Curbing needless maternal deaths from unsafe abortion
Historically, women around the world have tried to end unwanted pregnancies whether abortion is legal or not, often jeopardizing their safety and health by self-inducing or seeking a dangerous illegal procedure.
While there is very little relationship between abortion legality and abortion incidence, there is a strong correlation between abortion legality and abortion safety.
The World Health Organization, WHO, defines unsafe abortion as a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.
Unsafe abortion is common in places where abortion is illegal. Nearly half of all abortions worldwide are unsafe, and nearly all unsafe abortions occur in developing countries. In countries where abortion remains unsafe, it is a leading cause of maternal mortality.
Women who have unsafe abortions are at risk of serious medical problems, including incomplete abortion, hemorrhage (heavy bleeding), infection, uterine perforation (caused when the uterus is pierced by a sharp object), and damage to the genital tract and internal organs (by inserting dangerous objects such as sticks, knitting needles, or broken glass into the vagina or anus).
According to Professor Adetokunbo Fabamwo, a Consultant Obstetrician and Gynaecologist, Lagos State University Teaching Hospital (LASUTH), said, "55,000 unsafe abortions happen all over the world every day and 19 million unsafe abortions occur in developing countries every year."
Making this statement 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 said the risk of dying from an unsafe abortion is the highest in Africa, where most are carried out by non-physicians.
With the current figure in Nigeria, he said, "unsafe abortion contributes 13 percent 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 however, stated that "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 nets like medical abortion should continue to be explored."
LASUTH CMD, said that for now, 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.
According to him, 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 said 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."
He defines medical abortion as 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.
Fabamwo further explained 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 for women with certain medical conditions like bleeding disorders, heart disease, liver, kidney and lung disease as well as women on blood thinners or steroids.
According to a 2018, Performance Monitoring and Accountability 2020 (PMA 2020) survey, the most recent family planning data for Nigeria and Lagos indicated that abortions by women between 15 and 49 years in Nigeria has risen to between 1.8 and 2.7 million annually.
The survey results had provided new insights into the characteristics of women who have abortions and the pathways leading to abortion within or outside the healthcare system in three countries, Nigeria inclusive.
Dr Funmi OlaOlorun, the co-principal investigator of the PMA 2020 survey, said likely abortions are higher among women who are in their 20s, have at least secondary education, and live in urban areas.
The survey, she said, which indicated that unsafe abortion is an equity issue, found more than six out of 10 abortions were considered least safe, and 11 percent of women experienced complications for which they sought post-abortion care at a health facility.
Dr Ola Olorun stated that all together, 37 percent underwent surgery to ultimately terminate their pregnancy, seven per cent used Mifepristone/ Misoprostol and the remaining 56 per cent used other or unspecified medications or traditional methods.
In addition, most public tertiary facilities provided post abortion care (92 percent) and safe abortion services to save a woman’s life (83 percent); lower level public facilities and private facilities were much less likely to do so.
Abortion is a controversial topic in Nigeria. But it is still done in secret and mostly by non-physicians because of many reasons, including family planning services being out of reach; rape, incest, ignorance and lack of resources to raise and support a/another child.
Earlier, Ms Sybil Nmezi, founder and coordinator of Generation Initiative for Women and Youth Network, GIWYN, says Nigeria’s collapsing social, health and other support systems expose women to sexual violence, unwanted pregnancy, unsafe abortion and death.
Nmezi said, although 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."
According to her, 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 said, unfortunately, 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
Professor Ayodele Atsenuwa of Department of law at University of Lagos in an overview of the legal framework affecting abortion, stated that Nigeria’s abortion law is not as restrictive as many people presume since it still makes provisions for therapeutic abortion.
According to her, "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."
Atsenuwa added: "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."
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