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| Women waiting to receive care in the hospital. |
•Rise In Unsafe Abortion, Maternal Deaths Loom
Chioma Umeha
A little more than a year ago after the Mexico City Policy,
also known as the ‘Global Gag Rule,’ (GGR) was reintroduced by President Donald
Trump on his first day in office; the fear of its dreaded impact is beginning
to be felt.
GGR is an executive order by the US government that blocks
U.S. federal funding for non-governmental organisations that provide abortion
counselling or referrals, advocate to decriminalise abortion or expand abortion
services.
However, there were huge outcries following the signing of a
piece of paper which today is preventing millions of women around the world
from deciding what they can and can’t do with their own bodies.
The reality of the thought that the powerful white man in
the White House has effectively signed the death warrants of thousands of women
is staring the world in the face.
It is now clear that with one devastating display of his
presidential ink, President Trump reversed global progress on contraception,
family planning, unsustainable population growth and reproductive rights.
His executive order even has implications for the battle
against HIV, tuberculosis and malaria.
Today, things have turned bitterly true to the cries of many
who tagged the policy as, ‘Trump’s global assault on family planning.’
The policy has shut HIV programmes in Mozambique and health
clinics in Uganda; it has compelled women from Nepal to Namibia to seek out
deadly back-street abortions.
In Nigeria, the ugly tale of GGR devastating impact is not
different as health care workers say the policy has had disastrous effect.
As expected, clinics are shutting down, unsafe abortions are
rising sharply and families are losing critical services.
While there is no available data on deaths directly linked
to the policy, providers do have estimates of how many life-saving procedures
could have been offered by the funding they are now denied, and the numbers are
in some cases staggering.
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 number 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 per- formed 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.
“The U.S. government is complicit in these preventable
injuries and deaths due to President Trump’s decision to reinstate the global
gag rule,” she maintained.
As research shows, nearly half of all unplanned pregnancies
end in abortion in Nigeria. One in seven Nigerian women aged 15 to 49 have
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.”
“The government, however, in its current report to the
African Commission failed to include information regarding the number of deaths
as a result of unsafe abortions and the measures it is undertaking to reduce
this rate by ensuring women’s and girls’ access to safe abortion,” she notes
regrettably.
She insisted that GGR is harm to women’s reproductive
health.
Dr Ejike Oji, in his presentation titled, “Historical
antecedents of the GGR and its impact on Sexual Reproductive Health and Right,
Civil Society Organisation focal point for FP 2020, at the NRHJN meeting, “The
rule, which has reproductive-rights advocates reeling is significantly broader
than similar bans in place intermittently since 1984. Those past actions were
limited to about $600 million in family planning funding.”
On the impact, he says; “At a small health center in Lagos,
Nigeria, a nurse advises women on how to have a healthy pregnancy. The center
is supported by the U.N. Population Fund. This centre will be defunded.”
Hauwa Shekarau, Country Director, Ipas Nigeria, in her
paper, titled; Barriers to safe abortion services in Nigeria, says, both the
Criminal Code and Penal Code on
abortion are restrictive and outdated.
Her words; “The law is obsolete and is not meeting the
yearnings of the people. The law was inelegantly drafted.”
Legally restricting reproductive health services such as
abortion does not affect the number of abortions that happen, Shekarau explains.
“Legal restrictions on abortion make abortion unsafe,
especially for poor women. Where abortion is legal and safe services are
available, deaths and disabilities from abortion are greatly reduced,” the Ipas
Country Director says.
Shekarau cited the statement of Dr. H. Nakajima, Director-General, WHO,
1999, while condemning the country’s restrictive abortion law saying; “Hundreds
of pregnant women, alive at sunset last night never saw the sunrise this
morning.
“Some of them died in labour, some died of hemorrhage in a
hospital lacking blood, some died in the painful convulsions of eclampsia and
some died on the table of an unskilled abortionist trying to terminate an
unwanted pregnancy.”
Another medical expert, a family doctor, Dr Kay Adesola,
also shares his opinion on GGR, “Already Nigeria’s maternal mortality rate is
very high and the expanded GGR is going to create a huge gap. Women and girls
are the most affected as many of these women are going to die from causes
related to pregnancy and unsafe abortion.”
He charged the Federal, State and local government to fill
the gap of international donors to provide modern contraception in the country,
by increasing the budget line for family planning commodities for women and
girls, emphasising that once this is done, Nigeria’s MMR will reduce as well as
unintended pregnancies.
Dr. Folasade Oludara, Director, Family Planning, Lagos State
Ministry of Health, says the state family planning (FP) department has
oversight function and “We receive updates from our health care providers as
well as expand the FP providers so we can have enough in the system.”
Giving a breakdown of the department’s budget from 2017 till
date, Oludara says; “In 2017, the allocation for FP was N27 million, while this
year we have increased it to N186 million. That increase in the allocation came
about as a result of the Global Gag Rule.
“Lagos State need to harness its demographic dividend by
reintroducing FP in the services to this huge population, we will be in trouble
if the population end up having unwanted babies.
“The GGR will awaken Nigerians to embrace family planning
and the National Assembly to look at the country’s domestic law, it doesn’t
encourage abortion unless it endangers the life of the woman,” she adds.
