“It was a bad experience” – Emeka Nwankwo explores the struggle to get a safe abortion in Nigeria

Editor’s Note:

When Emeka Nwankwo approached us with his investigation into abortions in Lagos, he expressed some worry that as a male journalist, there would be glaring realities he would miss in his coverage of how abortion laws in Nigeria affect the country’s most disenfranchised. But it was a reality that needed to be explored, and the sobering conclusions we reach in the end of our investigation is worth the leap of faith. We hope it gives every reader a little more nuance on an incredibly complex subject.


WHO BEARS THE PAIN OF AN ABORTION?

Pain is a raging flame that consumes the entire body. It spreads, like fireworks, from the point of origin to every other place. And if you are a young woman, with no one to hold your hands as you lie on a gurney in an illegal clinic somewhere in Oshodi, legs spread apart and knees bent, handled by a female doctor, probing within you via your genitals, then the pain is as physical as it is emotional.

This was Derby, five years ago – long before she became a sex worker in Lagos. Derby had an abortion without anesthesia. It was a lonely experience. The abortion was illegal, and she paid only for the procedure itself, not for the necessary scans and tests that should come before the procedure and palliative care that should follow after. She says the doctor felt her stomach as a way to gauge how far along her pregnancy was. Doctors who perform these under-the-table abortions set their rates based on how far along your pregnancy is. Derby doesn’t remember the specific amount she paid. But it wasn’t much, somewhere around 2,000 naira, and it never goes above 10,000.

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Minutes earlier, before she had laid on that gurney, Derby had felt the pain of other women as she sat, shivering and waiting for her turn, fatal thoughts running through her mind. To the blissfully ignorant, the illegal clinic was a hair salon; hair extensions, weaves and hair products are displayed on the wall as a suitable distraction. Signage announcing the hair salon was deliberate, it turned everyone away, except the salon’s real customers.

A curtain divided the room into two: one half of it was the waiting room able to hold about ten people at any point; the other half was curtained off to hide  an operating room where the salon’s resident doctor carries out procedures. According to Derby, when the doctor isn’t moonlighting there, she works the night shift at a government owned general hospital in Lagos.

At first, Derby is hesitant to talk to me about the abortion she had. When she does talk about it, our eyes do not meet. We dance around the subject. School. Work. Sleep. Ethnic stereotype. Sex work. My use of ‘big grammar.’ Anything but her abortion. Soon, though, we fall into a rhythm: I ask, she ponders for a few seconds and then supplies an answer. I follow up for more clarification. And when it gets too awkward, she ignores me and go back to scrolling through Facebook. Till I rephrase or ask a different question. An answer may come, or not. It’s a slow dance.

We sit in a poorly lit room with mismatched curtains covering the windows, on the second floor of a female hostel, on a street off Opebi-Allen, Ikeja. Thanks to Nollywood, Allen became short hand for sex work in Nigeria, but despite the negative undertones, the area has remained one of the safest launching pads for young girls like Derby, who enter sex work without a pimp. The standing fan twirls, making a buzzing, irritating hum in the background. I ask for her real name and she demurs, insisting I call her Derby. Derby is her chosen name, a common practice among women in sex work. So, I did. Derby was 24 years when she had the abortion. “I wasn’t comfortable with having a child then. So, I aborted the pregnancy.”

Back at the hair saloon, shouts of pain, coming from behind the curtained partition, swell through the otherwise silent room and it re-echoes through Derby sending shivers down her spine. The shouts come from a woman having a dilation and curettage (D & C) without any anesthesia – an otherwise painful surgical procedure that involves scraping of the uterine lining to remove unwanted tissue.

“When it reached my turn, I asked the person after me to go. My body… like, I was shivering. I was very scared. Very scared. I knew it was very painful. After that day, I have taken other people there too. Whenever I go, I will always see married people. They go inside the clinic one after the other. You will be hearing their shouts,” Derby explains. “The day I went there were about 10 women there and a few men who came with their partners. Like the girl that took me there, it was her boyfriend, an army officer that first took her there.”

