Unsafe abortion is a major cause of injury and death among women worldwide. Statistics show that approximately 20 million unsafe abortions are performed annually. Olabisi Deji-Folutile examines the high prevalence of induced abortion despite its illegal status in Nigeria
Flora John was in tears as she told the story of how she lost her womb as a teenager. Then a Junior Secondary School pupil, she was impregnated by a neighbour who was a student in one of the federal polytechnics in the country. â€œConfused and afraid of the consequence of my action, both I and my boyfriend approached a registered clinic in Ikeja, Lagos State capital, to get rid of the unwanted baby,â€ she said. But, unfortunately, her small intestine was perforated in the process. Sensing that she might die from chronic infection, the doctor referred her to the Lagos University Teaching Hospital where she got a proper clean-up. â€œThough the operation was successful, the doctors told my parents that I might not be able to become pregnant again because the infection had affected my womb,â€™â€™ she said.
If John laments the near-impossibility of being ever able to have her own biological children, Mary Sunday wasnâ€™t that lucky. She died during an illegal abortion procured in Osogbo, Osun State, last month. Fifty-one-year-old Julius Olufemi is standing trial at a magistrateâ€™s court in Osogbo for allegedly performing the illegal abortion at about 1am on June 10 this year.
John and Sunday are among a third of Nigerian women of child-bearing age which studies claim have had an unwanted pregnancy at one point in time or the other. According to Guttmacher Institute and its Nigerian partner organisation, the Campaign Against Unwanted Pregnancy, 10,000 women die yearly in Nigeria from unsafe abortion. It is believed that an estimated 760,000 induced abortions occur in the country every year. The study says almost six in 10 abortions are carried out by medical professionals in hospitals and clinics â€“â€“ 55 per cent in private ones and three per cent in public ones. Others, according to the study, are done under much less safe conditions and by methods that are much more likely to result in health complications.
Unsafe abortion is a major cause of injury and death among women worldwide. Although data are imprecise, it is estimated that approximately 20 million unsafe abortions are performed annually, with 97 per cent taking place in developing countries. Unsafe abortion is believed to result in approximately 68,000 deaths and millions of injuries annually.
People give different reasons for terminating pregnancies. It is either they are too young, single or married but uninterested in having more children. As far as Nigeriaâ€™s laws are concerned, induced abortion is legal only if it is done to save the womanâ€™s life. And before abortion can take place on medical grounds, the doctor must seek the second opinion of another doctor.
A consultant gynaecologist at the Lord-West Medical Centre, Surulere, Lagos, Dr. Ibrahim Olaifa, describes abortion as the termination of a foetus before it reaches the age of maturity. According to him, there are two types of abortions, namely induced and non-induced abortion. While non-induced abortion occurs naturally, he said, induced abortion occurs when the pregnant mother decides to terminate the pregnancy without any medical justification.
But in spite of legal restriction, abortion rate is still high in Nigeria. For as low as N1,000, a woman could procure abortion in private clinics in the country.
â€œIn Nigeria, about 25 out of 1,000 pregnancies are aborted, compared to western countries where abortion is legal and done liberally. There, abortion rate is five out of 1,000 pregnancies. Non-legalisation of abortion contributes immensely to maternal deaths. We are losing about 60,000 women every year to abortion and 40 per cent of this figure are caused by complications from induced abortion,â€ Olaifa claimed.
Olaifa gave reasons ranging from economic to health and social considerations for the prevalence of abortion in the country, despite its illegality. He also cited the problem of poor family planning options as another factor. â€œA family that cannot take care of their children may want to terminate a pregnancy. If a woman is impregnated by someone that is not her husband, her boyfriend, in case of teenagers, she wonâ€™t want her parents to know; and sometimes, it could be because of promiscuity on the part of the woman. It could be because of parental disapproval of a relationship. Besides, a woman may not be healthy enough to carry a pregnancy due to some terminal ailments like cancer and so on,â€ he explained.
