The need to do more for women and girls was the focus by stakeholders in the Sexual Reproductive Health (SHR) sector again. Yinka Adeniran looks at the issue and efforts to tame the menace of unsafe abortion among women and girls.
For months, Sola Oduwole (not real name) could not forgive herself. She felt she had a role to play in what had befallen her family. She just lost a sister (Olawunmi) who was under the surgical blade to have one of her breasts removed. Olawunmi had been diagnosed of breast cancer. Sola looks at herself with pain and regret. Olawunmi died weeks after the surgery had been successfully carried out.
Her late sister (Olawunmi) had been complaining of pain on her right breast. She thought, it was just a boil after weeks of slight pain in her arm-ampit region.
A minor surgery had earlier been carried out to extract the particles. A further test carried out on the extracted part showed signs of cancer. She was advised to allow the breast be cut off due to the extent of the pain. It was so agreed and done.
Sola’s pains knows no bounds, both physically and emotionally. She felt she was the cause of all the troubles and misfortune that had taken her sister’s life.
She couldn’t lift her head to look into the eyes of Olawunmi’s husband, even though he (Kunle) never for once accused or blamed her (Sola) for anything.
She had thought she was helping her sister but now lives in regret. Part of the pain was the financial stress Olawumi’s husband had to go through. He had been the sole breadwinner for about five years after she lost her job, which made the family relocate to Ibadan, the Oyo state capital city.
Working as a non-academic staff in one faith-based tertiary institutions in the Southwest, there was no gainsaying that the cost of providing for the family of five could not be sustained by the income of the husband alone, yet the man of the house never failed to live up to expectations.
Their first son, about 15 years old, just got promoted to Senior Secondary School. The baby of the house, about 12 years old, is also rounding off his primary education. The guilt of not being able to support the upkeep of the family was killing Olawunmi, and Sola also shared the sentiment of the burden.
After rallying round to raise some funds, Olawunmi’s husband was able to secure a small shop for her somewhere around Iwo Road, Ibadan. They made the decision after it was resolved that the teaching jobs in nearby private primary schools could best be described as a slave trade due to the paltry pay.
Not too long after the shop was secured and plans to begin business operation started, Olawunmi discovered she was pregnant. She, at first, waved it off as an impossibility. But when she confirmed it, she could not imagine telling her husband of a pregnancy of baby number four, after their youngest child was over ten years old. The thought was killing to her. She was quite sure of what her husband’s response would be, but she couldn’t imagine adding another burden of childbirth and upbringing to the huge cost of running the current family.
She confided in Sola and they were both on the same page on the non-desirability of the pregnancy, hence the need for an abortion.
It was easy for Olawunmi to make up her mind, especially when Sola gave a tacit support and encouragement. The pregnancy was over five months before she resolved to abort it, despite so much discouragement from her husband. The husband kicked against it at first, but she insisted and stood her ground. And it was done. At the time of the abortion, she could not hide the pregnancy as all her organs and body system had already exposed her. But, she was not worried. She thought she was done, not knowing she just started another journey of her life.
What was Sola’s offence against herself? She felt her support for abortion of the unintended pregnancy was the cause of the problems. Although, she reasoned that, if Olawunmi had not been “too careless” to get pregnant, the changes in her body that developed to the lump in her breast would not have came up.
To her reasoning, the breast milk developing as a result of the aborted unintended pregnancy was a factor that could have led to the situation that later resulted in her sister’s breast cancer.
Sola’s dilemma accounts for the views of many women. Although research has not shown any link between abortion and breast cancer, many women in rural communities still carry the guilt and fear anytime they have to carry out abortion of unintended pregnancies, especially in unqualified facilities.
Sola felt she had a hand in the death of her sister through her tacit support and encouragement of the abortion of the unintended pregnancy.
Scholars to Action
Apparently worried by these views, medical experts, scholars, and researchers in the field of public health have also expressed deep concern over the alarming rates of death resulting from unsafe abortions in the country. As such, they have urged the government to significantly increase its investment in Sexual and Reproductive Health (SRH).
The experts were unanimous that the lives of women and girls aged 15 to 49, lost daily due to abortion-related causes, hold a value that far surpasses the funding required to establish the necessary facilities and services to ensure their survival.
This collective sentiment was articulated during a special session titled: The Public Health Challenges of Unintended Pregnancies and Abortion: Global and National Dimensions. The session was organised by the non-governmental organisation Academy for Health Development (AHEAD) based in Ile-Ife, Osun State, in collaboration with the Guttmacher Institute, headquartered in New York, USA. The event was an integral component of the 5th Scientific Conference of the Society for Public Health Professionals of Nigeria (SPHPN).
According to the experts, Nigeria bears a staggering annual loss of over 67,000 women due to abortion-related complications, with an alarming daily average of at least 20 deaths across the nation.
Leading the call, Prof Adesegun Fatusi, a distinguished figure in the realm of Community Medicine and Public Health, explained that Nigeria currently carries the heaviest burden of maternal mortality, based on the latest research by the World Health Organisation (WHO).
