By Sam Oditah
A 47-year-old single mother, Jane (surname withheld), lived in her dilapidated family house in a serene neighbourhood in Umuahia, the Abia capital. She relocated from Lagos in 2017 due to economic difficulties.
She lived with her 12-year-old daughter, Ebere, a junior secondary school student, and her aged auntie in a one-room apartment.
Painfully, Jane died on March 10 in rather sudden and bizarre circumstances.
The family, and indeed the entire village, woke up in the early hours of that day to receive the unexpected and startling news of her death.
Friends, relatives, even passersby, thronged the compound to behold the chilling sight of Jane’s lifeless body tucked inside a metal container under construction in front of her compound.
Family sources said she died from complications and excessive bleeding at a private health facility in Umuahia, while trying to procure abortion for an unintended pregnancy.
It was gathered that the “quack,” who carried out the unsuccessful procedure, made no efforts to reach out to her relatives when she died. Rather, he was alleged to have secretly moved her body to her compound in a Sienna bus around 11 p.m.
An eye-witness account said that the man hauled Jane’s body from the vehicle to the container, dumped it inside and zoomed off.
She was quietly buried while her relatives made no attempt to report the incident to the police.
The Police Public Relations Officer, Abia Police Command, SP Geoffrey Ogbonna, said the command was not aware of the incident.
That was how Jane, like hundreds of thousands of her kind in the developing countries, paid the supreme price for unsafe abortion.
Jane’s avoidable death readily brings to mind the negative impacts of Nigeria’s restrictive legislation on abortion and stifling implications of the U.S. Global Gag Rule (GGR).
Otherwise called Mexico City Policy, GGR was proclaimed by the former U.S. President Ronald Reagan in 1984 at the International Conference on Population held in Mexico City.
The policy prohibits foreign non-governmental organisations (NGOs), which depend on U.S. global health assistance, from providing legal abortion services or referrals.
It further bars advocacy for abortion law reform, even if carried out with the NGO’s own, non-U.S. funds.
Nonetheless, the policy safely made a proviso that allows access to safe abortion only in cases of rape, incest, or when a woman’s life becomes endangered by pregnancy.
Although every successive Democratic administration had always repealed the policy, Republican administrations reintroduced it, making the policy look like a U.S. political gimmick rather than a genuine and realistic approach to de-emphasize the use of abortion as a family planning strategy.
Upon assumption of office in 2017, President Donald Trump re-enacted an expanded GGR – Protecting Life in Global Health Assistance.
It applied to recipients of any U.S. global health funding, totalling an unprecedented $8.8 billion.
At a recent workshop for journalists on Women Sexual Reproductive Health and Right (WSRHR) and GGR in Owerri, the Imo capital, organised by Ipas Nigeria, resource persons took turn to discuss the policy vis-a-vis its implications and impacts on the reproductive health and right of women in poor countries.
Dr Abiola Akiyode-Afolabi in her paper on “Global Gag Rule: History, Concept and Implication for WSRHR,” spoke extensively on the U.S. withdrawal of funding from foreign NGOs that refuse to comply with the policy.
Akiyode-Afolabi expressed concern that the loss of USAID funding dealt devastating blows on “non certifying NGOs” even in countries where abortion is legally permissible in all situations or under circumstances of fatal impairment or where pregnancy poses risk to the woman’s health or socio-economic wellbeing.”
She said: “From 2001 to 2009, 20 developing countries in Africa, Asia and Middle East lost U.S.-donated contraceptives and many organisations and clinics were forced to reduce services, lay off staff or shut down entirely.”
Akiyode-Afolabi, who works with Women Advocates Research and Documentation Centre, Lagos, further highlighted the disadvantages of GGR to women.
She said that 70 per cent of world’s one billion poorest people are women, living in developing countries, “where their access to health services depend exclusively or to a large extent on foreign NGOs, whose programmes are supported.
“These women have likelihood of dying from pregnancy complications at a rate more than 500 times that of women in the United States,” she said.
She contended that “although GGR was meant to target abortion providers, it had terrible consequences for the health and lives of poor women and their families in ways that had nothing to do with abortion.
“The policy affects family planning, HIV services, maternal and child health and even malaria services. And in no place did it reduce abortions,” she said.
She argued that the policy was “inconsistent with international and U.S. legal principles that include the right to free speech, democratic participation and reproductive autonomy.”
