Inside Nigeria's Abortion Realities

Investigating harmful reproductive health practices in Nigeria

Sponsored By The West To Stop Abortions

Abortion is one of the more controversial issues in the world today. In Africa, it is a matter of life and death as many women do not have access to safe abortions due to restrictive abortion laws. The world health organisation estimates that 24 out of every 1,000 African women aged 15 - 44 have unsafe abortions every year. Recent studies have found that the mortality due to unsafe abortions in Kenya is over 33%, and up to 50% of all maternal deaths in Ethiopia is a result of unsafe abortions. These terrifying numbers reflect an urgent problem - one that is aggravated by an international network of western organisations.

“Stop the Pro-Abortion Madness!” a petition states boldly on the Citizen Go Website.

In May 2012, a radical Christian organisation called Hazte Oir organised the largest gathering of anti-abortionists from all over the world called “The World Congress of Families” in Madrid. This congress, attended by influential members of the religious right in the USA, right-wing politicians from Germany, France and Italy as well as representatives of the Russian Orthodox Church among others, lasted for 3 days and was closed off with a church service. These attendees all agree that preserving the father-mother-child family unit is the only way to save society.

A few months after this congress, Hazte Oir created the Citizen Go website, a platform that leads anti-abortion campaigns all over the world. What started as a campaign within Spain, has grown to become a worldwide movement with real political influence. Citizen Go has run many homophobic, anti-sex education and anti-abortion petitions in countries all over the world. In 2017, she opened an offshoot in Kenya called Citizen Go Africa to slow down social liberalisation in African countries with a strong focus on abortion. 

In 2019, Citizen Go ran a campaign against British health organisation Marie Stopes in Nigeria. Marie Stopes is a non-profit that offers a wide range of sexual and reproductive healthcare services including family planning, and safe abortion clinics. This was not the first time Citizen Go would go after Marie Stopes and in Kenya, the organisation had to temporarily shut down all their clinics. On May 21 2019, a Marie Stopes Clinic in the city of Lagos was raided by policemen and Dr Bernard Fatoye was temporarily arrested on suspicion of illegal abortion, a serious crime in Nigeria. However, Marie Stopes, via the information on their website, only carries out treatments for miscarriages and offers post-abortion care among other reproductive health services.

Citizen Go is not the only western organisation fighting hard to end abortion in Africa. One organisation, however, has gone beyond writing petitions and is now attempting to stop abortions that are already halfway through.

Christian-Based Organisation Offering Unapproved Abortion Pill Reversal Service To Nigerians

Heartbeat International is a network of pro-life pregnancy resource centres. Founded in the US in 1971, they are operational in over 60 countries with over 2800 affiliated pregnancy help locations including pregnancy help medical clinics, maternity homes, and adoption agencies. With a vision to ‘make abortion unwanted today and unthinkable for future generations,’ they run the ‘Abortion Pill Rescue Network.’ This network offers something called Abortion Pill Reversal, claiming that the abortion pill can be reversed in women who have changed their minds about having an abortion.

The abortion pill is another name for medical abortion, and it comprises two medications, Mifepristone and misoprostol, the latter taken 24-48 hours after the former. Mifepristone blocks the hormone progesterone which is responsible for the growth of the fetus, and misoprostol causes the uterus to contract and expel the pregnancy. Medical abortion has an efficacy rate of 98% and is typically prescribed for women who are under ten weeks into their pregnancies. Abortionpillreversal.com claims that there is an ‘effective’ process called abortion pill reversal that makes use of the natural hormone progesterone to reverse the effects of mifepristone. According to their website, their medical professionals have saved 64 – 68% of pregnancies this way.

In collaboration with Open Democracy, we went undercover to get more information on this organisation's operation in Nigeria. Our reporter, Amaka, posed as a 23-year-old woman residing in Lagos, Nigeria, who was six weeks pregnant and had taken the first dose of the abortion pill. Amaka got in touch with them via the chat option on their website, and an American-sounding nurse consultant who identifies as Kim C. RN reached out to her via telephone.

