Blurring the lines – The stark reality of safe abortion access in Nigeria

According to the World Health Organisation (WHO), about 73 million abortions take place worldwide every year. Worldwide, an estimated 22 million abortions continue to be performed unsafely each year, resulting in the death of an estimated 47,000 women and disabilities for an additional five million women with 29% of all pregnancies ending in an induced abortion. Almost every one of these death and disabilities could have been prevented through sexuality education, family planning, and the provision of safe, legal induced abortion and care for complications of abortion.

According to a more recent nationally representative study of women of reproductive age, there were 29 abortions per 1,000 women aged 15–49 in Nigeria, which is believed to have been 1.25 million induced abortions in 2012, or 33 abortions per 1,000 women aged 15–49.

Abortion has been defined as the discontinuation or termination of a pregnancy before attainment of viability. In other words, the termination of pregnancy before the fetus is capable of independent existence. This could be either spontaneously (i.e. miscarriage) or intentionally (i.e. induced abortion). In Nigeria, it is unlawful to perform an induced abortion unless it is done expressly to preserve the woman’s life. Hence, unless the pregnancy is putting her life in jeopardy, it is difficult for any pregnant woman who does not want to have a child to obtain an abortion at a government hospital, regardless of how serious or legitimate her reasons may be.

Because the average Nigerian woman cannot afford to engage the services of a willing private clinic, she is compelled to resort to unsafe abortion by patronising inexperienced workers who use inappropriate and contaminated instruments under unhygienic conditions to perform it. The result is the staggering statistics of 1,000 out of every 100,000 maternal deaths arising from the estimated 1,000,000 abortions performed annually in Nigeria. Also, it has the consequence of endangering our women’s reproductive health, particularly adolescents.

Today’s harsh reality is something that no restrictive abortion legislation can suppress no matter how stringent; in fact, it is what restrictive abortion laws are to be accountable for. The expediency of this situation motivated our approach to examine the necessity of reforming Nigeria’s abortion laws in order to provide access to safe abortion care and correct misinformation, regardless of one’s personal stance on the sanctity of human life.

Abortion is a historical practice that has been prevalent in human civilizations and is not a modern aberration. Despite the fact that abortion has always been lawful on a federal level, divisive political discourse has hindered practical access to abortion services. Misinformation and disinformation about abortion have been purposefully incorporated into political agendas and ideologies, creating a gulf between the general public’s view of abortion care and patients’ actual experiences receiving it.

The Legal Landscape

Nigeria’s abortion laws are some of the most restrictive in the world. In the northern states, the Penal Code Act of 1861, which is based on Islamic law, criminalises abortion except when it is performed to save a woman’s life. This strict interpretation limits access to safe abortion care and contributes to the prevalence of unsafe abortion practices in the region. The stigma surrounding abortion in these states is also particularly strong, driven by cultural and religious beliefs that view abortion as morally wrong or as a sin.

In contrast, the southern states operate under the Criminal Code Act of 1960, which allows for broader grounds for abortion, including to preserve a woman’s physical and mental health. However, the interpretation and implementation of these laws vary, leading to inconsistencies in access to abortion services across the region. Additionally, bureaucratic bottlenecks and the lack of trained providers further limit access to safe abortion care in the southern states.

The legal ambiguity and restrictions surrounding abortion in Nigeria create barriers for women seeking reproductive healthcare. Many women are unaware of their rights under the law or are unable to navigate the complex legal and healthcare systems to access safe abortion services. As a result, they often resort to unsafe practices, putting their health and lives at risk. Efforts to improve access to safe abortion care in Nigeria must address the legal challenges through reform of the outdated and restrictive laws.

Legal reform efforts should aim to decriminalise abortion and ensure that women have access to safe and legal abortion services when they need them. Additionally, public education campaigns can help raise awareness about the legal rights and options available to women seeking abortion care, empowering them to make informed decisions about their reproductive health.

