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Reducing Maternal Mortality Within Legal Framework
When Cynthia was raped by her abductors, who later released her, she knew she was in for more troubles. Missing her menstrual period for two months heightened her fears.
Testing positive for pregnancy broke her further.
She wasn’t ready to swallow another bitter pill – keeping the unwanted pregnancy from ‘evil’ men.
The unpreparedness, stigmatisation and fear of the unknown got the larger part of the 35-year-old and her blood pressure became high. She thought of only one way to get out of her troubles – termination of the pregnancy.
She unfortunately opted for a ‘quack doctor’ to avoid shame but, alas, the unsafe abortion resulted in complications that took her life.
Sadly, Cynthia is among 14 per cent of Nigerian women who have died as a result of unsafe abortion.
According to the World Health Organisation (WHO), unsafe abortion is a leading but preventable cause of maternal deaths and morbidunsafe
It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems.
Unsafe abortion, as defined by WHO, is a procedure for terminating an unintended pregnancy, carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards or both.
Data from WHO shows that globally, 4.7 per cent to 13.2 per cent of annual maternal deaths can be attributed to unsafe abortion.
Every year, an estimated 287,000 maternal deaths occur globally to which Nigeria contributes 14 per cent. Unsafe abortion accounts for about 10 to 14 per cent of maternal morbidity and mortality in Nigeria.
In an effort to reduce preventable maternal deaths, Lagos State Government, on June 28, released a document entitled “Guidelines on Termination of Pregnancy for Legal Indications.”
The 40-page document modelled after the National Guidelines for Legal Indications (2018) prepared by the Federal Ministry of Health is designed to provide guidance to medical practitioners and other stakeholders on when it is lawful or unlawful to terminate a pregnancy.
According to Lagos State Government, the goal of the document is to serve as a tool for provision of safe termination of pregnancies within the legal framework in circumstances whereby continuation of such pregnancies threaten the lives or physical and/or mental health of women.
It hopes that the Guidelines will help to reduce maternal morbidity and mortality in Lagos and, by extension, Nigeria.
It notes that Nigeria has the second-largest burden of maternal mortality globally, after India, regretting that many of the deaths are of known causes and preventable.
According to the state, a neglected area of preventable maternal deaths is related to the provisions of the Nigerian Abortion Law.
It acknowledges that the Nigerian Abortion Law permits termination of pregnancy in circumstances where the continuation of pregnancy threatens the mother’s life but “unfortunately, no formal efforts have been made through the development of policy instruments, guidelines or tools to implement these provisions to save the lives of Nigerian women whose existence is threatened by continuation of their pregnancies”.
It points out that induced abortion is illegal in Nigeria except when performed to save a woman’s life and that the penal code and the criminal code allow this exception, with specification of criminal penalties for non-compliance.
Lagos State had reviewed its abortion law in 2011 to extend the provisions to the mother’s physical health.
“Consequently, this Guidelines for Lagos State is intended to standardise practice and build the capacity of medical professionals in public and private facilities to identify pregnancies for which the law is intended so that ethical and safe management can be instituted.
“The document provides information on subsisting Nigerian law on termination of pregnancy, Lagos State revised law 2011, a compendium of medical conditions and circumstances where the continuation of pregnancy endangers the woman’s life, and describes the step-by-step options for ethical and safe medical management.
“It is envisaged that the enunciation, deployment and use of this Guidelines will preserve the lives of pregnant women from dying and assist those whose physical or mental health would be compromised with the continuation of their pregnancies,” it says.
According to the state, medical conditions that may constitute a threat to the life and physical health of a pregnant woman and make her to benefit from safe legal termination of pregnancy include obstetric and gynaecological conditions such as genital tract cancers, severe fetal conditions or malformation not compatible with extrauterine life.
Other conditions are heart and vascular diseases, including uncontrolled hypertension in the first or second trimester, pre-eclampsia and eclampsia and pulmonary embolism.
Kidney diseases, cancers, blood diseases, autoimmune diseases, diabetes mellitus refractory to treatment or with organ failure, can pose a threat to the life and physical health of a pregnant woman.
Similarly, psychiatric and other mental disorders which include psychiatric disorders with suicidal ideation, severe depression with suicidal tendencies, which may occur in rape and incest, can constitute a threat to the life and physical health of a pregnant woman.