When it gets to her turn, fear roots her to the chair as she processes the possible consequence of her action and the pain yet to come. To do or not to do. Either decision comes with a price, a lifelong one.  Pregnancy is something that often happens independent of a woman’s choice. The body does what it wants to do, never mind whether one is ready for the result. In choosing to abort, a woman reclaims the narrative and her body, making a conscious decision for now and the future. But in an environment like Nigeria, it could be a fatal choice.

Eventually, Derby makes a choice. She walks into the makeshift operating room, sits on the bed and, per the doctor’s instructions, spreads her leg. And though she doesn’t regret her choice to abort, Derby would rather not talk about it either. She, like most of us, has internalized the idea and stigma that abortion is a moral wrong.

WHO DETERMINES RIGHT FROM WRONG?

The saloon is never empty. Women, like Derby, looking for an affordable, secret and accessible way to get rid of unintended pregnancies or unaware of where to get a safe abortion, come to the saloon or other such unsafe, backstreet establishments spread across the country. Some live to tell the story; others, like Sukurat Adedoyin, a mother of eight in Ogun state, become a disembodied number, a tragic part of Nigeria’s alarming maternal mortality rate: 50,000 women die yearly from complications caused by unsafe abortions according to a 2015 estimate by the  Nigerian Medical Association – a significant increase from the 20,000 deaths occasioned by unsafe abortions in 2002.

Annually, according to a 2012 study by the University of Ibadan and the Guttmacher Institute, an estimated 1.2 million abortions are carried out across the country, mostly under unsafe conditions. Of this number, 212,000 were treated for arising from unsafe abortion while 285,000 experienced serious complications but did not receive any medical care.

A QUESTIONABLE LAW AND A PRO-CHOICE MINISTER?

Abortion is illegal in Nigeria, made so by two anti-abortions laws codified into the Criminal code of Southern Nigeria and the Penal code of Northern Nigeria. These laws, which are than an independent Nigerian state, prescribe up to fourteen years jail time for women – and anyone – who induces an abortion, except in cases where abortion is needed to save the life of the mother.

Recent surveys show that abortions are slightly higher in countries that criminalize it – coincidentally, the number of deaths and complications from unsafe abortion are higher in developing countries, like Nigeria, where abortion is illegal, single mothers are stigmatized, sex and reproductive health education is low, and access to modern family planning methods are also low. Notwithstanding these, abortions have continued across Nigeria, underground mostly, where it is carried out by quacks or induced by the women themselves.

Despite this, reproductive health rights is a highly unpopular topic in Nigeria and public opinions have shown that Nigerians are largely in support of the restrictive law – evidenced by the strong defense put up by religious and civil societies, as far back as 1972, whenever moves are made to reform Nigeria’s repressive abortion laws, and recently the pressure faced by the Imo state government, in south east Nigeria, after abortion was legalized in the state. The bill was repealed soon after by the state legislators following huge public backlash.

Former President Goodluck Jonathan sparked off a debate in 2012 after he called for the legislation of birth control in Nigeria and pledged $33 million to fund modern family planning. In keeping with his longstanding pro-choice stance on reproductive rights, Isaac Adewole, Nigeria’s present minister of health and former Coordinator for the Campaign Against Unwanted Pregnancy (CAUP), called for a review of Nigeria’s ‘bad abortion law’. His position was met with backlash – even efforts to promote contraceptives were also condemned.

As far back as 1991, Adewole, mostly through his academic publications, has actively advocated for a more liberal approach to reproductive health care law. Speaking on Nigeria’s restrictive abortion law, Adewole stated in a 2016 interview with Vanguard that:

“Unfortunately, the abortion law in Nigeria is complex because it penalizes the offender and the offended and as such, that is why nobody would readily report. Secondly, the law is not implementable. No one would come forward and say they have done abortion. Those who go to do abortion give fake names. If what we do not want is abortion, that law is bad because no one would report.”

