Break the law, save a life: Clandestine abortion providers in Nigeria

(c) David and Lucille Packard Foundation

Abortion laws in Nigeria are among the most restrictive in the world, allowing abortion only to save the life of the woman. According to Nigeria’s penal code, providing an abortion or even seeking services means risking years in prison. Still, contraceptive use is extremely low, and there are thousands of unwanted pregnancies each year. Despite the potential for punishment, thousands of women attempt to get abortions at any cost and by any means.

There are 760,000 abortions in Nigeria each year and approximately 60 percent of them are unsafe. The few safe abortion providers in Nigeria save lives by breaking their nation’s laws. But with such restrictive legal circumstances, why do providers continue to provide illegal abortions?

In early 2007, Akinsewa Akiode of Ipas Nigeria and a small team of Ipas researchers studied the challenges and motivations that fuel these clandestine abortion providers. Akiode presented his findings to activists, researchers and providers in May 2008 at the Global Health Council’s 35^th annual International Conference on Global Health in Washington, D.C. During the “Attitude and access: Abortion and post abortion care” panel, Akiode shed light on the situation of providers who break the law to fulfill what they believe to be their duty: saving lives. His presentation, “She will find a way: Clandestine abortion providers in Nigeria,” explored why abortion providers continue to provide services to women in Nigeria, despite the legal environment.

The Ipas Nigeria research venture on clandestine provider attitudes surveyed 17 providers in eight states.  It explored providers’ attitudes toward the law, perceptions of personal risk and strategies to avoid prosecution, as well as the motivations, sources of satisfaction and challenges that go with providing safe abortions to women in a restricted setting. 

At the beginning of the study, researchers assumed that most illegal abortion providers were in business for the money. An illegal abortion can cost up to 5,900.00 nairas ($50), making it a significant source of income.  However, according to the 2007-2008 United Nations Human Development Report, 92.4 percent of the Nigerian population lives on less than $2 a day, which means that very few women are wealthy enough to afford a safe abortion. And although well-off clientele may be limited, those with enough nairas do purchase safe abortion services from skilled providers with little fear of judicial retaliation.

“Initially it looked as if it were for the money,” admitted a physician from Northern Nigeria. “As you started growing, getting mature, some things are not just for the money.” According to Akiode, the study indicates that providers are often motivated by much more noble factors than money. Indeed, many providers told the researchers heartbreaking stories of women in desperate situations. A nurse in Southern Nigeria spoke of how the fear for women’s lives often motivates providers to help. That fear, she explained, makes providers say, “Come, we will do it for you.”

Many providers, especially those trained abroad, recognize that where abortion is illegal or heavily restricted, it’s most often unsafe — fueling their desire to prevent needless injuries or death.

“What I think made me more passionate is just coming back to Nigeria,” a gynecologist in Southern Nigeria explained. “I trained abroad, and we terminated pregnancies and there were at least two or three … every day.  I never saw any casualties, any complicated abortions, none.  I never saw this until I came home.”

But what happens to the abortion providers who get caught? Akiode’s research found that Nigeria’s abortion practices are much more liberal than its abortion laws. Although providers who offer illegal services are fearful of authorities, none of them seem afraid of actually going to prison. Akiode said the real problem in Nigeria is harassment and extortion — providers he interviewed described how some unscrupulous law enforcement agents usually turned a blind eye towards abortion as long as they got at least half of the client’s money.

Ultimately, said Akiode, providers’ primary motivation for offering safe abortion services is to reduce preventable deaths and injuries from unsafe abortion — a public health crisis that drains limited economic resources, burdens health systems and threatens the lives and well-being of the women and girls who make up the core of Nigeria’s families and communities.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258