The Conversation
20 May 2022, 00:40 GMT+10
The word “abortion” is used to describe two types of pregnancies that end before 20 weeks, which is now regarded as the age of viability of a pregnancy.
Spontaneous abortion occurs without an intention by the woman to stop the pregnancy, it is pregnancy loss before 20 weeks of gestational age. Induced abortion is the deliberate termination of a pregnancy because it is unwanted.
About 10% to 20% of all pregnancies in Nigeria end in spontaneous abortion. This is in line with rates elsewhere in the world. It is 12% in Ghana.
By contrast, induced abortion is thought to be more common in Nigeria compared with other countries. But it’s difficult to measure the incidence of terminations as abortions are restricted by law.
In 2015, the Guttmacher Institute estimated the incidence of abortion in Nigeria was 50.6 per 1000 per women of reproductive age. If accurate, this is one of the highest abortion rates in the world. The Guttmacher Institute is a research and policy organisation committed to advancing sexual and reproductive health and rights worldwide.
In Ghana, it is between 30 and 61 abortions per 1,000 women aged 15-49. This gives a mean rate of 44.
In Europe abortion rates are much lower. The Netherlands for example has abortion incidence of 8.6 abortions per 1000 women, while in Sweden it is 18.3 per 1000 women.
In a study I conducted in Benin City, Edo State in 2015, I asked women attending the gynaecology clinic at the University of Benin Teaching Hospital whether they have ever had induced abortion. About 72% said yes, with many reporting multiple episodes of abortion.
Based on my experience I believe these high levels continue. The pattern of abortions might have changed in the last seven years because of evidence that many more women are now self-induced with the use of drugs.
In addition, women continue to use dangerous substances to end pregnancies while untrained professionals and quacks with no clinical training continue to carry out many procedures. This makes abortion extremely dangerous and fraught with complications.
Restrictive laws contribute to abortion rate
The current abortion law in Nigeria was instituted by the British colonial government in the 19th century. It has never been changed. It is based substantially on Section 58 of the Offences Against the Person Act, 1861 of England.
The abortion law in Nigeria states that abortion is illegal unless done to save the life of the mother. It criminalises abortion with a steep penalty for both the woman and the personnel performing the abortion procedure. If caught, those who violate the law risk a 7-year (the patient) or a 14-year (the performer) jail term.
Conditions for carrying out abortions are prescribed by the Federal Ministry of Health in a publication titled National Guidelines on Safe Termination of Pregnancy for Legal Indications. These set out the conditions under which induced abortion can be safely carried out by health professionals.
The guideline is intended to build the capacity of medical professionals to identify pregnancies for which the abortion law is intended so that ethical and safe management can be instituted. It provides information on the subsisting Nigerian law on the termination of pregnancy, a compendium of medical conditions and circumstances where the continuation of pregnancy endangers the women’s life and a description of the step-by-step options for ethical and safe medical management.
This document is available in the Federal Ministry of Health and has been well published throughout the country. If well used and understood by health professionals, it will help identify pregnancies that pose threats to women, which can be properly handled by safe abortion care in health institutions.
From my experience, restrictive laws do not prevent women with unwanted pregnancy from resorting to abortion anywhere. This is true even in developed countries. It only makes the procedure dangerous and unsafe. It makes women seek abortions clandestinely at the hands of unqualified providers that could then result in death or disability.
The World Health Organization (WHO) defines unsafe abortion as “termination of pregnancy done by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards”.
US policy on abortion
I believe the US abortion policy should not affect Nigerian women because the US is governed by different laws and processes.
Abortion in the US has always been a contentious issue, and the related policies have varied due to the changing political circumstances in the country. It is sad that an issue such as unwanted pregnancy and abortion that results from personal encounters can be made a public and political discourse as happens in the US.
I find it objectionable that such public interference with family and private matter can be allowed to continue to fester in the political space despite the lack of evidence to indicate that abortion negatively affects the country in any particular way.
The long term solution is for countries like Nigeria to develop their population, reproductive health and development policies without external influences.
Abortion as women’s right
Several international organisations such as the WHO, the International Federation of Gynaecologists and Obstetricians, the Amnesty International, the Royal College of Obstetricians and Gynaecologists, and the United Nations have repeatedly issued guidelines to indicate that women have the right to decide on whether or not to have abortion.
In addition, it is recognised that women have a right to access family planning, safe abortion and post-abortion care.
I agree with these recommendations. They form part of the benchmarks for measuring global development and social equality, as enshrined for example in the Sustainable Development Goals.
Nigeria is a signatory to these documents including the Maputo Protocol that protect the rights of women on decision-making on safe abortion care, and has an obligation to protect those rights.
I fully support women’s rights to safe abortion and post-abortion care. They are necessary to build women’s agency and social empowerment in other ways.
Author: Friday Okonofua – Professor of Obstetrics and Gynaecology, University of Benin
