Unsafe Abortion: The Real Pandemic

Study Results by Performance Monitoring Action in 2014, with updated dissemination by Lagos State in March 2021, revealed that 6000 Nigerian women die from unsafe abortion-related complications every 12 months. Ayodeji Ake reports

“My mother must not know, she will develop high blood pressure” she said unhappily. Those were the words of Beauty, a 25-year-old damsel who resides in a small apartment with her mother and seven siblings in one of the rural areas in the federal capital territory, Abuja.

She was cold when she narrated how she discovered her first pregnancy five years ago after her secondary education, seeking admission into the higher institution.

Her ex-boyfriend wasn’t ready and she wasn’t as well. She was scared to tell her mother because she is the first child out of eight children and her mother has been the only one fending for the family after a divorce with her father years ago. Her mother was happy she already completed her secondary education so she can start working to assist the family financially.

“When I was 20 years old, I was in a relationship and I discovered I was pregnant. I was scared, I couldn’t share with anyone and my mother must not know. My friend gave me some advice and she told me about a particular drug. I browsed it and saw the drug. I read about it then I visited a pharmacy to get the drug. At that point I wasn’t worried nor scared because I didn’t want anyone to know about the pregnancy.

“I experienced cramps for hours and later it went down and I felt pain no more. I took a very strong anti-bacteria drug to prevent infection. I knew it was a very big risk, but I was just bothered about what people would say and I didn’t want any trouble” she said.

Beauty had an unsafe abortion that would have claimed her life because she didn’t want to disappoint her parent. She is one of the Nigerian women in their childbearing years that has an abortion, adding up to about two million abortion annually.

“Abortion is an important public health and health equity issue. More than six out of 10 abortions in Nigeria are unsafe, involving non-recommended methods from non-clinical sources, with disadvantaged women most likely to have an unsafe abortion. Disadvantaged women are also more likely to report difficulty-accessing care and receive poor- quality care.

“More than half of women, 56 per cent, who reported an abortion said they experienced a potential complication, with young, uneducated, poor, and rural women most likely to experience negative outcomes that require further treatment.”

A Professor of Obstetrics and Gynaecology, Oluwarotimi Ireti Akinola, noted that Nigeria has one of the highest maternal mortality ratios in the world. He added that unsafe abortion in Lagos State according to the 2018 report, contributes 11.3 per cent of maternal mortality.

Speaking in the same vein of the consequences of unsafe abortion, Akinola, said unsafe abortion may cause miscarriage and infections that may damage some vital organs in the body.

“Worldwide, about 20 million unsafe abortion takes place. Above 50 per cent of terminated pregnancies that take place are unsafe. Unsafe simply means that the person performing the abortion lacks the skill or performing it in an environment below the minimum required medical standard or both. Personally as a doctor, if I should perform an abortion in an environment that is less than minimal, then it becomes unsafe.

“Unsafe abortion means an abortion not done properly. If it’s not done properly, they may get infected which may result in immediate complication and physical damage to surrounding organs which may cause her bleeding and may lead to death.

“If they don’t die but get infected, the Infection may cause blockage of the fallopian tubes which in this case the person will be unable to conceive and suffer from infertility.

“It may damage the womb that the person may get pregnant and it will continue to drop, which is miscarriage. So there are so many things that could happen simply because of unsafe abortion. Infections could lead to death after which it has been spread to the pelvic organs, into the blood and other vital organs and we start wondering what may cause the death of such person not knowing it unsafe abortion. Unsafe abortion contributed, in Lagos, 11.3 per cent of maternal mortality from the report released in 2018, and 12.9 per cent globally of maternal mortality.

Fast forward 5 years and Beauty started living her dream. Beauty is now a 400 level biology student. She has been working and supporting the family financially and with the little money she gets. She is also running a part time education program in one of the universities in Nigeria.

But she is pregnant again.

“It happened unexpectedly and my boyfriend rejected the pregnancy because he is not financially buoyant” she said in a cracked voice.

“My boyfriend and I have been having a lot of issues and he has not been talking to me. He said I should get rid of it. I am not happy with him because he said some things to me I don’t like. I feel there are better ways we can both resolve this, not him making me feel it all my fault. It’s so frustrating. I have been feeling pain and not feeling too well. I wish I can make making him realise that I’m not stupid. I’m planning to report him to his elder sister. I’m still carrying the pregnancy and I’m over five weeks gone. He already gave me ten thousand naira to abort the pregnancy.

Her voice shakes: “I don’t know what to do at the moment, I’m confused. I stay with my family. My mother and seven siblings, which is why I’m having a rethink of the whole issue because I have a lot of responsibilities on me. Since my dad left us, myself and my mum have been shouldering the responsibilities of the family” she said.

She is not ready to be a mother, not interested in keeping the pregnancy. Memories of the previous abortion five years ago build so much fear in her and now stuck in between keeping the pregnancy or not. Would she keep the pregnancy and put more financial burden on her already weak mother who is still catering for seven children, or abort the pregnancy and risk her life? She asked herself repeatedly.

