It has been argued that there is no such thing as “NO ABORTION”; there is either “SAFE” or “UNSAFE” abortion. While some countries have accepted abortion as a legal entity and part of health care services, abortion remains illegal in many other places, including Nigeria and many African countries. All over the world, abortion still carries with it lots of criticism, opposition, stigmatization, and it has become a moral/religious issue instead of a health issue. The safety, ethical and legal aspects of abortion makes it an issue of strong global controversy.
Abortion has been defined as the deliberate termination of a pregnancy, usually before the embryo or fetus is capable of independent life (i.e before 28 weeks). In medical contexts, this procedure is called an “induced abortion” and is distinguished from a “spontaneous abortion” (miscarriage) or stillbirth.
Abortion is an important health issue and a recognized determinant of the Millennium Development Goals. MDG number 5 aims to improve maternal health by 2015, and to reduce the maternal mortality ratio by three quarters. Deaths from unsafe abortion are preventable, however abortion remains one of the 5 leading causes of maternal mortality and accounts for more than 10% of all maternal deaths around the world each year. So it is logical to answer those tough questions relating to the safety of abortion.
The familiar symbol of illegal abortion is the infamous “coat hanger”; the history being that desperate women used coat hangers in dangerous self-administered abortions. The coat hanger – often with the slash-circle “no” symbol – has become the premier symbol for the pro-choice movement.
Unsafe and Illegal Abortions: Not A Recent Development.
The practice of abortion dates back to ancient times. Pregnancies were terminated through a number of methods, including the administration of abortifacient herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. In the pre-modern age, many of the methods employed were non-surgical. Physical activities like strenuous labor, climbing, paddling, weightlifting or diving were a common technique, including battery and tightening the girdle. Others included the use of irritant leaves, fasting, pouring hot water onto the abdomen, and lying on a heated shells.
Over several centuries and in different cultures, there is a rich history of women helping each other to abort. Until the late 1800s, women healers in Western Europe and the U.S. provided abortions and trained other women to do so, without legal prohibitions. The State didn’t prohibit abortion until the 19th century, nor did the Church lead in this new repression, nor did the doctors . Hence abortion became a crime and a sin after the antiabortion laws took effect.
In 1803, Britain first passed antiabortion laws, which then became stricter throughout the century. The U.S. followed as individual states began to outlaw abortion. By 1880, most abortions were illegal in the U.S., except those ‘necessary to save the life of the woman’.
Abortion laws and their enforcement have fluctuated through various eras. In many western nations during the 20th century various activist groups and social reformers successfully worked to have abortion bans repealed.
On Jan 22 1973, the United States Supreme Court ruled on the Roe v Wade and Doe v. Bolton cases. These historic rulings made abortion legal in all states in the USA. Since then, anti-choice forces have mounted numerous attacks on women’s rights with various degrees of success. The same opposition occurs in other western nations where abortion is legal.
Coat Hanger Abortion – Real or just a Myth?
In an essay published in 2008 by Waldo L. Fielding, a retired obstetrician and gynecologist “Repairing the Damage, Before Roe”, Fielding recalled her experience as a young doctor. “I am a retired gynecologist, in my mid-80s. My early formal training in my specialty was spent in New York City, from 1948 to 1953, in two of the city’s large municipal hospitals. There I saw and treated almost every complication of illegal abortion that one could conjure, done either by the patient herself or by an abortionist — often unknowing, unskilled and probably uncaring. Yet the patient never told us who did the work, or where and under what conditions it was performed. She was in dire need of our help to complete the process or, as frequently was the case, to correct what damage might have been done. The patient also did not explain why she had attempted the abortion, and we did not ask. This was a decision she made for herself, and the reasons were hers alone. Yet this much was clear: The woman had put herself at total risk, and literally did not know whether she would live or die. This, too, was clear: Her desperate need to terminate a pregnancy was the driving force behind the selection of any method available. The familiar symbol of illegal abortion is the infamous “coat hanger” — which may be the symbol, but is in no way a myth. In my years in New York, several women arrived with a hanger still in place. Whoever put it in — perhaps the patient herself — found it trapped in the cervix and could not remove it.
“However, not simply coat hangers were used. Almost any implement you can imagine had been and was used to start an abortion — darning needles, crochet hooks, cut-glass salt shakers, soda bottles, sometimes intact, sometimes with the top broken off. Another method that I did not encounter, but heard about from colleagues in other hospitals, was a soap solution forced through the cervical canal with a syringe. This could cause almost immediate death if a bubble in the solution entered a blood vessel and was transported to the heart. The worst case I saw, and one I hope no one else will ever have to face, was that of a nurse who was admitted with what looked like a partly delivered umbilical cord. Yet as soon as we examined her, we realized that what we thought was the cord was in fact part of her intestine, which had been hooked and torn by whatever implement had been used in the abortion. It took six hours of surgery to remove the infected uterus and ovaries and repair the part of the bowel that was still functional.” she recalled.
