Practices in the Dark: Unsafe Abortion in Nigeria

Imagine you're travelling down a dark alley in Lagos. The road is uneven; potholes and open gutters seem to cover every step as you walk home. Grilled suya and plantain drifts into the air from cluttered street stands, and high life music mixes with hip-hop in the city's medley of car horns. The only light to guide you comes from amber flames lit in tin trashcans, and you stretch your arms out in front of you with each step, feeling for anything you may not see in the dark.

Now imagine that a young girl is crouched behind a cement wall, not five feet away from you. You don't see her, but she's there. In her hands are a small hanger and a pair of knitting needles. She's about to perform surgery. Armed with nothing but a pair of sharp objects and a bucket of water, she stabs her uterus and cervix until she nearly faints, unsure of whether she'll live or die. Today is her fifteenth birthday.

This is Nigeria's reality. Every day young girls and women perform unsafe abortions on themselves to terminate unwanted pregnancies, and no one notices. Moral and cultural beliefs prevent open dialogue about abortion, and laws prohibiting the procedure unless in order to save a woman's life make it very difficult for women to seek help when faced with an unwanted or accidental pregnancy. Because of this women must turn to private or unlicensed clinics, traditional healers, or themselves to terminate their pregnancy, which often ends with serious medical complications.

According to the World Health Organization, an unsafe abortion is “a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.” Untrained medical practitioners, incorrect equipment, and unsanitary conditions in developing areas combined with certain laws that restrict abortion as a legal practice can lead to unsafe abortions for such women, resulting in deaths or serious infections that lead to infertility.

About 20 million, or approximately half, of the induced abortions each year are estimated to be unsafe. Out of these 20 million, ninety-five percent occur in developing countries like Nigeria.

But most deaths and complications from unsafe abortions are preventable. Abortions performed by trained health care providers with proper equipment, correct technique and sanitary standards are relatively simple and safe. According to the Alan Guttmacher Institute in the United States, the likelihood of women dying as a result of abortion performed with modern methods is no more than one per 100,000 procedures. In developing countries, this figure is several hundred times higher. This is due to factors like discrimination against abortion patients, inaccessible services in rural areas, poor medical equipment, and lack of attention to patients' medical, social, and cultural circumstances.

There is hope, however, for Nigerian women who face the uncertainty of an unwanted pregnancy. Many organizations and advocacy groups, such as Centre for Reproductive Rights and World Health Organization, have advocated that abortion procedures be made legal in non-emergency situations, to avoid women visiting non-licensed medical practitioners and putting themselves at risk of illness or death. These organizations demand that abortion delivery be improved around the world, and recommend the use of manual vacuum aspirations (MVA) for treatment of complications, that health care providers should be trained in the use of MVA, and that post abortion care services should be established throughout to offer contraceptive counseling and services to women who've had an abortion.

With these organizations lobbying for safe abortion practices, and with the rise of women undergoing painful procedures to terminate unwanted pregnancies, the Nigerian government will have to re-examine its abortion policies and determine whether the lives of thousands of women are worth throwing into the dark.

*Reported by Amanda Hale

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To learn more about safe abortion advocacy, please visit the World Health Organization website at www.who.int.