By Chioma Umeha
“It was a Monday. I started working early; I cleaned my salon and washed all the towels. When I finished I went to Randle Health Centre and picked up two pregnancy tests.
“I honestly didn’t think I was pregnant, but wanted to put my mind at ease. I remember seeing the two lines show up and I burst into tears. This couldn’t be happening. Quickly, I visited my childhood friend, Adegoke at Apapa Road, Ebute Metta. She accompanied me to another Lab, close to Oyibo Market. There, I took another one. Positive! I was pregnant.”
This is the story of Mojisola, (not real name) a 37-year-old lady, hair dresser and secondary school leaver.
Moji as she is fondly called by acquaintances spoke exclusively to DAILY INDEPENDENT during an investigative tour of Otumara Community, Apapa area of Lagos.
Palpable pains and regrets were still noticeable from her expression as she continued her narrative concerning who was responsible for the pregnancy.
She said, “I was raped by some miscreants on my way to my house after work one Saturday. Hardly, did I expect that pregnancy as I was not ovulating at that time. So I did not want the pregnancy.
“I was 30 at that time. I continued to sob bitterly. Adegoke was trying to make me calm. She promised to help me terminate the pregnancy. She took me to a Chemist somewhere on Apapa Road.
“All I still remember is that the chemist took a needle filled with improvised explosives and inserted it into my uterus. She further gave me an herbal potion to drink to flush my uterus. Since I got married, I have been struggling to have a child.”
But, this deeply hidden secret later became a public spectacle she bled profusely and was at death’s door. When she next woke up after the ugly exercise, Moji told DAILY INDEPENDENT that she found herself at the Lagos University Teaching Hospital (LUTH), Idiaraba on a drip, breathing from an oxygen mask and running low on blood.
Doctors told her she was lucky to be alive. But, her uterus was removed after it became ruptured. Today, she is struggling with infertility.
These are just some of the things that girls and women turn to – 25 million times a year – in a desperate attempt to end their unintended pregnancies. Some live to tell their stories. Many others do not.
Counterfeit drugs, quack doctors, tea-leaves, knitting needles, even small bottles filled with improvised explosives are inserted into the uterus. Unsafe abortion is a major contributor to maternal mortality.
Today, unsafe abortions account for up to 11 per cent of global maternal deaths. A report by Marie Stopes International states, “The problem is particularly acute in the developing world. Across the different regions where we work an estimated five women die every hour as a result of unsafe abortion, and around the world around eight million more women suffer serious complications.”
And these numbers are likely to rise following the re-introduction of the Mexico City Policy – a Republican policy that blocks US Government funding to non-US organisations that perform abortion with their own funding, according to health industry analysts.
Many health industry watchers are seriously worried that this policy is at the moment negatively impacting on women’s health and their opportunities for the future,
They have condemned the policy which blocks funding to the world’s largest providers of modern contraception, stressing that it is counter-productive.
Analysts are worried that the policy has reduced women’s ability to prevent unplanned pregnancies while the number of women undergoing unsafe abortion has increased.
This is because of the stigma and misinformation that still surround the procedure. Even in countries where abortion has been legal for decades, abortion often remains a controversial subject with those against the procedure giving political, moral, social, ethical and religious reasons.
In Nigeria, abortion is legal only when performed to save a woman’s life. Still, abortions are common, and most are unsafe because they are done clandestinely by both skilled and unskilled providers.
The long-term impact of the ‘global gag rule’ has become very visible as family planning providers project that approximately two million women would be denied sexual and reproductive health services as a result of the order reinstated sometime last year.
Family planning and global health experts warn that the full consequences would continue to unfold.
Marie Stopes International (MSI) which provides contraception and abortion services in 33 developing countries has calculated it faces an $80 million funding gap as a result of the decision, which slashed 17 per cent of its donor income.
MSI has already closed some services in these countries.
Under the expanded version of the “global gag rule” introduced by President Donald Trump soon after his inauguration in January 2017, foreign NGOs that receive any United States global health assistance are prohibited from performing or promoting ‘abortion as a method of family planning.’ That includes offering legal advice or counseling related to abortion.
Some foreign organisations such as MSI have chosen to forgo U.S. funding and continue their work in women’s health – but the loss of resources could result in an additional 2.5 million unintended pregnancies, 870,000 unsafe abortions, and 6,900 avoidable maternal deaths, the organisation claims, leading to a 107 million pounds ($150 million) increase in direct health care costs.
“Unless we can fill the $80 million gap created by the global gag rule, it would deprive millions of women of the contraception they need to prevent an unintended pregnancy, and it is the world’s poorest women and girls who will bear the brunt,” Marjorie Newman-Williams, Marie Stopes International’s vice-president, said recently in a press release.
Commenting on the impact of the GGR on women and girls, Dimos Sakellaridis, the Country Director, DKT International Nigeria, said it is an infringement on their reproductive health and rights as well as a setback on family planning campaign.