Lagos State believes that having guidelines on safe termination of pregnancy for legal indications is very important as no woman should lose her life or have her physical or mental health compromised from conditions that can be prevented or addressed.
“It is in this regard that it is important to disseminate and implement the Guidelines as accepted by the Government of Lagos State to ensure that every woman in Lagos State gets the right care she deserves at the right time and place for safe termination of pregnancy for any legal indications,” the government states in the document.
It highlights standards and best practices with regard to legal indications, pre and post procedure care, methods and monitoring.
At the launch of the document, DrOlusegunOgboye, Permanent Secretary, Lagos State Ministry of Health, had said that the document was for safe termination of pregnancies within the ambit of the Criminal Law of Lagos State.
According to Ogboye, the document will provide evidence-based data and other information for health workers in public and private sectors with requisite skills to provide safe termination of pregnancy to reduce preventable deaths.
He gave the assurance that the document had undergone consultations with relevant technical stakeholders within the legal and health service context in the state and also with key opinion leaders in South-West Zone.
However, the state government’s release of the Guidelines has been frowned at by some residents and religious groups.
The Catholic Archbishop of Lagos, Most Rev. Alfred Martins, describes the release as legalising abortion through the backdoor.
Martins is worried that the Guidelines will create room for indiscriminate procurement of abortion.
He says it is untrue that all stakeholders were consulted in the process of drafting the Guidelines.
“The issue of abortion touches very much on ethical and religious sensibilities, and religious bodies were not consulted.
“Certainly millions of Catholics, who have always maintained their strong opposition to legalisation of abortion in any guise, were not consulted.
“The baby in the womb is a person that is distinct from the mother though he is in the mother’s womb; so, not even the mother has the right to kill him, talk less of the government purporting to give legal backing for their murder.
“We need to continue to explore ways of providing support for women who find themselves in difficulty as a result of their pregnancies rather than thinking of aborting a child who is innocent of the difficulty that the mother may be going through.
“Any attempt to terminate the life of an unborn child is tantamount to murder and should be treated as a capital offence,” Martins argues.
The cleric advises that focus should be on proper enlightenment on human sexuality and collaboration, in order to support women who get pregnant without being ready for the pregnancy.
Prof. Adetokunbo Fabamwo, Chief Medical Director, Lagos State University Teaching Hospital and a contributor to the development of the Guidelines, clarifies that the document does not support indiscriminate and illegal procurement of abortion.
“There are only two lawful grounds for therapeutic termination of pregnancy, and they are for preservation of a mother’s life and preservation of the woman’s physical health.
“We are not allowed to conduct pregnancy termination because someone says ‘I don’t want this baby; I’m not ready for it or I’m too young for it.
“The guidelines make it clear to public and private hospitals in the state what is allowed under the legal ambit in Nigeria,” Fabamwo, a Professor of Obstetrics and Gynecology, explains.
On the implications of the Guidelines to the state’s maternal health indices, Fabamwo is convinced that it will reduce maternal mortality and morbidity arising from unsafe abortion, since therapeutic abortion will be conducted by specialists in obstetrics and gyneacology.
For DrTunjiAkintade, a former Chairman, Association of Nigeria Private Medical Practitioners, the state government should be praised for coming up with the Guidelines which, he says, will improve maternal health.
He regrets that many women have died as a result of unsafe abortion.
Akintade is of the opinion that restricting access to safe abortions means will drive women into unsafe abortions, resulting in complications and, in some cases, deaths.
“Over the years, medical practitioners have been scared of prosecution, even when the life of a woman, her baby or her mental health is threatened due to pregnancy; they feel so reluctant to do anything to save her.
“Such a woman does not need to suffer based on a medical condition that got worse due to her pregnancy, and delay in providing medical intervention for such a woman can lead to death.
“We need to remove prejudice when lives are at stake. More so, every pregnancy is not the same; some women might have it easy while some might not.
“People should move beyond criticism and trying to force their religious beliefs on others,” he argues.
Akintade points out that proper documentation of the process is emphasised on the Guidelines to check abuse.
In reaction to the condemnation of the release of the Guidelines in some quarters, the state Gov. BabajideSanwo-Olu, on July 7, directed suspension of the implementation of the Guidelines.