He went on to underscore that, as per the Federal Ministry of Health’s data, approximately 11 percent of maternal deaths in Nigeria result from abortion. When combining these two statistics, it becomes evident that approximately 20 women tragically lose their lives every day due to abortion-related causes. This reality is both deeply concerning and troubling.
Fatusi, the Vice Chancellor, University of Medical Sciences, Ondo State, and foundation Secretary-General of SPHPN, stressed that the dire situation could be reversed if women Sexual and Reproductive Health (SRH) needs were adequately met with an additional per capital investment of $27.15 to supplement the current $3.11.
He explained, “If all the contraceptive, maternal, newborn, and abortion care needs in Nigeria were comprehensively addressed, the following sexual and reproductive health outcomes for women aged 15 to 49 years and their newborns would experience a significant improvement. Unintended pregnancies would decline by 80 percent; abortion rates would decrease by 80 percent; unsafe abortions would plummet by 80 percent; maternal deaths would diminish by 61 percent, and newborn mortality would drop by 76 percent.”
Fatusi also emphasised that the additional investment would encompass health services, policy and legal frameworks, norms, data, and research.
Providing a global perspective on unintended pregnancies and abortions, a Senior Research Scientist at the Guttmacher Institute, Dr Jonathan Bearak, shared insights from a recent survey indicating that rates of unintended pregnancies are declining on the average worldwide but increasing in Nigeria.
He further noted that abortion rates exhibit wide variations across countries, irrespective of whether abortion is prohibited or not.
The speakers in theor separate remarks, called upon the government and various stakeholders to escalate efforts and take comprehensive actions to safeguard the lives of women.
More concerns about unintended pregnancies
The Chairman, Management Committee, Association for the Advancement of Family Planning, Dr Ejike Orji, said unsafe abortion had more implication than what people may imagine.
He said, “One of the key things we could see is that unintended pregnancies, in Nigeria, in terms of real numbers are actually going up and abortion also is going up. The question now is why is abortion-related death and abortion rate going up? The question is very simple, when women are unsuccessful in stopping pregnancies that they don’t want, the most likely thing is that they want to terminate that pregnancy, whether it is legal or not. And what usually happens is that you have a lot of disabilities caused.
“In fact the greatest cause of infertility in Nigeria is complications from unsafe abortion. We are also playing cat and mouse game with the rate and what causes most of the deaths in Nigeria. We always try to put abortion 3rd or 4th or 5th but if you ask me, abortion is 2nd after postpartum hemorrhage.”
Fatusi, while harping on the implication of the statistics presented at the event, noted that more needs to be done saying, “We know from global data that deaths from abortion are due to unsafe abortion because the statistics show globally that abortion does not necessarily result in maternal mortality. The risk is not as significant. So, anytime we talk about abortion and death, we are practically talking about unsafe abortion.
“We know that unsafe abortion, as we define it, is when it is done by somebody who is not medically qualified or using a method that is not appropriate or recommended by WHO and that is the cause of death that we have from abortion. In fact, the proportion of death or abortion could be higher than what we are seeing because some of the figures will talk about women who are bleeding in pregnancy, can be people who have had abortion who will not talk about it or even who are infected in pregnancy. So, abortion is a huge challenge in Nigeria.”
Position of law on abortion, rape in the country
According to Fatusi, globally, when women want abortion, the law doesn’t stop them because women can go to any length to get it at all cost.
He said, “Do you know again that our law says you can have abortion only when the woman’s life is involved or when some mental conditions are involved? What we know globally is that when women want abortion the law doesn’t stop them. If a woman wants abortion, she will use anything that she can. We’ve done a study before where we looked at what women do when they don’t have access. Women will do practically anything and that’s why we need to look at the way forward. The first way forward is to understand why abortion happens.
“Abortion happens because the woman does not intend to have that pregnancy. So unintended pregnancy is the permanent cause of abortion. What our data says today is that almost half of women who have unintended pregnancy, in other words pregnancies they didn’t plan for, will go out and abort it. So if we can cut that to the minimum, in other words, ensure that every woman who needs contraceptives can have the information, the education and the service and obtain the contraceptive, then we would have cut down on the potential of abortion substantially.
“That is the place to start and along that we also must know that a lot of people that are affected, in fact the higher proportion of people who are affected by unsafe abortion are women who are under the age of 15-19. Young women who don’t have access and who don’t have money to procure safe abortion.
“So, one of the things to do to help people like that is to make sure they have enough education and information. So, things like comprehensive sexual education or family life and HIV education is important to help equip our young people, those are the foundations.
“The other foundation we must think about is the norms in our society. The social norms that deny people the opportunity to have access to contraceptives. We must think about the practices in our health facilities. When a young girl comes to our facilities sometimes what they do is deny her access. We must think therefore about that.