“The law has reversed the global progress made on contraceptives, family planning and reproductive health rights. It takes away the option a woman has to decide when and if she wants to have children.
The family planning expert predicted that because of Trumps’s GGR policy, “The rate of maternal mortality would shoot up and majority would result from unsafe abortion.”
Sakellaridis in an exclusive interview with DAILY INDEPENDENT noted, “The negative impact can better be imagined. We must not forget that for every woman who is denied access is a tragedy waiting to happen because of unplanned pregnancies, unsafe abortions and potential death. There will be an additional 660,000 abortions in Nigeria over the next four years, with 10,000 women dying as a result.”
Implementers also say it is impossible to estimate the true impact since many aspects are unquantifiable.
“The impact is not just about the size of project or country. Each individual service works through delivering health care, gaining trust with local communities, advocating health improvements and educating and empowering people to take control of their lives,” according to Rosemary Gillespie, interim director general of the International Planned Parenthood Federation, the world’s largest sexual and reproductive health NGO, which believes it stands to lose $100 million in funding as a result of the gag rule.
The fact that the Trump administration’s version of the policy applies to non-U.S. NGOs receiving any U.S. health assistance – rather than just family planning as with previous iterations of the policy – has also made it more difficult to predict the impact, experts say.
Recent data from the Guttmacher Institute suggest there remain 214 million women and girls worldwide who want to avoid or delay pregnancy but do not have access to contraception.
The most vulnerable at risk
Reacting, Professor Innocent Ujah, a Professor of Obstetrics Gynaecology, notes, “Unfortunately, the cut of fund for life-saving services by the US government under the GGR of Trump’s Administration will further worsen the maternal morbidity and mortality indices in all the developing countries of the world, Nigeria, inclusive. The overall reproductive health services will be the worse for it.”
Faulting the current abortion laws in the country, Ujah who is also Consultant Obstetrician and Gynaecological Surgeon, in an interview with DAILY INDEPENDENT, says they are very restrictive, as abortion is allowed only to save the life of woman.
The don currently with Department Of Obstetrics and Gynaecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, laments, “Unfortunately, many young girls and even married are dying in large numbers in Nigeria from unsafe abortion that is clandestinely performed by quacks.
Commenting on the way forward, he says, “Nigeria needs to step up its family planning/contraceptive services to prevent unplanned and unwanted pregnancy, particularly for the adolescents while it looks at the laws again in such a way as to be modified to accommodate issues of incest and rape.”
He tasked the government on its commitment, saying, “I want to suggest that Nigerian Governments should respond appropriately by increasing the budget for Reproductive Health and also make family planning widely available to mitigate the effects of the GGR Rule.”
On her part, Dr. Abiola Akiyode-Afolabi, Women Advocates Research and Documentation Center, (WARDC) Lagos, laments, the GGR rule has penalised hundreds of Non-governmental organisations (NGOs) and the women they serve in nearly 60 countries across the world.
Akiyode-Afolabi who spoke during a recent training of the Network of Reproductive Health Journalists of Nigeria (NRHJN) in Ibadan, Oyo state, decried the rate of illegal abortion, saying “GGR has destroyed the world and killed women who are at the receiving end.
“The rule thus jeopardise women’s right.”
She gave the context of unsafe abortion in Nigeria in her presentation titled, ‘Global gag rule (GGR) overview and the implication for NRHJN.’
“Of the 40 to 60 million abortions that take place annually, at least 20 million are performed under unsafe, illegal conditions and up to 50 per cent of these women require follow-up gynecological care.
Bemoaning the impact of unsafe abortion in Nigeria, she says, “Millions suffer permanent physical injuries, and at least 78,000 women die. Most of these deaths are preventable, and occur in countries where access to abortion is highly restricted or illegal altogether.
As research shows, nearly half of all unplanned pregnancies end in abortion in Nigeria. One in seven Nigerian women aged 15 to 49 has tried to obtain an unsafe abortion, either from ‘unqualified practitioners or qualified ones working under substandard medical conditions.’
“The restrictive abortion law means most abortions are clandestine and “very frequently unsafe,” Akiyode-Afolabi adds.
Painting a gory picture of the consequences, she states, “As a result, one quarter of all Nigerian women who have had an abortion report moderate or severe complications, and two thirds of women who have an unsafe abortion experience serious health consequences.
“Every year, hospitals in Nigeria treat approximately 142,000 women and girls for complications resulting from unsafe abortion. Based on recent reports, between 10, 000 to 34,000 women in Nigeria die annually as a result of unsafe abortion.
“Even where a woman obtains a legal abortion at a health care facility, inadequate staffing, training and equipment expose women to unnecessary risks. Among those who have an abortion performed by a physician, a large number developed complications and sought post-abortion care, indicating that the performing physician was not well-trained in abortion services. Few general practitioners receive training to perform abortions.”