The price of abortion in Nigeria ranges from N250 to a woman’s life.
Although they are officially sold in Nigeria for the prevention and treatment of post-delivery bleeding, abortion drugs are increasingly getting popular and their potential implications are far-reaching, pitching the country’s hard stance on abortion against the stark reality doctors and healthcare providers daily contend with at their clinics.
On healthnews.africa, the most popular story was published on February 14, 2018 and it’s on how Nigerians are taking to social media in search of information on abortion. Between then and now, the piece has been read over 8,000 times and it is now being read at least 100 times daily.
Between July and August, number of views increased by more than 600% and the outlook for September suggested the growth could exceed 1000%.
This strongly affirms that Nigerians are increasingly becoming interested in abortion even though hospitals cannot provide the service even when couples ask for it as a way of preventing giving birth to children they feel unprepared to raise.
It’s a legal matter
Nigerian doctors are aware of the abortion laws of Nigeria’s Criminal Code sections 228, 229, and 230. Section 228, which ruled that any person providing abortion to a woman is guilty of a felony and up to 14 years of imprisonment.
Section 229 added that any woman obtaining abortion is guilty of a felony and up to imprisonment for 7 years. Section 230 added that anyone supplying anything intended for a woman’s miscarriage is also guilty of a felony and up to 3 years of imprisonment.
On the other hand, the Penal Code which operates in northern states has abortion laws in sections 232, 233, and 234. The sections of the Penal Code parallel the Criminal Code, besides the exception for abortion with the purpose of saving the life of the mother.
The Penal Code’s punishments include imprisonment, fine, or both. The offenses of these codes are punishable regardless of whether the miscarriage was successful. No provisions have been made to the Criminal Code making exceptions for the preservations of the mother’s life.
However, the cases of Rex vs Edgar and Rex vs Bourne have made it generally accepted that abortion performed to preserve the mother’s life is not an appropriate transgression of the Criminal Code.
Unintended pregnancies on the rise
Since abortion remains illegal in Nigeria, getting accurate data on the number of abortion procedures carried out in the country is often difficult. But there are several indications regarding the number of babies at risk of abortion and the number of women considering pregnancy termination annually.
According to the Track20 Project implemented by Avenir Health, Nigeria’s contraceptive prevalence rate, modern methods (mCPR) is only 14.7%, while only 33.7% of women have their demand satisfied with a modern method of contraception.
While the number of unintended pregnancies averted due to the use of modern methods of contraception continue to rise with the latest estimate nearing 1.5 million, the number of unintended pregnancies at risk of unsafe abortion in the country continues to rise as shown below.
Since 2012, the number has steadily risen from 1.028 million to 1.104 million even though experts told healthnews.africa that the real figures are much greater than the officially reported figures since the practice of abortion is shrewd in secrecy.
Investigations by healthnews.africa revealed availability of family planning options has not transformed into reduction in the number of unintended pregnancies as the topic of family planning remains a very sensitive one to raise in families in several parts of Nigeria.
A cross section of sexually active Nigerian women told healthnews.africa that their male sex partners consider subject of contraceptives, particularly condoms, as a suggestion of infidelity and not geared towards preventing unintended pregnancies.
This trend is more pronounced in northern part of the country where recent survey showed women from the North-east and North-west constituted the highest percentage (92%) of those who do not use any form of contraceptives.
“If you talk about family planning in the north, they can stone you to death,” a middle-aged man from northeastern Nigeria told healthnews.africa at a family planning clinic in southwest Nigeria.
The availability of numerous religious and cultural beliefs on family planning are also creating bottlenecks for family planning advocacies in several parts of Nigeria thus increasing the number of unintended pregnancies and subsequently putting the lives of the women at risk.
Abortion and maternal mortality
The Guttmacher Institute connected unsafe abortion in Nigeria to the country’s high maternal mortality figures. While noting that abortions are common, and most are unsafe because they are done clandestinely, by unskilled providers or both, the institute noted that the practice of unsafe abortion is tightly connected to the death of many pregnant women in the country.
“Unsafe abortion is a major contributor to the country’s high levels of maternal death, ill health and disability. Nigeria has one of the highest maternal mortality ratios in the world, and little improvement has occurred in recent years,” the institute stated.
Putting the popularity of unsafe abortion into perspective, the institute noted that 56% of unintended pregnancies ended in an induced abortion; 32% ended in an unplanned birth and 12% in miscarriage.
Nigeria’s abortion black market
Since surgical abortion is not legally accessible in Nigeria, attention has shifted to medical abortion.
