Illegal induced abortion: a study of 74 cases in Ile-Ife, Nigeria

Abstract

Seventy-four women with complications of induced abortion were studied prospectively at the Obafemi Awolowo University, Nigeria. Twenty of the women were interviewed privately to elicit confidential information and also to determine their attitudes to contraception and to the Nigerian national abortion law. The results showed that abortion is prevalent in all classes of women and in married as well as unmarried women. There were 13 maternal deaths, accounting for 35% of the maternal mortality in the hospital during the period. Sepsis was the most common cause of death, and most of the abortions complicated by sepsis had been performed by medical practitioners. Interviews with the women revealed that most of them had knowledge of contraception but were unwilling to use it because of wrong information. Most women did not know that abortion is illegal in Nigeria, but felt that it should be. Measures that could be of value in reducing abortion-associated maternal mortality in Nigeria include training and retraining of physicians in the management of abortion and of abortion complications, family planning education of all fertile women, provision of confidential family planning services and liberalization of the abortion law.

PIP: All consecutive women admitted for complications of induced abortion at the Obafemi Awolowo University, Nigeria, from November 1988 through December 1989 were studied and interviewed. The interviews, conducted at the end of the stay by the staff member with most rapport with the women, asked about the abortion method, abortionist, cost patient's socioeconomic background, knowledge and practice of contraception, and knowledge and attitude toward the Nigerian abortion law. The 74 admissions accounted for 12% of all gynecological admissions. The patients ranged in age from 15 to 49, mean 22.8 years, and parity from 0 to 8, median O. 42% were ever married. 80% were Christians. The abortions were performed in 32% of cases by medical practitioners, 27% by non-medical persons, and 19% were self-induced. Self-induction methods included coat hangers, injections, ingestion of strong alcohol or tablets, instillation of native pessaries, potash, or gunpowder vaginally. Complications included sepsis (84%), hemorrhage (51%), uterine perforation (8%), cervical laceration (4%), septic shock (4%), perforation of gut or bladder, pelvic abscess, and psychosis. Treatment was broad spectrum antibiotics in all cases, evacuation of retained products in 76%, laparotomy in 7%, and hysterectomy in 2 cases. Hospital stay ranged from 1 to 60 days (mean 9.8). There were 13 maternal deaths (18%), or 35% of total maternal deaths in the hospital in this period. Sepsis was the cause of all deaths except one from hemorrhage. 54% of the fatal abortions were done by medical personnel, although none were obstetricians. In interviews of 20 subjects, it was learned that the majority of their abortionists were physicians, and costs ranged from $2 to 25 (US). All 20 women knew about effective contraception, but did not use it because they feared side effects, disliked the lack of privacy in clinics, and could not afford private providers. Only 4 knew that abortion is illegal in Nigeria, and only 2 thought it should be legalized, because they believed it is immoral. Contrary to common opinion, these women included married as well as single women, and the deaths were caused by physicians as well as lay abortionists.