PREGNANCY
By Sola OgundipeTheresa was serially raped by her uncle until she became pregnant at 14. When her parents and other family members found out, they didn’t hesitate before deciding that she would not keep the unintended pregnancy.
Pregnant mother
Theresa didn’t have a say in the matter, she wasn’t even consulted. Arrangements were made and she was taken to a back street hospital where a quack doctor carried out a Dilatation & Curettage (D&C).
But something went wrong. After the procedure, Theresa was in pains and bleeding. She was given some pain killers and sent home after being told the bleeding would stop. But the pain got worse and the bleeding didn’t stop. Before help arrived, Theresa bled to death.
Ada was 17, when after being raped by her own father she became pregnant. Unable to habour the thought of giving birth to her own father’s child, she decided to abort the pregnancy.
She made consultations and was directed to a particular clinic reputed for terminating unwanted pregnancies. After the procedure she continued bleeding with pains while still exhibiting pregnancy symptoms.
The next day, Ada slumped and was rushed unconscious to the nearest General Hospital where tests revealed that she had an ectopic pregnancy (pregnancy in the Fallopian tube). Worse still, the abortion attempt had significantly damaged her uterus. She was referred to the tertiary hospital and immediately booked for emergency surgery. To save her life, the affected Fallopian tube and uterus were removed.
Eighteen-year-old Simi was in High School when she had an unintended pregnancy. She was drugged and gang raped one night at a school party, but couldn’t identify those responsible. Unfortunately, she became pregnant. Her parents decided against abortion and insisted she would keep the pregnancy.
Simi had no say in the matter. She dropped out of school to give birth to a baby girl who is now 4 years old. She hopes to finish High School but is currently a single parent working to sustain herself and daughter.
These scenarios depict the current plight of women who are raped and their options when faced with unintended pregnancy. Rape is recognised non-consensual sexual intercourse. When a man has sex with a woman without her consent, it is rape and a crime in the country.
But if a woman is raped, and she becomes pregnant as a result, she still cannot get legal abortion because in Nigeria, abortion is restricted. The only legal way to have an abortion in Nigeria is if having the child is putting the mother’s life in danger.
Abortion carries a penalty of 14 years imprisonment, but it is common knowledge that several clandestine abortions are carried out in the country regularly, often with dire consequences for women involved.
The World Health Organisation, WHO, defines unsafe abortion as a procedure for terminating an unwanted pregnancy either by a person lacking the necessary skills or in an environment lacking minimal medical standards or both.
According to the Guttmacher Institute, 610,000 unsafe abortions are carried out in Nigeria every year. Worse still, 60 per cent of abortions carried out in the country are by non-physician providers such as pharmacists, paramedics, nurses, midwives, and other quacks.
The question of abortion legislation in Nigeria remains a big debate. Rape, unintended pregnancy and unsafe abortion are closely knit.
In Nigeria, abortion is governed by two laws that differ on geographical location. The north is governed by the Penal Code and the south by the Criminal Code.
Under the Criminal Code, rape is the act of any person having sexual intercourse with a woman or girl, without her consent, or incorrectly obtained consent. Under the Penal Code, rape is when a man has sexual intercourse with a woman against her will, without her consent, or with incorrectly obtained consent. Under the Criminal Laws of Lagos, rape is when a man has sexual intercourse with a woman or girl without her consent, or with incorrectly obtained consent.
“Out of the Shadows: Saving Women’s Lives From Unsafe Abortion in Lagos State”—a multimedia advocacy tool developed by the PRB, depicts how restrictive abortion laws and intense stigma compromise access to safe abortions and contribute to needless deaths in Nigeria and Lagos in particular.
The 14-minute video showcases how low contraceptive use leads to unplanned pregnancies that can increase the demand for safe abortion services. The PRB tool focuses on the causes and consequences of unsafe abortions, particularly in Lagos, and to increase support for greater access to comprehensive reproductive health services including safe abortion services.
Under the Safe Engage project, ending unsafe abortions and reducing maternal deaths in Lagos the goal. “We can prevent these needless deaths if decision makers prioritise access to safe abortion,” a presenter noted in the clip. When an abortion is performed in a timely manner, under the supervision or care of a trained health provider, and in a facility that meets minimum medical standards, major complications are very rare.
“Abortion is regarded as anathema in this part of the world, noted Prof Adetokunbo Fabamwo, a Professor of Obstetrics and Gynaecology at the Lagos State University College of Medicine, LASUCOM. Many people still feel that terminating a pregnancy is wrong. Admittedly, the laws are restrictive.”
Although under the VAPP Act, women are supported to terminate a pregnancy caused by rape or incest, in Lagos and States yet to adopt the law, if a woman is raped, she cannot get legal abortion.
Fabamwo who is also Consultant Obstetrician and Gynaecologist and Chief Medical Director, Lagos State University Teaching Hospital, LASUTH, Ikeja, Lagos, spoke during the Safe Engage workshop organised by the Lagos State government in collaboration with the Population Reference Bureau, PRB.
“If your father gets you pregnant and you go for an abortion, you have committed a crime and you will be jailed. That is how restrictive the law is. Advocates for the liberalisation of the law, are supporting this on-going effort by Safe Engage to enable us know how we can operate within the law such that there will be access and safety. That is what Safe Engage is all about.
Fabamwo said to reduce maternal morbidity and mortality from unsafe abortion, legislation in Nigeria to improve access to abortion services must be enacted.
“Inadequate knowledge of the law is an issue. Information on abortion statistics in Nigeria is limited by the restrictive abortion laws, but everyone must know the position of the law. The way forward is to improve access to safe abortion services and we must change certain things in our healthcare service structure.”
The Safe Engage programme is revolving around child health and maternal mortality issues. It shows the importance and magnitude of the problem with respect to maternal and child mortality and the need for government to address the issue. Lagos has taken the lead through the Safe-Engage programme. By training personnel and creating awareness, public hospitals in the State are providing legal abortion services.
In the views of Co-Principal Investigator, Performance Monitoring and Accountability 2020
(PMA 2020), Dr Funmi OlaOlorun, abortion must be performed by a medical doctor. “Medication abortion can be performed up to a gestational age of nine weeks, but the Maputo Protocol includes that women should have access to safe abortion if their lives, physical or mental health are in danger.
“First, public and private health facilities throughout Lagos State should implement the State Ministry of Health directive to ensure that high-quality abortion services are available within the full extent of the law—that means, performed by a medical doctor to protect the life and physical health of the woman.”
OlaOlorun, who lectures at the University of Ibadan, said from a survey in Lagos, “19 per cent of respondents reported using more than one method to terminate their pregnancy. Altogether 37 per cent underwent surgery to ultimately terminate their pregnancy, 7 per cent use mifeprostol/misoprostol, and the remaining 56 percent used other or unspecified medications or traditional methods.”
At the maiden presentation of in Lagos State in May 2019, former Lagos State Commissioner for Health, Dr. Jide Idris explained that the State is not trying to legalise abortion.
“What we are trying to do is ensure that people who ordinarily would have died from unsafe abortion have access to the right treatment. Apart from treatment, there must be some advocacy and public enlightenment about what the problems are. It is basically education and the education can break down cultural and religious barriers. A lot of our people die from unsafe abortion and it is the duty of government to do something about it.”
In the longer term, Lagos is pushing forward new legal and health system reforms, first by honouring Nigeria’s commitment to the Maputo Protocol, which ensures access to safe abortion when a woman’s life, is in danger.
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