When asked how her mother remained unaware of the pregnancy, she said she only sees her mother on Sundays. “I go to work every day so we both get home late at night is why she is yet to notice anything. Often, I act like I am okay but I know I have a lot going on with me” she said.

The realities of unsafe abortion

Thousands of Nigerian women die needlessly from unsafe abortion that could# be prevented. Abortion facts and figures 2021 by SAFE ENGAGE, revealed that every year one out of 20 Nigerian women in their childbearing years (15-49) has an abortion, adding up to about two million abortions annually. More than three in five abortions in Nigeria are unsafe which can lead to a range of health complications and even death for women.

According to report, since the research in 2014, Nigeria record 6000 deaths relating to unsafe abortion related complications every year.Using simple arithmetic until today’s date means that Nigeria has lost over 36,000 women and if no swift intervention, by the end of 2021, 42,000 deaths will be recorded.

According to the Co-Principal Investigator, PMA 2020 Study, Dr. Funmi Olaolorun, noted that in most states in Nigeria, abortion is only legal to save a woman’s life. Added that many women turn to abortion to terminate unwanted pregnancies outside of the narrow circumstances for which abortion can legally be obtained.

“The most recent abortion incidence estimates indicate there were 33 abortions per 1,000 women of reproductive age in 2012, thus it is a common health event. Given access to safe abortion is legally restrictive, the majority of these abortions were considered unsafe.

“From a public health perspective, we are most concerned about unsafe abortions because they can lead to life threatening complications. The maternal mortality ratio in Nigeria is high, with estimates ranging from 545 to 841.

“Using estimates for the proportion of maternal deaths due to unsafe abortion, we estimate there are approximately 6,000 unsafe abortion related deaths annually in Nigeria.

“Understanding the characteristics of women experiencing unintended pregnancies and subsequent unsafe abortion, along with their decision-making process and abortion experiences, can inform family planning, safe abortion, and post-abortion care programs and policies in order to better meet the reproductive health needs of these women moving forward” she said.

Despite legal restrictions

Olaolorun, stated that a lot of Nigerian women are not aware of safe abortion which could be in form of drugs that must be recommended by a doctor or through surgical means.

“Most women don’t know safe abortion methods or sources and instead rely on convenient options that are private but put women at risk.

“Post Abortion Care (PAC) service availability is poor among primary care facilities, which serve the majority of the population; less than half of these facilities reported providing any PAC services. Disadvantaged women who are most at risk of using unsafe abortion methods and experiencing complications are also least likely to be able to access PAC to treat potential abortion complications she said.

In her recommendations, she noted the need for legal expansion for safe abortion and provision of availability of quality and voluntary contraceptives services.

“Improve access to PAC by increasing the availability of basic PAC at public primary health care facilities. This can be achieved through provider training and provision of necessary commodities like manual vacuum aspirator kits and misoprostol.

“Ensure that safe abortion services are available to the full extent of the law in a given state. This can also be achieved through provider training and provision of necessary commodities like manual vacuum aspirator kits and mifepristone and misoprostol.

“Expand legal indications for safe abortion beyond situations in which the woman’s life is at risk

“Increase availability of quality, voluntary contraceptive services throughout the healthcare system to prevent unintended pregnancies” she said.

The Law/Violence Against Persons Prohibition (VAPP) Act

Abortion is criminalised in many countries because of the attachment to religion, culture and customs. In Nigeria, abortion is illegal and carries a jail term between 3 and 14 years imprisonment unless it is performed to save the life of a pregnant woman (this is a qualification which permits abortion on medical ground). Few cases are brought to the court on account of abortion.

The Criminal Code (CC) operating in Southern Nigeria and the Penal Code (PC) in Northern part of Nigeria provides for the criminalisation of Abortion.

Sections 228, 229 and 230 of the CC States:

Any woman who with intent to procure her own miscarriage unlawfully administers to herself any poison or other noxious thing or any person who assists her in doing the same is liable to imprisonment for a period ranging from three to fourteen years.

The issue of abortion strides reproductive health and rights, bodily integrity and the right to privacy. The decision in Roe v. Wade in the US opened the flood gate for challenge of Abortion laws in many states.

The VAPP act of 2015 which has already been adopted by 13 states of the federation including the federal capital territory Abuja, designed to seek legislative and legal framework for the prevention of all forms of violence against vulnerable persons, especially women and girls, which Lagos state, one of the most populous state in Nigeria with high prevalence of mortal mortality is yet to adopt.

Although, recently, in commemoration with of the Domestic and Sexual Violence Awareness Month, the Lagos state government signed the law establishing the Domestic and Sexual Violence Agency which also includes Sex Offenders Registers.

The Executive Governor of Lagos state, Mr. Babajide Sanwo-Olu noted that: “Any form of sexual violence is strongly abhorred by the state, and as individual. And it will not be tolerated nor accepted in any way, shape or form. Therefore, signing this law is a testament of what we stand for and stand against”.