On how much it costs to procure abortion, a family physician at St. Raphael Hospital, Okota, Lagos and National President, Association of General Private Medical Practitioners, Dr. Anthony Omolola, said abortion costs between N1,000 and N5,000 in Nigeria. He, however, said it could be higher, depending on the hospital and the nature of the pregnancy.
Both doctors agree that the safest period to abort a pregnancy is in the first trimester. Complications arising from unsafe abortions, according to them, could be either immediate or prolonged. These, they said, included severe blood loss leading to death; infections leading to infertility; uterus perforation; cervical laceration; renal failure; damage to the bladder and intestine perforation. They listed the prolonged effects of unsafe abortion to include infertility and chronic pelvic inflammatory disease.
The World Health Organisation believes safe and legal abortion is a fundamental right of women, irrespective of where they live. It says unsafe abortion is a â€œsilent pandemic.â€
According to the world health body, nearly 42 million women faced with unintended pregnancies have abortions yearly. A 2007 study conducted by the WHO and Guttmacher Institute says 20 million unsafe abortions take place each year, mostly in countries where abortion is illegal. Both bodies claim abortion is safe in countries where itâ€™s legal, but dangerous in countries where itâ€™s outlawed and performed clandestinely. According to WHO, nearly all abortions (92 per cent) are safe in developed countries, whereas in developing countries, more than half (55 per cent) are unsafe.
The risk rate for unsafe abortion, according to the world health body, is 1/270. Though other sources claim unsafe abortion is responsible for one in eight maternal deaths, anti-abortion critics contend that most statistics of people dying from abortion are flawed, as there are no accurate statistics about abortion from countries in the developing world.
A recent study titled, â€œUnwanted Pregnancy and Induced Abortion in Nigeria: Causes and Consequences,â€ done by Guttmacher, shows that approximately 68,000 women die annually in the world as a result of complications of unsafe abortion; and between two million and seven million women each year survive unsafe abortion but sustain long-term damage or disease (incomplete abortion, infection (sepsis), haemorrhage, and injury to the internal organs, such as puncturing or tearing of the uterus).
While countries like South Africa and Italy have legalised abortion, some states in the US forbid it. Abortion laws vary from country to country. In South Africa, the Choice on Termination of Pregnancy Act 92 of 1996 permits any woman of any age to get an abortion by simply requesting with no reasons given if she is less than 34 weeks pregnant. If she is between 13 and 20 weeks pregnant, she can get the abortion if her own physical or mental health is at stake, the baby will have severe mental or physical abnormalities, she is pregnant because of incest, she is pregnant because of rape, or she is of the personal opinion that her economic or social situation is sufficient reason for the termination of pregnancy. If she is more than 20 weeks pregnant, she can get the abortion only if she or the foetusâ€™ life is in danger or there are likely to be serious birth defects.
A woman under the age of 18 will be advised to consult her parents, but she can decide not to inform or consult them if she so chooses. A woman who is married or in a life-partner relationship will be advised to consult her partner, but again, she can decide not to inform or consult him.
According to the Associated Press and Ultimate Pro-Life Resource, abortion in Italy became legal in May 1978, when Italian women were granted the right to terminate a pregnancy on demand during the first 90 days. Although a proposal to repeal the law was considered in a 1981 national referendum, it was rejected by nearly 68 per cent of voters.
Italian women are eligible to request an abortion for health, economic or social reasons, including the circumstances under which conception occurred. Abortions are performed free-of-charge in public hospitals or in private structures authorised by the regional health authorities. The law also allows termination in the second trimester of the pregnancy only in one of the following cases: when the life of the woman would be at risk if the pregnancy is carried to term; or the foetus carries genetic or other serious malformations which would put the mother at risk of serious psychological or physical consequences.
Italian law states that, unless a state of emergency requires immediate intervention, a period of seven days has to occur between the medical authorisation and the effective date of the termination.
Although the law only permits pregnancy termination for women at least 18 years old, it also includes provisions for women younger than 18, who can request the intervention of a judge when the legal tutor refuses the intervention, or there are reasons to exclude the legal tutor from the process. The judge has to make a decision within five days of the request.
