How restrictive reproductive health laws endanger women’s lives

This piece by ENE OSHABA reveals the silent epidemic that is gradually leading to a dire public health crisis largely driven by restrictive women’s reproductive health laws despite international advocacy for reproductive rights.

Avoidable deaths

When a married mother of two, called his causing, a medical doctor, in desperation, seeking help to terminate an unplanned pregnancy due to financial and career pressures, his immediate reaction was one of moral indignation. “God forbid,” he said, brushing off her plea. Little did he know, this rebuff would set off a chain of events leading to her tragic demise.

Recounting this sad and life changing experience, a Medical Practitioner, Dr. Fehintola Akintunde stated: “My educated cousin sought help from an unqualified provider. She was taken to a remote village where the procedure was done improperly. She developed severe complications and was rushed to the Federal Medical Centre in Abeokuta.

“By the time I arrived, I found her lifeless body on a stretcher on the corridor. The words of her husband, who turned to me and said in Yoruba in front of our relatives: “You killed her,” haunted.me.for a long. It dawned on me that my refusal had contributed to her death.”

In another development, a medical student at the University of Abuja, who serves as the National Director, Standing Committee on the Sexual and Reproductive Health and Rights (SRHR) of the Nigerian Medical Students Association (NMSA), Ogochukwu Excel Nmesomachi, shared her experience of being judged as not morally upright simply for educating people about sex.

She lamented that such stigmatisation contributes to young people’s rwckless engagement in unsafe sexual activities due to a lack of proper information, leading to unintended pregnancies and the subsequent need to seek unsafe abortion services from unqualified practitioners as well as qualified personnel who operate in unsafe environment for fear of retribution as a result.od restrictive laws.

“I encountered a range of societal attitudes towards sexual and reproductive health. One striking example was a text message accusing me of encouraging immorality simply by promoting open discussions about sexual health. This incident underscores the deep-seated stigma surrounding conversations about sex, particularly among young people,” she stated.

She also narrated the story of a student who found herself pregnant and confided in a friend about her situation.

According to Nmesomachi, “Her friend, lacking proper knowledge and guidance, advised her to ingest harmful chemicals like hypo and detergent in an attempt to terminate the pregnancy. Tragically, the student followed this dangerous advice, resulting in severe health complications.”

Speaking further, Nmesomachi said, “If I had been equipped with the right information and had the laws been more lenient, I could have chosen a much safer option. This incident starkly illustrates the critical need for accessible reproductive health education and more compassionate legal frameworks.

“This is the result of lack of information, if she had proper sex education and also could access contraceptive this would have been averted.

“Another thing is the stigma young women go through when they want to buy condoms or other contraceptive but the boys are hailed when they go to same store to buy a condoms to satisfy their sexual urge.”

Why maternal mortality thrives 

These harrowing stories are common experience in Nigeria. They highlight the stark reality that the country’s stringent and restrictive women’s reproductive health laws were forcing many women to have children at the risk of their lives; and seek unsafe procedures for termination of pregnancies, often with fatal consequences.

Significant factors contributing to high maternal mortality rate as a result of unsafe abortions include the lack of information on the use of contraceptives and difficulty procuring same; as well as cultural and religious prohibitions. 

Improving access to contraceptive services is essential to reducing unwanted pregnancies and the associated complications.

Behind the alarming statistics lies a human cost of desperation and despair. Women facing unplanned pregnancies often find themselves in impossible circumstances, driven to seek unsafe abortion methods due to stigma, lack of access to safe services, or fear of legal repercussions.

The stories of survivors paint a poignant picture of the lengths women will go to in the absence of compassionate and comprehensive reproductive healthcare.

Maternal mortality remains a critical issue worldwide, with complications from unsafe abortions being a significant contributor. Each year, an estimated 7,000 women worldwide die from complications related to unsafe abortions, though this number likely underrepresents the true scale due to underreporting and stigma.

According to research done by the Guttmacher Institute, an estimated 456,000 unsafe abortions are done in Nigeria every year.

In a joint study carried out by the Society of Gynecologists and Obstetricians of Nigeria and the Federal Ministry of Health, Nigeria’s the number of women who engage in unsafe abortion was estimated at 20,000 each year.

Research has also revealed that only 40 per cent of abortions were performed by physicians with improved health facilities while the remaining percentage are performed by non-physicians. Thi is as a 2020 study of Nigerian abortion experiences found that most respondents were non-Catholic Christians.

According to Ipas Nigeria Health Foundation, “Unsafe abortions are one of the leading causes of maternal mortality in Nigeria, contributing up to 15 per cent of maternal deaths.”

