Access to safe abortion care for non-medical purposes or for a pregnancy that did not result from rape or incest has been outlawed in Lagos state under the new guidelines on safe termination of pregnancy released by the state’s Ministry of Health.
The policy which rides on existing provisions of the Criminal Law of Lagos State and the National Guidelines for Legal Indications 2018 restricts abortion to only endangered mothers, critically disabled fetuses and victims of rape.
It outlines the medical conditions that legally qualify for abortion and prescribes the procedures that medical facilities must follow to achieve safe and therapeutic termination and reduce preventable maternal deaths.
The policy listed obstetric and gynaecological disorders, heart and vascular diseases, kidney damage, cancers, blood diseases, and psychiatric and mental disorders among others as some of the conditions that can constitute a threat to life and physical health of a mother.
Before termination, the guidelines recommend a string of procedures including confirmation of pregnancy, physical examination, laboratory investigation, informed consent, and patient evaluation.
Olusegun Ogboye, the permanent secretary, Lagos State Ministry of Health, presenting the document at a stakeholders’ engagement in Lagos said the policy was borne out of the need to provide evidence-based data and information for health workers in public and private sectors with the necessary training to provide safe abortions.
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Citing the state’s abortion law, he noted that while therapeutic termination of pregnancy is permitted, the lack of clear guidelines has hindered the effective implementation at appropriate levels of care, resulting in avoidable deaths
In 2011, the Lagos State House of Assembly updated the criminal code, providing for abortion to save the life and protect the physical health of the woman.
“While physical health is covered under the Lagos legal framework, services conforming to the law have not been available in Lagos State health sector. This document provides information on relevant laws applicable in Lagos State while providing standards and best practices with regards to legal indications, pre and post-procedure care, methods, and monitoring,” Ogboye said.
He noted that the document had undergone wide consultation with relevant technical stakeholders within the legal and health service context in the state.
The development of the guidelines commenced in 2018 with the Safe Engage project led by the Lagos Ministry of Health and hosted by the Society for Obstetricians and Gynaecologists of Nigeria (SOGON), with support from Population Reference Bureau (PRB), he explained.
The Safe Engage project focused on two outcomes including ensuring that safe abortion services were available within legal limits and domesticating the Violence Against Persons Prohibition Act, supporting women to terminate a pregnancy caused by rape or incest.
Emmanuel Ajah, country director of Marie Stopes International Organization Nigeria (MSION), a reproductive health organisation, said the development of the policy document places Lagos ahead in state-backed interventions to stem the tide of unsafe abortion, improving health outcomes for women and girls.
He explained that some healthcare providers are unaware of the legal indications for safe termination of pregnancy even though they have the responsibility to determine when the life of the woman is in danger.
“Healthcare providers need to have the right understanding and make those critical decisions based on sound medical judgment and not on religion, culture, or other biases,” he said.
Similarly, Ayodele Atsenuwa, a professor of Law at the University of Lagos and a consultant on the document development said that the Lagos State Criminal law of 2011 only prohibits unlawful abortion.
The document, she noted, clarifies and explains what lawful termination of pregnancy means in the context of the law adding that education of law enforcement officers is important with regards to understanding the context of the law.
