By Adémólá Òrúnbon
At a recent gathering of pen professionals and press briefing by a collective of health-oriented Non-Governmental Organisations, NGOs, under the aegis of the Trust and Support Foundation (TSF) with the support of the Amplify Change, fearful details about the status of the healthcare delivery system of Nigeria were revealed, though expressed shock but showing on how to ensuring the reduction of these unwarranted maternal mortality and morbidity among women of reproductive ages through Safe Termination of Pregnancy (SToP).
According to Mrs Victoria Madukwem, the Executive Director, TSF emphasised that critical and bold steps need to be taken in reducing Maternal Mortality and Morbidity among Women of Reproductive Age in Nigeria, as the state of health of women, girls and couples in the country is really below acceptable global standards.
She added that statistics are abysmal and the realities are worse, but efforts of authorities do not seem to have yielded significant and positive results over the years. The society at large appears to be at a crossroads about what to do, and the major factor in all of this is the dearth of knowledge in the existing systems.
Though in her submission, she pointed out that the role of the media in promoting Safe Termination of Pregnancy (SToP) guidelines in Nigeria is clearly imperative and major, as the people are highly dependent on the media for information. The media has left the level of information dissemination, only to become community rally points.
She pointed out that there was a 14 per cent rise in deaths among women of reproductive age group in Nigeria from 917 per 100,000 live births of 1,047 from 2017 to 2020, according to the World Health Organisation (WHO) 2023 fact sheet 1. She noted that the figure is scary (and has not shown signs of reducing) as it makes maternal mortality in Nigeria 10 times the global Sustainable Development Goals (SDG) target 2 and the 3rd highest in the world after war-torn South Sudan and Chad 1.
Mrs Madukwem cited unsafe abortion as a cause for about 10 per cent of these deaths in Nigeria, as more than 60 per cent of abortions are unsafe. A study of unsafe induced abortion cases that presented with complications at Ogun State University (now Olabisi Onabanjo University Teaching Hospital) in Nigeria from 1988 to 2000 found that 20.4 per cent of cases of induced abortions resulted in maternal death, with the most common complications being septicaemia and anaemia, each with jaundice and peritonitis4. This situation resulted in many children growing up without their mothers, as well as worsening the cycle of poverty in the country.
In aligning with the SDG efforts of eliminating of all preventable maternal death by 2030, the Ogun state adopted and domesticated the Safe Termination of Pregnancy (SToP) for legal indications guidelines in 2023 with extensive collaboration of various stakeholders and have also compressed the guidelines into pockets size booklets for easy access by relevant healthcare practitioners, however, some gaps have been identified that requires serious attention to reduce drastically, the mortality among women of reproductive ages from unsafe abortion. This is the trust of the advocacy by the Trust and Support Foundation after engagement with critical stakeholders.
Though unsafe abortion is “a procedure for terminating a pregnancy performed by persons lacking the necessary information or skills or in an environment not in conformity with minimal medical standards, or both. Also, unsafe abortions resulted in complications that end up leading to the death of such women, especially because of la ack of access to Post-Abortion Care (PAC) and the fear of stigmatisation. Moreover, lack of trained staff, absence of necessary equipment and lack of PAC commodities and supplies are the main reasons for inability to deliver specific PAC services (such as surgical procedures for abortion complications, blood transfusion and Post-PAC contraceptive counselling).
A guest speaker at the gathering, Mrs Wemimo Adewuni Obiwale, opined for the full implementation of SToP by the states across the country, which would serve as an objective of saving women from preventable deaths and denying victims of sexual and gender-based violence, such as rape and incest survivors, the comprehensive medical services that are their right. She observed that for survivors of rape and incest, access to safe termination of pregnancy was not merely a medical procedure, but a pathway to reclaiming bodily autonomy, mental health, and the right to a life of dignity. She noted that the guidelines would also serve as a mechanism to free victims from the ongoing trauma of forced pregnancy.
Obiwale further stated that the current legal impasse leaves many women vulnerable to unsafe procedures, which contribute significantly to Nigeria’s high maternal mortality rate, appealing to the government at all levels to allow medical professionals to provide care confidently within the law, while ensuring standardised post-abortion treatment.
According to her, “The law would ensure that the guidelines explicitly cater to survivors of rape and incest, recognising the grave physical and psychological risks of forced pregnancy in such cases. It will prioritise women’s health and rights over political or religious sentiments, and recognise that the guidelines are a public health imperative to prevent avoidable maternal deaths.”
The guest speaker hailed the Ogun state government and states that have demonstrated progressive leadership by actively implementing similar guidelines, or taking steps to clarify provisions that enable women to access their sexual and reproductive health rights within the boundaries of the law, noted that such steps are vital to protecting women’s lives and upholding their fundamental rights. She said Women die as a result of complications during and following pregnancy and childbirth. The major complications that account for nearly 75 per cent of all maternal deaths are: severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortion.
The menfolk, religious leaders, and traditional leaders should be recruited into the vanguard to save the Nigerian women and girls. A constructive engagement of the menfolk, who have immense authority as husbands and policymakers, in Nigeria’s male-oriented environment is critical to health care delivery.
The provision of the Nigerian Health Act of 2014 that at least one per cent of the Federal Government’s portion of the Consolidated Revenue or Federation Account Allocation be directed to health care is observed in the breach. The dilapidated health facilities in most government hospitals compel higher budgetary allocation to capital projects than recurrent expenditures like travelling allowances, meetings, workshops, and retreats. Government policies must create an enabling environment for increased local production of drugs, equipment, and other medical consumables.
Section 17(3)(d) of Nigeria’s constitution provides that “the state shall direct its policy towards ensuring that there are adequate medical and health facilities for all persons.” State actors, who as humans are also susceptible to illnesses, must address this provision with the passion it deserves. An appreciation of the nexus between health and economy better persuades the unwilling to make adequate budgetary allocation to the health sector.
About The Author
Òrúnbon, a journalist, writer, public affairs analyst, and poet, wrote in from Federal Housing Estate Olomore, Abeokuta, Ogun State.
Can be reached via: orunbonibrahimademola@gmail.com or 08034493944 and 08029301122.
