Boniface A. Oye-Adeniran

Unwanted Pregnancy and Associated Factors Among Nigerian Women

CONTEXT Many Nigerian women experience unwanted pregnancies. To prevent associated health problems, it is important to understand the factors related to unwanted pregnancy in Nigeria. METHODS A community-based survey of 2,978 women aged 15-49 was conducted in eight Nigerian states. Univariate analyses and multivariate logistic regression analyses were used to determine the incidence of unwanted pregnancy, the incidence of seeking an abortion among women with unwanted pregnancies and the factors associated with unwanted pregnancy and abortion-seeking behavior. Additional analyses examined the prevalence of contraceptive use and womens reasons for seeking to terminate unwanted pregnancies and for not practicing contraception at the time their unwanted pregnancies were conceived. RESULTS Twenty-eight percent of respondents reported ever having had an unwanted pregnancy; of those, half reported having attempted to end their last unwanted pregnancy. Forty-three percent of women who sought an abortion did so because they were not married, were too young or were still in school. Of the women who were not practicing contraception when they had the unwanted pregnancy, 44% said that they were unaware of family planning, and 22% that they either did not have access to contraceptive services, services were too expensive or they were afraid of side effects. At the time of the survey, 27% of all respondents were at risk of an unwanted pregnancy. Almost half were unaware of contraceptive methods. CONCLUSIONS Nigerian women often turn to abortion to avoid unwanted births. The provision of family planning counseling and information could substantially reduce the incidence of unwanted pregnancy and induced abortion in Nigeria.

Severity and Cost of Unsafe Abortion Complications Treated in Nigerian Hospitals

CONTEXT Each year, thousands of Nigerian women have unintended pregnancies that end in illegal abortion. Many such procedures occur under unsafe conditions, contributing to maternal morbidity and mortality. METHODS In a 2002-2003 survey of women and their providers in 33 hospitals in eight states across Nigeria, 2,093 patients were identified as being treated for complications of abortion or miscarriage or seeking an abortion. Womens abortion experiences and the health consequences and associated costs were examined through bivariate analysis. Multivariate analysis was used to examine the characteristics of women by type of pregnancy loss and to compare characteristics among three groups of women who had induced abortions in differing circumstances. RESULTS Among women admitted for abortion-related reasons, 36% had attempted to end the pregnancy before coming to the hospital (including 24% with and 12% without serious complications), 33% obtained an induced abortion at the facility (not withstanding the countrys restrictive law) without having made a prior abortion attempt and 32% were treated for complications from a miscarriage. Of women with serious complications, 24% had sepsis, 21% pelvic infection and 11% instrumental injury; 22% required blood transfusion and 10% needed abdominal surgery. The women in this group were poorer and later in gestation than those who sought abortions directly from hospitals. They paid more for treatment (about 13,900 naira) than those who went directly to the hospital for an abortion (3,800 naira) or those treated for miscarriage (5,100 naira). CONCLUSIONS Policy and program interventions are needed to improve access to contraceptive services and postabortion care in order to reduce abortion-related morbidity and mortality.

Contraceptive prevalence among young women in Nigeria

Abstract In almost all societies in the world there is an increase in sexual activity among young persons (10 – 24 years). There is a need for contraceptive use among them to prevent high risk unintended pregnancies. This study was carried out to determine the contraceptive prevalence among young women in Nigeria. The study population was 832 young women between the ages of 15 and 24 years. Only 11.1% of the respondents had ever used contraceptives although 63.2% of them had had sexual intercourse. Contraceptive usage was significantly higher (p < 0.05) among the single sexually active women (38.5%) than among the married women (7.7%). Only 7.3% of respondents are currently using a contraceptive method. The main methods in use were condoms and pills. There is an unmet need for contraceptives among young women in Nigeria. It is necessary to improve these young womens abilities to protect themselves against unwanted pregnancies.

Sources of Contraceptive Commodities for Users in Nigeria

Background Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. Methods and Findings A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15–49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15–24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. Conclusion Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills.

Community-based survey of unwanted pregnancy in Southwestern Nigeria

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion.

Characteristics of abortion care seekers in south-western Nigeria.

This prospective hospital-based study was carried out to understand the characteristics of abortion care seekers in south-western Nigeria. Information was obtained from a total of 1876 women seeking abortion at hospitals using a questionnaire. The results show that majority (60%) were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7%. Most (63.2%) of the respondents were unmarried, but married women also constituted a significant proportion (30.2%) of the abortion care seekers. Students were the single highest group, while the predominant economic activity was trading (26.7%). Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. Most (35.5%) of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 27.4%. It is obvious from the results that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education especially in view of the current HIV/AIDS pandemic.

