Unsafe Abortion: Saving the Life of the Adolescent| By Olubunmi Osoteku

In spite of its prevalence among adolescents, professionals defined unsafe abortion as when abortion is done by somebody who is not medically qualified or by using a method that is not appropriate or recommended by the World Health Organisation (WHO).

Tomi is a beautiful, intelligent, disciplined female adolescent from a very religious background. She was brought up with the teaching that a woman should keep herself from sex until marriage and doing otherwise is a sin to God.

On gaining admission into secondary school, she mixes with the wrong crowd and gets influenced by peers who see nothing wrong in satisfying your desires, including having sex.

Eventually, Tomi gets pregnant! Her boyfriend denies the pregnancy and breaks up with her, saying he does not want to see her again. She is left on her own! Who does she turn to? Where does she go? What should she do? She is totally confused! How will she face society? The shame and stigmatisation will be too great. She can not tell her parents whom she knows she has disappointed and who may disown her.

She turns to her friends who advised her to get rid of the pregnancy. Since she does not know how to and is not financially buoyant, they take her to a cheap clinic where it can be done secretly. The pregnancy is aborted.

However, after some time, she starts having funny feelings in her abdomen. Then she starts bleeding profusely. Her parents are confused and rush her to the hospital, where the doctor confirms that she had an abortion done by a quack which has badly damaged her womb.

All efforts to stop the bleeding proves abortive and Tomi eventually succumbs to death, having lost too much blood. The life of a promising young girl cut short due to wrong choices, throwing her family, friends and society into deep sorrow and lamentation!

Tomi’s and other similar situations are prevalent in our world today, as adolescent pregnancies and unsafe abortion remain a major contributor to maternal and child mortality.

Based on a 2019 data by WHO, 55% of unintended pregnancies among adolescent girls aged 15 to 19 end in unsafe abortions, in low- and middle-income countries.

In Nigeria, the National Population Commission says 23% of girls aged 15 to 19 have started childbearing, causing complications which lead to diseases or death because of their immature bodies.

Public health experts say many adolescents engage in unsafe sex which leads to unintended pregnancies and in the long run, unsafe abortion. The experts lament how the rate of unintended pregnancies and abortion is going up in Nigeria, causing a rise in abortion-related deaths, as such happens when females want to terminate pregnancies they could not prevent.

Expressing worry and concern over the alarming rate of deaths resulting from unsafe abortion among adolescents, medical experts, scholars, and researchers in the field of public health have joined the call on government to significantly increase its investment in ensuring adolescents have adequate sexuality education, information and access to services.

Leading the call, Prof. Adesegun Fatusi, a distinguished figure in the field of Community Medicine and Public Health, and Vice Chancellor, University of Medical Sciences, Ondo State, revealed that Nigeria currently carries the heaviest burden of maternal mortality, based on the latest research by WHO, saying approximately 20 women tragically lose their lives every day due to abortion-related causes.

Fatusi noted that the higher proportion of people who are affected by unsafe abortion are women under the age of 15 and 19, who neither have access to services, nor money to procure safe abortion, urging government to work at improving the access of adolescents to comprehensive sexuality education, information on family life and HIV education, as well as quality services, in order to address the problem of unsafe abortion in Nigeria.

He stated: “Firstly is health. We must improve access of women to information, education and quality services. Secondly is our laws, our norms and our social policies that discourage women from having access when they need to. It’s interesting to know that if a woman is dying of abortion complications today, our regulation, our health services guideline says that woman must have access to services, but if the woman wants access to safe abortion, she cannot have it. So we must look at our law and say, what do we need to do differently?

“And the other thing we need to do is to look at our data and research to see what we can do to ensure that our women can access health services. What are the barriers that are standing between them and health services? What are the factors promoting unsafe abortion? What can we do about that? And if we are intervening, how do we monitor progress? Those are three fundamental pillars that we can look at in trying to address the question of unsafe abortion in Nigeria,” Fatusi explained.

Similarly, Dr Adedade Adegoke, an obstetrician-gynecologist in Ibadan, Oyo State, opined that adolescents need to have adequate social support to help them make the right choices, saying the society should be less judgemental, as the cultural environment of the country makes it difficult for adolescents to speak out when they get into such trouble as pregnancy because of the stigmatisation involved, among other things.