In a statement released by the state Commissioner for Health, Prof. Akin Abayomi, the governor directed further sensitisation of key stakeholders and members of the public to ensure a clearer understanding of the objectives of the Guidelines.
According to him, the state ministry of health is seeking different methods to eliminate illegal abortions and ensure that a mother does not die at childbirth and disrupt an entire family unit.
The governor is worried that illegal abortions and high risk pregnancies leading to unresolvable complications, rank high among contributors to maternal mortality.
According to him, the focus of the Guidelines is on creating opportunities to reduce maternal mortality in line with existing laws.
“In this regard, it became imperative to examine, in keeping with existing national and state laws and policies, if there are indeed justifications and medical reasons to offer abortion to a woman whose life is threatened by a pregnancy.”
Sanwo-Olu says suspension of the implementation of the Guidelines will enable the state executive council to deliberate on the matter and ensure adequate public sensitisation and stakeholder engagement to reach a consensus required for a successful guideline development.
Analysts urge expedited deliberations, sensitisation and engagement of stakeholders to ensure timely resolution of any issues around the Guidelines and take desired actions that will save lives of more pregnant women.
By: Oluwafunke Ishola
Ishola writes for News Agency Of Nigeria.
Dear Hon Minister,
First, a disclosure. You may not know me but we have met on two occasions in the house of our mutual respected Oga, first as a minister of state and second as a Governor, but l doubt if you can recognise me now. I am one of your admirers and critics.
As a two-term Governor of Rivers State, you did well in terms of infrastructure, for which l often commend you. I, however, sometimes disagree with you, particularly what l consider your streaks of high-handedness against those who disagreed with you politically.
I am writing this letter, with the hope that Don would send it to you, after watching your media interview with particular reference to your protégé and successor, Governor Siminalayi Fubara, a guy l have never met. No doubt, he would not have emerged as governor without your imprimatur. I do not have the details of your disagreement, and I am not even interested. What I am interested in is you to rise above the alleged offence.
Take a deep breath and have an introspective view of your political trajectory since 1999.
1999-2007: Obio/Akpor LGA Chairman
2007-2011: Chief of Staff, Rivers State
2011-2015: Education Minister (State)
2015-2023: Governor, Rivers State
2023-till date: Minister of FCT
And you are just 55!
I stand to be corrected, nobody from Rivers State has been so politically favoured and blessed by God as you are, not that you are the most politically-savvy politician from the State but it is just the Grace of God. I plead with you, do not take such grace for granted.
As governor of Lagos State in 2010, Governor Babatunde Fashola told me something that has stuck with me till today, regarding power and leadership. There was a three-month old strike by doctors in Lagos over pay increase. I stepped in to mediate between the doctors and the state, which by the grace of God, l was able to pull through after extensive negotiations with the doctors, and the strike was called off to the relief of millions of Lagosians. In the course of the mediation, Fashola told me that some people asked him to fire all the doctors but he made this profound statement: “Restraint is a powerful tool in leadership; the fact that you have the power to do something but chose to look the other way.” That statement has stuck with me till date. Why do you think American presidents, despite the temptation to press the nuclear button, when their interests are threatened, rather exercise restraint by refusing to go that route? It is leadership restraint.
Permit me to recall a story which you yourself regaled your audience with at the 70th birthday reception you held in honour of Dr Peter Odili. You said that when you wanted to contest for the Chairmanship of Obio/Akpor Local Government Council in 1998, you approached Dr Odili, whom you were meeting for the first time and sought his support. He obliged by giving you his support, and according to you, he gave you the first financial support towards your ambition, even when he himself was campaigning to run for the governorship of Rivers State. You became the chairman, and when you wanted to go for a second tenure, some political actors removed your name, and according to you, you ran to Dr Odili who was then the governor and he saved your political career by reinstating your name.
Fast forward to when you completed your tenure as the chairman of the local government, when your erstwhile friend, Rotimi Amaechi, who just became the governor, appointed you his Chief of Staff and that administration commenced a process to humiliate Dr Odili by setting up the Rivers State Truth and Reconciliation Commission, where your benefactor, Odili was the target and was put in the witness box.
Later when cracks began to emerge in your relationship with your boss, Amaechi, you ran back to your benefactor, Dr Odili to apologise for how your administration humiliated him. As a large-hearted person, he forgave you, and that began a wonderful relationship till date. Why am l making references to these incidents? If Dr Odili could forgive you and took you back, why can you not also forgive your political offenders, including Fubara, particularly since God has been so good to you?
