Abortion remains a contentious issue in Nigeria, shaped by the nation’s intricate blend of cultural, religious, and legal frameworks.
Broadly prohibited, the practice is only allowed under specific circumstances, as reported by Sunday PUNCH.
This delicate balance between prohibition and exception illustrates the ongoing tension between Nigeria’s colonial legal inheritance and contemporary demands for reproductive health rights.
Recently, the Chief Medical Director of Lagos State University Teaching Hospital and Professor of Obstetrics and Gynaecology, Professor Adetokunbo Fabamwo, called for a review of Nigeria’s abortion laws.
He argued that liberalisation could significantly reduce deaths caused by unsafe abortions in the country.
He made this assertion during his address at the sixth Annual Abimbola Omololu-Mulele Lecture, titled, ‘The Tortuous Road to Maternal Mortality Reduction in Nigeria: Avoidable Strongholds on Liberal Abortion Laws.’
The event was organised by the University of Lagos Office of Advancement and the Board of Trustees of Abimbola Aina Omololu-Mulele.
Held at the Old Great Hall, College of Medicine, University of Lagos, Idi-Araba, on Thursday, the lecture also honoured the late Mrs Frederica Omololu-Mulele.
During the lecture, Fabamwo acknowledged Mrs Omololu-Mulele’s significant contributions to child development, before shifting focus to Nigeria’s maternal mortality crisis.
He attributed a large proportion of maternal deaths to unsafe abortion practices and called for a re-examination of restrictive laws, which he argued had continued to endanger the lives of countless women.
According to the World Health Organisation, maternal death refers to the death of a pregnant woman due to pregnancy-related complications, underlying conditions worsened by pregnancy, or the management of these conditions.
Such deaths may occur during pregnancy or within six weeks of its resolution.
Fabamwo added that globally, “a woman dies of pregnancy-related causes every two minutes, with most of these deaths being preventable if the right care is provided at the right time. Unsafe abortion accounts for at least 13 per cent of maternal deaths worldwide.”
In Nigeria, stringent abortion laws often compel women to seek clandestine and unsafe procedures.
Despite advocacy efforts to liberalise abortion laws and permit safe terminations under medical supervision, significant challenges persist.
Using statistical data to highlight global disparities in maternal mortality rates, Fabamwo emphasised the importance of institutionalising safe abortion practices for medical reasons.
He also elaborated on global benchmarks for abortion laws, citing conditions such as saving the mother’s life, preserving physical and mental health, and cases involving rape or incest.
He lamented the resistance faced in legalising safe abortion practices in Nigeria, including attempts in states like Imo and Lagos.
Fabanwo specifically referenced the suspended “Lagos State Guidelines on Safe Termination of Pregnancy for Legal Indications,” a comprehensive 40-page document drafted under the leadership of the Permanent Secretary, Lagos State Ministry of Health, Dr Olusegun Ogboye.
He called for a review of this framework, urging stakeholders to reconsider its implementation.
The CMD proposed proactive engagement with leading media houses, breakfast meetings, luncheons, and roundtable discussions to enlighten the public on the urgency of this issue. He maintained that such steps are necessary to achieve the ultimate goal of liberalising abortion laws, thereby reducing deaths from unsafe abortions and safeguarding women’s health and well-being.
This plea comes amidst global and local efforts to reduce maternal mortality through initiatives at international, national, and community levels.
Fabamwo’s address underscores the pressing need for evidence-based humane reforms in Nigeria’s reproductive health policies.
The legal framework
Nigeria’s legal system on abortion is built on the Criminal Code Act (which applies in the southern states) and the Penal Code Act (enforced in the predominantly Muslim northern states). Both codes unequivocally criminalise abortion, though they allow narrowly defined exceptions.
A legal practitioner in Rivers State, Mrs Sotonye Peters, explained that the Criminal Code Act addresses abortion in sections 228, 229, and 230.
She noted that Section 228 stipulates that anyone who unlawfully performs an abortion commits a felony, punishable by up to 14 years of imprisonment.
“Section 229 specifies that a woman who attempts or consents to terminate her pregnancy is liable to imprisonment for up to seven years,” she said.
“Section 230 criminalises any individual who supplies drugs, instruments, or other means intended for illegal abortion, with penalties of up to two years in prison.”
However, Peters pointed out that the law provides an exception in Section 297, allowing abortion when it is necessary to save the mother’s life.
“The law states that a person is not criminally liable for performing a surgical operation on an unborn child to preserve the mother’s life,” she added.
The Penal Code Act
In the northern states, where Islamic principles under Sharia law influence legal norms, abortion is similarly criminalised under the Penal Code Act.
A legal practitioner, Mr Muhammed Sulaimon, stated that sections 232 and 233 mirror the provisions of the Criminal Code regarding penalties.
However, Section 236(2) permits abortion when deemed necessary to save the life of the pregnant woman.
These legal frameworks, while seemingly clear, are not without ambiguity, particularly in their interpretation and application.
Interpreting “saving the life of the mother”
The phrase “saving the life of the mother” is a critical aspect of abortion law in Nigeria.
However, what constitutes a life-threatening condition is not explicitly defined, leaving room for judicial and medical interpretation.
In practice, conditions like ectopic pregnancy, severe pre-eclampsia, eclampsia, and advanced-stage cancers during pregnancy are widely accepted as qualifying for the exception.
Judicial precedents, though limited, have expanded this interpretation to include instances where the pregnancy poses a significant risk to the mother’s mental health.
The influence of British jurisprudence, particularly the landmark case of Rex v. Bourne (1938), which ruled that an abortion to preserve a woman’s mental health was lawful, has been cited in Nigeria.
While not binding, this case has been referenced in academic and legal discussions advocating a broader interpretation of maternal life preservation.
