Author : Guttmacher Institute and University of Ibadan
Site of publication : Guttmacher Institute
Type of publication : Report
Date of publication : October 2015
In Nigeria, abortion is legal only when performed to save a woman’s life. Still, abortions are common, and most are unsafe because they are done clandestinely, by unskilled providers or both. Unsafe abortion is a major contributor to the country’s high levels of maternal death, ill health and disability. Nigeria has one of the highest maternal mortality ratios in the world, and little improvement has occurred in recent years. Contraceptive use remains low in Nigeria. In 2013, only 16% of all women of reproductive age (15-49) were using any contraceptive method, and only 11% were using a modern method-levels that remain virtually unchanged since 2008.
One in four pregnancies are unintended
14% of all women aged 15-49 in Nigeria have an unmet need for family planning: They are married and/or sexually active and they want to space their births or stop childbearing, but are not using contraceptives. Among sexually active unmarried women, 22% have an unmet need. In 2012, about one-fourth of Nigeria’s 9.2 million pregnancies were unintended. More than half (56%) of these unintended pregnancies ended in an induced abortion; 32% ended in an unplanned birth and 12% in a miscarriage.
Despite legal restrictions, abortion is common
In spite of Nigeria’s highly restrictive abortion law, an estimated 1.25 million induced abortions occurred in 2012. In 2012, the estimated abortion rate was 33 abortions per 1,000 women aged 15-49 in 2012. One in seven pregnancies (14%) ended in induced abortion in 2012.
Regional variation in abortion rates
Within Nigeria, rates of abortion vary: The proportion of pregnancies ending in induced abortion was lowest in the South West (11%), and highest in the North East (16%) and South South (17%). The higher rates of abortion in the North East and South South zones can be explained by two of the main underlying factors that increase women’s need for abortion: the desire for smaller families (mostly in the South South) and the nonuse of contraception (mostly in the North East).
Unsafe abortion is a major contributor to the country’s high levels of maternal death, ill health and disability
The slow uptake of family planning in Nigeria has contributed to the high levels of unintended pregnancy and abortion. As the number of children that women and couples want declines, their need for modern contraceptive methods to achieve their desired family size increases.
Unsafe abortion is dangerous and costly
Complications of unsafe abortion range from pain and bleeding to more serious conditions, including sepsis (systemic infection), pelvic infections and injury from instruments—and even death. About 40% of women undergoing abortion experience complications serious enough to require medical treatment. In 2012, 212,000 women were treated in health facilities for complications of induced abortion. In addition, an estimated 285,000 women had complications from unsafe abortion serious enough to require treatment in health facilities, but did not obtain the care they needed.
One in seven pregnancies (14%) ended in induced abortion in 2012
Unsafe abortion places a serious burden on the nation’s health system as well on the health and well-being of women and their families. The economic burden is substantial: A Guttmacher study found that in 2005, postabortion care in Nigerian hospitals cost US$132 per patient, of which US$95 was paid by families.
Implications and policy recommendations
Levels of both unintended pregnancy and unsafe abortion could be reduced if the Nigerian government and its local and international partners increased efforts to expand and promote family planning programs as well as sexuality and family life education throughout the country. Programs should offer high-quality care that includes counseling on a wide range of contraceptive methods and the ability to easily switch methods when needed. Even with improved contraceptive care, some women will still have unintended pregnancies and thus seek unsafe abortions.
About 40% of women undergoing abortion experience complications serious enough to require medical treatment
Although only a small number of women are eligible for legal abortion under current law (to save their life), an efficient process should be established that will give these women access to safe abortion services as early as possible in the pregnancy, so that they can benefit from the use of modern, less invasive methods. Additional efforts are therefore needed to prevent unwanted pregnancy and to reduce levels of unsafe abortion and its attendant health, eco- nomic and social consequences. While greater access to family planning and abortion care as allowed by current law is needed, the facts point to the additional need for informed debate on legal reforms that would expand access to comprehensive abortion care for Nigerian women.