Reproductive rights of women and girls in Nigerian have improved over time. However, there is a dare need for the review of reproductive laws and policies as well as its implementation. Discourse at a recent training by Ipas Nigeria Health Foundation for women journalists was centred on this, CHIZOBA OGBECHE reports.
Nigeria has a population of over 140 million and the reproductive age, 15-49 years, constitutes 50 percent of the Nigerian population, according to the African Women’s Development And Communication Network (FEMNET) in its Factsheet on Sexual Reproduction Health And Rights At A Glance.
The factsheet further indicates that, “Reproductive health indices in Nigeria are improving but they are still not good enough, for example the total fertility rate is 5.7, maternal mortality is 545 deaths per 100,000 live births, contraceptive prevalence of 13 per cent and HIV prevalence of 4.4 per cent.”
It further noted that, “The Federal Ministry of Health developed the reproductive health policy to guide the provision of reproductive health services in the country. Various laws (statutory, customary, and religious) are in force to address different areas of reproductive health.
“However, many of these laws do not reflect the reproductive health concept and are inadequate in actualising reproductive health rights of Nigerians.
“There are other policy documents that seek to address reproductive health system and these include, the National Health Policy and Strategy (1998) which emphasizes primary health care as the key to health care delivery; National Policy on Population for Development, Unity, Progress and Self Reliance (1988); Maternal and Child Health Policy (1994); National Adolescent Health Policy (1995); National Policy on HIV/AIDS/STI control (1997); National Policy on the Elimination of Genital Mutilation (1998). These policies shape the provision of sexual and reproductive health services in Nigeria stated in Revised National Health Policy (Federal Ministry of Health, 2004).
“In Nigeria, sexual and reproductive health services are provided at all levels of care, that is, tertiary, secondary, and primary. All persons in Nigeria (male or female, young or old) are provided with reproductive health services.”
The fact sheet named barriers to accessing SRHR services in Nigeria include, gender roles, inadequate funding, social taboos, religious factors, lack of proper infrastructure, and lack of access to information.
“The onset of COVID-19 in Nigeria, further compromised the already poor women’s access to sexual and reproductive health and rights, due to disruptions in the demand and supply of contraceptive commodities, the diversion of staff and resources to other clinical services, and clinic closures,” the fact sheet further stated.
Maternal mortality burden
World Health Organisation (WHO) posits that nearly 20 per cent of global maternal deaths happen in Nigeria.
According to the organisation, “Between 2005 and 2015, it is estimated that over 600 000 maternal deaths and no less than 900 000 maternal near-miss cases occurred in the country.
“In 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100 000 live births, with approximately 58 000 maternal deaths during that year. By comparison, the total number of maternal deaths in 2015 in the 46 most developed countries was 1,700, resulting in a maternal mortality ratio of 12 maternal deaths per 100 000 live births.
“In fact, a Nigerian woman has a 1 in 22 lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion; whereas in the most developed countries, the lifetime risk is 1 in 4,900.”
Improving access to contraceptive services has been identified as essential to reducing unwanted pregnancies and the associated complications. However, difficulty procuring contraceptives and the lack of information on proper use of contraception as well as cultural and religious inhibitions, among other factors, have continued to compound the situation.
Ipas intervenes
Worried by this trend, Ipas Nigeria Health Foundation, Partners for Reproductive Justice, a Non-Governmental Organisations (NGO), recently held a two-day sensitisation workshop on Women’s Sexual Reproductive Health and Rights (WSRHR) for members of the Central Working Committee (CWC) of Nigeria Association of Women Journalists (NAWOJ).
The Ipas Impact Network works globally to advance reproductive justice by expanding access to abortion and contraception.
“All people have the right to make fundamental decisions about their own bodies and health. That’s why we work with partners across Africa, Asia, and the Americas to ensure that reproductive health services, including abortion and contraception, are available and accessible to all,” the reproductive partner states.
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 two million abortions annually.
“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.
Speaking to participants at the workshop, which included some female journalists covering women and health issues, the Country Director, Ipas Nigeria Health Foundation, Lucky Palmer, decried the increasing maternal mortality rates in the country especially through unsafe abortions.
Palmer, who advocated the review of existing reproductive health laws and policies, tasked the leadership NAWOJ on the need for improved sensitisation on reproductive health of women and girls.
Making a presentation on Introduction To Women’s Sexual Reproductive Health and Rights, Palmer disclosed that unsafe abortion contributes to at least 13 per cent of the maternal mortality in Nigeria.
The country director further noted that women who survive unsafe abortions suffer acute and short-term complications, including haemorrhage, sepsis, trauma, infertility, increased risk of ectopic pregnancy and spontaneous abortions.
