Unsafe abortion has been proved to be one of the leading causes of avoidable deaths of women in many countries where it is prevalent. Unfortunately, almost half of all abortions worldwide are unsafe, and nearly all unsafe abortions occur in developing countries. This is just as evidence has shown that unsafe abortion is widespread in places where abortion is illegal.
Women who have unsafe abortions are at risk of serious medical problems, including incomplete abortion, infection, uterine perforation (when the uterus is pierced by a sharp object) and hemorrhage (heavy bleeding).
Also, unsafe abortion causes damage to the genital tract and internal organs (when dangerous objects such as sticks, knitting needles, or broken glass are inserted into the vagina or anus).
Describing the incidence as alarming, Professor Adetokunbo Fabamwo, a Consultant Obstetrician and Gynaecologist, Lagos State University Teaching Hospital (LASUTH) noted that unsafe abortion is an everyday preventable occurrence worldwide.
He said; “Globally, 55,000 unsafe abortions happen every day with 19 million of the unhealthy and deadly practice occurring in developing countries every year.”
Stating this recently at a two-day Population Reference Bureau (PRB) Safe Engage Training Workshop in Lagos, Professor Fabamwo, who is also the Chief Medical Director, (CMD) LASUTH, added that in Africa, nearly half of all abortions happen in the least safe circumstances.
The Professor also said the risk of dying from an unsafe abortion is the highest in Africa, where most are carried out by non-physicians.
Giving the breakdown of the situation in the country, he said; “Unsafe abortion contributes 13 per cent to all pregnancy-related deaths. About 610,000 unsafe abortions occur in Nigeria every year and half of the women that will die from it are young people or adolescents.”
He further stated; “Unsafe abortion continues to contribute needlessly to maternal mortality and morbidity in Nigeria, largely due to the consequences of a highly restrictive abortion law. Repeated attempts at liberalising the Nigeria Abortion Laws had failed despite a compelling case for it.
“There should be continued and relentless advocacy towards changing the law. Other safety measures, like medical abortion should continue to be explored.”
However, the LASUTH CMD said that currently, medical abortion is legal under the Lagos State Criminal Code if having the child will put the mother’s life and her physical health in danger.
He explained, under the code, “A medical doctor is not criminally responsible 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 CMD further noted that elective abortions were not usually done until the Ministry of Health’s circular of April 2019, adding; “Now, for legally indicated cases, options of medical and surgical abortions are now available.”
According to him, medical abortion is a procedure that uses medication to end a pregnancy. It does not require surgery or anaesthesia and can be started in a medical office or at home. It is most effective in the first trimester of pregnancy.
Giving more details, Fabamwo said that medical abortion is done to complete an early miscarriage or to end an unwanted pregnancy if there is a medical condition that makes continuing a pregnancy life-threatening. The pregnancy, of course, must be less than nine weeks.
However, he said, medical abortion is not applicable under certain medical conditions like in women on blood thinners or steroids, bleeding disorders, heart disease, liver, kidney and lung disease
The 2018 review of Performance Monitoring and Accountability 2020 (PMA 2020) survey show that the most recent family planning data for Nigeria and Lagos revealed startling statistics of abortions among Nigerian women aged between 15 and 49 years.
Specifically, he said abortions among Nigerian women aged between 15 and 49 years has risen to between 1.8 and 2.7 million annually, according to PMA 2020 survey.
The survey results also unveiled the characteristics of women who have abortions and reasons for the practice within or outside the healthcare system in three countries, Nigeria inclusive.
Dr Funmi OlaOlorun, the co-principal investigator of the PMA 2020 survey provided further analysis. Dr OlaOlorun said, likely abortions are higher among women who are in their 20s, with at least secondary education and live in urban areas based on PMA 2020 survey.
The survey, she said which indicated that unsafe abortion is an equity issue, found more than six out of 10 abortions which were considered least safe, and 11 per cent of women experienced complications for which they sought post-abortion care at a health facility.
Dr OlaOlorun said the overall survey shows that 37 per cent of women underwent surgery to ultimately terminate their pregnancy while seven per cent used Mifepristone/ Misoprostol. The remaining 56 per cent, she said used other or unspecified medications or traditional methods.
Also, most public tertiary facilities provided post abortion care (92 per cent) and safe abortion services to save a woman’s life (83 per cent); lower level public facilities and private facilities were much less likely to do so.
In Nigeria, abortion is a debatable issue. Yet the practice continues to go on secretly and mostly carried out by non-physicians because of many reasons. These include ignorance, poor access to family planning services, rape, incest, lack of resources to raise and support a /another child, rape and incest.
Professor Ayodele Atsenuwa of Department of law at University of Lagos giving a summary of the legal framework affecting abortion said that Nigeria’s abortion law is not as restrictive as many people presume since it still makes provisions for therapeutic abortion.
She noted; “There are criminal provisions against abortion, but abortion is lawful when the legal indication within the provisions of the law is satisfied.
“It is important that our response to abortion should be based on the law. It is not that there are no instances when a woman can have a lawful abortion, the law is very clear.”
Professor Atsenuwa who faulted the country’s abortion law said; “That has always been in the law, even in the 1904 criminal code. There is a definition of what is the crime and anything that does not fit that definition is not the crime.”
“Defence is available, especially under the provisions of sections 297 of the criminal code and something similar is in section 201 of the criminal law of Lagos State.
Atsenuwa said; “It is important that we disseminate information about when the law recognises that it is necessary to allow women to have access to safe abortion. It recognises that there are circumstances when it is in the best interest of the society to allow women have access to abortion that is safe and affordable.”
On her part, Ms Sybil Nmezi, founder and coordinator of Generation Initiative for Women and Youth Network (GIWYN), alleged that Nigeria’s collapsing social, health and other support systems expose women to sexual violence, unwanted pregnancy, unsafe abortion and death.
Nmezi explained, though women’s sexual and reproductive health is related to multiple human rights, including the right to life, health, privacy, education, the prohibition of discrimination, make an informed decision and be free from torture, stating that, “Nigeria does not implement or enforce most of them.”
She stressed, messages such as, “Only bad women have abortions and contraceptive” or “A pregnancy is more valuable than the woman carrying it,” must also be changed in the media.
Nmezi lamented that many people lack understanding of provisions under the law when women can assess abortion and this had contributed to the misconception on the illegality of abortion in Nigeria