In their conversations – which occurred within 48 hours – Kim C. RN requested that Amaka fill a consent form to give her (Kim) permission to contact a medical team in Nigeria that would prescribe the progesterone and guide her through the whole process. When Amaka showed signs of fear and doubt regarding the procedure, she tried to alleviate these fears using religious sentiments.

“People are praying for you…asking God to send you a million angels. This is a really tough time in your life, and we wanna support you. Your heart is changing. God is working and just let him guide you.”

The medication for the abortion reversal would cost Amaka about 20-30 dollars every week, and she would need to take it up until her 12th week of pregnancy. If she is not covered by insurance and is unable to afford this, Kim C. RN assured her that there are resources to cater for women who cannot bear the financial cost of this process. Following their conversation on the phone, Amaka received and signed a consent form via email, which stated that the Abortion Pill Reversal is “not FDA approved” and is an "off-label use of progesterone." This document also stated that she (Amaka), understands that the outcome of the procedure cannot be guaranteed,  and will "seek emergency medical care immediately" if she experiences any heavy bleeding, faintness, severe abdominal pain or fever.

Although it is reiterated on their website that the Abortion Pill Reversal process is for women who have only taken the first dose (Mifepristone) of the abortion pill, the consent form does not discourage women who have taken the two doses from taking progesterone in an attempt to reverse the abortion. It reads

Currently, our program is designed to serve women who have taken mifepristone...However, for women who have taken the first and second drugs of the medical abortion regimen, mifepristone on day one and misoprostol 12-48 hours later, progesterone may be beneficial to support the pregnancy even though it is not an antidote to misoprostol.

In the last communication with this group, via WhatsApp, Kim C. RN said that she could not find a medical team nearby but recommended support places that could help Amaka get the progesterone prescription. These places include Catholic Anti-Abortion Crusade in Lagos and Project for Human Development in Surulere. We reached out to a spokesperson from Project for Human Development who confirmed that they are indeed affiliated with Heartbeat international. However, according to the spokesperson, they have not been involved in any abortion pill reversal process yet and are focused more on preventing abortions in the first place and helping these young mothers give their babies up for adoption.

The abortion pill reversal was created by Dr George Delgado, a California physician and medical director of Culture of Life Family Services. Despite several warnings from medical organisations that have called this reversal unsafe and unethical, Dr Delgado continues to administer and advertise this procedure. He also accepts speaking engagements, where among other topics, he pushes the debunked claim that abortion is linked to breast cancer. In 2018, the University of California, San Diego (UCSD) asked Dr Delgado to stop listing an affiliation with them.

In 2018, Dr Delgado published a case series on 754 women who had called a reversal hotline. Out of the 547 women who were given progesterone within 72 hours of taking Mifepristone, 257 reported live births, giving a reversal rate of 48%. According to Dr Delgado, this proves that the Abortion Pill Reversal is a safe and effective procedure. This study has been criticised in The New England Journal of Medicine for its methodology and results. Another attempt to study the Abortion Pill Reversal process had to be stopped over safety concern. The lead researcher on this study said “It wasn’t safe for me to expose women to this treatment.”

“Claims regarding abortion “reversal” treatment are not based on science and do not meet clinical standards,” says the American College of Obstetricians and Gynaecologists.

Abortion is legally restricted in Nigeria, and conversation on this topic is controversial. The only legal way to have an abortion in Nigeria is if having the child endangers the mother's life. Asides from the law, abortion is morally frowned upon by many, if not all, religious bodies in Nigeria. Nigerian women who want to have an abortion often go through illegal abortion clinics or attempt it themselves. These factors make Nigerian women a vulnerable group for the Abortion Pill Reversal process – from those who feel guilty about their decision to abort to those trying to avoid any medical or legal complexity of abortion. 

An abortion pill reversal, if possible, is another way that women can exercise bodily autonomy. However, this process is still largely untested and has been labelled unethical. With no sufficient evidence to prove that it works, these women could be partaking in a dangerous human trial. 

Our Bodies, Whose Choice?

Three Nigerian women anonymously shared their abortion tales with us, and the reality is unsettling.