“So, firstly is health. We must improve access of women to information, education and quality services. Secondly is our laws, our norms and our social policies that discourage women from having access when they need to. It’s interesting to know that if a woman is dying of abortion complications today, our regulation, our health services guideline says that such woman must have access to services but if the woman wants access to safe abortion, she cannot have it. So we must look at our law and say, what do we need to do differently?
“The other thing we need to do is to look at our data and research to see what we can do to ensure that our women can access health services. What are the barriers that are standing between them and health services? What are the factors promoting unsafe abortion? What can we do about that? And if we are intervening, how do we monitor progress? Those are three fundamental pillars that we can look at in trying to address the question of unsafe abortion in Nigeria.”
On the issue of rape victims and other abuses to women, the Professor said, “The Violence Against Persons Prohibition Act (VAPP) law says that if a woman is violated and she gets pregnant, she has a right to access services. In fact, the service provider or the protection officer has a duty to ensure that the woman has access and transportation that will take her to the services that she needs. Our guideline on safe abortion or safe termination of pregnancy also emphasises that if a woman has mental illness, she should be able to have access. That is what our laws and our guidelines dictate today.”
In her views, the National Coordinator, African Youth and Adolescent Network on Population and Development (AfriYan Nigeria), Elizabeth Alatu-Williams, said there are many adolescents and young persons who are engaging in unsafe sexual activities, which is predisposing them to unintended pregnancies and which in the long run, lead to unsafe abortion.
“So, it’s extremely important that we procure them with comprehensive sexuality education and this is basically a form of education that empowers them with life skills around goal-setting, self-esteem, values, assertiveness, being able to make decisions for themselves, being able to say no to sex until when they know that they are ready, and also being able to engage in safe sex if at all they actually have it or engage in sexual activities.
“That’s why comprehensive sexuality education is so important and the Nigerian government has already published or approved the family life and HIV education curriculum which is our own adaptation of the CSE curriculum being implemented in junior secondary schools in Lagos and a couple of other states within Nigeria.”
Alatu-Williams, who is the also the Founder/Executive Director, Sustainable Impact and Development Initiative, added that other stakeholders must join the government in the fight against the menace of sexual activities pervasive among adolescents and young people if unsafe abortion must be tamed, especially creation of safe centres where adolescents and young people can have access to sexual reproductive health education, information and service that is free of discrimination, stigma and is affordable and accessible.
A call to save more women and girls
In her views, the Country Director, IPAS Nigeria Health Foundation, Lucky Palmer, said the gathering is a clarion call on all stakeholders to come to the aide of women and girls who daily die due to the abortion-related causes.
“Well, the report is damning. We cannot have our women dying everyday. If we really want to move forward as a people, we need to pay attention to the health of our mothers, of our sisters. It’s about time that we need to collectively take a decision, whether the life of our women, of our sisters, of our daughters are worth being saved.
“And can we do it? Yes, it is not rocket science, the solutions are there. We only need to take decisions, amend the law that needs to be amended and give power and authority to our healthcare workers to provide the right care and treatment for the women of Nigeria, including abortion.
“Abortion is a healthcare treatment, it is not a social concept. It’s just like treating HIV, hepatitis B. So, abortion is a right for every woman that needs the service to be treated.
“Nigeria was one of the countries that did not achieve the minimum target for maternal mortality then by the SDG. We are now coming towards the halfway of the MDG. It should not be at the end of the day again that Nigeria will be found among those countries that did not meet the target and abortion is a low hanging boot that we can stop by changing our law and for example, just even allowing those women who were forced into getting pregnant through sexual violence to have access to the right type of treatment that they want.
“We can reduce this number of women who are dying every hour, at least two women from Nigeria die from complications of unsafe abortion. Can we turn the unsafe abortion to safe abortion? Yes, the trainings are there, the guidelines are there, but we need to change our laws and empower our healthcare workers to do the right thing.”
She also made case for proper sex education for youths and adolescents to prevent abortion in their midst, while also listing the benefits to include: giving proper sex education to youths and adolescents; teach against unprotected sex, if they must have sex; create safe and convenient spaces for adolescents to freely ask questions and clear their doubts about sex;
Changing the Narrative
In his view, Country Director, MSI Reproductive Choices Nigeria, Emmanuel Ajah believes the government needs to show more commitment beyond mere rhetorics.
“There are a couple of things that we need to do. First and foremost is government sincerity and support to the drive of sexual and reproductive health services. We just mentioned here that there are no commodities, so even when you have providers trained, there are no commodities that are available when people get into the facilities for them to be able to take up some of those services.
“In some communities, especially in the North, you have really poor human resource for health. So, we need to make sure that even as we have done, we must ensure that there are many more people that are trainable and that can be equipped to continue to provide services.
“At the religious, traditional and cultural levels, we need to ensure that all of those social norms and cultural changes that continuously impede the uptake of family planning services are addressed. Our religious and traditional leaders must be involved in whatever we are doing.There is the need for our women, our girls to be able to make choice as part of their lives and it has become very important that we give them that support.”
