Abortion Bans Are Not Pro-Life: Moving Towards Comprehensive Reproductive Health Policies
The argument for abortion bans have mostly been a “pro-life” position. This movement has often based its argument on unfounded scientific statements, fear mongering tactics, moral, religious, and cultural grounds. Sadly, these have influenced the drafting of legislation on abortions thereby infringing on the human and reproductive rights of women in Nigeria. No one group, practice or opinion should be the premise upon which a law is made in a State.
Laws must prioritise providing access to safe abortions, these will translate to better outcomes for the physical, mental, and socio-economic well-being of a person with an unintended pregnancy. Many unsafe abortions will drop drastically, as indicated by the statistics and examples from other jurisdictions with moderately restrictive or broadly liberal laws on abortion.
The legal framework governing abortions in Nigeria is highly restrictive. In the South, the relevant provisions stating the offence and penalty of abortion are sections 228, 229, 230, 297, and 328 of the Criminal Code Act (Cap. C38 Laws of the Federation of Nigeria, 2004).
In the North, the relevant provisions are sections 232, 233, 234, 235 and 236 of the Penal Code and the Sharia Penal Code Law for states under the Sharia Legal system.
These provisions, particularly the Criminal Code, provide for the criminalization of any act whatsoever by any person including medical practitioners and health workers that attempts to terminate any pregnancy even where the woman is not certified pregnant. It attracts a 14-year imprisonment sentence.
Section 229 of the Criminal Code further imposes a 7-year sentence on a woman who attempts to terminate her pregnancy by any means whatsoever even if in fact, it is discovered that she is not pregnant. Section 230 makes it an offence for any person to unlawfully procure for any person anything whatever, knowing it is to be used to cause the miscarriage of a woman, the law makes it immaterial if she is pregnant or not. Here, the punishment imposed is 3 years imprisonment.
Section 297 of the same Criminal Code creates a defence thus, it allows a person acting in “good faith and with reasonable care and skill” to perform a surgical operation upon an unborn child for the preservation of the mother’s life.
It is interesting to point out that section 297 of the Criminal Code section states that attention be paid to the “patient’s state at the time” and to “all the circumstances of the case”. Paying mind to the “patient’s state” has in no way included the mental state, socio-economic status and survival of the mother. One would think these are matters crucial to deciding a mother’s fate.
Also, the above section indicates that attention be paid to “all the circumstances of the case”, unfortunately, efforts have not been made to include additional grounds upon which a woman may decide to get an abortion. A moderately restrictive law will include rape, unintended pregnancy by minors, incest, and grave fetal anomaly as a legal ground to have an abortion.
The societal and health impacts of restrictive abortion bans in Nigeria are dreadful. Statistics reveal the 1-year abortion incidence among women who took the survey directly (respondents) was 29.0 per 1000 women aged 15–49. In contrast, the abortion incidence among confidantes (women reported by respondents as having had abortions) was higher at 45.8 per 1000 women aged 15–49.
The results of the survey state that women with secondary or higher education in their 20s, and women living in urban areas were more likely to report having had an abortion in the previous year. These responses were notably consistent for both respondents and confidantes, denoting similar patterns of abortion prevalence across demographic groups.
Unsurprisingly, a significant majority of reported abortions among both respondents (63.4%) and confidantes (68.6%) were categorized as the most unsafe. These results portray the reality of abortion bans as women seek out unsafe practices to secure an abortion. The research also revealed that women aged 15–19, those who had never attended school, and women from the poorest socioeconomic backgrounds were significantly more likely to have had the most unsafe abortions.
These bans mostly affect women of a certain vulnerable age, educational level and socio-economic status. These bans worsen the circumstances in which these women find themselves in society.
These statistics show that bans do not reduce the rate of abortions, they only make it a life-threatening situation for vulnerable women. Abortion bans have in no way translated to lower rates of abortions, where legislation has been highly or moderately restrictive, women have partaken in unsafe services to avoid judgement and arrest. They have to deal with the high cost of services, poor training shortage of staff etc.
The health impacts of unsafe abortions are numerous, from pain, bleeding, sepsis (systemic infection), pelvic infections injury from instruments and worse, death. Long-term effects include infertility and chronic reproductive tract infections.
Contrary to fear-mongering tactics, scientific findings point to it being significantly safer to undergo a first-trimester abortion performed by a trained practitioner than carrying a pregnancy to term.
The risk of death due to complications from a first-trimester legal abortion in the United States is only 7% compared to childbirth. However, in Sub-Saharan Africa, many abortions still result in preventable health issues for women.
The moral considerations held by “pro-life” people state that allowing legal/ safe abortions will make the procedure more appealing and a quick and flippant approach may be adopted without considering the gravity of the decision. The importance of such a decision is not lost, and so is deciding to carry a child to full term, a woman however should hold the right to decide on both as anything less than that affects her autonomy.
The autonomy and the reproductive rights of women in Nigeria are hardly protected an example is the restrictive law on abortion which continues to deny women access to safe abortion services and facilities. The reproductive rights of women must cover all aspects of the right to regular access to safe, and affordable reproductive healthcare services, and at the core of this is the right to determine her reproductive choices.
Despite opposing views as explored above, arguments and reports have indicated that abortions carried out under supervised medical conditions rarely result in incomplete abortions or medical emergencies. These are informed findings legislators should concern themselves with when legislating on reproductive healthcare. The risk is greatly reduced as against the stereotype that abortions are somehow risky and complicated.
Also, since laws are to protect the rights of citizens, great consideration should be made to amend the existing laws on abortions that impede the rights of women. Legal instruments such as constitutions, health codes, and reproductive health laws can codify vital provisions legalizing abortion.
Also integral to promoting reproductive health and rights is fighting misinformation, legislating on providing easier access to reproductive health services, and the power to make choices that affect their physical, mental, and socio-economic status. Also, access to comprehensive sex education at all levels should be explored. A comprehensive abortion care strategy needs to be adopted.
This includes the provision of, abortion management and post-abortion care. This will cover care related to miscarriage(spontaneous and missed abortion), induced abortion(the deliberate interruption of an ongoing pregnancy by medical or surgical means), incomplete abortion as well as fetal death (intrauterine fetal demise).
Also, attention should be paid to improving the well-being and care of children already born. There has been a failure to provide structures, policies, and legislation that are mindful of the overall upbringing of children in society. These steps could include better policies on maternity and paternity leave, access to health and education, provision of creches in organizations, etc.
A look at several countries that have liberalized abortion laws reveals desirable outcomes. In Zambia for example, the Zambian Termination of Pregnancy Act permits abortion on socio-economic grounds and must be carried out in registered hospitals by three medical doctors signatures of all three people must be sought. For example, Gambia 2010 passed its first Women’s Act which provides for the protection of women’s "reproductive health rights" and allows for an abortion because such pregnancy threatens the life of the woman, or in a situation where the fetus has a grave anomaly.
Of noteworthy mention, The Republic of The Gambia, Office of the Vice President and Ministry for Women’s Affairs, Women’s Act, 2010 pointed out that the procedure cost is covered if the woman cannot sort the bills.
The Constitution of Kenya 2010, reform, has a moderately restrictive law on abortion, it allows abortion where there is a need for emergency treatment, or “the life or health of the woman is in danger, or if permitted by any other written law. The Provisional Constitution of the Federal Republic of Somalia authorized abortion in cases of necessity, especially to save the life of the pregnant woman.
In the end, choices about women's bodies should be left to women who own those bodies.