Advocacy for Reform of the Abortion Law in Nigeria

Abstract Safe abortion services are only legal in Nigeria to save the life of the woman. Widespread incidence of unsafe induced abortions often results in death or irreparable harm to women. The Campaign Against Unwanted Pregnancy (CAUP) was launched on 17 August 1991 to address this public health crisis through advocacy for reform of the abortion law, research, education and preparation of service providers, and development of a constituency to support provision of safe abortion to the full extent of the law. CAUP commissioned an evaluation in 2004 to examine and analyse the work of the campaign during its 14 years of existence, which included a review of documents, a participatory learning workshop with CAUP, and almost 50 interviews with different stakeholders. This article, adapted from the evaluation report, tells how CAUP took a taboo topic and, in the midst of an extremely complex political and cultural environment, made it a legitimate subject for public discussion and debate. The Campaign undertook groundbreaking research on abortion in Nigeria. Service providers are being trained to provide, to the full extent of the law, safe abortions and post-abortion care, and advocacy efforts are continuing to lay the groundwork for improving the abortion law. Résumé Les services d’avortement médicalisé ne sont autorisés au Nigéria que pour sauver la vie de la femme. Les nombreuses interruptions de grossesseàrisque se terminent souvent par la mort de la femme ou des séquelles permanentes. La Campagne contre les grossesses non désirées (CAUP) a été lancée le 17 ao t 1991 pour régler cette crise de santé publique par le plaidoyer pour la réforme de la loi sur l’avortement, la recherche, la formation des prestataires de services, et la création de groupes de soutien des avortements s rs conformesàla loi. En 2004, la CAUP a commandité une évaluation pour analyser son travail pendant ses 14 ans d’existence, avec un examen de documents, un atelier d’apprentissage actif et près de 50 entretiens avec différents acteurs. Cet article, adapté du rapport d’évaluation, montre comment la CAUP a abordé un sujet tabou et en a fait un thème légitime de débat public, dans un environnement politique et culturel extrÁmement complexe. La CAUP a entrepris des recherches pionnières au Nigéria. Les prestataires de services sont formés pour pratiquer, en conformité avec la loi, des avortements s rs et des soins post-avortement, et les activités de plaidoyer se poursuivent pour préparer une amélioration de la loi sur l’avortement. Resumen En Nigeria se ofrecen servicios de aborto seguro y legal únicamente para salvar la vida de la mujer. La gran incidencia de abortos inducidos en condiciones de riesgo con frecuencia propicia la muerte o daños irreparables de las mujeres. La Campaña contra el Embarazo No Deseado (CAUP) se lanzó el 17 de agosto de 1991 con el fin de tratar esta crisis de salud pública mediante la promoción y defensa de reformas de la Ley de Aborto, investigaciones, la formación y preparación de los prestadores de servicios, y un aumento en la inscripción de electores a favor de la prestación de servicios de aborto seguro al máximo alcance de la ley. En 2004, CAUP encargó una evaluación para examinar y analizar el trabajo de la campaña durante sus 14 años de existencia, la cual incluyó una revisión de los documentos, un taller de aprendizaje participativo con CAUP, y casi 50 entrevistas entre diferentes partes interesadas. En este artáculo, adaptado del informe de la evaluación, se explica cómo, en medio de un ambiente polático y cultural sumamente complejo, CAUP convirtió un tema tabú en uno legátimo para el debate público. La Campaña emprendió investigaciones pioneras sobre el aborto en Nigeria. Se están capacitando a los proveedores para que ofrezcan servicios de aborto seguro y de atención postaborto al máximo alcance de la ley, y los esfuerzos de promoción y defensa continúan preparando el terreno para mejorar la ley de aborto.

Induced abortion in Nigeria: findings from focus group discussion.

Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning, unwanted pregnancy, abortion, adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects, high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier.

The use of the sisterhood method for estimating maternal mortality ratio in Lagos state, Nigeria

Summary Estimates of maternal mortality are crucial to inform the planning of reproductive health programmes and guide advocacy. The aim of this study was to obtain a population-based estimate of maternal mortality in Lagos State, Nigeria. The sisterhood method was used in 2008 to carry out the survey using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within 6 weeks after childbirth. The survey involved 4,315 respondents who provided information on 9,910 ever married sisters. The life-time likelihood (risk) of maternal death for women aged 15–49 years was found to be 0.0239 or 1 in 42. The estimated maternal mortality ratio was 450 per 100,000 live births with a 95% CI of 360 and 530. Out of 111 reported deaths, 35 (31.5%) occurred during pregnancy, 49 (44.1%) occurred during delivery and 27 (24.3%) within 6 weeks of delivery.

Causes of maternal mortality in Lagos State, Nigeria

Background: Maternal mortality remains a major problem in many parts of the world including Nigeria.Understanding the causes of maternal mortality is crucial in confronting the challenge of unyielding high rates. The aim of this study was to determine the direct and indirect causes of maternal mortality in Lagos State, Nigeria. Materials and Methods: The study is a descriptive cross-sectional survey. The study population consisted of adults residing in Lagos State, Nigeria. The sample size used for this study was 29,988. The respondents were selected by multistage sampling from all the local government areas in the state. Data were collected using a structured interviewer-administered questionnaire. Data entry, cleaning, validation and analysis were done using Statistical Package for Social Sciences version 15.0. Results: Among the 29,988 respondents, 306 (1.0%) gave a history of married sisters who died during pregnancy, childbirth or during the postpartum period. Of the 306, 138 (45.1%) died during pregnancy; 107 (34.9%) died during childbirth, and 61 (19.9%) died during the postpartum period. Abortion, ectopic pregnancies and hypertension were the most commonly mentioned cause of death during pregnancy, while anemia, prolonged labor and obstructed labor were the common causes during childbirth. Human immunodeficiency virus/acquired immunodeficiency syndrome , infection and malaria were the common causes of maternal death during the 6 weeks after end of pregnancy/childbirth. Conclusions and Recommendation: Over half of the maternal deaths in Lagos State occurred during labor and immediately postpartum. Community education on the importance of having skilled attendants at delivery must be provided. Emergency obstetric care should be available, accessible and affordable at health facilities, and efforts must be made to prevent unwanted pregnancies and unsafe abortions by increasing contraceptive use. The malaria control efforts should be intensified.