By Kingsley Kalu Samuel, AWA Initiative
Nigeria stands at a critical crossroads in its fight to safeguard the lives and futures of its women. Despite recent strides made by government initiatives and international partnerships, like the World Bank’s $570 million primary healthcare project aimed at reducing maternal and child mortality, the country remains haunted by a hidden crisis: unsafe abortion. In Nigeria, where one in every 13 women is at risk of dying from complications related to pregnancy and childbirth, unsafe abortion practices are not only a deeply personal tragedy but also a public health emergency that exposes systemic failures.
Imagine being forced to undergo a procedure in secrecy, away from safe, regulated medical care; and this is the lived reality for countless Nigerian women and girls. While many celebrate the improvements in primary healthcare services, the silent epidemic of unsafe abortion continues to claim lives, leaving behind scars, both physical and emotional. As an advocate for comprehensive reproductive healthcare,
I believe that the restrictive legal framework and social stigma surrounding abortion are fueling a crisis that is as preventable as it is tragic. Unsafe abortion is a critical driver of Nigeria’s maternal mortality crisis, and only by reforming both our healthcare infrastructure and our repressive and restrictive legal environment can we hope to save lives, uphold women’s rights, and empower every Nigerian woman to live with dignity and security.
We must acknowledge that while abortion itself is not inherently dangerous, the conditions under which it is performed when forced underground by Draconian laws and pervasive social stigma are deadly. Making it very necessary for us to examine the facts, understand the context, place ourselves in a woman’s shoes, and work together toward a future where no woman is forced to choose between her life and unwanted pregnancy.
Nigeria’s Maternal Health: A Tale Of Two Realities
Nigeria’s maternal health landscape is complex, marked by significant progress in some areas and deep-rooted challenges in others. Over the past decade, massive investments have improved primary healthcare, upgrading facilities, increased skilled birth attendants, and better access to critical services like antenatal care and family planning. These interventions have undeniably contributed to higher rates of safe deliveries in urban centers and among populations with relatively better access to resources.
Yet, while some Nigerian communities are beginning to reap the benefits of these initiatives, a disturbing reality persists: maternal mortality remains stubbornly high. The country continues to contribute disproportionately to global maternal deaths. Many regions, particularly in rural and conflict-affected areas, are left with underfunded health systems, staffing shortages, and dilapidated infrastructure that cannot meet the needs of vulnerable women. In these settings, the promise of improved maternal health is often shattered by delays in accessing care and by the sheer cost of medical services.
Socio-economic disparities further exacerbate the situation. Women from lower-income households or those with limited educational opportunities are often the last to benefit from national improvements. The harsh truth is that for many Nigerian women, the quality of maternal health services is determined by where they live, how much they earn, and what information they have about their bodies and their rights. Even when new facilities are built, if they are not accessible or affordable, the gap in care persists.
An equally troubling dimension of this crisis is the hidden epidemic of unsafe abortion, a practice driven by economic constraints, cultural taboos, and, above all, a repressive legal framework. While government initiatives have improved aspects of maternal care, the stigma attached to abortion means that many women resort to clandestine procedures performed in unregulated settings. Data from studies indicate that unsafe abortion is a leading contributor to maternal mortality in Nigeria, especially among young women aged 15 to 24. For these young women, the intersection of poverty, limited reproductive education, and cultural condemnation leaves them with few safe alternatives when facing an unwanted pregnancy.
Nigeria’s Hidden Nightmare
Now, let’s talk about the elephant in the room: unsafe abortion. This is not a topic easily broached in polite conversation, but it cannot be ignored if we are to address Nigeria’s maternal health crisis. Unsafe abortion is defined by the World Health Organization (WHO) as the termination of an unwanted pregnancy carried out by individuals lacking the necessary skills or in an environment that does not meet minimal medical standards. In Nigeria, this definition is all too real.
