The Throes of Womanhood
With joy in her heart and hope in her voice, Bisi Tella, a 26-year-old banker sang into the night as she prepared for her church international crusade the next day. Soon after, she slept.
Bang! Bang! Bang! In the dead of night, the men of the underworld came calling. They robbed and plundered her apartment. Bisi was not only robbed but raped by three men amidst pleas and screams. Angry and ashamed, she kept it from her family.
A month later, Bisi missed her period. She was pregnant. Anger, frustration and sadness set in. How could she wake up every day seeing the face of the child whose father robbed and raped her? How would she cope with the trauma? There was only one option- abortion.
Her eyes were dilated, her body frail, from continuous vomiting, stooling and fever, days later. Her neighbors aided her to the hospital as she could barely walk. She was admitted for severe pelvic pustule and intestinal rupture. She needed an urgent surgery.
But not all those who go under the knife make it alive. Some die in the process. Every day, women in Nigeria die from pregnancy complications. Every year, an average of 576 pregnant women per 100 000 die in Nigeria, making the country the second largest contributor to maternal mortality rate in the world. Why are these women dying?
Blame the Law
While most media reports blame the death of pregnant women on the country’s poor health system, pregnancy complications and unsafe abortion, none have examined the restrictive abortion laws. It is an established fact that unsafe abortion is a major cause of maternal mortality. Still, beyond unsafe abortion lies a restrictive law that sends these women to their early graves.
The legal system governing Nigeria comprises two codes- criminal code covering 19 Southern states and the penal code covering 17 Northern states. Sections 228, 229 and 230 of the criminal code and sections 232 to 236 of the penal code punishes anyone who conducts abortions with 14 years of imprisonment; the woman on whom the abortion is conducted seven years of imprisonment; and anyone who supplies instruments for the abortion, three years imprisonment.
Only the penal code (section 235) provides an exception for abortion when the woman’s life is endangered. The criminal code does not but the judicial precedence set in Rex v Edgal made similar exception in its application.
The restrictiveness of the abortion law has not stopped women from seeking abortion. It did not stop Bisi. As the World Health Organisation (WHO) asserted, women of reproductive age, no matter the status or profile, are prone to having unplanned pregnancies and most likely will resort
to abortion.
This especially occurs when they find themselves in circumstances such as rape. The possibility of having abortion after rape is high as the victim will want to avoid the traumatic experience of having the child. Inferring from Godwin Akaba, a gynecologist and obstetrician with 16years experience in maternal health in Nigeria, a woman that has been raped may not want to keep the
pregnancy, it is pointless to force her. She should be allowed to make her choice.
The illegality of abortion in Nigeria, notwithstanding, a research by Bankole, Adewole and others in 2012 found that every year, about 1.25 million unsafe abortions are done annually in Nigeria, out of which 212 000 had abortion complications, constituting a leading cause of maternal
mortality (about 40 percent). As a study by Mustafa Lamina in 2015 showed, these deaths are a consequence of unwanted pregnancies which is the major cause of unsafe abortion.
This is similar with Tanzania. According to the Guttmacher Institute report in 2013, Tanzania’s abortion law is very restrictive permitting abortion only to save a woman’s life. Yet unsafe abortion is widely practiced and is a major cause of maternal death in the country. Currently, Tanzania has one of the highest maternal mortality rate in the world with 454 per 100 000 live births. Berer in a study in 2002 on health policy showed that there is a link between restrictive abortion laws, unsafe abortion and a high maternal mortality.
To abort the baby, Bisi tried induced abortion, drinking different herbal mixtures and spirits (known as ogogoro in Nigeria). Neither worked.
Wolves in Sheep Clothing
Two streets away lay a chemist shop, (popular illegal drug stores with quacks called chemists who sell cheap drugs). Bisi walked to the chemist shop to see the chemist, Chinedu.
