… Access To Quality Care Reduces Maternal Mortality – WHO
Governor Babajide Sanwo-Olu
A passionate appeal has gone to Governor Babajide Sanwo-Olu of Lagos State to reinstate the suspended STOP Guidelines in order to save lives of our girls and women.
Research has shown that many lives have been lost in the last four years of this unwarranted suspension.
The STOP (Safe Termination of Pregnancy) Guidelines that some people misunderstood are mere legal-medical protocols established to standardize procedures and reduce maternal mortality from unsafe abortions.
The impacts of restrictive abortion have been quite disheartening. And the STOP Guidelines are simply out to shed more lights on how to handle cases having co-morbidity with other health complications among others.
The suspension of the guidelines is pure political, showing that our leaders are failing women and only paying lipservice to girls and women’s health.
Let’s imagine an example of a pregnant woman with co-morbidity of breast and cervical cancers. Definitely, such indicators might deserve a safe termination of such pregnancy by a qualified medical personnel and one can only imagine the outcome of not having access to such care due to the suspension of this life-saving guidelines.
People regard Lagos State as pacesetter in every good things, it is therefore surprising to have the state suspending such great working document when other states are adopting the guidelines.
Speaking to our Correspondent on why Lagos is suspending the Guidelines, many stakeholders, women, girls and men too, were of the opinion that the reasons are both religious and political which are nothing compared to human lives.
Many are even saying that maybe our amiable governor is not aware of the details of the STOP Guidelines. And some people are saying how could that be when our caring first lady is a medical doctor herself. Head or tail, it’s high time Lagos State lift the suspension because our girls, women’s lives matter.
The essence of the STOP Guidelines is to guide our doctors and since the document has been suspended, there’s no reference points for our doctors to deal with such cases, thereby making people to patronize quacks which will eventually lead to unsafe termination and death.
It’s all about knowing the legal & medical angles of safe termination of pregnancy thus, reducing maternal mortality. A recent case is that of a youth corper that died from unsafe abortion while many go unreported.
According to Dr. Maryam Olaide Jagun, the Executive Director, Centre for Bridging Health Gaps, CBHGaps,Lagos State started the great task of coming up with the guidelines and suspended it while other states are adopting the document to standardise care across board. “It is simply a medico-legal framework put together by different medical professionals and legal experts to serve as guide to our doctors. It’s all about bridging the gap between science and implementation.”
Dr. Jagun addressing journalists during the training in Lagos recently.
“In cases like Cancers, Cardiac Arrest disease, chronic kidney disease; we cannot allow such women to keep the foetus.”
The Lagos state government launched the Guidelines on Safe Termination of Pregnancy for legal indications, a landmark public health document designed to standardized how medical professionals handle pregnancies that threatens a woman’s life. Barely a month after, Governor Sanwo-Olu ordered its suspension.
According to the Guttmacher Institute, an estimated 456,000 unsafe abortions are performed in Nigeria annually. The WHO’s 2023 Trends in Maternal Mortality report reveals that Nigeria accounts for nearly 28.5 percent of all global maternal deaths. A Nigerian woman faces a 1-in-19 lifetime risk of dying during pregnancy, childbirth, or the postpartum period. compared to 1-in-4,900 in most developed countries.
“What the guideline did was to bring law and medicine together. I call it a medical-legal marriage.” Dr. Jagun explained. She was one of the principal architects of the STOP Guidelines and has continued to advocate for its reinstatement.
“The legal framework is already existing. Nobody can change the law. The document’s seven chapters covered the legal framework, medical indications, methods, post-abortion care, monitoring and evaluation, a comprehensive clinical roadmap that had been absent from Lagos healthcare for decades.”
“Doctors are left feeling less protected. Medical professionals operate in a fog of legal uncertainty. A woman with chronic kidney failure whose organs are failing, can her doctor intervene? A cardiac patient whose pregnancy is driving her heart toward collapse? A teenager who was raped and is now twelve weeks pregnant? In each case, the law as written in Nigeria’s Criminal Code (Sections 228 to 230) and the Penal Code (Sections 232 to 234) permits termination to preserve the mother’s life. But it does not spell out how, or by whom, or under what clinical conditions. The STOP guideline was built precisely to close that gap. Its suspension reopened the gaps and lapses.” Dr. Jagun shed more light on the issues.
The Nigerian Constitution, under Section 33, guarantees every person the right to life. Between a foetus and our girls and women, whose lives should be more important if I may ask?
The Maputo Protocol obliges member states to permit medical abortion in cases of rape, incest, threats to mental or physical health, and severe fetal anomaly. Nigeria ratified the Protocol in 2005 and Lagos’s STOP Guidelines was a practical step toward honouring that obligation. The state’s decision to suspend it is not in good taste at all.
Cross section of participants during the training organised by CBHGaps.
In his remarks, Mr. Akin Jimoh, the Programme Director, Development Communications Network, stated that there’s misinformation all over social media because many people do not really understanding what the issues are.
“When the guideline was launched on June 29, 2022, it was almost immediately mischaracterised, by religious groups, social media commentators, and some media outlets, as a state endorsement of abortion on demand. On July 7, Governor Sanwo-Olu ordered the suspension, citing the need for “adequate deliberation” and “stakeholder engagement.” The Commissioner for Health, Prof. Akin Abayomi, issued a retraction, promising the guidelines would not be implemented until the executive council had deliberated and public sensitisation had taken place.”
Four years after, no form of any deliberation nor public awareness was done while innocent souls are dying. Girls and women who cannot access care at certified health facilities end up patronising quacks, with its attendant repercussions.
Globally, unsafe abortion causes approximately 23,000 deaths per year, accounting for around 8 percent of all maternal deaths worldwide. In West and Central Africa, approximately 1 in every 200 abortions results in the woman dying. Safe abortions, by contrast, have mortality rates below 1 per 100,000 procedures.
This is to tell us the importance and ripple effects of having access to quality care.
Some of the medical indications outlined by Dr Jagun that the STOP Guidelines would have addressed in clinical details includes: cancer requiring chemotherapy or radiotherapy, cardiac failure, chronic kidney disease, severe hypertension with convulsions, ectopic pregnancies. “If someone has a chronic kidney failure and the organs are going, and the person may die, will you tell the person to keep the pregnancy?”
There are several such conditions where continuation of the pregnancy may lead to death. Are we then saying that women’s lives don’t matter again?
In some quarters, they have the feelings that the guidelines will be abused. “Will you say because someone is going to abuse malaria drugs, people with malaria should not benefit?” Dr Jagun asked. “If there is abuse, Police should do their job. Nobody should hold our hands in the discharge of our clinical duties.”
Speaking further, Mr Akin Jimoh urged the state government to remember the implications of the suspension. “These are women who are up to, if not more than 50% of the population of Nigerian voters. These are women who provide for us. These are our mothers. The Yoruba will say that we should hear the voice of the mother and the baby. But a number of times, we hear the voice of the baby, and we don’t hear the voice of the mother.”
Media professionals were trained on the legal framework, the constitutional provisions, the Maputo Protocol, the criminal and penal codes, and the clinical indications that may warrant safe termination of pregnancy.
It’s now very clear that this is simply a medical-legal document developed by combined efforts of legal scholars, gynaecologists, oncologists, cardiologists, nephrologists, and psychiatrists among others for the use of health workers.
As a role model state, the best parting gift from Governor Sanwo-Olu is to show that our girls and women’s lives matter by lifting the suspension. ‐‐———————————————‐—–
Group photograph of participants and facilitators after the training.