For countless women, particularly those aged 15–24, the choice to terminate a pregnancy is not made lightly. According to a documentary produced by A Well-Informed Adolescents Initiative (AWA Initiative), these women are left with very few alternatives, especially when they have to contend with economic hardships, lack of education about sexual and reproductive health, and pervasive cultural taboos. When safe, legal abortion services are not available, many women are forced to seek help from unqualified providers operating in clandestine conditions. The consequences are dire—ranging from severe infections and hemorrhage to long-term disabilities and, tragically, death. Research and studies based on demographic surveys have consistently shown that unsafe abortion is one of the primary drivers of Nigeria’s high maternal mortality rate.
But why does unsafe abortion persist? A beautiful question, but the answer will leave you cracking your head. However, the reasons are multifaceted. First, there are socio-economic factors: many Nigerian women, especially those in impoverished rural areas, cannot afford or access comprehensive reproductive healthcare services. They often live in communities where family planning resources are scarce, and discussions about reproductive health are shrouded in silence and stigma. When an unwanted pregnancy occurs, the absence of affordable contraceptives and safe abortion options leaves them with a grim choice. You guessed it.
Second, cultural and social norms play a massive role. In Nigeria, abortion is not just seen as a medical procedure—it is a moral and social taboo. The stigma attached to abortion forces women into secrecy, making it nearly impossible for them to seek out safe services even when available. Stories abound of women suffering in silence, undergoing dangerous procedures behind closed doors, and even losing their lives as a result. In interviews and artistic performances, such as the theatrical production “M/Other,” women have openly discussed the mental and physical toll that unsafe abortion takes on their lives. Yet, these stories are too often dismissed or hidden.
Third, and perhaps most damningly, is the restrictive legal environment in Nigeria. Abortion laws are among the most prohibitive in the world. With the legal framework criminalizing abortion except under the most narrowly defined circumstances, women are forced to navigate a perilous maze of clandestine procedures. This legal repression not only deters women from seeking safe abortion services but also discourages healthcare providers from offering them, even in cases where it might be medically necessary. The cumulative effect of these factors is a system where unsafe abortion remains a hidden but deadly crisis. A nightmare we can’t seem to wake from, a silent expression of broader inequities, and a glaring example of how policies and social norms can endanger lives. And with restricted access to a legal and safe option, these unsafe practices will continue to claim lives and exacerbate the country’s maternal mortality crisis.
Can Healthcare Be Criminalized?
When we examine the legal and policy framework surrounding abortion in Nigeria, the picture that emerges is one of draconian restrictions and outdated norms that have little regard for women’s health and autonomy. The laws in Nigeria are unvarnished: abortion is criminalized under the Criminal Code Act (applicable in Southern Nigeria) and the Penal Code Act (in Northern Nigeria). Both sets of laws impose harsh penalties on women and providers alike, leaving little room for exceptions even in cases where a woman’s life is at risk.
Under these laws, any attempt to terminate a pregnancy is considered a crime. In many instances, women who undergo abortion—even when it is medically necessary—risk being labeled as criminals, facing long prison sentences, and being ostracized by their communities. A recent editorial highlights that these legal provisions contribute significantly to the unsafe conditions under which abortions are performed. The legal language is cruel and uncompromising: a woman who procures her abortion is subject to severe punishment, regardless of her circumstances. So I ask again, can healthcare be criminalized? And what does it mean for our Nigerian women?
Simply, in a society where abortion is already shrouded in taboo and stigma, the criminalization of abortion creates a climate of fear. Women who might otherwise seek safe and professional medical care are forced into the shadows. Providers, too, are deterred from offering necessary services due to the risk of prosecution. As a result, safe abortion services are scarce, and when they do exist, they are often inaccessible to the majority of women who need them.
A critical analysis in the African Human Rights Law Journal argues that Nigeria’s restrictive legal framework not only violates women’s reproductive rights but also actively contributes to the high maternal mortality rate. The legal framework, shaped by conservative cultural and religious values, fails to account for the realities of women’s lives. It ignores the fact that restricting abortion does not reduce its incidence—it merely pushes the practice underground, where it becomes unsafe.
