The Pressing Need Expanding Access to Safe Abortions in Nigeria

While there may still be an ongoing debate on women’s right to an abortion, certainly women who choose to have abortions deserve access to safe procedures.

In Nigeria, abortion is illegal. In southern states, Sections 228-230 of the Criminal Code provide that any person involved in the abortion procedure is guilty of a felony. Persons who carry out the procedure will be imprisoned for 14 years; persons who ‘aid and abet’ by supplying anything intended for an abortion will be imprisoned for three. Women who abort are also guilty of a felony, which is punishable by imprisonment for seven years. Sections 32-234 of the Penal Code assume a similar position in northern states, prescribing punishments ranging from fines to imprisonment for offenses relating to abortion.

Abortions: The Current Situation

Nigeria’s abortion laws easily make Nigeria one of the most restrictive countries on abortion-related issues. Only licensed and trained health practitioners at certified government and private health centres can legally induce abortions in cases where this will save the mother’s life. Despite the stringent legal restrictions, both skilled and unskilled personnel carry out abortion procedures on thousands of women daily. Existing legislation has not only prevented the institutionalization of safe abortion practices, but has also succeeded in driving abortion underground, meaning abortions are often carried out by quack doctors and non-physicians with no formal training. It is no surprise then that most of these procedures are unsafe.

In 2017, the World Health Organization reported about 295,000 women died from preventable causes during pregnancy and childbirth. A subsequent study in 2019 by the BMC Women’s Health Journal reported unsafe abortions accounted for 8 per cent of maternal deaths globally. According to the Guttmacher Institute, unsafe abortion remains ‘an important contributor to maternal morbidity and mortality in Nigeria’, with an estimated 61,000 women dying annually in Nigeria from abortion or complications during childbirth. Those that survived are faced with complications such as, among others, sepsis, vesicovaginal fistula, anaemia and a ruptured uterus that may require a hysterectomy. Other factors driving such high morbidity and mortality rates include the restrictive abortion laws, untrained providers, inadequate post-abortion care facilities in health institutions, limited access to family planning counselling, information and services, as well as the poor socio-economic status of Nigerian women. 

The Impact of Unsafe Abortions

The impact of unsafe abortion extends beyond morbidity and mortality; there are also social costs these women face. A 2018 article on individual-level abortion stigma posits in both developed and developing countries women face abortion stigma. Religion and purity culture play a huge role in shaping perceptions and opinions where abortion is concerned; and, in Nigeria specifically, having an abortion does not conform to the accepted standards of morality and chastity prescribed for women. This stigma could lead a woman to seek the procedure ‘underground’, where there may be more discretion, or to even carry the pregnancy to term without the emotional ability or financial capacity to care for their new-born. 

Furthermore, the shame associated with abortion could prevent women from seeking the necessary post-abortion care. In addition to social costs, complications from unsafe abortions also have financial implications. HowToUse, an online community dedicated to sharing facts and resources on safe abortion, reports that getting a safe abortion in Nigeria can cost as much as N37,000 (approximately $103). This is already a huge amount considering the poverty rate in Nigeria. News reports show that almost 100,000,000 people in Nigeria live in abject poverty and survive on less than $1 a day; unsurprisingly, women in rural areas make up a considerable part of this number. According to 2020 data gathered by the World Poverty Clock, 63 per cent of the nearly 96 million Nigerians living in extreme poverty can be found in rural areas, and 48 per cent of Nigerians living in poverty are women. Undoubtedly though, the cost of getting a safe abortion is still cheaper than the cost of treating complications resulting from unsafe abortions. Other impacts include the risks associated with breaking the law and the possibility of strong religious sanctions. Existing laws in Nigeria also restrict counselling and adequate training of health professionals on abortion-related issues that could support women before and after the procedure. A 2013 study of women in low-income countries found that women who receive family planning counselling and services following their abortion are less likely to have repeat abortions or unplanned pregnancies, and are more likely to accept or use contraceptives.

Increasing Access to Safe Abortions

The need for increased access to safe abortion practices in Nigeria is undeniable and one way to guarantee this is a review and amendment of the current abortion laws. The reformation of abortion laws in Nepal demonstrates how effective legislation can be in reducing maternal mortality and there are lessons to be learned from the results. Prior to 2002, Nepal’s 1963 Legal Code identified abortion as ‘an offence against life’ and prohibited abortions even in life-threatening pregnancies. This legislation was reformed to permit abortion in specific instances with the consent of the adult woman (or guardians for those under 16), further supported by a series of guidelines, protocols and tools, training and facility upgrades, and comprehensive abortion care services. The results speak for themselves. Nepal’s maternal mortality ratio dropped to 229 per 100,000 live births by 2009 (versus 539 in 1996) and abortion complications were down to 26 per cent by 2008 (versus 41 per cent in 1998).

There have been a few unsuccessful attempts to review the abortion laws in Nigeria, which were handed down from the British Colonial government and date back to the 1980s. In 1982, the Nigerian Society of Gynaecologists and Obstetricians supported the Termination of Pregnancy bill, which would permit abortion where continuing the pregnancy ‘posed a great risk to the well-being of the woman’s existing children and if there was a substantial risk of the child being born with mental abnormalities and/or physical handicaps’. The bill failed to be passed, following vehement opposition from religious leaders and the Nigerian National Council of Women’s Societies, who argued passing such legislation would ‘increase promiscuity within society’. Since then, there have been further attempts to reform the abortion laws, but steady opposition has meant these laws remain unchanged till date.

While there may still be an ongoing debate on women’s right to an abortion, certainly women who choose to have abortions deserve access to safe procedures. In this day and age, women who have unintended pregnancies should have ready access to reliable information and necessary counselling; and, in all cases, these women should have access to quality services to treat complications that result from abortions

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