Outcome of an intervention to improve the quality of private sector provision of postabortion care in northern Nigeria.

The outcomes of an intervention aimed at improving the quality of postabortion care provided by private medical practitioners in 8 states in northern Nigeria are reported. A total of 458 private medical doctors and 839 nurses and midwives were trained to offer high-quality postabortion care, postabortion family planning, and integrated sexually transmitted infection/HIV care. Results showed that among the 17009 women treated over 10 years, there was not a single case of maternal death. In a detailed analysis of 2559 women treated during a 15-month period after the intervention was established, only 33 women experienced mild complications, while none suffered major complications of abortion care. At the same time, there was a reduction in treatment cost and a doubling of the contraceptive uptake by the women. Building the capacity of private medical providers can reduce maternal morbidity and mortality associated with induced abortion in northern Nigeria.

A survey of attitudes and practices of reproductive health and family planning services among private medical practitioners in four states of the Niger-Delta region of Nigeria.

BACKGROUND: Abortion is widespread in the Niger-Delta region of Nigeria, with resulting high rates of morbidity and mortality. It is thought that the private sector provides the majority of abortion services in Nigeria as a result of the restrictive abortion law in the country. The oil-rich Niger-Delta region accounts for 90% of the country's resource, is economically active and has increased opportunities for sexual networking. METHOD: This study assays the attitudes of staff at family planning (FP) services and practices of reproductive health and FP services among private practitioners in four states of Niger-Delta of Nigeria (the states of Edo, Delta, Bayelsa and Rivers). RESULTS: Women who had unwanted pregnancies were attended by 119 (87.5%) respondents. However, only 33 (24.0%) provided services for termination of pregnancy. Indeed, just over half (72; 53.4%) counselled women to continue the pregnancy while fewer (35; 25.9%) referred women to other clinics. However, there was no evidence to suggest that doctors followed up on those women counselled to continue their pregnancies. Most private sector service providers of abortion services in Nigeria (69.7%) are non-specialist doctors. CONCLUSION: Education of private practitioners in the principles of abortion, post-abortion care and FP is recommended to alleviate abortion-related morbidity and mortality in Nigeria.

Private medical providers' knowledge and practices concerning medical abortion in Nigeria.

To investigate the knowledge and practices regarding medical abortion and postabortion care in northern Nigeria among private physicians--the principal providers of such services in the area--122 doctors operating separate clinics in five states--Bauchi, Borno, Kaduna, Niger, and Taraba--were interviewed by means of a structured questionnaire. The results showed that 22 percent of the doctors reported that they terminate unwanted pregnancies, whereas nearly all reported that they manage complications of unsafe abortion. Manual vacuum aspiration and dilatation and curettage performed singly or in combination were the most common methods of abortion and postabortion care reported by the doctors. Only one doctor reported exclusive use of medical abortion in the first trimester, and three reported its exclusive use in the second trimester. Only 35 percent of the doctors listed misoprostol as a drug that they knew could be used for abortion and postabortion care, and only 12 percent listed mifepristone. By contrast, 49 percent listed inappropriate or dangerous drugs for use in abortion provision in the first and second trimesters of pregnancy. We conclude that private practitioners in northern Nigeria have limited knowledge of medical abortion and postabortion care, and that a capacity-building program on the subject should be instituted for them.

Perceptions of policymakers in Nigeria toward unsafe abortion and maternal mortality.

CONTEXT: In Nigeria, abortion is permitted only to save the life of a woman. Unsafe abortion is common and is a major cause of maternal mortality, yet policymakers have done little to address the problem. METHODS: In-depth interviews were conducted in 2008 with 49 Nigerian politicians and officials to assess their awareness of unsafe abortion and its role in maternal mortality, and to determine their perceptions of the policies and actions needed to address these problems. RESULTS: Participants had poor knowledge of Nigeria's abortion law and the number of abortions and abortion-related deaths, though many knew of women who had died or nearly died from unsafe abortion. Policymakers were guided by moral and religious considerations rather than by evidence-based approaches. About one-third of informants felt that abortion should not be legal under any circumstances, one-fifth supported liberalization on medical grounds and a similar proportion believed that abortion should be legal in cases of rape and incest. Strategies recommended by respondents to reduce maternal mortality included facilitating access to contraceptives, providing sexuality education, improving the health care system, empowering women and providing free pregnancy care. CONCLUSIONS: Intense public health education and advocacy targeting policymakers is needed to increase political will for reducing abortion-related maternal deaths in Nigeria. Presenting statistics on unsafe abortion together with compelling personal stories will likely resonate with policymakers and contribute to an informed public debate on abortion law reform.