Academic journal article International Perspectives on Sexual and Reproductive Health

The Incidence of Abortion in Nigeria

Academic journal article International Perspectives on Sexual and Reproductive Health

The Incidence of Abortion in Nigeria

Article excerpt

Induced abortion is illegal in Nigeria except when performed to save a woman's life. Both the penal code, which is generally applied in the country's northern states, and the criminal code, which generally applies in the southern states, allow this exception, and both regions specify similar criminal penalties for noncompliance. (1) Yet pregnancy terminations are quite common, and because they are often performed clandestinely or by unskilled providers, most are unsafe. (2) The first national study to examine the incidence of abortion estimated that in 1996, about 610,000 abortions, or 25 per 1,000 women aged 15-44, occurred in Nigeria. (3) A decade later, another study noted that if the abortion rate had not changed since 1996, then 760,000 abortions would have occurred in 2006, given the increase in Nigeria's population during this period. (4)

Since the release of the 1996 estimates, the Nigerian government and other stakeholders have initiated a number of policies and programs to improve the reproductive health of women in the country. Notable among them are the government's efforts to achieve the United Nations Millennium Development Goals, including Goal 5, to improve maternal health. This goal has two targets: to reduce the maternal mortality ratio by 75% between 1990 and 2015, and to provide universal access to reproductive health by 2015. A 2010 government report concluded that progress toward achieving these targets has been slow, and that the modest progress that has been made in reducing maternal mortality has not been accompanied by improvements in other indicators, such as family planning uptake and the proportion of births attended by skilled health workers. (5)

In the hopes of better understanding the scale of clandestine abortion and related reproductive health issues facing Nigerian women, we present new estimates of the incidence of induced abortion in Nigeria, at the national level and for each of the country's six geopolitical zones.

METHODS

Data Sources

We produced our estimates using the Abortion Incidence Complications Methodology (AICM), an indirect approach that has been used to estimate the incidence of abortion in more than 15 countries. (6-9) The methodology relies on data collected through two surveys: a Health Facilities Survey, which gathers information from facilities that treat postabortion patients (i.e., women with complications from induced or spontaneous abortions), and a Health Professionals Survey, which collects information about abortion provision from knowledgeable key informants. These surveys are described in detail below. In addition, we used fertility and other data from the 2013 Nigeria Demographic and Health Survey (NDHS) (10) and population estimates from the United Nation's 2012 revision of the World Population Prospects in our calculations. (11) The study was approved by the Guttmacher Institute's institutional review board and by the University of Ibadan Ethical Review Committee.

Health Facilities Survey

All public and private health facilities that had the capacity to provide postabortion care services were included in the sample frame for the survey. We compiled a list of potentially eligible health facilities using the most recent (2007) National Bureau of Statistics' Directory of Health Establishments in Nigeria, supplemented by information from the 2007 National Health Insurance Scheme and the Ministry of Health's Department of Hospital Services. Slightly more than 5,000 facilities were deemed eligible.

It was important to represent all six of Nigeria's geopolitical zones, because women's social and demographic characteristics vary greatly across the country, particularly between the northern and southern zones.* Therefore, using information from the Nigerian census and the 2008 NDHS, [dagger] we grouped the states in each zone into tertiles according to the proportion of women who lived in urban areas, and randomly selected one state per tertile (and thus three states per zone). …

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