Confiding in him, “I want to abort this baby, I have never done it before, please help me”, she begged, crying profusely. “No problem, na my work”, Chinedu said in broken Nigerian English,
“just bring 10 000 naira, I go do am for you”. A week later, Bisi had the abortion in the chemist shop at night. He carried out dilation and curettage, a risky abortion procedure popularly called D and C. The next day, Bisi felt a sharp abdominal pain, and subsequently, intense bleeding and a huge bulge in her vagina. The foetus was not completely removed.
Lurking around in hospitals, chemists, herbal houses, and homes are unqualified persons who hide under the illegality of the abortion law. These persons popularly called quack doctors use highly risky methods and different dangerous equipment such as unsterilized needles, wheel spokes to forcefully remove the baby or rupture the pregnancy.
These instruments lead to infertility, excessive bleeding, puncture of the uterus, vaginal mutilation, septic abortion, infections, shock and death. The standard practice before an abortion, as Tobor Agbogidi, a general medical practitioner based in Nigeria with over 10years experience analysed is to conduct an ultrasound scan to get a full view of the pregnancy. Since quacks do not have such facilities, they invade the pregnancy and injure their victims.
Due to these harmful methods, unsafe abortion is a major cause of maternal deaths in Nigeria. As the 2015 Guttmacher Institute report shows, where abortion is illegal or restrictive, it is conducted in secret using unsafe methods leading to the death of the woman.
Even when the law permits abortion to save a woman’s life, it makes no distinction between those performed by qualified doctors and unqualified ones or recognized health centers and the unsafe ones.
Utter Disrespect for her rights
The restrictive abortion laws infringe a woman’s right to good health, dignity and life. Nigeria is signatory to the Charter of the Convention on the Elimination of All forms of Discrimination
Against Women (CEDAW). Article 12 of the charter guarantees equality of men and women to access good healthcare.
In the African Charter of Human and People’s Rights ratified by Nigeria, Article 16 guarantees the right of every individual to the “best attainable physical and mental health”. Also, Article 14
(2c) of the Charter directs states to authorize medical abortion in the case of rape, sexual assault, incest and other circumstances where the pregnancy might endanger the woman’s life.
The harsh restrictive abortion laws in Nigeria violate all these provisions. It pushed Bisi to commit unsafe abortion, subjecting her to physical and psychological damage resulting from abortion complications, denying her right to safe abortion. It failed to protect Bisi in the event of unwanted
pregnancies.
The relationship between the law and the well-being of an individual can be understood through the theory of therapeutic jurisprudence. Yomi Olukolu, a Barrister and Senior Lecturer of Jurisprudence and International Law, University of Lagos, Nigeria defines the theory as the processes and outcomes of a law that affects a person’s total well-being - physical, emotional and
psychological. Linking this theory to the abortion law, it shows that the abortion laws are unconstitutional and infringe on the woman’s right to privacy and self-determination. They affect not just her reproductive health but also her economic status and other aspects of her life.
However, those who say they are “pro-life” would disagree. They argue against abortion claiming it is wrong to terminate the life of a foetus which is sacred. Those in support of abortion “pro-choice” such as Abigail Ogwezzy-Ndisika, a gender activist and professor of communication would refute. She argues that it is not worth the trauma, pain and psychological torture of bringing an unwanted child into the world and the woman should have a right to determine how she want to treat her body. She refutes that the life and well-being of the woman is as important as the child.
Thus, the failure of the law on reproductive health is evident. Reproductive health is a right. When a law forces a woman to carry a pregnancy, denying her the freedom to choose how many children she wants to have, these rights are being violated.
The abortion law is therefore a tool of intimidation, coercion and hinders women from fully exercising their reproductive rights. It brought Bisi so much suffering and degrading treatment, pain and torture. The law violated not only her right to health but also her dignity.
In addition, the abortion law renders the right to life clause in section 33 subsection 1 of the constitution useless. This section holds states responsible for the loss of life. Many incidences of unsafe abortion have led to death. Therefore, the abortion law threatens the lives of women and the government is responsible for this. Mahmoud Fathalla in the WHO report describes pregnancy-related deaths as the highest denial of women’s rights.