Key statistics in Nigeria as contained in a statement made available by Ipas showed that 4.6 per cent of women of reproductive age (15 – 49 years) undergo an abortion each year, equaling nearly 2 million abortions annually.

The statement noted that, “More than six out of 10 abortions in Nigeria are unsafe”, stressing that “Unsafe abortion contributes about 13 per cent– 30 per cent to the total maternal deaths.

“Maternal mortality is 1047 per 100,000 live births (behind South Sudan and Chad)” the statement added.

Legal framework

Abortion in Nigeria is heavily restricted, permissible only when the life of the mother is at risk. This legal framework leaves many women with limited options, pushing them towards unsafe, clandestine procedures. The lack of skilled practitioners and accessible, safe abortion services exacerbates this crisis, leading to a high maternal mortality rate in the country.

The Country Director, Ipas Nigeria Health Foundation, Lucky Palmer, while speaking during a two-day sensitisation workshop for the Central Working Committee (CWC) of Nigeria Association of Women Journalists (NAWOJ) on Women’s Sexual Reproductive Health and Rights (WSRHR), recently in Lagos, expressed worry on the increasing maternal mortality rates through unsafe abortions.

He lamented that misinformation around abortion-related issues was gaining grounds than the reality of the situation. 

“Ipas Nigeria has recently been targeted by misinformation campaigns threatening the organisation’s efforts to provide essential sexual and reproductive health care access and services to women across Nigeria,” he said.

Lagos case study

Legal abortions, when performed timely and by trained health service providers in proper facilities, are typically safe with minimal complications. However, restrictive laws, prohibitive costs, poor access to health services, and social stigma prevent women from obtaining safe and legal abortions.

A critical issue in Lagos and throughout Nigeria is the lack of awareness about the legal provisions for safe abortion.

As contained in a documentary report by the Women Advocates Research and Documentation Centre (WARDC) the Lagos State Criminal Code, updated in 2011, permits abortion to preserve the life and physical health of a woman, provided it is performed by a medical doctor.

Medication abortion is allowed up to nine weeks of gestation as per the National Agency for Food and Drug Administration and Control.

 The report showed that despite these provisions, a survey revealed that none of the 49 Nigerian policymakers and executives responsible for maternal health legislation could accurately state the specific legal conditions for abortion. Law enforcement officials often wrongly prosecute service providers who operate within the law, and public health facilities are typically unprepared to offer legal abortion services due to a lack of knowledge among medical and nursing personnel.

The report stated that the Ministry of Health was currently working to disseminate the 2011 criminal code and ensure safe abortion services are provided under legal indications. However, Lagos state has yet to adopt the 2015 Violence Against Persons Prohibition (VAPP) Act, which ensures comprehensive medical services for victims of rape and incest. Without this act, victims are often compelled to resort to unsafe methods, risking their physical and reproductive health.

“Countries that have made abortions more accessible, such as Mexico City, have seen significant reductions in maternal deaths. From 2008 to 2012, maternal deaths decreased by up to 60 per cent  compared to the years before abortion was legalised. Unsafe abortions also impose heavy financial burdens,” the documentary highlighted.

“In 2012, public hospitals in Lagos and the Federal Capital Territory spent 123 million naira treating abortion complications. If safe abortions were more accessible, these costs could be significantly reduced,” it added.

Regional focus, data

Sub-Saharan Africa, where Nigeria is located, bears a disproportionate burden of maternal deaths.

According to the World Health Organisation (WHO), 90 per cent of global maternal deaths occur in this region, largely due to complications from unsafe abortions and inadequate healthcare infrastructure. In Nigeria, the risk of dying from pregnancy-related complications is among the highest in the world.

A harrowing statistics as shown in the WARDC documentary highlights this issue: in 2012, more than 9 million pregnancies occurred in Nigeria, 25 per cent of which were unintended. Over half of these unintended pregnancies ended in abortion. By 2017, between 1.8 to 2.7 million pregnancies in Nigeria ended in abortion, with most of these procedures performed unsafely by untrained individuals in substandard environments. These unsafe abortions result in severe physical consequences, including infections, damage to reproductive organs, and even death.

The documentary further disclosed that women often feel unable to discuss their situation due to intense social stigma, which compounds the emotional and psychological trauma.

“Current estimates suggest Nigeria’s maternal mortality ratio ranges from 576 to 814 deaths per 100,000 births, with unsafe abortions contributing significantly. Approximately 5,000 maternal deaths annually, or about 14 every day, are attributed to unsafe abortions.

Other case reports

Dr. Fehintola’s experience is mirrored in countless other stories including a university student who died after undergoing an unsafe abortion. Such stories highlight the tragic outcomes of inadequate maternal healthcare and restrictive abortion laws.