Adegoke said: “One of the first things that is important is to speak to people who can help. These could be people from the family, the parents, from school, or from church. That is why it is important for us to have social environments that are open and receptive to these people to speak up because stigma prevents a lot of people from speaking up.

“So it’s important we have an environment that will listen to them when they make a mistake because at one point or the other, everyone makes a fault or the other. If one cannot find that kind of support, it’s important to go to a hospital that is certified and reputable so that they can get the kind of help they need to prevent unsafe abortion,” she advised.

Charity, they say, begins at home. The government alone should not be saddled with the responsibility of caring for the adolescents. Mrs Aboyede Ojo, a mother of three adolescents, in Ibadan, believes that if adolescents are properly guided by their parents, who make out time to understand them and speak their language, the rate of unintended pregnancies and unsafe abortion among adolescents would most likely be minimal.

Ojo said: “You have to come down to their level. You have to speak their language because at times they might be saying something but they might mean another thing. So when you understand them it will be easy for you to penetrate into their mind and from there you can talk about things such that you don’t make it look outrageous when you’re talking about sex because when you mention sex they may want to shy away.

“But by the time you understand how you can talk about it that they won’t be shy about it, they will open up. The basic thing is that parents should get to understand them, get to talk with them on a daily basis as time permits. I know parents can be busy but if you want to enjoy your children in your old age you too have to make time out so that you can have peace at your old age too,” she asserted.

Religious bodies, as part of society, also have roles to play in ensuring that adolescents are properly raised and given moral education.

Pastor David Bello, a clergy with the Word Alive Ministries International, Ibadan, maintains that building adolescents up, giving them moral advice, motivating, advising, and counselling them is very necessary and a core responsibility of religious bodies.

Bello noted: “The church should take their interest seriously by setting up their own kind of assembly where they can meet, communicate, fellowship, build capacity, engage in regular social interaction, social activities, games, picnics, competitions, and relate with one another to build confidence because most of these vices are as a result of loss of self confidence.

“The church should give them their own kind of pastor, a youthful, young pastor that they can connect with, relate with so that they would have opportunities to really discuss and bare out their minds. And if there are burdens that they would ordinarily not want to disclose to the adult population because of fear of how they would be treated, they would be more comfortable to relate with a younger pastor,” he suggested.

In her views, Elizabeth Alatu-Williams, the National Coordinator, African Youth and Adolescent Network on Population and Development (AfriYan Nigeria), said there are many adolescents and young persons who are engaging in unsafe sexual activities, which is predisposing them to unintended pregnancies, which on the long run, leads to unsafe abortion. She advocated proper sexuality education and safe spaces for adolescents.

Alatu-Williams stated: “Illiteracy does not mean you cannot read and write, in every area of our lives we have some type of illiteracy. So, for adolescents, they need access to comprehensive sexuality education. Firstly, to have safe sex when they must have sex. Secondly, what do you do if you have unprotected sex? I think it’s important and we must give access to that for our adolescents.

“We can determine to continue to play the ostrich rule, hide our head in the sand, but the truth is that our young teens are having sex. They are educated about sex through social media and we need to correct it, give them the right information and give them a space where they can ask questions so that even when they see it on social media, they can ask questions, they know who to go to,” she argued.

In changing the narrative, Emmanuel Ajah, the Country Director, MSI Reproductive Choices Nigeria, believes that government needs to show more commitment beyond mere rhetorics, be more sincere and give support to the drive of sexual and reproductive health services.

“There are no commodities, so even when you have providers trained, there are no commodities that are available when people get into the facilities for them to be able to take up some of those services. We must ensure that there are many more people that are trainable and that can be equipped to continue to provide services.

“At the religious, traditional and cultural levels, we need to ensure that all of those social norms and cultural changes that continuously impede the uptake of family planning services are addressed. I think people have seen that we need to be able to have our girls be able to make choices as part of their lives. So, it has become really very important that we give them that support,” Ajah affirmed.

Experts agreed that it is difficult, if not impossible, to prevent adolescents from engaging in unsafe sexual activities, which could result in unintended pregnancies, sexually transmitted infections, abrupt stop to education, stigmatisation, diseases, unsafe abortion and ultimately death, among other things.

The increasing rate of unintended pregnancy and unsafe abortion among adolescents is a menace that is worrisome and troubling. It is therefore imperative to provide adequate sensitisation and comprehensive sexuality education to adolescents in Nigeria in order to prevent unintended pregnancy and help them make the right choices.