Determinants and barriers to safe abortion care in Nigeria: A mixed method study

Sunday M. Abatan, Soladoye S. Asa

Abstract

Barriers to safe abortion care are major contributors to the high levels of maternal death, ill health, and disability in Nigeria. This study employed a mixed-method approach to investigate the determinants and barriers to safe abortion care in Nigeria. The quantitative aspect of this study used data from the 2019-2020 follow-up survey. These were 1388 women from six Nigerian states who reported an abortion experience in the 2018 baseline cross-sectional survey of Nigeria Performance Monitoring for Action (PMA) datasets. Twenty in-depth interviews were performed with women seeking post-abortion treatment at two teaching hospitals in southwest Nigeria (FETHI and LAUTECH). Approximately 30% of the 1388 abortions performed were unsafe. Younger women were less likely to practice safe abortion care (OR=0.64, p<0.05). The odds of safe abortion care increased with education level (OR=1.83, p<0.05),(OR=2.62, p<0.001), and (OR=3.84, p<0.001) for primary, secondary, and higher education. Other are residence, marital, and wealth status, The IDI results revealed that the majority of abortions are performed in a private, unconventional location. Low socioeconomic position, sociocultural norms, and legislative constraints all pose significant challenges to safe abortion care in Nigeria. To enhance access to safe abortion in Nigeria, the government must evaluate socio-legal obstacles.

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References

WHO. Clinical practice handbook for quality abortion care. WHO 2022. Published 2022. Accessed January 18, 2024. https://www.who.int/publications-detail-redirect/9789240075207

Bercu C, Filippa S, Jayaweera R, Egwuatu I, Nmezi S and Zurbriggen R. Grosso, Kristianingrum B, ManeiroI A, Liparelli M, MS and SA Sandoval.qualitative exploration of how the COVID-19 pandemic shaped experiences of self-managed medication abortion with accompaniment group support in Argentina, Indonesia, Nigeria, and Venezuela. Sexual and Reproductive Health Matters. 2022;30(1):2079808.

Gerdts C, Rupani A, Conner K and Ragosta S. Collapse of the Abortion Care Infrastructure: There Aren’t Enough Hands to Fill the Gaps. American Journal of Public Health. 2022;(0):e1-e2.

Cook RJ, Dickens BM and Horga M. Safe abortion: WHO technical and policy guidance. International Journal of Gynecology & Obstetrics. 2004;86(1):79-84. doi:10.1016/j.ijgo.2004.04.001

Akinlusi FM, Rabiu KA, Adewunmi AA, Imosemi OD, Ottun TA and Badmus SA. Complicated unsafe abortion in a Nigerian teaching hospital: pattern of morbidity and mortality. Journal of Obstetrics and Gynaecology. 2018;38(7):961-966. doi:10.1080/01443615.2017.1421622

Bankole A, Adewole IF, Hussain R, Awolude O, Singh S and Akinyemi JO. The incidence of abortion in Nigeria. International perspectives on sexual and reproductive health. 2015;41(4):170.

Bell SO, Omoluabi E, OlaOlorun F, Shankar M and Moreau C. Inequities in the incidence and safety of abortion in Nigeria. BMJ Global Health. 2020;5(1):e001814. doi:10.1136/bmjgh-2019-001814

Onasoga OA and Arunachallam S. Abortion procurement and post-abortion care services: experiences of Nigerian adolescents. Sierra Leone Journal of Biomedical Research. 2018;10(2):12-19.

WHO. Trends in maternal mortality: 1990 to 2013: estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank: Trends in Maternal Mortality: 1990– 2010. 2012, Geneva. Published 2016. Accessed October 25, 2019. https://apps.who.int/iris/handle/10665/112682

iAHO. iAHO Maternal Mortality Regional Factsheet. Published online 2023. Accessed January 23, 2024. https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Maternal_Mortality_Regional_Factsheet.pdf

Quiroz Y, Llorens E, Novoa R, Motta G, Llurba E, Porta O, Parra J, Ballarin J, Palou J. and Bujons, A. Pregnancy in patients with exstrophy-epispadias complex: are higher rates of complications and spontaneous abortion inevitable? Urology. 2021;154:326-332.

Harris LH, Debbink M, Martin L and Hassinger J. Dynamics of stigma in abortion work: findings from a pilot study of the Providers Share Workshop. Social Science & Medicine. 2011;73(7):1062-1070.

Coast E, Lattof SR, Meulen Rodgers Y van der, Moore B, Poss C. The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers. PloS one. 2021;16(6):e0252005.

Akande OW, Adenuga AT, Ejidike IC and Olufosoye AA. Unsafe abortion practices and the law in Nigeria: time for change. Sexual and reproductive health matters. 2020;28(1):1758445.

