Context: Nigerian adolescents generally have low levels of contraceptive use, but their reliance on unsafe abortion is high, and results in many abortion-related complications. To determine why, it is important to investigate adolescents' perceptions concerning the risks of contraceptive use versus those of induced abortion. Methods: Data were collected through focus-group discussions held with adolescents of diverse educational and socioeconomic backgrounds. All were asked what they knew about abortion and contraception, and each method of contraception was discussed in detail. In particular, youths were asked about contraceptive availability, perceived advantages of method use, side effects and young people's reasons for using or not using contraceptives. Results: Fear of future infertility was an overriding factor in adolescents' decisions to rely on induced abortion rather than contraception. Many focus-group participants perceived the adverse effects of modern contraceptives on fertility to be continuous and prolonged, while they saw abortion as an immediate solution to an unplanned pregnancy-and, therefore, one that would have a limited negative impact on future fertility. This appears to be the major reason why adolescents prefer to seek induced abortion rather than practice effective contraception. Conclusions: The need to educate adolescents about the mechanism of action of contraceptive agents and about their side effects in relation to unsafe abortion is paramount if contraceptive use is to be improved among Nigerian adolescents.

A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy, the prevention of spontaneous perineal tears and the care of episiotomy wounds in this institution.

A 10-year (1990-9) review of all maternal deaths at Mater Misericordiae Hospital is presented. A total of 104 deaths occurred out of 13,391 deliveries (MMR 777/100,000). Haemorrhage, sepsis and Hypertensive diseases in pregnancy were the leading causes of death. Age below 15, Nulliparity, Grandmultiparity, low socio-economic class, lack of formal education and being unbooked were also significant risk factors. Delay in accessing health facility was also an identified contributing factor. Public enlightenment to encourage utilisation of antenatal facilities, prompt referral of complicated cases and adequate equipping of the referral hospital is suggested.

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