Understanding Abortion in the Nigerian Context

What is an abortion?
An abortion is a termination of a pregnancy before it reaches the age of viability; it could be spontaneous or induced. 

A pregnancy is only as good as the survival chances of the fetus in the womb, and these chances depend on a lot of factors, the most important being TIME. Ending a pregnancy before the fetus has good survival chances is what we term an abortion. It could be spontaneous or induced.

The age of viability of a pregnancy is the period in a pregnancy when a fetus is more likely to survive outside the womb of the mother. 

Abortions are sometimes referred to as miscarriages, because of the erroneous belief that miscarriages are the ones that occur without any intervention. Miscarriages are also abortions. A spontaneous abortion is the most common cause of pregnancy loss in the first trimester.

Approximately 73 million induced abortions occur worldwide each year according to the World Health Organisation (WHO). Research indicates that only 40% of abortions are safe, while the remaining 60% are unsafe. Access to safe, prompt and affordable abortion care is a critical public health issue concern.

Are all abortions illegal in Nigeria?
In Nigeria, the deliberate termination of a pregnancy before it reaches the age of viability is deemed illegal, and can only be carried out when it is proven that the pregnancy is a life threatening risk to the mother.

Different abortion laws govern the Northern and Southern regions of Nigeria; the Southern region allows abortions to protect both the physical and mental well-being of the woman. 

The Penal Code applies in the North, where the majority are Muslims, while the Southern region is governed by the Criminal Code. However, a significant issue is that the law does not specify who is qualified to administer an abortion or the conditions under which it should be performed.

Although abortions are illegal, post-abortion care is very much legal in the country and available at both private and public health facilities.

What qualifies for a legal abortion?
A legal abortion is one that is supported by the law. It is synonymous with a safe abortion, which is performed by a qualified healthcare worker under standard conditions and guidelines. An abortion performed by an unqualified individual is considered unsafe and illegal.

How is a medical abortion different from a surgical abortion?
A medical abortion is carried out with the sole use of medication (drugs) to terminate a pregnancy. It is approximately 99% effective and is usually performed within the first 9 weeks of pregnancy. Abortion medications work by blocking the hormone progesterone, which supports the pregnancy, and they also soften the cervix and contract the uterus to expel the pregnancy. Within 12 weeks of gestation, a medical abortion may be safely self-managed by the woman at home, provided she has access to accurate information and support from a qualified healthcare worker.

Surgical abortion, on the other hand, uses surgical tools and techniques to terminate a pregnancy. It is typically conducted at later stages, especially during the second trimester (after 24 weeks). Various surgical methods exist depending on the stage of gestation and other factors, including Manual Vacuum Aspiration (MVA), Electric Vacuum Aspiration (EVA), Dilation and Curettage (D&C), and Dilation and Evacuation (D&E), among others.

Which type of abortion can you get in a Nigerian hospital?Both medical and surgical abortions are available in Nigerian hospitals. However, the legality of the situation is crucial. Conditions to access abortion in Nigeria may include being at least 18 years old, having a health risk due to the pregnancy, providing consent, and affordability.

Why is post-abortion care important?
Post-abortion care (PAC) includes follow-up check-ups, management of any residual side effects or complications, and contraception services. It is essential because various complications can arise from an abortion, especially if it is performed unsafely or by unqualified personnel. Potential complications include infection, uterine perforation, heavy or abnormal bleeding and pain. Therefore, women who undergo an abortion must seek and access post-abortion care to manage these complications.

Knowing when to seek post-abortion care
Receiving a safe abortion is important because healthcare workers provide necessary instructions on further steps to take. Unfortunately, safe abortion services may not always be financially accessible or culturally accepted. It is important to recognize symptoms that signal danger and require medical attention. 

Some warning signs include excessive bleeding, fever, severe pain, or any other prolonged symptoms following an abortion. Women should go to a hospital if they experience any of these symptoms.

Dangers of over-the-counter abortion medications and self-management
Using over-the-counter drugs and attempting self-abortion poses significant risks, and over-the-counter abortion medications are no exception. 

Due to a lack of experience and misinformation, individuals may take medications incorrectly, exacerbating the situation and potentially leading to severe health consequences, including death.