How COVID-19 Upset Family Planning Services, Threatened Women’s Lives

  • The deadly combination of a rigid lockdown, health workers’ industrial actions, and economic hardship occasioned by the pandemic led to a wave of unwanted pregnancies and unsafe abortions across Nigeria.

Omolara* had an unsafe abortion this year and it nearly killed her. Since she gave birth to her first child last year, she has been faithfully receiving contraceptive injections every three months. After a lengthy conversation with her husband, they had agreed child spacing was in the family’s best interests and that the injection was their preferred method.

But they were not expecting the outbreak of a new coronavirus, let alone that it would affect billions of lives, including theirs, in unimaginable ways.

Nigeria’s first case of COVID-19, an infectious disease that broke out in December 2019, was announced on February 27. A month later, the federal government imposed restrictions on movement in Abuja, Lagos and Ogun states, and this was soon adopted by other state governments.

The government of Ondo State, where Omolara lives, imposed a 12-hour curfew from April 14, with the only exceptions being the sale and purchase of food as well as emergency medical needs.

The streets became deserted. Businesses were shut down. And Omolara, who before was apprenticed at a tailoring shop, was stuck at home with her husband. As she could not visit the State Specialist Hospital in Akure for her dose of contraceptives, which was due for renewal by mid-March, she soon became pregnant.

It was way too soon, she thought, especially not in her financial circumstances, worsened by the COVID-19 pandemic. And especially not only about a year since her last childbirth. Scared, she started seeking ways “to flush it out”. She visited a neighbourhood chemist and explained her predicament. They recommended some drugs, which she said ultimately worked.

But along the line, the bleeding became overwhelming. It was so excessive she had to exhaust one pack of Virony sanitary pads within three days. She had no idea what to do, so she returned to the drugstore and bought a set of painkillers. Omolara passed outㅡand she is still not sure for how long.

“By the time I opened my eyes, I had been admitted at a private hospital,” the 30-year-old nursing mother recalls.

She was released after two days of regaining consciousness but not before coughing out N100,000. Having lost their sources of livelihood to the pandemic, Omolara and her husband had to borrow from families and friends to raise the hospital bill, and they are still not done paying back the loans. She is even more agitated because she would have paid about a quarter of that amount were it a state-owned health facility.

Health experts have observed an increase in unintended pregnancies and unsafe abortions during the lockdown. Dr Omolaso Omosehin, head of the Lagos Liaison Office, United Nations Population Fund (UNFPA), in July, blamed this on the delay in the distribution of family planning commodities during the period.

Recognising how the pandemic could spell danger for maternal health, the World Health Organization (WHO) cautions that access to contraceptive services remains essential during the outbreak.

“Contraception and family planning information and services are life-saving and important at all times,” the organisation says on its website. It explained that by preventing the negative consequences of unwanted pregnancies, unsafe abortion, and sexually transmitted infections, contraception could help reduce the pressure on already-overworked health systems.

But, in Nigeria, many women of reproductive age had difficulty gaining access to family planning services, especially during the peak period. Asides the government-imposed restriction on movements and the general fear of contracting COVID-19, the situation was further complicated by a series of strikes.

About 150 resident doctors at the Ondo State University of Medical Sciences Teaching Hospital (UNIMEDTH) had in January embarked on an indefinite strike over multiple months of salary arrears. Again, on June 23, the National Association of Government General Medical and Dental Practitioners in the state declared a strike over salary deductions and the special COVID-19 hazard allowance.

One industrial action by the National Association of Resident Doctors (NARD), in June, crippled operations at major facilities, including UNIMEDTH in Ondo town and Akure, the Federal Medical Centre in Owo, as well as General Hospitals in Ikare Akoko and Okitipupa.

Dolapo,* 26, a resident of Akure, had also started using the contraceptive injection of 13 weeks before the COVID-19 outbreak. She should have renewed in April but could not. Two months later, she discovered she had become pregnant. The couple, just a year and a half into their marriage, decided they could not keep the baby. So, Dolapo’s husband called a friend who took her to see a quack doctor.

“When the lockdown started, we were both asked to stay at home without pay. If we had some money, maybe we would even have gone to a private health facility to get the injectable contraceptive. But there was nothing,” she laments.

The abortion was conducted without complication but not everyone who attempted it was as lucky. This is because not only could women not benefit from contraceptive services, but the strike by health workers meant they could also not access post-abortion care at public health facilities.

According to Nigeria’s criminal and penal codes, any woman who tries to procure her own miscarriage or anyone who assists her is guilty of a felony and can be jailed. The courts have ruled that abortion is only legal if it is required to save the woman’s life. As a result, two to three million women resort to unsafe abortions every year. But it is highly dangerous.

WHO estimates that between 4.7 and 13.2 per cent of maternal deaths are as a result of unsafe abortion. In Nigeria, about 212,000 women were treated for complications arising from induced abortion in 2012. Some of the common complications include heavy bleeding, incomplete evacuation of the foetus, infection, uterine perforation, and damage to internal organs.

“Mentally too, it affects them,” suggests Lagos-based maternal health expert and nursing officer, Adebayo Olajumoke.

“There is a lot of guilt associated with abortion, especially when it is unsafe. There is a lot of trauma attached to it. This is also because the quacks don’t show a lot of empathy in providing the service to them.”


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