Access to safe abortion remains one of the most contested public health and human rights issues worldwide. The past few years have seen significant setbacks, from the US Supreme Court’s Dobbs v. Jackson Women’s Health Organisation decision overturning Roe v. Wade to the reintroduction of the Global Gag Rule (GGR), and in Lagos State, Nigeria, the suspension of the Lagos State Safe Termination of Pregnancy (STOP) guideline for legal indication.
These developments collectively threaten reproductive health outcomes, particularly in Nigeria, where restrictive abortion laws already contribute to high maternal mortality rates. As we examine these global and national shifts, assessing their implications on public health and human rights is crucial.
Policies that limit abortion access do not eliminate abortions; they only push them underground, making them more unsafe. According to the World Health Organisation (WHO), unsafe abortion is one of the leading causes of maternal mortality globally, contributing to 10-13 percent of maternal deaths in Nigeria. Restrictive laws disproportionately impact marginalised women, particularly those who cannot afford safe alternatives.
Nigeria already has one of the highest maternal mortality rates in the world, with 512 deaths per 100,000 live births. Many of these deaths are preventable with access to safe abortion and post-abortion care. Yet, the policy landscape continues to move in a restrictive direction.
The Global Gag Rule (GGR), officially known as the Mexico City Policy, is a US policy that prohibits foreign organisations receiving American global health funding from providing, counselling, or advocating for abortion services—even with non-US funds.
Historically, when this rule is enforced under Republican administrations, it reduces funding for critical reproductive health services, including contraception and maternal healthcare. When President Trump expanded the GGR, its devastating effects were felt across sub-Saharan Africa, including Nigeria.
Clinics closed, and funding for essential SRHR services—including HIV prevention and maternal care—was significantly reduced. Now, with discussions to reinstate an aggressive version of the policy, Nigerian healthcare providers face an uncertain future.
The most concerning aspect of the GGR is that it does not reduce abortion rates. Instead, studies have shown that it increases the number of unsafe abortions, as more women are denied access to contraception and reproductive health services. The ripple effect extends beyond abortion, weakening entire healthcare systems and increasing maternal deaths.
When the US Supreme Court’s Dobbs v. Jackson decision, which overturned Roe v. Wade, sent shockwaves through global reproductive rights movements. This ruling emboldened anti-choice movements, especially in Lagos State, Nigeria, and created a precedent where governments can roll back long-standing reproductive rights under the guise of legality.
Read also: How Roe v. Wade’s 1973 Supreme Court ruling started U.S abortion rights debate
For countries like Nigeria, where abortion is already restricted, the Dobbs decision reinforced existing challenges. It has fuelled opposition to progressive reproductive health policies and emboldened conservative actors working to undermine reproductive autonomy.
It also affects international advocacy and funding, making it harder for local organisations to secure resources for comprehensive reproductive healthcare.
The Lagos STOP guideline suspension: A step backward
In June 2022, the Lagos State Ministry of Health unveiled the Lagos State Guidelines on Safe Termination of Pregnancy for Legal Indications. This policy document provides clear directives on the safe termination of pregnancy within the state’s legal framework.
The 40-page document was developed to address gaps in the implementation of abortion services permissible under the Lagos State Criminal Code, particularly the provisions allowing termination of pregnancy to save a woman’s life and preserve her physical health.
However, following opposition from anti-choice groups, the government suspended the guideline one week later, leaving healthcare providers and women in limbo.
The suspension of the STOP guideline represents a dangerous politicisation of public health policy. Without clear legal guidance, doctors are hesitant to provide lifesaving care for fear of legal repercussions, and women facing medical emergencies are left without options. This policy vacuum undermines medical ethics and unnecessarily burdens Nigeria’s fragile healthcare system.
Why Nigeria Must Prioritise Public Health Over Politics
Nigeria has committed to reducing maternal mortality and achieving Universal Health Coverage (UHC) under global frameworks such as the Sustainable Development Goals (SDGs). Yet, restricting abortion services contradicts these commitments. If Nigeria is serious about improving maternal health outcomes, reinstating the Lagos STOP guideline should be a priority. Restrictive abortion laws disproportionately affect the poor, rural populations, and victims of sexual violence, exacerbating existing inequalities.
A call to action
Nigeria cannot afford to let global anti-choice policies dictate local health outcomes.
Policymakers must reinstate the Lagos STOP guideline to provide explicit legal protections for medical professionals and ensure access to safe abortion in permitted cases.
They must invest in comprehensive reproductive health services, including contraception and post-abortion care, to reduce the incidence of unsafe abortions.
Policymakers must also resist the influence of restrictive global policies like the GGR and advocate for evidence-based policies that prioritise public health over ideology.
They need to engage in national dialogue on abortion access based on medical science and human rights principles rather than political or religious considerations.
Abortion is not just a moral or legal issue—it is a public health emergency. Restrictive policies do not save lives; they cost lives. It is time for Nigeria to stand on the side of science, human rights, and public health.
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