By Angela Onwuzoo
Indications have emerged that Nigeria could prevent maternal deaths from unsafe abortion, if the federal and state governments institutionalise medical abortion services in all obstetrics and gynaecology units of secondary and tertiary health facilities in the country.
Some experts, who expressed worry over the high rate of deaths recorded from unsafe abortion in the country, blamed the preventable deaths on the nation’s restrictive abortion laws.
They noted with dismay that unsafe abortion was one of the leading causes of maternal mortality in Nigeria, contributing to about 13 per cent of the total number.
Data from the fact sheet of Guttmacher Institute, show that unsafe abortion has negative consequences beyond its immediate effects on individual women’s health. Treating complications from unsafe abortion increases the economic burden on poor families and incurs considerable costs to already struggling public health systems.
According to the experts, the nation’s restrictive abortion laws if not reviewed, would continue to put the lives of women seeking abortion services at risk by resorting to unskilled providers who often carry out the procedure in substandard environments. Currently, Nigerian criminal law only permits legal abortion to preserve the life of the mother.
However, the Lagos State government in 2011, citing physical health and other health concerns, took a bold step and enacted its own Criminal Law which legalises abortion when performed in good faith by skilled personnel.
The state Criminal Code, Chapter 21, Clause 201, states that, “A medical doctor is not criminally liable for performing in good faith, with reasonable care and skill, a surgical operation on any person for his benefit, or on an unborn child for the preservation of the mother’s life and physical health, if the performance of the operation is reasonable given the circumstances of the case.”
The Lagos State government under the above law has created access to safe abortion services in obstetrics and gynaecology units of its health facilities which now offer medical abortion by skilled personnel.
To further intensify access, the state government recently, launched its Safe Engage Advocacy Tool and a documentary titled: “Out of The Shawdows: Saving Women’s Lives from Unsafe Abortion in Lagos State.”
Speaking at a SAFE ENGAGE Journalists Training Workshop in the state, organised recently by Population Reference Bureau in collaboration with the Network of Reproductive Health Journalists of Nigeria, Chief Medical Director, Lagos State University Teaching Hospital, Prof. Adetokunbo Fabamwo, clearly stated that ban and restriction on abortion, did not prevent it from happening.
Fabamwo who is a Professor of Obstetrics and Gynaecology, pointed out that denying women access to safe abortion services would rather jeopardise the lives of those requiring the services as they would resort to quacks, which he said would further increase maternal mortality rate.
“Restrictive abortion laws, prohibitive costs, poor access to safe health services, and intense social stigma are barriers that prevent women from accessing safe and legal abortion.
“Estimates show that unsafe abortions account for roughly 5,000 maternal deaths every year in Nigeria, or on average, 14 maternal deaths each day. Unsafe abortions are also costly to women and the health care system”, he said.
The LASUTH boss revealed that due to the nation’s restrictive abortion laws, 60 percent of abortions in Nigeria were carried out by quacks, while 40 percent were performed by doctors with skills.
According to him, most abortions carried out in Africa were unsafe owing to restrictive laws, adding that though there were lack of statistics on abortion in Nigeria because of the restrictive laws, unsafe abortion remained high.
In his presentation which centred on overview of the medical aspects of abortion, Fabamwo who reiterated the state government’s commitment to providing improved access to medical abortion, noted that besides unsafe abortion damaging the reproductive organs, post abortion care was six times more expensive than safe abortion.
“Medical abortion is a procedure that uses medication to end a pregnancy; and can only be done by a medical doctor under the provisions of the State Criminal Law.
“In Lagos, if the mother’s life and physical health are at risk, the doctor is legally free to end the pregnancy through medical abortion.
“Under the Lagos Criminal Code, a medical doctor is not criminally responsible for performing abortion in good faith with reasonable care and skill for the preservation of life”, he said.
He identified lack of access to family planning, unstable relationship, wrong partner, rape, incest, employment policies and ignorance as some of the reasons for abortion.
He also listed acute renal failure, incomplete abortion, infertility, chronic pelvic pain, increased risk of ectopic pregnancy as complications of unsafe abortion.
Charting the way forward, he urged the state government to adopt the Violence Against Persons (Prohibition) Act, improve access to safe abortion services, recognise mental health as reason for legal abortion and train nurses on the provision of medical abortion.
Also speaking, Co-Principal Investigator, PMA2020, Dr Funmi Olaolorun, said programs and policies that would improve women’s and men’s knowledge of access to and use of contraceptive methods should be implemented to reduce unintended pregnancies and abortions or unplanned births that often follow.
“The provision and quality of post abortion care should be improved and expanded to reduce illness and death from unsafe abortion”, she said.