“Women have been made to consume ground glass or undergo procedures with bicycle spokes,” Dr. Fehintola reveals. “The desperation and the lengths to which they go to terminate unwanted pregnancies are horrifying.”

On his part, Mr. Palmer recounted a harrowing incident involving a dangerously unsafe abortion. A pregnant girl desperate to terminate her unwanted pregnancy was advised to use a sugarcane stick for the procedure.

“While I was working at Maris Stoops, a case came in where the girl had used a sugarcane stick to terminate her pregnancy, and it got stuck. The idea was for the particles to decompose inside her and infect the fetus, thereby ending the pregnancy. Though this crude method ultimately worked, it resulted in severe complications,” he shared.

These stories underscores the dire consequences of inadequate access to safe abortion services and the urgent need for comprehensive reproductive health care as well as review of obsolete laws.

Need for improved healthcare services

Addressing maternal health issues effectively requires a multifaceted approach. Improved access to healthcare services, including safe abortion procedures and contraception, is crucial. Enhancing the training of medical practitioners and educating communities about reproductive health can also play a pivotal role in reducing maternal mortality.

Speaking in the documentary report, the Chief Medical Director of the Lagis State

Teaching Hospital (LSTH), Prof. Adetokumbo Fabamwo, explained that access to safe abortion is an equity issue. “Women in rural areas, with less education, or from lower-income backgrounds are more likely to undergo unsafe abortions, disclosing that a 2020 survey found that less than half of respondents used medically acceptable procedures for abortions, with many resorting to dangerous methods like using chemical concoctions.

“Social stigma exacerbates the issue, making it difficult for women to find safe services and for providers to offer them. Stigma also hampers efforts to dispel myths, collect data, and improve care quality,” said the ED of WARDC Dr. Abiola Akiyode-Afolabi.

On her part, a Medical Practitioner at the LSTH,  Olufunke Olamiloge, regretted that despite the restrictive laws, economic and social barriers, and social stigma, women continue to seek abortions, adding that in Lagos for instance, it is estimated that 4 – 6 per cent of women of reproductive age have had an abortion in the past year, with over 60 per cent of these performed unsafely.

She maintained that misconceptions and stigmas surrounding abortion persist, often driven by cultural, religious, and societal norms.

“These misunderstandings hinder open discussions and the implementation of evidence-based healthcare policies. There is a dire need to dismantle these barriers through education and advocacy.

“The financial and social ramifications of maternal health and unsafe abortions are profound. Women who survive unsafe procedures often face long-term health complications, impacting their ability to work and provide for their families. Moreover, the societal stigma attached to abortion can lead to isolation and mental health issues,” said Olamiloge.

“We saw sepsis with haemorrhage, acute renal failure, then had to have either a peer authoritative trust or the fact remove out of the entire thing not to talk of high level treatment with very, very strong antibiotics. We had quite a number of mortality from these cases was that that we performed safely abortion is an uncomplicated procedure,” the LSTH chief medical director added.

Call for change

The tragic loss of Dr. Fehintola’s cousin underscores the urgent need for reform in Nigeria’s approach to reproductive health. Legal restrictions and societal stigmas surrounding abortion endanger women’s lives and health.

Ensuring safe abortions and reducing maternal deaths in Nigeria requires several steps. Public and private health facilities must implement the  Ministry of Health’s directive to provide high-quality abortion services within the law.

In the same vein, WARDC had called on the Ministry of Health to enforce National Clinical Guidelines on safe abortion to cover the physical health of women especially those in Lagos state, adding that hospitals and health centers need the necessary materials and training to offer adequate services.

“Furthermore, the Health and Women’s Affairs Ministries  should press for the adoption of the  Violence Against Persons (Prohibition) Act, 2015 (VAPP Act) which is a landmark legislation in Nigeria aimed at addressing and eliminating all forms of violence against individuals,” WARDC stressed in the documentary.

Advocates such as Ipas Nigeria Health Foundation,  WARDC and many other women based organisations, are also urging the Nigeria government, at all levels, to  be more committed to the implementation of the Maputo Protocol, ensuring access to safe abortion when a woman’s life, physical health, or mental health is at risk.

This as they have alao advocated expanding training for medical professionals and strengthening the healthcare system are also crucial steps.

They have argued that “Restrictive laws and barriers do not prevent abortions; they only make them less safe and accessible, putting women’s lives at risk. By taking decisive actions, Nigeria can set an example for the rest of Africa, improving access to safe abortion and preventing unnecessary deaths.

“By improving access to safe abortion services, increasing education on contraception, and fostering an open dialogue about reproductive rights, Nigeria can make significant strides in reducing maternal mortality and ensuring women’s health and safety.”