Also, the legal system in Nigeria offers little in the way of defense for women who seek abortion services. There are a few narrow exceptions—typically when the woman’s life is at risk—but these exceptions are rarely applied in practice. The lack of clear, supportive legal provisions leaves healthcare providers hesitant to offer safe abortion services, and women are left with no legal recourse. This cruel approach, let’s call it what it is, undermines public health efforts and perpetuates a cycle of injustice and vulnerability.
From a rights-based perspective, the current legal environment in Nigeria is deeply problematic. Women’s reproductive rights are human rights, and the inability to access safe abortion services is a violation of those rights. As advocates for gender equality and comprehensive healthcare, we must challenge the narrative that frames abortion as inherently immoral. Instead, we should recognize that safe abortion is a matter of life and death.
Imagine standing at the crossroads of life and death—where every decision could mean survival or tragedy. If I were in the shoes of a Nigerian woman facing an unwanted pregnancy under our current legal framework, I’d feel not only the physical weight of the situation but also an immense emotional burden. Every day would be a battle against fear, shame, and uncertainty—emotions that are intensified by laws that treat my most basic human right as a crime.
Reflecting on this, I realize that the current narrative frames abortion as inherently immoral, neglecting the profound reality that, for many, it is a desperate measure for survival. I would challenge this narrative not with judgment but with empathy. I would stand in solidarity with every woman who has been forced to hide her struggle, whose pain is magnified by silence and stigma.
Consider this: every time a woman is denied safe, legal abortion services, she is not just risking her health—she is risking her life. The cruel legal framework, combined with socio-economic barriers, means that many women, especially those from marginalized communities, have no choice but to resort to clandestine procedures. The irony is that while safe abortion practices exist and are medically sound, the law pushes them out of reach for the vast majority of women who need them.
The economic cost of this crisis is staggering as well. When women suffer complications from unsafe abortions, they often require expensive emergency medical care, prolonged hospital stays, and long-term rehabilitation. This not only places an enormous burden on the healthcare system but also on families and communities already struggling with poverty. Every maternal death or severe complication represents a preventable tragedy—a loss of potential, productivity, and hope.
Did you know that unsafe abortion has broader social ramifications? Women who experience complications from these practices often face stigmatization, isolation, and long-term psychological trauma. The intersection of unsafe abortion and maternal mortality is not just a healthcare issue—it is a public health issue that affects the very fabric of Nigerian society. It undermines the ability of women to participate fully in economic, social, and political life, and it perpetuates a cycle of gender-based inequality.
Data and reports underscore that the consequences of unsafe abortion extend far beyond the individual. They ripple out to affect families, communities, and the nation as a whole. When a mother dies or is left with debilitating complications, the loss is felt by her children, her family, and her community. In a country where maternal mortality is already among the highest in the world, every additional death is a stark reminder of the urgent need for change.
The link between unsafe abortion and maternal mortality is a damning indictment of the status quo. It forces us to ask: How many more lives must be lost before we accept that our current approach is not only outdated but also inhumane? The evidence is clear: restrictive abortion laws, socio-economic inequities, and cultural stigmas are driving a preventable crisis that claims thousands of lives each year. Until we address these root causes, unsafe abortion will remain a major contributor to Nigeria’s maternal mortality crisis.
Road To Comprehensive Healthcare Access
If we are to stem the tide of maternal deaths and ensure that every Nigerian woman can access safe reproductive healthcare, we must adopt a holistic approach that tackles the problem on multiple fronts. It is not enough to build new clinics or train more health workers—we must also reform the legal and policy environment that drives unsafe practices. Here are some concrete recommendations for moving forward:
1. Integrate Safe Abortion Services Into Maternal Healthcare
Safe abortion services should be an integral part of comprehensive maternal healthcare. This means ensuring that all women have access to high-quality, affordable, and safe abortion care as part of a broader spectrum of reproductive health services. The World Bank’s recent initiatives demonstrate that targeted investments can yield life-saving improvements.
2. Revisit Restrictive Abortion Laws
The legal framework in Nigeria must be revisited. Current laws criminalize abortion and force women into dangerous, clandestine procedures. Policymakers should consider adopting a more liberal legal framework that allows for safe, medically supervised abortions—especially in cases where a woman’s health is at risk. Legal reforms should draw on international best practices and be informed by evidence which outlines how a rights-based approach can protect women’s health and autonomy.