In Ireland, abortion is legal only on strict medical grounds. But a 1993 referendum made it legal to advertise abortions available in foreign countries and allow people to travel overseas to obtain abortions.
In Poland, abortion was legal under the communist government. The post-communist democratic government enacted the present law in 1993. In 1996, it passed a more liberal law, allowing abortion up to 12 weeks for various reasons, including financial hardship and emotional problems, but the high court declared this law unconstitutional.
In Spain, abortion is legal up to 12 weeks in cases of rape, deformed baby, or danger to the motherâ€™s life or mental health. The law was passed in 1985, but in practice, the â€œmental healthâ€ clause has resulted in abortion on demand (up to 12 weeks) as psychiatrists will routinely certify that a womanâ€™s mental health is endangered.
In England, Scotland, and Wales, abortion is legal up to 24 weeks. But in Northern Ireland, there is no specific law either allowing or prohibiting it, and in practice it is rare.
In Switzerland, abortion is illegal unless the motherâ€™s life is in danger. A 1977 referendum to allow abortions up to 12 weeks was rejected. A 1988 referendum to drop the life-of-the-mother exception was also defeated.
In Germany, abortion is legal, but the mother must present a certificate showing that she has consulted a counsellor first. The counsellor may be from a church group, the Red Cross, or the government.
In Denmark, abortion is legal on demand through the 12th week. Romania was the only country where abortion was illegal under communist rule, and this prohibition was enforced with very invasive government action. But when the communist government was overthrown, abortion was legalised through the 12th week.
While pro-abortion groups argue that legalising abortion will reduce the number of deaths from backstreet abortion, those against it say it is wrong to legalise procedures that kill the innocent just to make the killing process less hazardous.
From the childâ€™s point of view, they claim there is no such thing as a safe, legal abortion. According to them, it is always deadly. â€œFor every two people who enter an abortion clinic, only one comes out alive. Typically, those appealing to the emotions through the use of this argument completely avoid the real issue, since it is easier to talk about coat hangers than dead children,â€ they argue.
The Secretary-General, Nigerian Supreme Council of Islamic Affairs, Dr. Abdul Lateef Adegbite, told our correspondent in a telephone interview in Lagos on Tuesday that the Islamic faith does not allow abortion. He said abortion is only permitted on medical grounds.
â€œA Muslim woman can only seek abortion when she is in clear danger and a medical report is issued to confirm this,â€ he explained. To avoid cases of abortion, he said, â€œWe advise people to practise safe, protected sex, or have sex during their safe period or embrace medical ways of family planning.â€
According to anti-abortion critics, rape, which is one of the reasons pro-abortion groups cite for supporting abortion, is a horrible attack on an innocent human being, and something that should be made to look safe and legal. â€œWe do not try to make kidnapping or child abuse safe and legal. If abortion kills children, our goal should not be to make it as safe and legal as possible, but to provide alternatives and legal restrictions that help avoid it in the first place.
â€œAbortion is horrible primarily because it is a process in which instruments of death invade a womanâ€™s body and kill her innocent child. Neither laws nor slogans nor attractive waiting rooms nor advanced medical equipment can change the nature of abortion. What it is it will always be â€” the killing of children,â€ critics said, in reaction to an article on abortion in The Lancet, a global health journal.
A recent study in Soweto shows that the rate of abortions for women older than 20 years decreased from 15.2 per cent in 1999 to 13.2 per cent in 2001; the rate for women aged 16-20 decreased from 21 per cent to 14.9 per cent; and the rate for women aged 13-16 decreased from 28 per cent to 23 per cent. In 2001, 27 per cent of abortions were second-trimester.
Also, subsequent to the legalisation of abortion in Italy in 1978, abortion rates among Italian women first rose and then declined steadily, from a peak of 16.9 abortions per 1,000 women of reproductive age in 1983 to 9.8 per 1,000 in 1993.
But antagonists of legalisation of abortion laws say the history of abortion in Poland, for instance, invalidates claims that making abortion illegal would bring harm to women.