Sade was 16 years old when she was raped and became pregnant. Having no family member she could turn to for support, she asked her friend, a medical student who told her to get misoprostol. She procured the pill from a pharmacy and followed the instructions all by herself. Although the abortion was successful, nine years later, Sade is still dealing with what she considers side effects of the procedure, such as severe abdominal and body pains during her ovulation and period - which she never experienced before the abortion. Sade, who is now 25 years old, believes that every woman should have access to safe abortions. However, she did not always hold this view.

"That single situation turned my life around, and it made me stop judging people. Before that, I used to be extremely judgmental. I just thought people brought pregnancy on themselves. You know, unprotected sex and all of that. However, the situation they are in might not be their fault, but they're in it anyway, and they just wanna get out of it."

Kachi was not so lucky with the pill as her situation got a bit complicated. She was 23 years old when she discovered that she was four weeks pregnant. Certain that she did not want a child and getting no response from the person who got her pregnant, she bore the financial cost alone. Unable to get mifepristone, she settled for only misoprostol which she claims did not work. Kachi describes the experience as 'scary.' According to her, she bled as the textbooks said she would, but she did not feel too well afterward. So, she took a pregnancy test again and discovered she was still pregnant. After making inquiries, she found a private hospital to get an evacuation from and went alone.

"It happened at night, and I used an Uber to and fro. The doctor didn't even want to use anaesthesia; I had to strongly insist. It was weird. I wasn't admitted after the procedure. I was sedated on my way back home, so I was afraid and paranoid that the driver would carry me away. "

Being a healthcare professional, Kachi considers herself lucky.

"I had to go through corners to do mine, and despite how it looked, I had it easy; there was access to drugs and colleagues. I can't imagine what it's like for people without that

Carrying a pregnancy to term by force is inhumane."

Many anti-abortion arguments claim that having an abortion could lead to mental health problems and stir up negative emotions in the person. However, researchers have found no connection between abortions and mental disorders, and studies have shown that most women feel happiness and relief after having an abortion. A 2013 study revealed that women who were denied an abortion felt more regret and anger than women who successfully had one.

For Zainab, who had an abortion when she was 21 years old, this is what she had to say.

"Afterwards, all I felt was a lot of relief. It was pain-free for me, and I was safe, and more importantly, it didn't damage me in any way that I can think of. Also, I didn't feel like I just killed anyone or something like that."

This argument, although specious, is not unrelated to the truth. While some women truly experience negative emotions before or after an abortion, it is often linked to the stigma and lack of access to abortions, and sometimes, the pregnancy itself. 

"I try to tell myself that I'm not ashamed or worried about the stigma, but it's not true. My best friend doesn't know, not because she'll judge me or not understand. But I just don't know. So other than me and my boyfriend and of course the very kind woman who listened and helped me get what I needed, I've never shared this with anyone," Zainab disclosed.

Abortion has always existed, and even the tightest anti-abortion laws do not stop it from happening. According to a study conducted by Ipas, an international non-profit advocacy group, over 2 million abortions occur annually in Nigeria. The consequence of these anti-abortion laws is that women with unintended pregnancies are forced to have unsafe abortions. According to a Guttmacher study, in 2012 alone, 212,000 women were treated for complications of induced abortion in health facilities in Nigeria, and almost 10% of near-miss events - cases where the woman would have died without the quick intervention of health services - were attributed to unsafe abortions.

There is a lot of controversy on the morality and spirituality of abortions, and anti-abortion rhetoric often rests on this premise of immorality and sin. However, many things are often left out of the conversation, such as the physical, social and mental health of the women denied access to abortions. These three strangers have more than just abortion in common. Their stories share common themes of uncertainty, despair, and loneliness.

"Very often, I come online or watch the news and find one debate or the other about my womb and what I should do with it," says abortion rights activist Oluwapelumi Alesinloye-king. 

"Imagine reading that supposedly more liberated countries are funding organizations in Africa - not to help kids born to poor mothers or provide support for teenage mothers- but to force a woman to carry her pregnancy to term. It may be our bodies, but it is not our choice."