It was a cold, rainy, early morning. The rain had started late that night and the downpour was torrential. I had been awake through it all studying for an exam and was about to get some sleep.
Just as my head hit the pillow, an ambulance siren tore into the night and grew louder and louder. I turned in the bed hoping for it to be something else. I was the physician on call and it had been largely uneventful so far at the hospital where I was working in southern Nigeria. I got out of bed.
It was a case of a 19-year-old who was rushed in to hospital because she had had severe weakness, dizziness and fainting spells for three days. She told me she hadn’t had her period for three months and had had an attempted abortion. She was too afraid to tell her parents about her pregnancy – they were prominent churchgoers and held in high regard in the community.
Legal abortion wasn’t an option for her as her life was not deemed to be in danger, a pre-requisite in Nigeria. Single parenthood would have ruined her and her highly placed family’s reputations. Her mother had earlier regaled her with tales of virginity and how she should remain chaste for her husband.
Pressured into danger
When she went for an abortion, she had been led into a dimly-lit, dingy room with a small bed in the middle where the medicine dealer, popularly referred to as the “chemist” in local parlance, used a bike wheel spoke to get rid of her baby.
She had been bleeding consistently since then but had been afraid to present at the hospital. Now, it was dawning on her that she might die.
Her boyfriend was 21 and he was scared for her. They had been having sex for about six months, relying on condoms and chance to prevent pregnancy. Alas, they ran out of luck.
I started resuscitative measures and diagnosed her with septic abortion with shock. She had a burning fever.
All attempts to save her life were eventually futile and she gave up within three hours.
It has been four years since that night, but I still see her face clearly. I am haunted by her pleas not to let her die.
Out-dated perceptions fuel backstreet procedures
I was born a Catholic and I grew up hearing that abortion is wrong; they told me the same about contraceptives.
Unsafe abortions remain the leading cause of maternal mortality and morbidity in Nigeria with backstreet abortions killing an an estimated 50 000 women a year.
The lack of documentation and the also the fact that a lot of these procedures take place in unorthodox settings – by traditional healers, roadside medicine dealers and poorly trained physicians who are not up to date with current abortion procedures – contribute towards the burgeoning figure.
Poverty is also a factor, as many families living on less that a dollar per day cannot afford contraception.
Despite the apparent restrictive abortion laws in Nigeria, very few people have actually been prosecuted due to the lack of diligence in gathering evidence, perpetual delays in the courts, and the fact that it is not a reportable crime; people only tend to report when things go wrong because of the fear of stigmatisation within society.
Life-long consequences of illegal abortions
The complications resulting from unsafe abortions are multiple and include sepsis, severe haemorrhage and, at worst, maternal death.
Those who survive may have to deal with pelvic inflammatory disease, adhesions and secondary infertility in a country where a high premium is placed on fertility and childbearing.
Guilt also has a lasting effect on such women. Every day some confused girl gets pregnant when she is not ready to have a baby. She could be anyone; a girlfriend, wife or sister.
As I left the 19-year-old’s fixed and dilated pupils staring at me as if accusing me of not doing all that I could to save her, I wondered if there was anything Nigeria could do to save her people from preventable causes of maternal mortality?
It is pure madness that a country that accounts for less than 1% of the global population should be responsible for 14% of global maternal deaths. Can we do better or are we going to continue like this? – © Guardian News and Media 2016