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Conscious not to offend the sensibilities of conservative Nigerians, steering up controversy and bad publicity with political implications, Adewole on assuming office as the minister of health, has largely remained silent on the issue of abortion and the problematic law, preferring instead to engage with modern family planning as a means to curb unsafe abortion. He argued that if contraceptives are widely adopted then the incidences – and need – of abortion would be reduced.

This, too, appears to be the strategy of the federal ministry of health (FMoH): promote modern family planning and prevent unwanted pregnancies. (All effort to reach the FMoH for a comment proved impossible, bungled by irritating civil service rules. The ministry’s spokesperson, Boade Akinola, and Adebimpe Adebiyi, Director of Family Health, FMoH, refused to speak on the issue without a written permission from the minister or permanent secretary. Emails and phone calls to the minister’s office were unanswered).

“As a state, we need to align with the legality, or otherwise, of abortion in Nigeria and we know as of today that abortion is illegal in this country – unless it is clinically recommended. Rather than commit to illegality, what we have done instead is to make family planning methodologies, particularly long acting reversible contraceptives (LARC), available to our teeming women,” says Babatunde Ipaye, the Ogun state commissioner for health.

Aware of the volatility of the issue and the attaining controversy, government and reproductive health activists appear to be towing the same strategy and are increasingly weary of discussing the issue so as not to whip up public sentiments that might threaten the little progress made so far in providing reproductive health care.

Underneath this silence on abortion and focus on family planning is the issue of Global Gag Rule, re-enacted by the Trump administration.

A gag

In a powerful essay published on Catapult, a young Nigerian detailed his girlfriend’s journey in procuring an abortion. At the end of the essay was a mention of Marie Stopes’ clinic address (an international NGO that provides reproductive health care services for women in different countries).

The day I head out in search of the Marie Stopes clinic in Lagos was, like much of Nigeria in January, hot and dusty. Earlier, I had found and spoken to a doctor working on the facility who invited me to come over to the clinic. I did. But that was the end of it. The doctor would not speak to me on the record unless his superiors in Abuja cleared it. They didn’t.

Much like most other organizations providing safe and cost effective reproductive health care services across the world, Marie Stopes was also affected by the Global Gag Rule – otherwise known as the Mexico City Policy. Repealed by the Obama administration and brought back by the Trump administration, the Global Gag Rule is a United States government policy that prohibits NGOs, receiving government funding, from performing or actively promoting abortion as a method of family planning.

In an article posted on its website, Marie Stopes says that it faces $80 million funding deficit following the reenactment of the gag rule, a situation that will affect the world’s poorest women and girls leading to an estimated ‘870,000 unsafe abortions and ‘6,900 avoidable maternal deaths.’

Unsafe abortion in developing countries

Of the 25 million abortions that take place in developing countries, the World Health Organization estimates that “8 million were carried out in the least safe or dangerous conditions.” Africa, the WHO notes, has the highest number of mortality arising from unsafe abortion.

“Women in developing countries have opted for abortion as a means of preventing unwanted or unintended pregnancy. Because they haven’t been exposed to family planning, when they get pregnant what they simply do is to take it out,” explains Dr. Omasanjuwa Edun, State Team Leader at John Hopkins University CCP/Nigerian Urban Reproductive Health Initiative.

Edun further adds “that with all the stigmas associated with family planning, most women will not want to go through with it. They’d rather not use family planning, but instead stand the risk of getting pregnant and taking it out at the risk of their lives because a proportion of abortions will end in fatality and some will end up with complications.”

Aware that a pregnancy would complicate her life in so many ways and her boyfriend, who was squatting with a friend, had no money to care for herself and a child, Joy made the choice to terminate her pregnancy. First, she tried – and failed – to self-induce abortion by taking herbal concoction and a drug.