Stigma and Shame
“I was ashamed, who will people say is the father of the baby?”, Bisi said, justifying her abortion at the hospital, with every strength she had.
The WHO report also showed that abortion is highly stigmatized in many developing countries and Nigeria is no exception as there is a stigma attached to premarital or extramarital sex. A predominantly negative attitude attached to women who seek abortion is common, viewing them as inferior, shameless, promiscuous and having evil intentions.
Abortion-related stigma is closely linked to the sociological concept of gender roles. Gender roles assign prescriptive behavior to members of a sex. Overtime, this becomes socially and culturally acceptable. In Nigeria, a woman’s identity is conflated with motherhood and a care-giver of the home. Consequently, a woman who seeks an abortion is seen as falling below the standards of womanhood.
As a research by Bayla Ostrach in 2016 shows, this stigma is “one of the strongest determinant of abortion legality”. It is not just a cultural or moral phenomenon but highly institutionalized and structural in many settings. Jide Bamiro, the head of Laboratory, department of Gynecology and
Obstetrics, Lagos University Teaching Hospital, Lagos, Nigeria, points to stigma and culture as a primary reason why the law remains restrictive. In turn, women become very secretive with their abortion intentions and actions. Thus, the higher the stigma, the more illegal abortion will be and the more unsafe abortion will get.
The God factor
Bisi’s religion forbids abortion. As a worker in church, it is a taboo as she would be guilty of obstructing God’s will - the child.
Strong religious sentiments keep stalling the reform of the abortion law in Nigeria. The churches are frontrunners, actively campaigning against reforming the abortion law, conscientising their members. The research by Oye-Adeniran, Long and Adewole shows that strong religious
sentiments and tensions has made Nigeria very volatile to abortion law reforms. Sometimes, even health practitioners campaign against the reforms because of their religious convictions.
Another study by Illbudo in 2014 on Nigeria, Burkina Faso and Brazil reveals that countries where religious ideologies are extreme view babies as treasures from God and prohibit abortion for whatever reason, leading to a high prevalence of restrictive laws and unsafe abortion.
The combination of weak protection of human rights, stigma and religious ideologies impacting abortion laws is not peculiar to Nigeria. In Africa, despite the legal policies and frameworks, the rights of women are disrespected. Extreme religious practices prevail. In many regions in Africa especially East Africa and West Africa, abortion stigma is used to justify restrictive abortion laws and unsafe abortion. It is no wonder that over half of abortion and maternal deaths in the
world come from Africa.
Reform the law
“It is urgent to reform the laws”, Michael Ogwezzy, a Barrister and lecturer of Public International says, “so that the death of more women must be averted”.
The 2006 WHO report links legalized abortion to improved sexual and reproductive health, while unsafe abortion is most common in countries with restrictive abortion laws. For example, in South Africa, after abortion was legalized in 1997, the abortion mortality dropped by 91% from 1998 to 2001. The report showed that the rate of unsafe abortion mortality is highest in countries with restrictive abortion laws.
Any active intervention to stem the high maternal mortality rate in the country would have little impact if changes are not made to the abortion law, a study by Henshaw, Adewole and others in 2008 reveals. More women will suffer and get killed if the laws are not relaxed. The law is obsolete, non-responsive to the current abortion situation in the country and is discriminatory
against women.
This is not the first time there will be calls for reform of the abortion law in Nigeria. In 1992, a coalition of the advocacy group, Campaign Against Unwanted Pregnancies (CAUP) and the Ministry of Health almost led to the reformation of the law but for opposition by religious bodies and other opponents. If the law had been reformed, unsafe abortion and maternal deaths in Nigeria would have been reduced. If the law had been reformed, Bisi would have had a safe abortion.
Days after the surgery, Bisi continued vomiting and got weaker. A week later, she died.