Fight for women’s lives

By Casmir Igbokwe

Published: Sunday, 16 Mar 2008

FIDELIA (not real name) was rushed to the Federal Medical Centre, Owerri, Imo State, with a referral from another hospital. The 23-year-old girl, who was the second in a family of seven, was presented with abdominal pain and some other ailments. Seventeen days earlier, she had terminated an unwanted eight-week-old pregnancy by unsafe means. During the procedure at a chemist shop in Rivers State, Fidelia reportedly bled profusely.

At the FMC Owerri, doctors noticed that her vulva was smeared with blood; she was very pale, feverish and dehydrated. They made a provisional diagnosis of septic abortion, severe anaemia and renal compromise. They later performed surgery for the girl and drained out 700mls or one big bottle of pus from her peritoneal cavity.

Even after the surgery, the girl’s condition did not improve. At a point, she reportedly developed fits, hallucinations and became irrational. Thirty days later, Fidelia died. Cause of death? Renal or kidney failure, secondary to septic abortion.

This story, as narrated by a consultant gynaecologist at the FMC Owerri, Dr Emily Nzeribe, points to a disturbing reality in our world today. That reality, according to Nzeribe, is that of the 210 million pregnancies that occur yearly in the world, an estimated 46 million or 22 per cent end in induced abortions. Out of this number, 20 million are unsafe and eventually lead to about 13 per cent of pregnancy-related deaths.

Even with restrictive laws on abortion, Nigeria reportedly records about 760, 000 abortions every year. Official statistics indicate that the maternal mortality ratio in the country is about 1,000 deaths per 100, 000 live births. Unsafe abortions, according to experts, account for a greater number of this figure. The reason is because the Nigerian society, as Nzeribe put it, “is hypocritical; the laws are restrictive; there is low use of contraceptive and family planning services.”

Here lies the crux of the matter. Most citizens abhor any overt or covert attempt to legalise abortion. Senator Daisy Danjuma, for instance, introduced a bill on National Institute of Reproductive Health in the last political dispensation. That bill was at the instance of the Society of Gynaecology and Obstetrics of Nigeria. And it was aimed at reducing maternal mortality in Nigeria and hence attaining one of the United Nations Millennium Development Goals of achieving a 75 per cent reduction in maternal mortality by 2015. No sooner had Danjuma proposed that bill than severe criticisms followed. Some people labelled it an abortion bill. They almost went for the woman’s jugular.

One major reason for this is that Nigeria is a deeply religious society. The Catholic Church, for instance, does not support any form of artificial family planning methods. Not even the use of condom is permitted. It preaches total abstinence from sexual acts for unmarried people and the Billings ovulation method of family planning for married couples. Ovulation method partly involves some calculation whereby a woman must know when it is safe to have sex that will not result in pregnancy.

Ideally, total abstinence and ovulation method are desirable. They are against promiscuity. They check unwanted pregnancy. And they make for a better and healthier society. I support these wholeheartedly.

However, the reality is that this ideal situation is practically unrealistic and socially unrealisable. Sex is one of the physiological needs of man. At 14, most girls are already sexually active. Last week, I was in Owerri for a workshop on increasing community awareness on sexual and reproductive health and rights of women. An international non-profit organisation called IPAS organised the workshop.

According to the Country Director of the organisation in Nigeria, Dr Ejike Oji, the average age of first sexual intercourse for all women is 15.9 years. And one fifth of world population or 1.2 billion people are adolescents. These adolescents, he notes, make up 13-40 per cent of maternal mortality. Sixty to 80 per cent of unsafe abortions occur among them. An estimated 10,000-15,000 women, Oji stresses, die in the country yearly from unsafe abortion. This situation has been worsening over the years and it places Nigeria atop the countries with the highest maternal mortality rates in the world.

In Western Europe and some other advanced societies, the reverse is the case. In Italy, for instance, maternal mortality rate is said to be five per 100, 000 live births and the lifetime risk of maternal death is said to be one per 13, 900. In some countries like Norway, it is near zero.

The point is that while developed countries tackle their problems dispassionately, developing countries tend to play the ostrich; while developed countries treat issues scientifically without much recourse to religion, Nigeria and some other developing countries present a façade of religion but do exactly the opposite of their religious doctrines.

The questions are: if you are a woman and your husband impregnates your 14-year-old sister, who is living with you, will you support the girl to have the baby and keep him in the family? Or will you ask for the termination of the pregnancy? Or will you allow the girl to choose what to do with the pregnancy?

And if you are a man, who witnesses the raping of your wife by four armed robbers, will you allow her to have the baby and keep him in the family or force her to terminate the pregnancy? At the said workshop, the majority of the participants supported the termination of pregnancy for the two scenarios. The near consensus was that having the baby would be a permanent stigma and the child might grow to also become an armed robber.

This is partly why societies like IPAS are advocating a change of attitude. They want women to be given a choice on how to deal with an unwanted pregnancy. In Nigeria, abortion is illegal. Sections 228 to 230 of the Criminal Code prescribe severe punishment for any person, including the pregnant woman herself, who contravenes that law. The law gives room for abortion only when it is done to preserve the mother’s life.

A lawyer and policy consultant to IPAS, Mrs Sarafina Ojimaduka, says Nigeria’s Criminal and Penal Codes are based on a colonial law, which was passed almost 150 years ago. There is need, she concludes, for a review of our restrictive abortion laws especially for the interest of women and girls who are victims of sexual violence, rape and incest.

This seems to be the way forward. A 1998-2001 study by the Medical Research Council indicated that the introduction of the Choice of Termination of Pregnancy Act in South Africa some 11 years ago brought a reduction in the maternal mortality rate of unsafe abortions in that country to 91 per cent. For the moralists and the religious, who will definitely cast the first stone, the question remains, will you prefer your daughter visiting a quack to procure an unsafe abortion that may lead to her death or to qualified personnel empowered to carry out the function? Will you want a child that is a product of incest or rape by armed robbers? This, definitely, is an issue for serious debate.

Note: In my piece last Sunday entitled “Between Obasanjo’s birthday and PDP’s convention,” I noted that it was mainly Oyo and Ogun State governments that placed 71st birthday adverts for former President Olusegun Obasanjo in an Ibadan based newspaper, Nigerian Tribune. I meant to say Osun and not Ogun, as Ogun never placed any advert for him in any newspaper. The same printer’s devil I blamed for the mix-up in the one-page birthday advert for the man in The Guardian decided to revenge. The error is regretted.