The World Health Organization recommends mifepristone combined with misoprostol as the most effective method of medical abortion. Where mifepristone is unavailable, however, misoprostol alone is being used by providers to terminate unwanted pregnancies and by women to self-induce abortion.
healthnews.africa reported the story of a couple that sought to abort their latest pregnancy but could not do so at the hospital because the doctor considered it an illegal practice. When individuals like such couple are denied abortion services, they usually go for second opinions usually nurses, community health workers, traditional birth attendants and pharmacists.
While abortion practices are illegal in hospitals, healthnews.africa confirmed that abortion drugs can be easily gotten over-the-counter in chemist shops in several parts of the country.
“When I was denied abortion at the hospital, I asked the owner of the chemist shop on my street for the pills and she gave them to me without asking questions,” a 23-year old lady told healthnews.africa in Ibadan, southwest Nigeria.
She said she was initially scared to ask for advice on abortion when she was denied the service at the private hospital but the experience at the pharmacy was a sharp contrast. She was guided on what to use, how to use it and what to do afterwards.
healthnews.africa’s inquiries at local pharmacies showed misoprostol, the popular drug for abortion among Nigeria’s abortion seekers only cost about N250 (69 US Cents).
healthnews.africa gathered when used early, the risk of complications is low and no different than that of a miscarriage. Per 100 women around 3 will need medical care. For women that seek abortion services late into the pregnancy, the drug alone may not be good enough for the abortion as evacuation may be needed.
healthnews.africa’s investigations revealed products of conception can be evacuated by medical quacks for NGN5000 (about US$14) while hospitals charge about NGN20,000 (about US$56) to evacuate the aborted fetus.
The disparity in the cost of aborted fetus evacuation, medical experts said, is the major cause of complications arising from abortion in Nigeria. healthnews.africa reported how a woman contracted HIV after seeking abortion services from quacks that used same abortion kit for five ladies.
Describing why Nigerian hospitals are directly involved in evacuating aborted pregnancies, Dr. Victoria Adepoju, a clinical physician and Executive Director of the African Development and Empowerment Foundation (AfricanDEF) said hospitals can legally intervene in cases of missed, septic, incomplete and complicated abortions.
“There could be septic abortion when the process is done by quacks with unsterilised equipment resulting in infections. We are also allowed to intervene when the abortion is incomplete necessitating the need for evacuation. Hospitals can also step in when there are complications of evacuation such as punctured uterus and several others,” she said.
For women that are already aware of this provision, the usual practice is to use the drug and rush to a good hospital for evacuation. That way, they are able to abort and access healthcare services at the same time. For those that cannot afford good hospitals for the evacuation, they are at the mercy of quacks.
Service in high demand
“I only stopped doing abortion when my husband found out I was providing the service,” said a female auxilliary nurse in Ibadan.
She recounted how she traveled across cities in southwest Nigeria to assist females with abortion.
“The last one I did was in Lagos. My friend called me that the fetus refused to abort after several doses of misoprostol. So I went to Lagos and administered oxytocin intravenously. When I returned, my husband asked if I was providing abortion services and I said yes. He forbade me from doing it and I’ve stopped since then,” she said.
Nigerian doctors said the inability of hospitals to provide abortion services to patients irrespective of their reasons as long as the life of the mother is not threatened, has created a booming business for anyone who can claim he or she can provide such.
“This is the reason why unsafe abortion is a leading cause of maternal mortality in Nigeria and women are dying daily from the shoddy activities of quacks collecting money from women in exchange for abortion,” Dr. Victoria said.
An African problem
Nigeria is not the only country in Africa where unsafe abortion is on the rise. About 93% of women of reproductive age in Africa live in countries with restrictive abortion laws.
On the continent, only 3 countries (Tunisia, Cape Verde and South Africa) allow women to access abortion services without any restrictions.
In spite of the obstacles towards accessing the service, abortion is on a meteoric rise on the continent. Across the developing world, more abortions are done in Africa than in Latin America and the Caribbeans.
What is happening in Nigeria is also similar to what obtains in Africa which is the world region with the highest number of abortion-related deaths. In 2014, at least 9% of maternal deaths (or 16,000 deaths) in Africa were from unsafe abortion.
Experts told healthnews.africa that the deaths associated with unsafe abortion will continue to rise until either unintended pregnancies are significantly reduced by aggressively promoting various family planning methods including unpopular ones such as vasectomy, and/or putting systems in place to ensure safe abortion.
healthnews.africa contributor, Dr. Adetola Oladimeji, reported that Nigeria must improve women’s access to contraceptives to reduce incidence of unsafe abortion.
“Many women will keep dying in Nigeria from unsafe abortions except the use of modern family planning methods and contraceptives increases among women of reproductive age. This and improved provision of safe abortion and post-abortion care services have been identified to reduce the incidence of women dying from unsafe abortions in different countries around the world,” she reported.