She also said it further “undermines U.S. foreign policy objectives that encourage the building of democracy, civil society and women’s participation as equals in society.
“It runs counter to the U.S. commitment to women’s reproductive rights and health,” Akiyode-Afolabi said.
Dr Mazi Ejikem, an Obstetrician Gynecologist at the Abia State University Teaching Hospital, Aba, said that GGR had greater impact on poor countries across the globe, considering that “countries that benefit from donor agencies and NGOs are actually poor.”
According to Ejikem, “It is on record that abortion and pregnancy rates are high in poor countries.
“It is also on record that in societies where there is poverty, where per capita income is low, where access to family planning is not possible and even family planning, there are increased chances of getting pregnant.
“And those societies that are poor also have the chances of having more complications associated with pregnancies, such as maternal deaths, mortality, morbidity, neonatal and infant deaths and early childhood deaths.’’
Ejikem said that any section of the reproductive right of the woman that was altered as a result of the policy “will impact negatively on the overall health status of women.”
He said that the reproductive right of women “offers the woman the right to have control freely over her reproductive potential.
“In other words, women should have the right to get pregnant or not and right to abortion. So why must the right to abortion be taken away from them?”
He feared that majority of the hospitals and clinics that offer reproductive health services in poor countries would either reduce their services or shut down entirely with the danger of affecting other components of the reproductive health.
“Even the staff of the hospitals and clinics are faced with the risk of job loss, thus worsening the unemployment situation with its consequential effect on the immediate and larger societies.’’
He argued that “unsafe abortion is higher in societies, where women are not allowed to have their say regarding abortion and sex or their health, with respect to pregnancy.
He said that because of poor abortion services, many woman had died while undergoing unsafe abortion.
“Many have also committed suicide because they are not ready to be pregnant, especially because of the thought of caring for the child.
“So many things will lead to women not wanting pregnancy. Also, many things will lead to women getting pregnant.
“A woman may decide not to get pregnant, yet she can get pregnant against her wish because family planning would have failed.
“She could get pregnant as a result of rape and societal pressure – trying to fend for the family and being prone to sexual harassment – they willingly accept advances from men, not necessarily rape.
“It is also on record that in societies, where abortion is illegal, abortion rate is relatively high and Nigeria is one of such countries, even though it is legally prohibited.
“Therefore, America’s Global Gag Rule is an impediment to the reproductive right of women.
“As an obstetrician gynecologist, I will never support anything that will negatively affect the reproductive right of women.
“So, this GGR needs to be repealed so that women will have their full right to reproductive health.”
Available statistics show that 295,000 women died during pregnancy and childbirth in 2017 with the reintroduction of GGR by Trump’s administration. And 94 per cent of the figure is said to have occurred in low-income countries.
Of the figure, Sub-Saharan Africa accounted for two-third (96,000) maternal deaths, while Asia had only one-fifth (58,000) deaths.
It is on record also that unsafe abortion accounts for 13 per cent of the mortality rate and of the 56 million abortions that occur every year globally, 55,700 deaths involve women.
A breakdown of the statistics further show that Nigeria recorded induced abortions totalling 610/100,000 life births in 1996; 760,000/100,000 life births in 2006; 1.25 million in 2012, where 33 abortions per 1000 women aged 15 to 49 and 1.8 million to 2.7 million, with about 41.1 per cent/1000 aged 15 to 49. In all, the most affected were adolescent girls.
Reports attribute the high abortion mortality in developing countries to the lack of information on contraception access and use, resulting in unintended pregnancies, lack of information and access to safe abortion services, restrictive abortion laws and shortage of trained staff and equipment.
An Umuahia-based reproductive health analyst, Mr Emmanuel Emeka, advocated a repeal of the policy as panacea to unsafe abortion.
Emeka also charged developing nations to take measures to liberalise their abortion laws.
“Laws should be liberalised to provide for exceptions, such as pregnancies from rape, incest and threat to life.
“This will allow people with the need for abortion services to freely walk up to a health professional to get expert attention.
“There should be increased education and enlightenment on contraceptive uptake to prevent unintended pregnancies and recourse to unsafe abortion,” he said.
The consensus of stakeholders on WSRHR and GGR is to abrogate the policy. They hope that the incoming Democratic administration of the U.S. President-elect, Joe Biden, will muster the political will to yield to popular demand and abolish the policy, ad infinitum.