[CAVIE-ACCI] It was shortly before noon on Friday, September 2, 2016. As an unrelenting downpour fell on D-line, an urban residential area of Port Harcourt, the capital of Rivers State, Ann* sought shelter in a nearby church, while her boyfriend paid the cab driver.
Then they entered a nondescript, unfinished one-storey building.
Ann was 17 and enrolled in a university pre-degree programme. After she fell pregnant, her boyfriend, a 29-year-old medical laboratory science graduate, had taken her to the building to see a doctor who ran a private, unregistered clinic. She did not want to be there.
“I was still a kid, just 17. I did not know anything about my body. I was more or less a child,” Ann explained, her voice strained, as she mined her memory for details.
The building was on a side street just off a main road and had shops on either side of it. The downpour had emptied the street, but for one roadside seller who still managed to display her snacks. Inside, a four-room apartment was used as a makeshift clinic. The interior walls were mildewed and stained; the white paint almost completely chipped away.
Ann met three other women in the waiting room; they were also there to see the male doctor who ran the place with two female nurses. One nurse briefly conferred with the doctor before Ann was called into the room they used as a theatre.
The procedure – a surgical abortion – would cost her boyfriend 7,000 naira ($17.95).
Inside the theatre, there was a brown leather gurney positioned diagonally. A wooden cabinet was mounted above it and nearby, stood a trolley with metal pans.
Just 20 minutes after Ann walked into the room, the procedure was over. “I was just whisked into a room …” she recalled, exasperated. “I was not given any pre-abortion [treatment] nor any post-abortion treatment.
“We got into business right on, immediately … there was this stuff that’s like a really big injection, like a really big syringe. Instead of attaching a needle-like a normal injection, the doctor attached a very big metal object. I will liken it to six or seven TV (whip) antennas joined together … that is how long and how big it was.
“Immediately, he started sucking [and] I felt a pain I had not experienced before. It was so, so bad. At a point, I had to tell him to please pull it out of me. Please, please, please, I told him. I was writhing in pain but at the same time I could not move because I did not want to harm myself by shaking.”
When the procedure was finished, a nurse helped Ann into the recovery room; then, minutes later, she was told to vacate the space because another patient needed it.
Induced terminations of pregnancy are common in Nigeria where it is estimated that 1.8 to 2.7 million abortions occur annually. That is 41.1 per 1,000 women. A vast majority of these abortions, like Ann’s, are unsafe and carried out secretly due to Nigeria’s anti-abortion laws.
The laws against abortion mean that a woman cannot access the service in standard healthcare facilities unless there is an immediate risk to her life. Coupled with Nigeria’s longstanding conservative leanings on women’s sexual and reproductive rights, abortion is widely considered a taboo and women who choose the procedure are often stigmatised.
Like Ann, many Nigerian women prefer to go through it under the cover of secrecy, away from the gaze and knowledge of the public. The consequences of this are the complications that arise from unregulated abortion methods, which can include other reproductive health complaints and in extreme cases, can even lead to death. Nigeria has one of world’s highest maternal mortality rates and recent research estimates there may be as many as 6,000 abortion-related deaths in the country each year, the majority of which are preventable. Globally, between 22,000 and 31,000 women and girls die as a result of unsafe abortions each year.
Nigeria’s abortion laws have their origin in colonial jurisprudence. Under the law, the only legal avenue for a pregnancy to be terminated is if a woman’s life is critically threatened. Beyond that, abortion is illegal and carries a heavy jail term.
Abortion is legislated against by the two legal codes in Nigeria depending on one’s geographical location.
In the southern part of the country where the Criminal Code is adopted, Sections 228, 229 and 230 punish abortion. Section 228 stipulates that “any person, who with intent to procure miscarriage of a woman whether she is or not with child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses any force of any kind, or uses any other means whatever, is guilty of a felony, and is liable to imprisonment for fourteen years”.
Section 229 punishes women who undergo an abortion, stating that they are “guilty of a felony” and are liable to imprisonment for “seven years”, while Section 230 stipulates imprisonment of three years for any person “who unlawfully supplies” materials intended to “be unlawfully used to procure the miscarriage of a woman”.
In the northern part of Nigeria, where the Penal Code is applicable, Sections 232 to 236 prescribe punishment for abortion. Section 236 says if “causing death of quick unborn child by act amount to culpable homicide” the person “shall be punished with imprisonment for life or for a less term and shall also be liable to fine”.
Effiom Effiom, Nigeria’s country director for Marie Stopes, an international NGO that provides reproductive health services including abortions, believes women should be able to make their own decisions about their health. “I think it is chauvinistic and really backward to begin to sit and legislate around women’s bodies,” he explained.
An inevitable service
It was a quiet, sunny afternoon in early January and Dr Adeniyi* had just carried out an abortion in his clinic in Itire Ijesha, a suburb of Lagos. It was dilation and curettage (commonly called D&C), an abortion method that Dr Kingsley Odogwu, the director of clinical services at Marie Stopes, described as “obsolete” because “medical science has found it not to be … safe”.
Still, it remains popular among those Nigerian medical practitioners who carry out abortion procedures illegally.
A few minutes past noon, the clinic at Itire Ijesha was quiet. The power had gone out and only one woman sat waiting in the reception area, while three nurses walked briskly past in the passageway that linked all three rooms in the facility.
The walls of Dr Adeniyi’s office were covered in black wallpaper with white horizontal stripes. Cardboard covered the only window, leaving the room largely in darkness. Still, it was possible to make out a table on which there were stacks of paper, a stethoscope, two Bibles and a Quran. To one side of the room was a gurney with a flat-screen television above it. On it, slouched against the wall, sat a middle-aged woman – the fixer – who arranges things between the doctor and the women and girls seeking his services.
Seemingly unfazed by the fact that his work is illegal, Dr Adeniyi spoke with the assurance of somebody rendering an inevitable service.
“You can never stop abortions, never,” he said. “All of these (the deaths and complications arising from unsafe abortions) happen because there is a law. If abortion is legal, almost all doctors will be doing [the procedure] and everyone will access normal healthcare. Nobody will have to hide or cut corners.”
Nigeria’s chronically underfunded health system leaves room for uncertified doctors and healthcare workers to flourish, with little or no disturbance from the authorities. According to the Nigerian Medical Association, the professional body for registered doctors and dentists in the country, only 40,000 doctors cater to an estimated population of 200 million people.
Other than the clinics where abortions are carried out covertly, like Dr Adeniyi’s, procedures are mostly done in places run by people without a medical licence who may have picked up some skills doing apprenticeships at private or cottage hospitals – small facilities offering basic healthcare to the surrounding population.
“There are a lot of [uncertified] nurses who have worked with doctors before and they have seen the doctors perform it several times. They go and set up their own clinic for money, without having the equipment. They only improvise. They think: this is how the doctors do it,” Dr Adeniyi explained.
By Aljazeera and ACCI