The Incidence of Abortion in Nigeria

Abstract

CONTEXT-Because of Nigeria's low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country's restrictive abortion law. Up-to-date estimates of abortion incidence are needed.METHODS-A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria.RESULTS-An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15-49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed.CONCLUSION-Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality.Induced abortion is illegal in Nigeria except when performed to save a woman's life. Both the penal code, which is generally applied in the country's northern states, and the criminal code, which generally applies in the southern states, allow this exception, and both regions specify similar criminal penalties for noncompliance. 1 Yet pregnancy terminations are quite common, and because they are often performed clandestinely or by unskilled providers, most are unsafe. 2 The first national study to examine the incidence of abortion estimated that in 1996, about 610,000 abortions, or 25 per 1,000 women aged occurred in Nigeria. 3 Author contact: abankole@guttmacher.org. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptA decade later, another study noted that if the abortion rate had not changed since 1996, then 760,000 abortions would have occurred in 2006, given the increase in Nigeria's population during this period. 4 Since the release of the 1996 estimates, the Nigerian government and other stakeholders have initiated a number of policies and programs to improve the reproductive health of women in the country. Notable among them are the government's efforts to achieve the United Nations Millennium Development Goals, including Goal 5, to improve maternal health. This goal has two targets: to reduce the maternal mortality ratio by 75% between 1990 and 2015, and to provide universal access...

Challenging unintended pregnancy as an indicator of reproductive autonomy

“…In reviewing recently published estimates of unintended pregnancy across US states [17], Stevenson and Potter identify the impact that differential completeness in the reporting of unintended births and abortions could have on comparisons of unintended pregnancy among US states [18]. The noncomparability of sources is even more pronounced in countries and states that lack complete vital registration of abortion [19,20]. A key function of public health indicators is to permit comparisons across place and across time, so biases in comparisons are a substantial limitation on the usefulness of unintended pregnancy as an indicator.…”

“…This inference, in concert with our field's frequent assumption that women are using contraceptive methods that they freely chose, fuels narratives that implicitly highlight women's failures rather than those of the health care systems on which they depend. The pathway is often the decomposition of unintended pregnancies into those due to contraceptive misuse or failure and those due to nonuse of contraception [19,21]. A sentence such as "Approximately half of unintended pregnancies result from non-use of contraception, and half result from inconsistent or incorrect use and contraceptive failure" [22,23] commonly follows a sentence regarding the incidence of unintended pregnancy in a population.…”

Awareness and perception of vasectomy among antenatal women in a tertiary health facility in southeast Nigeria

“…1 Nigeria has one of the highest maternal mortality ratios in sub-Saharan Africa and ranks second as the country with the highest number of maternal deaths in the world, with illegal and unsafe abortions contributing 20-40% of about 60,000 maternal deaths that occur yearly. 2,3 These preventable deaths are attributable to either lack of or inaccessible means of family planning in the communities. 3 With an estimated population of 167 million accounting for over two-thirds of the population of West Africa, a growth rate of 28% and fertility rate of 6.5 births per woman, the overall contraceptive prevalence among women in Nigeria had only recently attained a double digit figure at 16%.…”

“…2,3 These preventable deaths are attributable to either lack of or inaccessible means of family planning in the communities. 3 With an estimated population of 167 million accounting for over two-thirds of the population of West Africa, a growth rate of 28% and fertility rate of 6.5 births per woman, the overall contraceptive prevalence among women in Nigeria had only recently attained a double digit figure at 16%. 4 In the United Kingdom, the contraceptive prevalence among women ages 15-49 was reported at 84% and the maternal mortality ratio (MMR) was only 7 per 100,000 live births.…”

The Imperative to Expand Provision, Access and Use of Misoprostol for Post-Abortion Care in sub-Saharan Africa

“…These developments are most apparent in Latin America whereas in SSA, abortion remains largely outlawed and abortion rates are similar 5 , but the ratio of abortion-related deaths to live births was estimated at 10/100,000 in 2008, as opposed to 80 in Africa 1 . In Africa's largest country, despite legal restrictions, approximately 1.25 million Nigerian women were estimated to have had an abortion in 2012 and 40% of them experienced complications serious enough to require treatment 6 . Abortion-related mortality (and morbidity) is becoming a particularly African problem.…”