Anyone who has traversed Ada George Road, Port Harcourt and seen the humongous, palatial estate you reside in, that takes a substantial part of that road, would know that you are not lacking materially. Coupled with that, you are a Minister in the current government and your wonderful wife is a judge. What else does any human being want?
My brother, please calm down, and let go of your ego and learn from history. Who would have thought that a whole General Shehu Yar’Adua (rtd) could die like a chicken inside prison; who would have imagined that a whole Bashorun MKO Abiola, the then richest man in Africa could spend five years in detention and die in custody, despite his international connections; who would have imagined that Major Hamza Al-Mustapher, the de facto Head of State during the junta of General Sanni Abacha, a man even Generals genuflected for, would spend 14 years in prison? Please, pause and think. This life is ephemeral. As the book of Ecclesiastes 1 states: life is vanity.
In Oyo State, there used to be the strong man of Ibadan politics, Lamidi Adedibu but his house in Molete, Ibadan is now desolate after his death. Adedibu was law as far as Ibadan politics was concerned. He was feared by all political actors across the nation. Before him, there was Busari Adelakun, otherwise known as “Eruobodo” in Ibadan politics. They have all been consigned to the dustbin of history. Learn from these because whether you like it or not, you would also pass away one day like all mortals.
God has been so good to you. Though I do not have the details of your feud with Fubara, you claim he is an ingrate, but this same “ingrate” took bullets for you as your Accountant-General when the EFCC was investigating your government. If you did not have confidence in him, you would not have put him forward to succeed you. Please, rise above political offences and be a leader. May it not be counted against you that since 1999, your successor would be the first governor of Rivers State to be impeached. No garland for such feat. It would be a pyrrhic victory and your new political masters in Abuja would even be wary of you. You are new to Bola Tinubu’s school of politics. Do not get carried away.
May God guide you right.
By: Richard Akinnola
Speaker of the House of Representatives, Rep. Tajudeen Abbas, has recommended the privatisation of oil refineries in the country to enable them function optimally.
Abbas gave the recommendation yesterday, while receiving the management of NNPCL led by the Group Managing Director, (GMD), Mr Mele Kyari in Abuja.
He described the state of refineries over the years as shameful, adding so much money was being spent on workers as salaries and allowances for doing very little.
“There is need to make these refineries have multi -dimensional uses, if there is no crude oil, are there other activities that can make the workers to be active so that why they earn is deserved? I need you and your management to look at how we can turn around these decades of losses.
“One way to do so is to find a way to privatise these refineries; we have spent so much money and time deceiving ourselves that some businesses can be run by government.
“In the case of the refineries, we have now realised that some sectors of NNPC business can only be handled by the private sector and our refineries are one of those.
“The inadequacies will become manifest as soon as Dangote refinery comes on board because the competition will be there and inefficiencies of the refineries will become more naked.
“I want you to put it as part of your cardinal objectives; let us find ways to privatise our refineries so that they can be active ,so that in the near future, they will be able to compete with new refineries that will come up,” he said.
Abbas said that the NNPCL is central to the economic development of Nigeria, pledging the commitment of the House of Representatives to supporting the company to succeed.
According to him ,the House is concerned about the high rate of oil theft as it is draining revenue, affecting forex availability and causing inflation in the country.
The speaker said that the House had inaugurated a special committee on oil theft,to interface with stakeholders with a view to addressing oil theft in the country.
Earlier, Kyari said that all refineries would become fully operational and Nigeria would become a net exporter of petroleum products by the end of 2024.
He noted that subsidy was responsible for poor activities at government-owned refineries over the years ,saying that the removal of subsidy was already attracting a lot of private sector investments.
“I can confirm to you that by the end of December latest, we will start the Port Harcourt Refinery; early in the first quarter of 2024, we will start the Warri Refinery and by the end of 2024, Kaduna Refinery will come into operation.
“This is the commitment we are giving today and you can hold us accountable on this.
”In 2024, many initiatives, including the rehabilitation of our refineries, and also the efforts of small- scale refiners, and the coming of the Dangote Refinery, will make Nigeria a net exporter of petroleum products.
