Abortion Deaths in Nigeria Attributed to Archaic Methods

It was a decision that changed Auntie Vero’s life. Unmarried and pregnant as a young woman in the early 1970s, she sought an abortion. But the general practitioner had little experience in the procedure, and it went horribly wrong.

When she got home, she began to suffer excruciating abdominal pain and swelling. Later, she learned that she was bleeding internally. In a panic, she rushed back to the same doctor, a decision that proved nearly fatal.

Now 52, Auntie Vero, as she is affectionately called by friends and family, still vividly remembers the pain and how she struggled to free herself from the doctor’s grasp.

“I was shouting and screaming; it was so painful,” said Vero, an attractive woman with short-cropped white hair who requested that her full name not be used. “That was the work of the devil.”

The bloating and convulsions continued even after Vero, a onetime schoolteacher who had her first abortion four years earlier, left the doctor’s office, armed only with a couple of aspirin.

Later, her brother took her to a specialist. Surgery, followed by eight weeks in a hospital, revealed that her uterus had been perforated and that she would never again be able to conceive.

Still, Vero counts herself lucky. She survived. Today she is a fierce critic of abortion unless the mother’s life is in jeopardy and the procedure is performed by a trained specialist using modern equipment.

Although Vero’s ordeal happened more than two decades ago, medical researchers in this West African nation say abortions performed primarily by nonphysicians using harmful and archaic methods still are rampant and cost the lives of thousands of women per year.

Sex Education Not Widespread

Few women who have been through it are willing to talk openly. Abortion is a crime in Nigeria, except to save a woman’s life. Violators risk spending seven to 14 years in jail.

Contraceptives are not widely available in Nigeria, and sex education is not as widespread as some women’s rights activists would like.

A joint study by the New York-based Alan Guttmacher Institute and the Nigerian Campaign Against Unwanted Pregnancy, or CAUP, recently found that Nigerian women obtain about 610,000 abortions each year, a rate of 25 per 1,000 females ages 15 to 44.

Although the figure is moderate compared with some Eastern European and South American countries, it is much higher than in most of Western Europe and slightly above that of the U.S.

Most alarming, the researchers say, is that as many as 60% of abortions in Africa’s most populous country are performed or induced by nonphysicians, doctors with little or no training in the procedure, or by women themselves, often in unsanitary conditions and using dangerous instruments.

According to the study, abortion is the cause of 1,000 maternal deaths for every 100,000 live births in Nigeria. Local researchers believe that as many as 50% of the deaths of teenage girls are the result of unsafe abortions.

The problem is not unique to Nigeria, researchers say, noting that one in eight maternal deaths of women of childbearing age in West Africa are attributed to abortion.

Nigeria Has Ignored Seriousness of Problem

Medical specialists and women’s rights advocates hope the results of the study, due to be officially released in Nigeria in February, will prompt the new and more public-oriented military government of Gen. Abdulsalami Abubakar to make abortion safer and less clandestine.

Past regimes have tried to downplay or simply ignore the seriousness of the problem. No current government official was readily available for comment.

“The findings will show that, irrespective of self-denial and righteousness, [abortion] is taking place,” said CAUP coordinator Dr. Boniface Oye-Adeniran. “The first step is to educate the policymakers that it is taking place, and that will force public debate.

“In any situation where you make things illegal, people are going to seek services underground,” Oye-Adeniran said, “and those who are going to provide services cheaply are the charlatans, the quacks; and those who are not qualified to perform the proceedings are the ones who are going to cause the most complications to the woman.”

Dr. Stanley Henshaw, deputy director of research at Guttmacher, which studies reproductive health and promotes policy analysis and public education, said greater awareness of the seriousness of the problem might encourage more qualified physicians to provide abortions.

Corruption and mismanagement by previous governments have led to high costs for treatment and shortages of everything from basic drugs to contraceptives in Nigeria. According to the study, only 6% of married women are said to use contraceptives. Across Africa, contraception is not widely practiced--either by men or women.

Researchers found that Nigerian women seek abortions to avoid premarital births, limit the number of their children to six or fewer and to space their children at healthy intervals.

Many consult nonphysicians because they are ignorant of the risks, unaware of the safest time to perform the operation or because qualified doctors are too expensive. Some women lie about their length of gestation because an earlier abortion is cheaper.

There is no system of health insurance in Nigeria. Cash on demand for treatment is typical. Since it is a crime to perform or seek an abortion, mainly because of religious, social and traditional beliefs, many women go for the most discreet and cheapest method.

“If public policy was more favorable to providing safer abortion to women, it would be possible to improve the training and skills of the physicians as well as the nonphysician providers,” said Henshaw, of Guttmacher.

Although otherwise liable for jail time, abortion providers are exempt from prosecution if they can prove that they performed the operation in “good faith” and with “reasonable skill” in order to save a woman’s life, local women’s rights activists said.

“It doesn’t say where; it could be on my dining room table,” said Ngozi Iwere, project manager of Community Life Project, a Lagos-based family planning center. “It’s little wonder women are being butchered everywhere.”

Some women’s rights activists and Nigerian medical researchers want their government to amend the law. Proposed reforms include allowing abortion in cases of rape or incest, providing 48 hours of compulsory counseling for abortion patients and designating approved clinics where trained doctors could safely perform the procedure.

Advocates also are pushing for improved sex education to increase awareness of family planning and to promote abstinence.

“Abortion on demand is not the issue here,” said Iwere. “But those who choose to do so should be able to do it safely.”

Financial Concerns, Shame Led to Abortions

Auntie Vero presumed the doctors who performed her abortions knew what they were doing. Her decision to terminate both pregnancies was driven by financial concerns and shame.

“I was a young girl,” Vero recalled, speaking from her home in the working-class Surulere neighborhood of Lagos. “There was a stigma of having a baby without being married. I was the senior daughter in the family. My parents were not working. In my sober moments, I decided not to continue [with the pregnancy], and to wait for the right person to come along.”

She married in 1977. But she neglected to tell her husband about her history, and her inability to bear a child soon led to marital problems. Nine years later, the couple split up.

“I’ve paid my price,” said Auntie Vero.