Illegal abortions in Nigeria
In Nigeria abortion is legally restricted, permitted only to save the life of the mother. But at least 760,000 abortions happen every year, mostly outside the legal parameters, out of which up to 34,000 women die annually from unsafe abortions, according to reports by the Guttmacher Institute and the government of Nigeria. The numbers range widely because of the inadequacy of data particularly from the secret procedures. Unsafe abortions often lead to complications such as hemorrhaging, infection and perforation of the bowels or uterus and death.
In the United States, where abortions are legal, there are 0.6 deaths for every 100,000 procedures; in sub-Saharan Africa, the rate is 460 deaths per 100,000 procedures, according to Guttmacher. Africa has a higher abortion rate than the U.S., despite restrictive laws in most countries. Across the continent there were 29 abortions per 1,000 women in 2008, compared with 19 in the U.S. Nigeria has one of the highest rates of maternal death in the world, with 545 per 100,000 live births in 2008. In fact, up to half of maternal deaths in Lagos have been said to be arguably related to abortion.
However, it seems a veil of silence is covering Nigeria’s large abortion market; even though abortion happens all the time and across the social spectrum. Many abortion providers are poorly trained, and the market is unregulated. And Nigeria being the second most-religious country in the world in accordance to the Gallup Study in 2012, this also have created a deep stigma around abortion. Aside from a few abortion-rights activists who are pressing to promote safer conditions and to liberalize laws state by state, abortion remains taboo. Reproductive-health activists are also reluctant to discuss the issue for fear of undermining progress in other areas, such as access to contraception.
While wealthy Nigerians can access and afford skilled doctors; most women are left with dangerous, cut-rate “quacks”. Some operate out of their homes or sketchy clinics; ‘pharmacists’ and local drugstores perform abortions in the back rooms of their shops and sell ‘cytotec’ (misoprostol) in dangerous doses readily over the counter, even medical students learn how to do them, which can lead to deadly mistakes. Herbalists or traditional healers also set up shop at the market and use plants to treat a wide range of ailments. Some herbal treatment combines abortifacient leaves with local liquor. Local hawker that sell drugs from their baskets at night set up in front of the brothels pedaling wares like condoms, made-in-Nigeria herbal remedies and abortion pills, including prescription-only abortion drugs like cytotec!!
Abortion in Nigeria is illegal and carries a heavy jail sentence–up to 14 years imprisonment–unless it is performed to save the life of the pregnant woman. Nevertheless, a large number of clandestine abortions continue to be carried out regularly, often with dire consequences for the lives and health of the women involved.
Grounds on which abortion is permitted:
To save the life of the woman – Yes
To preserve physical health – Yes
To preserve mental health – Yes
Rape or incest – No
Foetal impairment – No
Economic or social reasons – No
Available on request – No
Two physicians are required to certify that the pregnancy poses a serious threat to the life of the woman.
Note that Nigeria has two abortion laws: one for the northern states and one for the southern states.
Both laws specifically allow abortions to be performed to save the life of the woman. In addition, in the southern states, the law allows abortions to be performed for physical and mental health reasons.
However, the Nigerian abortion law does not give guidelines about who can do it, where it can be done, until what gestational age, and other pertinent specifications. With that law, any quack on the street can do an abortion and claim it was to save a woman’s life!
The Big Question: What About Contraception
While it seems implausible that a sexually active urban young woman who studied to secondary/tertiary institution, speaks English, styles hair and look pretty around the city wouldn’t know about birth control, it is a sad reality! There is still an unbelievably low prevalence of contraceptive use among Nigerian youths. Many studies have revealed that more than while more than two-thirds had had sex, contraceptives use is just a little over twenty percent. Hence the high incidence of unwanted pregnancies and the high prevalence of illegal abortion in the country.
For Interest Purposes…
What are the methods of abortion and at what stages of pregnancy are they used?
Many illegal techniques of abortion have been described. One of the techniques is to put a urinary catheter into the cervix and leave it there; there is also the use of knitting needles and wire coat hangers and th equally horrifying method of using the spokes of a bicycle wheels and other unsterilized sharp objects.
The following abortion methods are in common use:
- Suction Aspiration — 6-12 weeks
- D & C (Dilation and Curettage) — 6-12 weeks
- D & E (Dilation and Evacuation) — 12-24 weeks
- D & X (Dilation and Extraction or Partial Birth Abortion) — 24-36 weeks
- Prostaglandin or Live Birth Abortion — second or third trimester
- RU-486 (Early chemical abortion) — up to 56 days gestation
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