The alarming rate of maternal mortality, especially in the area of unsafe abortion, which is estimated as the second largest contributor to maternal death in the developing countries like Nigeria has remained a source of concern to stakeholders in the health sector including non-governmental organisations who are working tireslessly to address the problem.
Reports show that in Africa for instance, most women die needlessly from prevetable causes during childbirth.
The situation is worse in Nigeria as the country has been described as one of the most dangerous places in the world to give birth with the fourth worst maternal mortality rate in the world ahead of only Sierra Leone, Central African Republic and Chad.
According to the World Bank estimates, Nigeria’s Maternal Mortality Rate (MMR) is still as high as 821 per 100,000 live births, making the country account for 10 per cent of global maternal deaths.
Experts say the major causes of these deaths are; sepsis, obstetric haemorrhage/bleeding, unsafe abortion, obstructed labour and pre-eclempsia, poverty, cultural practices, religious beliefs among others.
Tracing most of these deaths to unsafe abortion and unplanned pregnancies in particular, some of the experts say there was an urgent need to improve maternal care in the country which they note should include access to safe abortion and expansion of access to family planning services.
A 2017 Guttmacher Institute study estimates that 26 percent of these unintended pregnancies end in abortion.
The study noted that more unintended pregnancies mean more unsafe abortions and more children than a family can cater for.
Unfortunately, current global effort aimed at improving access to safe abortion and family planning services in the developing countries including Nigeria is being hampered by the expanded Global Gag Rule (GGR) of the US President, Mr. Donald Trump which stakeholders described as a threat to women’s health.
The Global Gag Rule is a US Executive Order that means any international organisation that provides or promotes abortion services – regardless of how those services are funded – is prohibited from receiving US Government funding.
The Global Gag Rule also known as Mexico City Policy was first enacted by Ronald Reagan in 1984. Since then, successive presidents have alternatively rescinded and re-enacted the policy.
One year after the reinstatement of the policy by Trump’s administration, access to contraceptive commodities and services, including provision of voluntary family planning information, education and services around sexual and gender-based violence like rape, female genital mutilation are adversely affected.
Stakeholders say Trump’s Global Gag Rule will reverse decades of global progress on reproductive, maternal and child health, leading to an increase in unintended pregnancies, unsafe abortions, maternal and child deaths.
Stressing that the policy will have a devastating impact on millions of women and girls in many developing countries.
Already, some NGOs in Nigeria, Kenya and Uganda have started cutting down on reproductive health services, thereby denying many women of reproductive age needed services including awareness about family planning, use of contraceptives, counselling on preventing unsafe abortions, among others.
Commenting on the policy, Bernard Washiaka, programme manager for Family Health Options Kenya, one of the country’s main providers of sexual and reproductive health services, said an end to its programmes would have a major effect on many women and young girls.
Studies conducted by PAI show that the global gag rule often cuts off women’s access to health care services entirely.
Confirming the impact of GGR in Lagos with regards to funding, Director, Family Health and Nutrition at the State Ministry of Health, Dr. Folashade Oludara, said since 2001, the United Nations Population Fund (UNFPA) has been supporting Lagos State in family planning programmes, post abortion care, among other reproductive health care services.
“But from last year, the United Nations agency said funding would go down. This year, 2018, the UNFPA has not given Lagos any funding nor supported us in any programme unlike before.”
Another stakeholder and Director General, International Planned Parenthood Federation (IPPF), Tewodros Melesse, said : “This policy blocks access to sexual and reproductive health services in the poorest and hardest to reach communities where we are currently changing lives. We can’t support something which tries to restrict people’s choices or take them away. The global gag rule undermines those human rights, so IPPF cannot sign the policy.”
Melesse added: “Ending this US aid, which currently stands at $600m (£474m), will result in cuts to funding for sexual and reproductive health services in at least 30 countries where IPPF partner organisations work.”
According to the World Health Organisation (WHO),about 16 million girls aged 15 to 19, and one million girls under the age of 15, give birth every year. The majority of these girls, live in low- and middle-income countries.
Also speaking, President and CEO of Global Fund for Women, Musimbi Kanyoro, said : “This expansion of the global gag rule will mean that entire communities in dire need of health care will be left without critical services from birth control to maternal health care and HIV screenings. This new policy goes far beyond the issue of access to safe and legal abortion, and puts the lives of women at risk.”
A recent study published by The Lancet publication revealed that restricting access to abortion by law does not reduce the number of abortions but only increases the risks to lives of women and girls.
For Médecins Sans Frontières (MSF) ,the Trump administration should stop playing politics with women’s rights and other global health efforts.
According to the Executive Director of MSF, Jason Cone, “The medical consequences of unsafe abortion are dire and should be treated as such. Governments should not play politics with the lives of women and girls.
“No matter what the risk or barrier, women will continue to seek ways to end pregnancies and they will continue to needlessly die if safe abortion care is not accessible. The Trump administration needs to face these facts and end policies that endanger the lives of women and girls.”
For Melinda Gates: “We are concerned that this shift could impact millions of women and girls around the world. It’s likely to have a negative effect on a broad range of health programmes that provide lifesaving treatment and prevention options to those most in need.”