Prolonged Suspension of Abortion Guidelines in Lagos Could Impact Nigeria’s Fight Against Maternal Mortality

Nigerian laws restrict the procurement of abortion in many cases, except when the continuance of a pregnancy poses a severe risk to the carrier. However, not enough structures have been developed to legally and safely enforce that law, leaving many health workers unsure of how to help women get an abortion within the ambit of the law.

Nigeria’s alarming maternal mortality rate has been linked to a series of preventable causes, some of which are complications from unsafe abortions. According to research, unsafe abortions contribute to 10 percent of maternal deaths in Nigeria, which is about 6,000 women, according to the 2019 study.

“When the Lagos State Government, specifically the Governor Babajide Sanwo-Olu, suspended the guideline, it was a terrible backlash for all the work and effort that we put into the developing of that guideline, based on the alarming rate of maternal death in Nigeria and in Lagos state,” Wemimo Adewuni, media and communications manager at Women Advocates Research and Documentation Centre (WARDC), a civil society group that has been advocating for the suspension to be lifted, tells OkayAfrica.

Founder of the WARDC, Dr. Abiola Akiyode-Afolabi recalls feeling shocked and disappointed when she first learned of the suspension. Then, came anger. “The governor had chosen political likeability over the lives of real women and girls,” she says. “We know that the poorest in society are more likely to procure unsafe abortions. People with better access to finance and quality healthcare are less at risk of having unsafe abortions. We expected that the governor would truly be a steward of the people of Lagos state — not only for the rich and well-to-do, and prioritize their health, safety and well-being. This anger led us to stage a long protest with over 1,000 women to express the displeasure of the Lagos women with the action of the governor,” says Akiyode-Afolabi, whose organization has launched a Pink Movement campaign, to advocate for the adoption of the guidelines to save women’s lives.

A statement from the Lagos State Commissioner for Health, Professor Akin Abayomi, at the time of the suspension, said that the state executive council needed time to deliberate on the guideline, based on criticism from interest groups regarding its release. These interest groups, activists tell OkayAfrica, did not fully engage with the details of the guideline and its intention; which is to save the lives of women, before calling for its suspension.

A primary highlight in the guide’s executive summary was the importance of establishing the document as a means to achieve the Sustainable Development Goal of significantly reducing maternal deaths in Nigeria by 2030. A goal that Lagos — the second most populated state in Nigeria, after Kano, and the country’s most progressive — has a huge role to play in achieving.

Activists and reproductive rights groups have continued to sound the alarm about the dangers of limiting access to safe pregnancy termination in one of Nigeria’s most populated states. “Lagos is a model state in many areas. For instance, Lagos has done well in combating sexual and gender-based violence [head on], going on to have an agency that addresses sexual and gender-based violence,” Adewuni says, adding that the creation of the guideline by the state’s health ministry shows that it has identified the high avoidable deaths that have occurred due to unsafe abortions.

The fight to reinstate the guideline

Akiyode-Afolabi has consistently highlighted the importance of providing access to safe abortion for survivors of sexual abuse. “We are not asking for unbridled abortion. What we are asking for is for victims of rape, incest and women with chronic health conditions such as chronic pelvic pain, uterine perforation, pelvic inflammatory diseases and others, to be able to decide whether or not they want to keep a pregnancy,” she said in a recent webinar. The aim is for the Pink Movement to start from Lagos State and go to other parts of the country, “because we can no longer keep quiet.”

Akiyode-Afolabi tells OkayAfrica, “Since the guideline was suspended two years ago, we can only imagine how many more women and girls have died from unsafe abortions.” She also notes that the heavy stigma victims of rape and incest, as well as married women who have no access to contraceptives, face while trying to procure a safe abortion tends to leave them at the mercy of unqualified doctors and other self-help methods. “Girls and women are drinking concoctions and using hangers to terminate pregnancies,” she says.

The way forward

Activists have continued to call for change through protests and an online petition. Meanwhile, advocacy groups and NGO representatives intimate with the matter say there have been some talks regarding the suspension. But the Lagos State government is yet to state where it stands on lifting the ban and how it plans to alternatively address the vacuum left by the suspension of the guideline. The growing silence and lack of swift action from the government, civil groups say, will continue to drive up the rate of unsafe abortions.

“Lagos state, which has moved forward in addressing issues like traditional birth attendance, all in a bid to reduce maternal death, if [it] now shuts its eye to this other leading cause of maternal death it, unfortunately, sets a bad example for other states, especially states in more rigid culture, with more rigid cultural practices like the North, where we're still even advocating and fighting for the VAPP (Violence Against Persons Prohibition) law to be implemented,” Adewuni notes.

Africa recorded 69 percent of the global maternal deaths in 2020, with Nigeria ranking third at 1,047 deaths per 100,000 live births, behind Chad (1,063), and South Sudan (1,223). Lagos’ maternal mortality rate is 555 deaths per 100,000 live births, according to a study published by the National Library of Medicine in 2020.

Adewuni says, “It's not just a number. These are real women, real girls who have been raped, who have health challenges, whether physical or mental, or who are at a loss as to what to do in a situation where they get pregnant and they can't progress with it. Lagos needs to lift suspension on that guideline and ensure that health workers [have] everything they need to implement [it].”