By Ruth Choji

One of the main causes of maternal death in Nigeria is unsafe abortion practices. It has been attributed as one of the reasons why Nigeria's maternal mortality rate is 1,100 deaths per 100,000 live births.

A research has shown that about 34,000 women die annually in Nigeria as a result of unsafe abortion. According to the World Health Organization (WHO), every eight minutes a woman in a developing nation dies of complications arising from an unsafe abortion.

Abortion becomes unsafe when a pregnancy is terminated by persons lacking the necessary skills, or when it is done in an environment without standard medical tools. Even though abortion is not legal in Nigeria except if it is done to save the mother's life, it is common knowledge that both qualified and unqualified doctors engage in it with impunity. According to a research, most of the patrons of quacks are teenagers who got pregnant most times accidentally. The WHO, deems unsafe abortion one of the easiest preventable causes of maternal mortality and observes, however, that, the overall abortion rate has declined, while the proportion of unsafe abortion is on the rise. But the reports went on to indicate an association between unsafe abortion and restrictive abortion laws.

Speaking on the dangers of unsafe abortion, Hauwa Shekarau, the acting representative of IPAS, an NGO that deals with women health rights said though permitted only to save a woman's life, induced abortion is common in Nigeria. According to her, "a new study 'The incidence of abortion in Nigeria,' conducted by researchers at the Guttmacher Institute and University of Ibadan finds that 1.25 million abortions were performed in the country in 2012, compared with the 610,000 abortion estimated to have occurred in Nigeria in 1996. Most of these abortions were clandestine and many were unsafe".
Shekarau, who is the current president of FIDA, (Federation Of Female Lawyers In Nigeria) also states that, Nigeria has a low level of contraceptives use and as a result, about one quarter of the 9.2 million pregnancies that occurred in the country in 2012 were unintended and more than half (56 per cent) of these unplanned pregnancy ended in abortion and that, it is important for all women to have access to the highest attainable standards of health and safe reproductive health choices, including safe abortion.

While advocating for a lasting solution to unsafe abortion in Nigeria, Shekarau said "No woman should risk her life, her fertility or well-being or the well-being of her family because she lacks reproductive health care. Death and injuries from unsafe abortion are traumatic because they can be avoided. Since they are entirely preventable, and yet women still don't have access and right to reproductive health services".

The FIDA boss further stated that "although abortion is heavily restricted throughout Nigeria with one set of laws applying in Northern Nigeria and other laws applying in Southern Nigeria, but that the generally accepted understanding across the nation among policy makers, health care providers and women themselves is that, abortion is legally prohibited with the limited exception of cases where the woman's pregnancy endangers her life.

According to her, Nigeria ratified the protocol to the African Charter of Human and Peoples Right on the Right of Women in Africa(Maputo Protocol) in 2004, effectively pledging to protect the rights of women and girls and guarantee the right to sexual and reproductive health.

On her part, Dr Christiana Alade, a gynecologist who spoke with LEADERSHIP Sunday on unsafe abortion said "most of the reasons people give for having abortion is that they don't want more children, the mother is not ready to have a child, the don't want people to know they are pregnant, there are problems with the fetus, their health or their partner doesn't want to have the child."

She also said, although the decision to keep the pregnancy or to terminate it is personal, but that, an estimated 142,000 women are treated annually for abortion related complications with about 4000 dying from complications because unsafe abortion can lead to hemorrhage, sepsis, pelvic infections and internal injury from instruments used in the procedure. Hemorrhage, septic shock, anemia, intra-abdominal injury that can perforate the uterus and caused damage to the cervix while reactions to can lead to pelvic pain or pelvic inflammatory disease, an increased risk of ectopic pregnancy and infertility.

"The trouble starts when the women doesn't visits a specialist, that has basic hospital and medical facilities that can do dilation and curettage (D&C) or manual vacuum aspiration (MVA). Because of finance and shame, the young women prefer to visit quacks, who will provide them with some liquid concoctions, made from local herbs, give them tablets, injections or insert objects into women's private part to induce bleeding," she said.

There are different methods of aborting a pregnancy, like the vacuum curettage, which is done in the first trimester of pregnancy. It is done when a suction tube with a sharp cutting edge, inserted into the womb through the dilated cervix to dismember the body of the developing baby and tears the placenta from the wall of the uterus, sucking blood, amniotic fluid, placental tissue, and fetal parts into a collection bottle. Dilate curettage is done when the cervix is dilated or stretched to permit the insertion of a loop shaped steel knife. The body of the baby is cut into pieces and removed and the placenta is scraped off the uterine wall. Blood loss is worst from D & C, and can lead to uterine perforation and infection. Another method is the "Salt Poisoning" or hypertonic saline abortion that is done after 16 weeks of pregnancy. A needle is inserted through the pregnant woman's abdomen to draw the accumulated fluid. And a concentrated salt solution is put there so that the baby can swallow it as poison and some few hours later, the mother goes into labor and delivers a dead, burned, and shriveled baby. The gynecologist can also recommend a hysterectomy abortion, which is similar to the Caesarean Section, it is where incisions are made in the abdomen and uterus and the baby, placenta, and amniotic sack is removed.
Another medical personnel who spoke on unsafe abortion is Dr Godwin Akaba, a gynecologist with the Gwagalada Specialist Hospital. He said, unsafe abortion comes about when the unwanted pregnancy is terminated by persons lacking the necessary skills, in an environment lacking basic medical standards.

To abort, he said some women do crazy things like taking toxic solutions, laundry bleach, detergent solutions, acid, herbal remedies, tea made of livestock manure, bitter concoction and assorted drugs like uterine stimulants, quinine and chloroquine (used for treating malaria) and a host of dangerous things just to abort the pregnancy while others take drugs like uterine stimulants, such as misoprostol or oxytocin, wire, knitting needle, rubber catheter, coat hanger, ballpoint pen, bicycle spoke, and sharp curette.

To reduce unsafe abortions, the gynecologist states that attention should be paid to improved sexual and reproductive health in Nigeria, family planning method, made easy and available, counselling centers opened to pregnant teenage girls to come for counselling. The laws on restrictive abortions, he said, must be reviewed so that women will stop visiting quacks while tools like MVA equipment be sold at low cost, family planning and sex education, introduced in schools for young people.