Wangdi K and Gurung M. Understanding the Factors Associated with Abortion among Women Seeking Abortion Related Health Services in Phuentsholing General Hospital, Bhutan. Int Arch Nurs Health Care. 2016;2(10.23937):2469-5823.

Mumah J, Kabiru CW, Mukiira C, Brinton J, Mutua M, Izugbara CO, Birungi H. and Askew, I.. Unintended pregnancies in Kenya: a country profile. Published online 2014.

Kabiru CW, Ushie BA, Mutua MM, Izugbara CO. Previous induced abortion among young women seeking abortion-related care in Kenya: a cross-sectional analysis. BMC pregnancy and childbirth. 2016;16(1):1-10.

Okonofua FE and Onwudiegwu U, Odunsi O. Illegal induced abortion: a study of 74 cases in Ile-Ife, Nigeria. Tropical Doctor. 1992;22(2):75-78.

Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame GMC, Williams T, Chen H, Fotheringham C, Lagrou D, Schulte-Hillen C and Powell B. High severity of abortion complications in fragile and conflict-affected settings: A cross-sectional study in two referral hospitals in Sub-Saharan Africa (AMoCo study). Published online 2022.

Fawole OI, Okedare OO and Reed E. Home was not a safe haven: women’s experiences of intimate partner violence during the COVID-19 lockdown in Nigeria. BMC women’s health. 2021;21(1):1-7.

Giuffrida MM, Kulkarni MJ, Nagle DC, Wali MK and Casey SE. Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a qualitative study of clients and community members. BMC women’s health. 2021;21(1):1-11.

Bolarinwa OA, Olagunju OS and Olaniyan AT. Factors associated with low contraceptive use amongst vulnerable mothers in South West State, Nigeria. African Journal of Primary Health Care and Family Medicine. 2020;12(1):1-4.

Akaba GO, Abdullahi HI and Atterwahmie AA, Uche UI. Misoprostol for treatment of incomplete abortions by gynecologists in Nigeria: a cross-sectional study. Nigerian Journal of Basic and Clinical Sciences. 2019;16(2):90.

PMA. Nigeria Round 5 Female Follow-up (Abortion) Survey | PMA DataLab. Published online 2020. doi:10.34976/7ty2-va92

Byrne ME, Omoluabi E, OlaOlorun FM, Moreau C and Bell SO. Determinants of women’s preferred and actual abortion provision locations in Nigeria. Reproductive health. 2021;18(1):1-9.

Juma K, Ouedraogo R, Amo-Adjei J, Sie A, Ouattara M, Emma-Echiegu N, Eton J, Mutua M and Bangha, M.,. Health systems’ preparedness to provide post-abortion care: assessment of health facilities in Burkina Faso, Kenya and Nigeria. BMC health services research. 2022;22(1):1-13.

Casas L, Vivaldi L, Montero A, Bozo N, Álvarez JJ and Babul J. Primary care and abortion legislation in Chile: A failed point of entry. Developing World Bioethics. 2023;23(2):154-165.

Savage O. Appraisal of the sexual and reproductive health of women in Nigeria from the perspective of internally displaced persons. Nnamdi Azikiwe University Journal of International Law and Jurisprudence. 2021;12(2):129-144.

Oladeji, O., Oladeji, B., Chamla, D., Safiyanu, G., Mele, S., Mshelia, H. and Agbor, J., Sexual violence–related pregnancy among internally displaced women in an internally displaced persons camp in northeast Nigeria. Journal of interpersonal violence. 2021;36(9-10):4758-4770.

Bankole A, Remez L, Owolabi O, Philbin J, Williams P. From unsafe to safe abortion in Sub-Saharan Africa: Slow but steady progress. Published online 2020.

Shellenberg KM, Moore AM, Bankole A, Juarez F, Omideyi AK, Palomino N, Sathar Z, Singh S and Tsui AO. Social stigma and disclosure about induced abortion: results from an exploratory study. Global public health. 2011;6(sup1):S111-S125.

Akinyemi AI, Bankole A, Stillman M, Owolabi O, Erinfolami T. Abortion pills are being widely used in Nigeria: women and suppliers talk about their experiences. The Conversation. Published September 28, 2022. Accessed January 23, 2024. http://theconversation.com/abortion-pills-are-being-widely-used-in-nigeria-women-and-suppliers-talk-about-their-experiences-191431

Bessa MMM, Drezett J, Adami F, Araújo SDT de, Bezerra IMP and Abreu LC de. Characterization of adolescent pregnancy and legal abortion in situations involving incest or sexual violence by an unknown aggressor. Medicina. 2019;55(8):474.

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