Maternal mortality, unwanted pregnancy and unsafe abortion

 Beliefs & Attitudes related to unwanted Pregnancy & abortion

Unwanted pregnancies are a common occurrence among highly active and mobile populations with  demographic characteristics as ours where young people aged 16-29 years are in the majority, coupled with a high fertility rate and low contraceptive utilization rate as ours here in Nigeria.

 The preliminary report of the 2008 Demographic & Health Survey (NDHS) confirms this, indicating that the Nigerian woman has a fertility ratio of about 5.7 children per woman[1]. As reported by some studies on Adolescent Sexuality in Nigeria, the age at commencement of sexual activity by Nigerian youths is progressively decreasing[2], just as there is still a low contraceptive prevalence among the Nigerian woman, averaging less than 40%[3]

 The above triad of average high fertility rate, preponderance of a relatively young & mobile population, coupled with a low contraceptive utilization rate is a fertile ground for unwanted pregnancies not only among young unmarried girls, but also among the married, more mature ladies. It is therefore not surprising to contend with a plethora of unwanted pregnancies across the length & breadth of Nigeria.

The contribution of death from illegal abortions to maternal mortality in Nigeria has been exhaustively captured in a recent study captioned Broken promises, where it was estimated that of the about 55,000 annual maternal deaths in Nigeria arising from pregnancy & related complications, over 33,000 are due to cases related to complications arising from illegal abortions.[4] It is therefore important to determine the social & cultural determinants, if any that underpin this catastrophe, while elaborating the issues related to it like family planning choices, early sexuality education for prevention of unwanted pregnancies, and the desirability or otherwise of liberalising the abortion law to give more latitude to choice by the woman, as against the current situation where women can only obtained legal abortion when their health and lives are seriously threatened. Considering the fact that mortality figures from abortion related deaths are alarming, concerted efforts should be made to address this at different levels by reducing the prevalence of unwanted pregnancies through timely & appropriate sexuality education, liberalisation of the abortion law, as well as provision of enhanced basic obstetric care services to cater for the cases of septic abortions that we will still have to contend with for some time to come.

          

 Findings from a survey on Socio-economic determinants of maternal mortality in Nigeria (2009) survey, especially the FGDs among community/traditional leaders consistently indicate a high level of denial on the prevalence of illegal abortions among youths in their communities. As seen in some attached FGDs in the appendix, community leaders pointed to the government as the source of possible solutions to prevent unwanted pregnancies by young girls, apparently oblivious of their responsibilities as parents & community leaders.

However, earlier quantitative studies using questionnaires administered to housewives, coupled with FGDs among women attending ANCs show that they support the liberalisation of abortion laws as it relates to cases of rape; in addition to when their lives may be threatened, and not just waiting for when their lives are in real danger. 
Detailed report of this report, authored by Dr. John Onyeokoro and Dr. Ejike Oji (2009) wil be discussed subsequently.

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[1] Nigeria Demographic & health Survey, 2008-Preliminary report; National Planning Commission

[2]  Action Health Inc.  Hidden- A profile of married adolescents in Northern Nigeria, 2006.

[3]  NDHS 2008 Preliminary Report, NPC.

[4]  Broken Promises-Human rights, Accountability & Maternal deaths in Nigeria, CRR & WARDC 2008,