POLICY BRIEF Policy Brief
Implementation of Reproductive Health Policies and Laws in the Nigerian National Health Policy BACKGROUND Nigeria joined the other 192 Member States of the United Nations and adopted the 2030 Sustainable Development Goals in September 2015. Goal 5, target six calls for “ensuring universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development, and the Beijing Platform for Action and the outcome documents of their review conferences.”i In addition, Nigeria endorsed regional agreements, including the African Agenda 2063, the Maputo Protocol, and the Maputo Plan of Action on Sexual and Reproductive Health and Rights, all of which provide a strong normative framework for realizing gender equality and human rights on the continent, including sexual and reproductive health and rights. Despite Nigeria adopting these international and regional standards, there are clear demands for continuing efforts to enact laws, craft policies, foster funding, and develop national programs that will meet the needs of all Nigerian people. Such needs are particularly pronounced in the case of access to the full array of sexual and reproductive health services, including safe abortion. In 2017, the annual incidence rate of abortions in Nigeria was 41.8 per 1,000 women aged 1549 – nearly 1.8 million abortions. More than six out of 10 abortions were considered unsafe, and 11 percent of women experienced complications for which they sought post abortion care (PAC) at health care facilities. ii PAC is an integral component of comprehensive abortion care and includes interventions to treat complications sustained from unsafe and incomplete abortions and often are done to save a woman’s life. Nigeria’s annual maternal mortality ratio, one of the highest in the world, is 814 deaths per 100,000 live births and includes deaths during a pregnancy and within 42 days of a termination of a pregnancy. iii Unsafe abortion contributes to 13 percent of maternal mortality figures. ABORTION LAW S IN NIGERIA Nigeria’s legal restrictions to abortion remain archaic, and contrary to evidence based on medically accurate information necessary for responsible policies. Abortion is regulated by the Penal Code, Law No. 18, 1959, and the Criminal Code, Section 297, 1916. iv In those laws, both the procurer and supplier of surgical and medical abortion risk imprisonment of up to 14 years. The only exception is when an abortion is performed to save the life of a woman. Section 297 of the Criminal Code states: “A person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for his benefit, or upon an unborn child for the preservation of the mother's life, if the performance of the operation is reasonable, having regard to the patient's state at the time and
POLICY BRIEF | 2 to all the circumstances of the case.”v These restrictions gamble with women’s lives as it remains unclear when and how abortion can be provided to save the woman’s life. The clause is very narrow. In addition, research and lived experiences from Nigeria and around the world demonstrate that the clause is rarely used to grant women legal abortions. In the last two decades, bills to liberalize abortion restrictions have been introduced in the National Assembly, but have failed to pass due to social stigma and misconception surrounding abortion. For example, in 1981, the Termination of Pregnancy Bill, sponsored by the Society for Gynecology and Obstetrics of Nigeria, was introduced in the House of Representatives, but external pressure and consistent lobbying efforts from religiously affiliated and conservative organizations led to the proposal’s repeal.vi On May 29, 2012, the Violence Against Persons Prohibition (VAPP) Bill was signed into law in Imo State’s House of Assembly. The VAPP Act Law No. 12, Section 40 (1) stated: “Every woman shall have the right to enjoy reproductive rights, including right to medical abortion in cases of sexual assault, rape, incest and where the continued pregnancy endangers the life or physical, mental, psychological or emotional health of the mother.” Again, the development of a law that guaranteed reproductive freedom was challenged by religious, conservative, and anti-abortion organizations, and unfortunately the law was repealed. RESTRICTIVE NIGERIAN LAWS INCREASE HEALTH INEQUALITIES Health inequalities are unjust and unethical differences in the health statuses of different population groups. Unsafe abortion affects those most marginalized like ethnic and gender minorities, who face educational and income disparities. Abortion access is therefore a social, gender, racial, and reproductive justice issue. Restricting legal access to abortion does not decrease the need for abortion. In fact, it increases the number of women seeking illegal and unsafe abortions, leading to increased complications, morbidity, and mortality. Rural, poor, less educated, low-income, young, and unmarried women are disproportionately disadvantaged. With high rates of families living under the poverty line and with low literacy rates across Nigeria, access to safe abortion currently depends on privilege, such as access to information, income, transportation, and other resources. Most Nigerian women are left behind. It is important to stress that illegal abortion does not need to be unsafe abortion. Nigerian women continue to procure safe abortion under very restricted laws.vii The harm reduction framework is an evidence-based public health and human rights framework that prioritizes strategies to reduce harm and preserve health in situations where policies and practices prohibit, stigmatize and drive common human activities underground.viii Harm reduction provides women with accurate information that allows them to make informed decisions about their
