriend. She said the last abortion she did took her to hell and back. She has vowed never to engage in the procedure again, especially in a country where it is illegal to perform abortion, thereby making the practise unregulated as it is often done underground, majorly by quacks and jacks of all trade.

“The last abortion I did almost killed me, as I bled for days afterwards. It took me over a month plus before I could gain myself back,” she said.

The bigger but scary picture
Ola and Favour are just a little drop among the several hundreds of thousands of Nigerian females who engage in unsafe abortion, which has no doubt caused the death of many in the country.

According to a researchconducted by a United States-based Guttmacher Institute, in collaboration with University of Ibadan (UI) and Ipas, a non-governmental organisation, over 1.25 million abortions are carried out in Nigeria every year, with majority of such procedures done in secret and mostly by unprofessional hands. Traditional attendants and herbalists inclusive.

A recent BBC report suggests that of the high number of abortions recorded in Nigeria, over 60 per cent are unsafe, while 20 per cent of the 60 per cent are done by traditional healers or the women themselves.

Comparison of the research from Guttmacher Institute and the BBC report, clearly shows that of the 1.25 million abortions done in the country every year, about 750,000 are unsafe, while about 150,000 unsafe abortions are done by traditional healers or the women themselves, such that a chunk of these women do not come out of it alive.

Precisely, Prof. Innocent Ujah, the Director General of Nigerian Institute of Medical Research (NIMR), put the number of deaths from unsafe abortions in the country at 34,000, adding that this has contributed between 13 per cent and 50 per cent of maternal and child mortality in the country.

Ujah said this in Abuja at a forum organised by the Federation of International Gynaecologists and Obstetricians (FIGO).

In a gloomier picture, the Chairman, Nigeria Medical Association (NMA), Ebonyi State Chapter, Dr. Chidi Esike, said about 50,000 Nigerian women die yearly in Nigeria due to complications caused by unsafe abortion, adding that majority of the victims were teenagers and school girls.

With about 50,000 deaths occurring in the country due to unsafe abortion every year, it therefore means that about 137 women die every day in the country due to unsafe abortion alone.

Using Ujah’s figure suggests that almost a hundred lives are lost daily due to the menace.

According to experts, abortion becomes unsafe when a pregnancy is terminated by persons lacking the necessary skills, or when it is done in an environment without standard medical tools. However, in Nigeria it is illegal to perform abortion, except the life of the mother is in danger.

What the World Health Organisation Says
According to the World Health Organisation (WHO) worldwide, an estimated five million women are hospitalised each year for treatment of abortion-related complications, such as hemorrhage and sepsis, adding that complications due to unsafe abortion procedures account for an estimated 13 per cent of maternal deaths worldwide, or 67,000 per year.

“Almost all abortion-related deaths occur in developing countries. They are highest in Africa, where there are an estimated 650 deaths per 100,000 unsafe abortions in 2003, compared with 10 per 100,000 in developed regions. Nigeria still has one of the highest maternal death rates in the world.

“Approximately 220,000 children worldwide lose their mothers every year from abortion-related deaths. Additional consequences of unsafe abortion include loss of productivity, economic burden on public health systems, stigma and long-term health problems, such as infertility,” adding that more than one-third of the approximately 205 million pregnancies that occur worldwide annually are unintended and about 20 per cent of all pregnancies end in induced abortion.

The health body also noted that of the 23 million pregnancies that occur in developed countries, more than 40 per cent are unintended, and 28 per cent end in induced abortion. Of the 182 million pregnancies that occur in developing countries, more than one-third are unintended, and 19 per cent end in induced abortion (8 per cent are safe procedures and 11 per cent are unsafe).

“Two- thirds of unintended pregnancies in developing countries occur among women who are not using any method of contraception,” WH0 says on its website.

Way forward
While experts are of the opinion that every adult has the right to sexual and reproductive life, they believed the low level of contraceptive use has contributed to the number of unwanted pregnancies in the country, which in turn spur abortion.

A gender advocate and human rights lawyer, Hauwa Shekarau in a report, stated that Nigeria has a low level of contraceptives use and as a result, about one quarter of the 9.2 million pregnancies that occurred in the country in 2012 were unintended and more than half (56 per cent) of these unplanned pregnancy ended in abortion and that, adding that it was important for all women to have access to the highest attainable standards of health and safe reproductive health choices, including safe abortion.

While advocating for a lasting solution to unsafe abortion in Nigeria, Shekarau said “No woman should risk her life, her fertility or well-being or the well-being of her family because she lacks reproductive healthcare. Death and injuries from unsafe abortion are traumatic because they can be avoided,” she added.

The WHO is also concerned that women in Nigeria and other developing countries still have an unmet need for contraception, meaning they are sexually active; are able to become pregnant; do not want to have a child soon or at all; and are not using any method of contraception, either modern or traditional.

The health body specifically called for increased awareness on contraceptive use, as well as its availability in developing countries, Nigeria inclusive, stating that it would give women choices on whether or not to prevent pregnancies in the first case.

There are also arguments on whether the illegality of abortion in the country has caused the increase of unsafe abortion or if it’s pruning it down.

But one thing experts are unanimous about is the role of contraception in preventing unwanted pregnancies, which would mean there will not be room for abortion to say the least.