Medical conditions that qualify for legal abortion
Several life-threatening medical conditions have been identified as meeting the legal threshold for therapeutic abortion in Nigeria.
One of these is ectopic pregnancy. This occurs when a fertilised egg implants outside the uterus, most commonly in a fallopian tube.
Experts say ectopic pregnancies are non-viable and can lead to severe bleeding or death if not treated promptly. In such cases, the law permits termination.
Ectopic pregnancy is also considered a medical emergency, as it can result in severe internal bleeding, rupture of the fallopian tube, and even death if untreated.
In Nigeria, ectopic pregnancies are one of the few conditions under which abortion is legally permitted, as they fall under the life-saving exceptions outlined in the country’s restrictive abortion laws.
Nigeria’s abortion laws, based on both the Penal Code in the North and the Criminal Code in the South, permit abortion only when it is necessary to save the life of the woman.
This restriction means that ectopic pregnancies, which are non-viable and pose a direct threat to the mother’s health, are generally managed through surgical or medical intervention without legal repercussions. The exception aligns with international medical standards, which prioritise the mother’s life in life-threatening situations.
However, complications persist due to limited awareness, stigma, and inadequate healthcare infrastructure.
Many Nigerian women still seek unsafe procedures because they lack access to trained medical professionals or fear legal consequences.
Reports show that this gap is further exacerbated by the low rate of modern contraceptive use in Nigeria—only about 11 per cent of women use modern contraceptives, resulting in nearly 10 million unintended pregnancies annually, many of which end in unsafe abortions.
These unsafe practices significantly contribute to Nigeria’s high maternal mortality ratio, which is estimated at 512 deaths per 100,000 live births.
To address this issue, experts recommend enhancing healthcare access, raising public awareness about safe abortion practices for medically indicated cases like ectopic pregnancies, and amending restrictive abortion laws to align with global human rights frameworks, such as the Maputo Protocol.
This also involves better implementation of reproductive health policies, such as Nigeria’s Violence Against Persons Prohibition Act, which seeks to protect survivors of gender-based violence, including rape, and ensure comprehensive medical care.
Another special case where abortion can be legal in Nigeria is severe pre-eclampsia and eclampsia.
These conditions involve high blood pressure during pregnancy, which can lead to seizures, organ damage, and even death. When continuing the pregnancy endangers the mother’s life, termination is considered necessary.
Advanced cancer requiring treatment is another scenario in which abortion is legally permitted, as continuing the pregnancy may impede treatment or worsen the mother’s condition.
A medical practitioner, Dr Moses Akanda, stated that pregnant women in Nigeria diagnosed with aggressive cancers may require immediate chemotherapy or radiotherapy, treatments that can harm the fetus.
The Dubai-based doctor added, “If delaying treatment jeopardises the mother’s life, abortion becomes a lawful medical option.”
Another case involves mental health crises. Though not explicitly outlined in the statutes, medical research suggests that severe mental health conditions, such as psychosis or suicidal ideation triggered by pregnancy, are increasingly considered valid grounds for legal abortion when they pose a significant risk to the mother’s survival.
Challenges in accessing legal abortion
While the law permits abortion in specific life-threatening situations, women often face significant barriers to accessing these services.
Access to healthcare facilities capable of performing life-saving abortions is limited in rural and underserved areas. Women in remote regions may need to travel long distances to urban centres, leading to fatal delays in emergencies.
A sociologist, Dr Akanimoh Umoren, noted that the criminalisation of abortion fosters stigma, deterring women from seeking even legally permitted procedures.
“Healthcare providers, fearful of legal repercussions or societal backlash, may also hesitate to perform abortions, even when justified under the law,” he stated.
Umoren also pointed out that the ambiguity in Nigeria’s abortion law can be problematic.
“The lack of clear guidelines on what constitutes a life-threatening condition often leaves decisions to the discretion of individual medical practitioners. This inconsistency can lead to delays in care or denial of services,” he added.
He further highlighted that medical personnel, especially in rural areas, may lack the training to recognise conditions that qualify for therapeutic abortion, exacerbating delays and increasing risks for pregnant women.
Societal and ethical considerations
In Nigeria, abortion is not just a legal issue but also a deeply moral and cultural one. The dominance of Christianity and Islam, both of which generally oppose abortion, contributes to societal resistance to legal reforms. Apostle Philip Udofot, a preacher from a Pentecostal church in Port Harcourt, explained that many Nigerians view abortion as morally unacceptable, irrespective of the circumstances. Religious leaders, according to him, exert significant influence, often opposing even life-saving procedures.
Despite legal restrictions, abortion remains widespread in Nigeria, with many women resorting to unsafe methods. According to the Guttmacher Institute, an estimated 1.25 million abortions are performed annually, most of them clandestinely. These unsafe abortions contribute significantly to maternal mortality, causing complications such as sepsis, haemorrhage, and organ damage.
Calls for Reform
Human rights activists, medical professionals, and legal scholars have increasingly called for reforms to Nigeria’s abortion laws. Their arguments focus on expanding the legal exceptions and addressing systemic barriers to care.
Advocates have also suggested that the law should include exceptions for pregnancies resulting from rape, incest, or severe fetal abnormalities incompatible with life.
They highlight the emotional and physical trauma suffered by women forced to carry such pregnancies to term.
A retired nurse from the Rivers State Ministry of Health, Mrs Eremina Pepple, stated, “Healthcare systems must be strengthened to ensure that women eligible for legal abortion can access services promptly and safely. This includes training medical personnel, providing adequate resources, and establishing clear guidelines for therapeutic abortion. The government must also educate the public about the existing legal provisions for abortion and the risks of unsafe procedures. Such efforts can help reduce stigma and encourage women to seek lawful care.”
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