3 | POLICY BRIEF pregnancies without putting their lives and health at risk. NIGERIAN LAW AND POLICIES MUST CHANGE A number of actors are key to produce the necessary changes regarding abortion laws and policies in Nigeria. The goal is to enact laws and craft policies to empower women, respect their human rights, and promote their health. Legislators must repeal restrictive laws that threaten women and adolescent girls’ lives and health, and ensure that they can enjoy the right to safe abortion. It is time for Nigeria to rid itself of its archaic laws by acknowledging that abortion is a common event in women’s reproductive lives, and by advancing reproductive rights, dignity, and bodily autonomy. Abortion must not be criminalized. Policymakers can help prevent unnecessary harm to women’s health and lives, while also pushing for necessary legal and policy reforms by:
Setting up a national network of legal abortion services, currently secured under the law, in cases where the pregnancy endangers the life of the woman, including adolescents;
Eliminating third party authorizations entirely for the cases of legal abortion, including parental consent for adolescents;
Minimizing administrative requirements for legal abortion and establish clear national protocols for health care providers, including the prohibition of refusing services based on claims of conscience;
Supporting campaigns that raise awareness about the harmful impact of restrictions on abortion provision;
Supporting campaigns that raise awareness on where and how to obtain contraception, emergency contraception, safe abortion, and post abortion information and services; and,
Creating programs that expand and promote family planning programs, and comprehensive sexuality education for all adolescents and young people.
Health care providers can:
Advocate for prompt provision of abortion in cases of rape, incest, fetal impairment, and risk to health;
Ensure that women’s rights to health care and confidentiality are respected by providing prompt, legal, and safe abortion services upon her request, without requiring forensic evidence, police examination, and/or judicial authorization; and,
Ensure prompt and quality post abortion care to women and adolescent girls in need.
We at the Generation Initiative for Women and Youths Network (GIWYN) have been working hard to move the public discussion about abortion to the next level. We acknowledge women’s groups and community health providers’ role in promoting access to safe abortion information
POLICY BRIEF | 4 on the ground. We firmly believe in women’s capacity to make their own decisions, and we want to be there for them when they do.
iS Kowalski. Global Development Plan Signals a Turning Point for Women and Girls. September 8, 2015. https://iwhc.org/2015/09/global-development-plan-signals-a-turning-point-for-women-and-girls (accessed January 18, 2019) iiE Omoluabu. (2017) PMA 2020 Abortion Survey Results: Nigeria. Survey conducted by the Performance Monitoring and Accountability (PMA2020) in collaboration with Bill and Melinda Gates Foundation. https://www.pma2020.org/sites/default/files/AbortionModule_Brief_111518.pdf. (accessed 29 September 2018) iiiWorld Health Organization (2018) Nigeria fights high maternal mortality through improved quality of care. June 2018. https://afro.who.int/news/nigeria-fights-high-maternal-mortality-through-improved-quality-care? country=979&name=Nigeria (accessed, November 2018) ivI Okagbue. Pregnancy Termination and the Law in Nigeria in Studies in Family Planning Studies in Pregnancy Termination and the Law in Nigeria. Studies in Family Planning, Vol. 21, No. 4 (Jul. - Aug., 1990), pp.197. https://www.jstor.org/stable/1966614?seq=1#page_scan_tab_contents v Nigeria: Criminal Code Act. Chapter 77, Part 5: Offences against the person and Relating to Marriage and Parental Rights and Duties, and against the Reputation of Individuals. June 1, 1916. https://wipolex.wipo.int/fr/text/218191. (accessed February 6,2019) viI.O.U Ujah, S.O Shittu. A situation analysis on abortion in Nigeria. International Federation of Gynaecology & Obstetrics (FIGO) prevention of unsafe abortion & the society of Gynaecology & Obstetrics of Nigeria (SOGON) Introduction. viiK Jelinska, S Yanow. (2018) Putting abortion pills into women's hands: realizing the full potential of medical abortion. Contraception, Volume 97, Issue 2, February 2018, pp. 86-89. https://www.sciencedirect.com/science/article/pii/S0010782417303724#. viiiA Hyman, et al. Misoprostol in women's hands: A harm reduction strategy for unsafe abortion. Contraception, Volume 87. Issue 2 (2013), pp. 128-130. https://www.endabortionstigma.org/es-MX/Home/Resources/Ipas %20External%20Publications/Misoprostol-in-womens-hands-A-harm-reduction-strategy-for-unsafeabortion.aspx. (accessed February 6, 2019)
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