“We will no longer be talking about fuel importation by the end 2024, I am very optimistic that this will crystalise,” he said.
Kyari said that it was not the practice of the company to publish its financial statements some years back , but that the practice had changed, and all the company’s accounts from 2018 till date were now in the public space.
Kyari put the expected government revenue from the company by the end of 2023 at N4.5 trillion, saying that NNPCL was returning value to shareholders in line with the objectives of the Petroleum Industry Act.
Kyari said that the company had a robust supply plan assuring that there would be no shortage of fuel over the Christmas season and beyond ,and that no one could hold the country to ransom.
The Federation Account Allocation Committee says it shared N906.96billionn among the three tiers of government for October 2023.
FAAC disclosed this in a communiqué issued at the end of its latest meeting on Wednesday.
According to a statement by the Director, Press and Public Relations, Ministry of Finance, Stephen Kilebi, on Wednesday, the total figure shared for October was a slight increase of N3.48billionn compared to the N903.48billionn shared in September 2023, recovering from a decrease recorded in the previous month.
The total amount included gross statutory revenue, Value Added Tax, Augmentations from Forex and Non-oil Mineral Revenue, and electronic money transfer levy, among others.
The communique disclosed that although a gross total of N1.35trillion was generated, only N906.955billion was shared to the three tiers of government as Federation Allocation for October 2023.
The total revenue distributed for October 2023, was drawn from Statutory Revenue of N305.070 billion, VAT of N323.446billion, EMTL of N15.552billionn, Exchange Difference of N202.887billionn and Augmentation of N60.000billionn, bringing the total distributable amount for the month to N906.955billion.
From the total revenue from Gross Statutory Revenue, Value Added Tax, Electronic Money Transfer Levy, Exchange Difference, and Augmentation of N60bn, the Federal Government received N323.355bn, the States received N307.717bn, the Local Government Councils got N225.209bn, while the Oil Producing States received N50.674bnas Derivation, (13% of Mineral Revenue).
The Communique stated that “the Federation Account Allocation Committee at the end of the meeting indicated that the Gross Revenue available from the Value Added Tax for October 2023, was N347.343bn, which was an increase from the N303.550bn distributed in the preceding month, increasing to N43.793bn.
“From that amount, the sum of N10.894 billion was allocated for Cost of Collection and the sum of N10.003 billion was given for Transfers, Intervention, and Refunds. The remaining sum of N323.446 billion was distributed to the three tiers of government of which the Federal Government got N48.517 billion, the States received N161.723 billion, and Local Government Councils got N113.206 billion.
“Accordingly, the Gross Statutory Revenue of N660.090 billion received in the month was lower than the sum of N1,014.953tn received in the previous month of September 2023 by N354.863bn. From that amount, the sum of N38.942bn was allocated for the Cost of Collection and a total sum of N316.078bn for Transfers, Intervention, and Refunds. The remaining balance of N305.070bn was distributed as follows to the three tiers of government: Federal Government was allocated the sum of N147.574bn, States got N74.852bn, LGCs got N57.707bn, and Oil Derivation (13% Mineral Revenue) got N24.937bn.
“Also, the sum of N16.199bn from the Electronic Money Transfer Levy was distributed to the three tiers of government as follows: the Federal Government received N2.333bn, States got N7.776bn, Local Government Councils received N5.443bn and N0.647bn allocated for Cost of Collection.
“The Communique disclosed N262.887bn from Exchange Difference, which was shared as follows: Federal Government received N93.323bn, the States got N47.334bn, the sum of N36.493 billion allocated to Local Government Councils, and N25.737bn given to Derivation (13% of Mineral Revenue) while the sum of N60.000bn was for Transfers, Intervention and Refunds.
“It disclosed that N60.000bn Augmentation was shared as follows: the Federal Government got N31.608bn, the States received N16.032bn, while LGCs got the sum of N12.360bn.”
Also, the balance in the Excess Crude Account stayed at $473,754.57 as of November 22, 2023.
FAAC revealed that N50.674bn was given for the cost of collection, and N386.081bn was allocated for Transfers Intervention and Refunds.
Petroleum Profit Tax, Import Duty, VAT, Customs External tariff, and EMTL increased significantly.
However, Excise Duties, Oil and Gas Royalties, and Companies Income Tax recorded a decrease.
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