ABORTION: Causes Of Unsafe Abortion And Its Complications -By Gayovwi Victory Oghenero

Abortion is a deliberate act of terminating a pregnancy before birth. Unsafe Abortion on the other hand, is an unprofessional termination of pregnancy. The World Health Organization (WHO) defined unsafe abortion as a procedure for terminating a pregnancy performed by persons lacking the necessary skills or in an environment that did not conform to minimal medical standards, or both. This article will share the danger of unsafe abortion in our society today.

In Nigeria, an estimated 1.25 million induced abortions occurred in 2012 alone. This was equivalent to a rate of 33 abortions per 1,000 women aged 15–49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15– 49. Fifty-six percent of unintended pregnancies were resolved by induced abortions. About 285,000 womenexperienced serious health consequences undergoing abortion but did not receive the treatment they needed. These figures are more than double from the estimates reported 10 years earlier. A survey by Okonufua et al. in the late 1990s reported that about 610,000 unsafe abortions a year were carried out in Nigeria, while about half of the 20,000 women who died from the complications of unsafe abortion were adolescents. The death rate from unsafe abortions in Nigeria was thought to be one of the highest in Africa.

Worldwide, issues concerning abortion have always been delicate and often generate complex moral, ethical, andreligious debates and dilemma. It has been reported that notwithstanding the legal, moral, or cultural status of abortion, there are women who will seek to terminate an unwanted pregnancy. Evidence showed that restricting access to abortion services does not reduce the number of abortions, instead it does affect the safety of these women along with a barrage of psycho-social trauma. The punitive nature of our laws that allow abortion only when the mother’s life is in jeopardy means that women especially the young unmarried girls resort to all manners of clandestine options as exemplified the cases presented above. Studies have confirmed that the proportion of unsafe abortions are significantly higher in countries with restrictive abortion laws like Nigeria, than in countries with less restrictive laws. This was evident from the study by Chigbu et al, in 2018 from South-eastern Nigeria. The study showed that while 57.7% of women were aware of the abortion laws in Nigeria and 59.2% had previously done abortion for unwanted pregnancies, as high as 78.3% reported that abortion laws will not influence their choices of abortion service providers in cases of unwanted pregnancies.

The factors fuelling unsafe abortion in our environment are multifaceted. They include stigma associated with having a baby out of wedlock, the fear of disappointing ones’ parents and relatives with unwanted pregnancies, the refusal of health workers to provide abortion services based on personal conscience or religious belief, the sociocultural beliefs and indeed the financial constraints needed to procure safe abortion. These are worsened by the restrictive abortion laws and requirements that are not medically justified, including criminalization of abortion, mandatory waiting periods, provision of biased information or counselling, third-party authorization and restrictions regarding the type of health care providers or facilities that can provide abortion services. Another major contributor to unsafe abortion practice is none-use of or poor accessibility to contraceptives. Most unwanted pregnancies will be prevented and the need for an abortion drastically reduced with correct and consistent use of an effective contraception. This however, does not entirely eliminate the need for abortion.

There is urgent need for massive reorientation of the people on issues surrounding abortion. Comprehensive sexual education should be a basic component of the academic curriculum especially from the junior secondary school level. Here, evidence-based information on abortion and contraception should be provided to prevent unwanted pregnancy. A thorough review of the restrictive abortion laws in Nigeria is long overdue and has become inevitable. I agreed with Prof. Adimma’s recommendations of a combination of advocacy, liberalization of restrictive abortion law, training of health workers on Post Abortion Care(PAC) services, inter-organizational collaboration, development of right based code of ethics, inclusion into medical training curriculum, socio-economic empowerment of women, provision of PAC services in every health facility, and improvement of access to quality family planning services to reduce the prevalence and complications of unsafe abortion. It is rather ironical that a ‘skilled’ health provider denies a young unmarried girl an abortion in a seemingly ‘safe environment’ for whatever idiosyncratic reasons only to quickly accept and manage the same patient when she returns with emergency complications following an unsafe abortion of the same pregnancy.

Unsafe abortion has catastrophic consequences and those for who survive it, the sequalae often lasts for a lifetime. A holistic plan of action is needed starting with a review and amendment of the current restrictive abortion laws. We can no longer continue to turn a blind eye on the devastating effects of unsafe abortion on the lives and the reproductive carriers of our girls and young women. A stitch in time, they say, saves nine.