Eventually, she found a qualified doctor who agreed to carry out the procedure. And even though the doctor was married, the abortion came with a price. “I went to the doctor, met with him. I didn’t have money and the doctor said ‘you fine girl, what is wrong with you? Since you don’t have money I have to sleep with you and help you to remove it.’ So, he inserted the drug [Misoprostol] inside me and said that in four days’ time the thing will come out. But it didn’t so I had to go back to him,” says Joy, admitting that she had sex with the doctor in lieu of cash payment.

When the drugs failed to work, Joy returned to the doctor who performed a D&C. Afterwards, the doctor asked that daily for the next seven days, Joy must sit on a bucket of hot water, mixed with Dettol disinfectant and drink Lipton tea. This she did.  Joy would eventually inform her boyfriend of the abortion, and although he disapproved they, however, have continued with their fractured relationship.

“It was a bad experience,” Joy recalls. “This thing, eh, none of it will happen and it will not be scary. It is luck. Even if you pay N10,000 you might end up not having a child again because of all these quack, quack doctors. Once they put scissors inside they feel they can draw the thing out. But when you go to hospital, they will scan you and even after they will prescribe drugs, take care of you and tell you to take hot water so it will flush well.”

Late last year, Joy moved to Lagos. No one in her family knows Joy is in this city presently – they believe she is still in Abuja, working and schooling. In Abuja, where she had migrated to from Aba, Joy had worked as a cook in a female hostel. The realization that domestic work was drudgery and she could potentially earn more doing sex work, had given her the courage to seek out Lagos, a more prosperous market for sex work, where she knew no one.

Last month, Joy’s on and off boyfriend, whom had impregnated her leading to the abortion, had called to complain that “you are now half naked in Lagos. What kind of life are you living there?”

Their relationship is one filled with uncertainty, complications, deception and subjective justification. “I know that, me too, I’m cheating. He too is cheating. But my own is different. I’m hustling,” Joy says.

Joy and Derby insists that they are unlikely to become pregnant without their choice again, owing to their knowledge and use of contraceptives. “If the condom burst during sex, I will take antibiotics – ampiclox – immediately. And hot water,” says Joy. “I am not praying to get pregnant out of wedlock. No!”

She adds that “Some of us [sex workers] take injections – but that’s for those that do skin to skin (sex without condoms).”

Both women consider it ludicrous when I asked if they’d have an abortion again. Pregnancy would only happen if marriage was in the equation. “How I go plan not to marry someone and I still dey sleep with am without condom? Although, yes, condom fit burst o. But God forbid,” Joy says snapping her fingers.

Derby, on the other hand, looks at me askance and replies, “condom is not for pleasure. It is for protection.” And if she knows any young, unmarried woman facing a dilemma on whether to abort or not, Derby would advise, first, a critical examination of the relationship.

“If the guy is okay, I will advise her to go on,’ she says.

While Joy is more open to talk about her experiences and opinion, Derby is reserved and calculated. (“My own is that it [abortion] is not good,” says Joy. “Why I no go feel guilty? My first blood, I come comot am.”). One thing that stands out to me, is that though both girls engage in sex work, neither fits into the narrow description I have come to associate with women who get abortions. I ponder on this as I leave, wondering what percentage of the women I meet on a daily that have had abortions. There is, after all, an uptick in the number of abortion of procedures carried out between 1994 – 2012.

“One third of Nigerian women have experienced an unwanted pregnancy and many turn to illegal abortions,” according to this report published on the Pulitzer Center website. This statistic also greatly affects the maternal mortality rate of Nigeria – which is among the highest in the world.

But even as Nigeria evolves and Minister Adewole dreams of lowering Nigeria’s   maternity rate by 2030, restrictive legislation, widespread gender bias, amongst several other factors, still pose a major challenge in tackling the issue of abortion.

Mazi Emeka :