3. Expand Access To Family Planning And Reproductive Education
Preventing unwanted pregnancies is a critical step in reducing the demand for abortion. Comprehensive reproductive health education must be made available to both girls and boys from an early age, and family planning services should be expanded and made more accessible, particularly in underserved areas. Studies have shown that increased access to contraception reduces the incidence of unintended pregnancies and, by extension, the need for abortion. Educational initiatives should aim to dismantle the stigma surrounding reproductive health and empower women to make informed choices.
4. Address Socio-Economic And Cultural Barriers
It is essential to tackle the broader socio-economic and cultural barriers that contribute to unsafe abortion. This includes improving the overall economic conditions of marginalized communities, ensuring that healthcare services are affordable, and launching public awareness campaigns to challenge the taboos and stigmas associated with abortion. Community-based programs can play a key role in changing attitudes, as seen in innovative projects like the theatrical production “M/Other,” which uses art to shed light on maternal mental health and reproductive challenges, and AWA Initiatives If Na You, Wetin You Go Do Campaign, which uses innovative campaign strategies to create awareness on the dangers of unsafe abortion as well as the safe and legal option of abortion.
5. Strengthen Health System Infrastructure
While legal and policy reforms are very important, they must be complemented by robust investments in the healthcare system. This means upgrading health facilities, ensuring a reliable supply of essential medicines and equipment, and hiring and retaining skilled healthcare providers. The disparities in health outcomes between urban and rural areas underscore the need for targeted investments that ensure equitable access to quality care nationwide.
6. Engage Men and Boys In Reproductive Health Education
Changing societal attitudes requires the engagement of all community members, including men and boys. Educational programs that target boys can help to break down the gender stereotypes that stigmatize abortion and reproductive health issues. When boys understand and support the rights and health needs of women, they become powerful allies in the fight against unsafe abortion and maternal mortality.
Enough Is Enough
It is time for Nigerian society and the international community to acknowledge that the status quo is unacceptable. Every day, women are forced to navigate a labyrinth of unsafe practices, legal restrictions, and cultural taboos, all of which contribute to an epidemic of preventable maternal deaths. As we have seen, unsafe abortion is not a fringe issue; it is a core driver of Nigeria’s maternal mortality crisis, one that affects families, communities, and the entire nation.
I call upon policymakers, healthcare professionals, civil society organizations, and community leaders to champion comprehensive reproductive healthcare. We must demand legal reforms that free women from the shackles of archaic laws, invest in health infrastructure that reaches every corner of the country, and launch educational initiatives that empower young people with the knowledge and resources they need to make informed decisions about their bodies.
For too long, unsafe abortion has been hidden in the shadows—an issue wrapped in shame and silence. It is time to bring this hidden crisis into the light. Let us replace stigma with support, secrecy with open dialogue, and fear with empowerment. We owe it to every Nigerian woman and to our nation as a whole to ensure that no one is forced to choose between their life and an unwanted pregnancy.
Change will not come overnight, but every journey begins with a single step. Let this be that step. Whether you are a policymaker drafting new laws, a healthcare provider advocating for better services, or a community member challenging harmful stereotypes, your voice matters. Together, we can create a future where every woman has access to safe, comprehensive reproductive healthcare—a future where maternal mortality is reduced to a distant memory.
To all those who read this, I leave you with this: What if it were you? Imagine the weight of that choice—the fear, the isolation, the crushing burden of having to decide between your own life and an unsafe, very risky procedure simply because the system denies you safe, legal care.
It is time to break the silence, challenge the status quo, and demand change—period.
Kingsley Kalu (KK) Samuel is the Program Manager, Program Manager, A Well-Informed Adolescents (AWA) Initiative and can be reached via www.awainitiative.org or awainitiative@gmail.com.
NB: Opinions expressed in this paid article are strictly attributable to the author, K.K. Samuel, and as the author may deem fit for AWA Initiative, and do not represent the opinion of CrossRiverWatch.