In this piece, Ijeoma UKAZU, takes a look at the new Lagos policy on abortion against the recent United States Supreme Court’s ruling overturning Roe vs Wade and which has continued to generate mixed reactions across the world. Excerpts:
The Lagos state government has recently released a guideline for safe termination of pregnancy within the ambit of the criminal law of the state.
The policy document provides evidence-based data as well as information for health workers operating in the public and private sector with needed skills and training to perform safe termination of pregnancy to reduce preventable maternal mortality deaths in Nigeria.
According to the National Demographic Health Survey, NDHS 2018, Nigeria Maternal mortality rate is put at 512 per 100,000 live birth. Unsafe abortion accounts for about 10 to 14 per cent of maternal morbidity and mortality in Nigeria.
According to a study conducted by Anastasi et al, to determine the subnational maternal and child mortality ratio data from two urban slums in Lagos state. The study found a maternal mortality ratio of 1,050 per 100, 000 live births estimated for the two urban slums communities of Lagos, which was very high nearly doubling the figure previously estimated for the state of 545 per 100,000 live births.
To achieve the Sustainable Development Goals by 2030 in eliminating all preventable maternal deaths, Nigeria must make efforts in identifying and preventing all prevalent causes of maternal deaths in the country.
One of such preventive measures to maternal mortality but neglected area is the provisions contained in the “Nigerian Abortion Law.” The law permits the termination of pregnancy in circumstances where the continuation of pregnancy threatens the mother’s life. Unfortunately, no formal efforts have been made through the development of policy instrument, guidelines or tools to implement these provisions to save the lives of Nigerian women whose existence are threatened by the continuation of their pregnancies.
Induced abortion is illegal in Nigeria except when performed to save a woman’s life. The penal code and the criminal code allow this exception with the specification of criminal penalties for non-compliance. However, Lagos state reviewed her law of 2011 to extend the provisions to the mother’s physical health.
The intention of this guideline is to standardize practice and build the capacity of medical professionals in public and private facilities to identify pregnancies for which the law was intended so that ethical and safe management can be instituted.
The Lagos state government said, it is envisaged that the enunciation, deployment, and use of this guideline will preserve the lives of pregnant women from dying or who’s physical and mental health would be compromised with the continuation of their pregnancies.
Presenting and launching the document at a stakeholders’ engagement, the permanent secretary, Lagos State Ministry, Dr Health, Dr. Olusegun Ogboye, noted that the production of the policy document was borne out of the need to provide evidence-based data and information for health workers in public and private sectors who have the requisite skills and training necessary to provide safe terminations to reduce preventable deaths.
Ogboye explained that while therapeutic termination of pregnancy is permissible under the law in Lagos State, the absence of clear guidelines has stalled the effective implementation at appropriate levels of care resulting in preventable deaths.
In his words: “In 2011, the Lagos State House of Assembly updated the criminal code, providing for abortion to save the life and protect the physical health of the woman. While physical health is covered under the Lagos legal framework, services conforming to the law have not been available in Lagos State health sector.
“This document provides information on relevant laws applicable in Lagos State while providing standards and best practices with regards to legal indications, pre and post procedure care, methods and monitoring. I must state here that this document has undergone wide consultation with relevant technical stakeholders within the legal and health service context in the state.”
Ogboye further notes that the process to develop the guidelines commenced in 2018 with the Safe Engage project led by the Lagos Ministry of Health and hosted by the Society for Obstetricians and Gynaecologists of Nigeria, SOGON, with support from Population Reference Bureau, PRB, He added that stakeholders in the Stater health sector worked with key opinion leaders in Lagos and the southwest region to develop a tailored advocacy tool for terminations within the legal context.
He pointed out that the advocacy messages on the Safe Engage project focused on two immediate outcome including ensuring that safe abortion services were available within legal indications in Lagos and domesticating the Violence Against Persons Prohibition Act, supporting women to terminate a pregnancy caused by rape or incest.
“To guide the implementation, one of the follow up recommendations of the project was the adaptation of the National Standards and Guidelines for Safe Termination of Pregnancy within Legal Indications within the Lagos State context. The Federal Ministry of Health had developed and disseminated the national guidelines on safe termination of pregnancy which highlights the compendium of conditions and circumstances under which termination of pregnancy could be instituted.
“The guideline was intended to build the capacity of health professionals to identify pregnancies for which legal termination could be instituted. Marie Stopes International in Nigeria in collaboration with the Population Reference Bureau proposed to support the state government to adapt the document,” he said.
The permanent secretary explained that the process for national guidelines adaptation included technical meetings to discuss sections of the law supporting safe abortion and conditions permitted within the legal framework to save the lives and the physical health of mothers; and validation meeting with the broader stakeholders to review the document.
“All that hand work has culminated in today’s dissemination of the guidelines. We hope this dissemination today will help guide health providers to provide this service within the ambit of the law”, Ogboye stated.
Earlier in his remarks, the Country Director of a leading reproductive health organization, Marie Stopes International Organization Nigeria, MSION, Mr. Emmanuel Ajah, stated that the development and dissemination of the policy document has once again proven that Lagos is leading the way for state-level intervention to stem the tide of unsafe abortion and give women and girls improved health outcomes.
While noting that abortion in Nigeria is not illegal but restrictive, Ajah said significant numbers of health providers are unaware of the legal indications for safe termination of pregnancy.
He posited that it is important that the healthcare providers who have the responsibility to determine when the life of the woman is in danger as prescribed in Nigeria’s laws need to have the right understanding and make those critical decisions based on sound medical judgment and not on religion, culture, or other biases.
“The domestication of this policy provides that needed guidance to healthcare providers on medical conditions in pregnancy that pose a high risk to the woman’s life and health if the pregnancy progresses to term, and on the standard management of abortion within the extent of the law in Lagos state. This policy is a demonstration of the commitment of the Lagos state government to improving maternal health, especially mitigating the impact of unsafe abortion practices in the State”, he stated.
Vice Chancellor of the University of Medical Sciences, Otukpo, Prof. Innocent Ujah, who was one of the Consultants who developed the document averred that the enunciation, deployment and use of this guidelines will preserve the lives of pregnant women and women whose physical or mental health would be compromised with the continuation of their pregnancies.
He explained that the guidelines provide information on subsisting Nigeria law on termination of pregnancy, Lagos State revised law 2011, a compendium of medical conditions and circumstances where the continuation of pregnancy endangers the women’s life and describes the step-by-step options for ethical and safe medical management.
Speaking in the same vein, Prof. Ayodele Atsenuwa, who is a Professor of Law at the University of Lagos and also a consultant on the document development, explained that the Lagos State Criminal law of 2011 only prohibits unlawful abortion.
She noted that the document clarifies and explains what lawful termination of pregnancy means in the context of the law adding that education of law enforcement officers is important with regards to the interpretation of this law
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