In an online publication titled, Getting rid of the unwanted standards for social protection of motherhood and on abortion, Dr. John Willke said, â€œPoland, along with the rest of the Iron Curtain, Eastern Europe countries, was occupied for 44 years by Russia. Russia legalised state-paid abortion in the first three months of pregnancy. What are the official figures of the number of abortions performed annually during those years in Poland? In 1960, it was 150,400; in 1965, 168,600; in 1970, 148,200; in 1975, 138,600; in 1980, 138,000; in 1985, 135,500. By 1990, with the advent of the Solidarity independence movement and the influence of Pope John Paul II, the number of abortions had declined to 59,417. This was a spontaneous movement. It was at this time that abortion was made illegal in Poland except in the most exceptional cases.â€
What was the result?
Willke continues, â€œIn 1998, the total number of induced abortions in Poland was 253. What were the reasons given for these? To save the â€œlife and healthâ€ of the woman â€” 199 for â€œfetal impairment;â€ 45, for rape, and incest, 9. In summary, then, here, we have a large nation that, for four and a half decades, had abortion-on-request, paid for by the state. Certainly, the practice of abortion in Poland had become deeply ingrained. Then came independence and a law that took the total number of abortions down to 0.004 per cent of what they had been, and this contrary to all predictions by government agencies, the media, the UN and Planned Parenthood. To perhaps everyoneâ€™s surprise, there have been 25 per cent fewer miscarriages and 30 per cent fewer women dying, compared with what it had been while abortion was legal. In the latest annual report, 21 women died from pregnancy-related problems, with none listed as dying from illegal abortions.
â€œThese are firm statistics. The facts above have been annually reported and heatedly discussed by the Polish parliament, its ministries of health, labour, social welfare and education, as well as by mass media, non-governmental organisations and anyone else interested in the problem.â€™â€™
He adds, â€œIn fact, the women in Poland are clearly healthier now, from a gynaecologic and obstetric standpoint, than they were when abortions were legal.
â€œConsider the mother who haemorrhaged, was transfused, got hepatitis, and died months later. Official cause of death? Hepatitis. Actual cause? Abortion. A perforated uterus leads to pelvic abscess, sepsis (blood poisoning), and death. The official report of the cause of death may list pelvic abscess and septicaemia. Abortion will not be listed. Abortion causes tubal pathology. If she has an ectopic pregnancy years later and dies. The cause listed will be ectopic pregnancy. The actual cause? Abortion.â€™â€™
Interestingly, while abortion is legal in a country like Italy that is nominally 97 per cent Catholic, it sparks political debate in the more religiously pluralistic United States. The Pope once asked Catholic churches to stop participating in the counselling certification, on the grounds that this makes the church a party to abortion.
Nearly all religious groups in Nigeria frown at abortion. The Director of Communication, Catholic Church, MSG Gabriel Osu, told our correspondent in a telephone interview that the church was against abortion. He said, â€œAbortion is tantamount to bloodshed and for no reason should a Catholic woman have abortion.â€™â€™
Explaining why the Catholic Church opposes abortion, the Bishop of Catholic Diocese of Abeokuta, Bishop Adewale Martins, said the opposition was rooted in the law of God, which forbids a man from taking the life which only God could provide.
He said, â€œThe position of the Catholic Church is that each human person at all stages of life (from the moment of conception to natural death)
is precious and is a gift of God, which no one has a right to terminate at will. It is really part of the commandments of God when he said â€˜thou shall not kill.â€™â€
Even when a woman becomes pregnant as a result of
rape, the cleric said, the child should not bear the consequence of the action against the woman or the mother. But he admits that rape is a traumatic experience.
Matins said, â€œRape is traumatic and an unspeakable evil. It is more traumatic when it results in pregnancy. It is not the child, however, that deserves the death penalty. Even rapists will not be put to death if convicted. The unfortunate woman should be assisted and supported but not to kill the innocent child who has no fault in the sad event.â€
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