It is evident that despite the criminalisation of abortion, women continue to perpetrate the acts, unfortunately, under unsafe conditions expedited by the state of the law. This obviously causes more deaths than ever and naturally arouses concern by the society and the government authorities.

Decluttering the narrative, promoting access to safe abortion care

In Nigeria, accessing safe abortion care is a contentious issue fraught with myths, misconceptions, and misinformation that often obscure the reality of sexual and reproductive healthcare. These falsehoods cloud the public’s understanding thereby impeding efforts to provide fundamental healthcare services to women in need.

According to popular belief, the sanctity of human life and cultural values could be compromised by the legalization of abortion. On the other hand, empirical data indicates that the reverse is actually true: making abortion illegal has led to women dying or being disabled when complications arise from botched abortion procedures. The majority of these abortions are carried out covertly, by inexperienced providers, or by both.

Consequently, unsafe abortion continues to be a significant cause of maternal morbidity and mortality in Nigeria, a country with one of the highest maternal mortality ratios worldwide. Beyond issues of safety, the illegality of abortion implies that those seeking services could be financially taken advantage of by those who perform the procedure, and they could refrain from accessing hospital-based care unless it is absolutely required.

In addition, a recent study documented high levels of abortion stigma among close to half of Nigerian abortion seekers.Silence and secrecy shrouds abortion in Nigeria and women who have had an abortion limit disclosure for fear of exclusion, judgment, and shame in families and social circles. Such a culture of secrecy may be a product of, or exacerbated by, the legal status and perceived illegality of abortion in Nigeria.

One of the most pervasive myths is that abortion is illegal in Nigeria. While Nigeria as a country does have restrictive laws surrounding abortion, it is permitted in certain circumstances, such as when the life of the woman is at risk or to preserve her physical and mental health. However, the lack of clarity in the law and misinformation perpetuated by societal attitudes often lead women to believe that abortion is completely prohibited, driving them to seek unsafe alternatives.

Another common misconception is that abortion is inherently unsafe or dangerous. This belief is fueled by the stigma surrounding abortion, which portrays it as a dangerous and morally reprehensible act leading to a lack of access to relevant and accurate information. In reality, safe abortion procedures performed by trained healthcare providers are significantly safer than unsafe methods. Unsafe abortions, on the other hand, can lead to severe complications, including hemorrhage, infection, and even death.

Also, when completed in line with the World Health Organisation’s guidelines, abortion is one of the safest medical procedures in the world.For decades, opponents of abortion rights have spread falsehoods that suggest abortion is harmful, impairs fertility, or negatively impacts mental and physical health. These myths have been used to intimidate women and prevent them from accessing this medical service. Ultimately, having an abortion does not make one a bad person; regardless of the reason for the procedure, abortion is healthcare just as much as any other routine preventive procedure and should be treated as such.

Furthermore, there is a misconception that only certain types of women seek abortion – those who are promiscuous or irresponsible. This stereotype is harmful and ignores the fact that women from all walks of life may find themselves in situations where they need to consider abortion. The decision to have an abortion is often a complex and deeply personal one, influenced by a variety of factors including health, socioeconomic status, and personal circumstances.

The most common reasons for seeking an abortion are limited financial resources, the pregnancy coming at the wrong time in life, and not having adequate support. Two thirds of abortion patients already have at least one child, meaning they know the physical, emotional, and financial responsibility that an additional child would bring.

That being said, we cannot know all the personal and medical circumstances behind someone’s decision to continue or end a pregnancy. Every person’s situation is different, and we should respect that this decision is theirs to make. Addressing these myths and misconceptions is central to promoting access to accurate information about safe abortion care and promoting women’s sexual health and rights.

This can help dispel myths and reduce stigma, thereby enabling women to make informed decisions about their reproductive health. More specifically, legal reforms are needed to clarify the legal framework surrounding abortion and ensure that women have access to safe and legal abortion services when they need them.