While lamenting the fact that misinformation around abortion-related issues was gaining grounds, he stated that, “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.”
The country director, who said the workshop was designed to equip women journalists with knowledge needed to counter the misinformation and make them strong advocates of WSRHR, implored participants to stand in the gap for gender with their reports which will help stem the tide of unsafe abortion and give women healthier choices.
Nexus between maternal death, unsafe abortion
In his presentation with the theme: “Burden of Maternal Death from Unsafe Abortion” a Gynaecologist, Dr. Fehintola Akintunde, disclosed that one woman dies every minute globally, owing to factors including restrictive women’s reproductive health laws.
These restrictive laws, he said, were forcing many women to have children at the risk of their lives; as well as seek unsafe procedures for termination of pregnancies, often with fatal consequences.
He noted that termination of pregnancies, when performed timely and by trained health service providers in proper facilities, were safe and with minimal complications.
Dr. Akintunde, who recounted the experience of his council, a university graduate, who was married with children but procured unsafe abortion in a bid to terminate an unplanned pregnancy and died in the process, said lost many enlightened women have lost their lives in under similar circumstances of ended up with other health complications which may not allow them have children.
According to the medical practitioner, “Women have been made to consume ground glass or undergo procedures with bicycle spokes, and even worse. The desperation and the lengths to which they go to terminate unwanted pregnancies are horrifying.”
He maintained that abortion services were, particularly, important for women and girls who are victims of sexual violence, rape and incest, even is stressed that there was an urgent need to bring issues of maternal health to the front burner.
Dr. Akintunde, who said, “There is a need for a review of our restrictive abortion laws due to the Human Rights Implication of Unsafe Abortion,” tasked NAWOJ and other related unions and bodies to consider sponsoring a National Policy Framework for the Reduction of Maternal Mortality in Nigeria to push for safe termination of pregnancies without the usual stigma and judgement.
Legality of abortion
Contrary to widely held opinion abortion is not illegal in Nigeria, Dr Akintunde revealed to participants.
He, however, noted that most states in the country, with the exception of Lagos state, were operating with rather obsolete laws.
A documentary by the Women Advocates Research and Documentation Centre (WARDC) indicated that 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.
The report, however, 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 working to disseminate the 2011 criminal code and ensure safe abortion services are provided under legal indications.
“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,” the reports further stated.
Deploying Nigeria’s commitments in reporting WSRHR
Also, while making a presentation on Nigeria’s International, Regional and National Commitments to WSRHR, Ipas Partnership Programme Manager, Barr. Doris Ikpeze, gave participants practical tips on how the VAPP Act, the African Charter on the Rights of Women in Africa (2003), Universal Declaration on Human Rights, and other Protocols and Platforms of Action could be effectively deployed in the coverage of WSRHR issues and reports.
She enjoined journalist to always highlight systemic issues and barriers to justice in their reportage of WSRHR related issues.
In her presentation, on Access to Healthcare, Role of the Media, a Development Journalist, Ene Oshama, harped on the need for media practitioners to challenge stigma, harmful stereotypes relating to women’s reproductive rights and to strive to disseminate accurate information on WSRHR.
“As journalists, editors, and leaders in the Nigeria Association of Women Journalists (NAWOJ), you are advocates. In consideration of that role, you have a task to ensure that we teamed up to bridge the gap in awareness creation by addressing people whose everyday lives are daily being watched, talking of policy makers.”
She tasked participants to invest in research and accurate data gathering; giving priority to human angle stories that will create awareness on situations, as well as seeking expert opinions and deploying multimedia tools in other to make their reports attractive.
She also highlighted the VAPP Act as one of the tools for media advocacy and enjoined participants to ensure they deployed it as part of media tool to drive home their advocacies.
NAWOJ makes commitment
On her part, NAWOJ National President, Hajiya Aisha Ibrahim, pledged the commitment of the leadership of the association to step down the training to its members in the 36 states and the FCT.
The president, who was represented by the Deputy National President, Comrade Lilian Okonkwo-Ogabu, thanked the Ipas for the training and opportunity to build the capacity of the leaders and members of the association.
Hajiya Ibrahim, who expressed hope of a more enduring partnership with Ipas in the campaign and advocacy for improved reproductive rights of women and girl in the country stated: “No woman should die bringing forth life and no one should die trying to access care during pregnancy, whether wanted or unwanted. Our duty as women journalists is to inform and diligently guide women and the girl-child to access quality Healthcare and make informed choices in so doing.
“The quality of tools that this training has deposited in us will help us produce quality reports. We thank your organisation and look forward to enlarged training of our members across the board.”