In a move that played out at the United Nations General Assembly in September, US Department of Health and Human Services Secretary Alex Azar announced that the United States and 18 other states, including Saudi Arabia, Hungary, Iraq, Mali, the Democratic Republic of the Congo, and Yemen jointly condemned policies that promoted sexual and reproductive rights of women in the UN’s newly adopted Universal Health Coverage Political Declaration.
A joint statement read, in part, “We do not support references to ambiguous terms and expressions, such as sexual and reproductive health and rights in U.N. documents, because they can undermine the critical role of the family and promote practices, like abortion, in circumstances that do not enjoy international consensus and which can be misinterpreted by U.N. agencies.”
Universal health coverage is a global plan backed by the World Health Organization to ensure affordable primary health care in UN member states. Reproductive health is a key indicator for measuring coverage progress. But the United States is dragging its feet on supporting the declaration, complaining about terms because UHC doesn’t exactly suit its agenda.
Not only does the Trump administration promote antiabortion policies within its own borders, but in 2017 it also exercised its option to institute the “Global Gag Rule,” which restricts agencies and initiatives from accessing US funds that could be used to provide or share critical information about abortions. This is especially devastating to communities in the developing world.
Nigeria has been particularly hard hit. It is perhaps why President Muhammadu Buhari’s government felt compelled to align with the US faction. And while it is hard not to focus on the irony of the world’s biggest democracy forming alliances with weaker states to restrict women’s physical, economic, and social autonomy, a more alarming issue is that of Nigeria being economically forced into an alliance.
As Africa’s most populous country, Nigeria needs to rethink its strategies on reproductive rights as a matter of national urgency. Nigeria’s population is growing at 3.2 percent every year, alarming, considering the economic growth is stagnating in comparison. Scarcity is already forcing people to leave the country in droves with their eyes on America, Canada, and Europe. Family planning advocacy efforts are ongoing but have not been a great success. Contraceptive use is so low among women, that Nigeria’s main objective in partnership with Family Planning 2020, an initiative launched seven years ago to increase contraceptive use 27 percent by next year. The current rate is still at 14.2 percent.
But while contraceptive use is low, the abortion numbers are surprisingly high. Abortion is largely illegal in Nigeria and carries a prison sentence of seven years for women and 14 years for providers. It’s a cultural and religious taboo that amounts to social suicide if one is found out. Yet despite the conservative stance, abortions remain common because of high rates of unintended pregnancies. An estimated 1.25 million pregnancies ended in induced abortions in 2012.
Marie Stopes Nigeria, a nongovernmental agency that promotes reproductive health services in 37 countries, says it prevented more than 700,000 unsafe abortions in 2018 alone in Nigeria, presumably by providing post-abortion services. Abortion is legal in Nigeria when the woman’s life is in danger, providing NGOs like Marie Stopes some leeway to operate in this highly conservative society. But Marie Stopes refused to sign the global gag rule, a move that has cost it critical US aid.
The mere presence of Marie Stopes in the country provokes debates around abortion restrictions. Many are strongly opposed to it on sociocultural and religious grounds. In some cultures, families are expected to be large, as a sign of prosperity, and, in rural communities, more children means more hands to farm the land. Abortions remain contentious under Islam and Christianity, both major religions in Nigeria.
A petition signed by nearly 3,000 people forced Marie Stopes’s Lagos offices to shut down in May. Police invaded the clinic, arrested an official, and, according to reports, harassed patients. Antiabortion groups allege that Marie Stopes kills preborn babies and should be banned in Nigeria. The only solutions to unwanted pregnancies, international antiabortion movement Citizen Go Africa says, should be “proper sex education, advocating for chastity, encouraging adoptions, and creating more crisis pregnancy centres.”
That argument assumes that family planning and chastity can prevent sexual abuse and rape. An estimated 2 million Nigerian girls are sexually abused annually. Many of these attacks result in unwanted pregnancies. But the restrictions on abortions push women and girls to dangerous situations. Unsafe abortions weigh heavily on the country’s maternal health care system and contribute to one of the highest maternal mortality rates in the world, at 800 per 100,000 live births compared with 12 per 100,000 live births in developed nations like the United States.
High fertility rates of 5.5 births per woman complicate the situation. The Nigerian government is working to create awareness of free contraceptives, but the results are dismal. Contraceptives use remain low, partly due to patriarchal cultures and low literacy levels: There are misconceptions that contraceptives lead to permanent infertility.
While the population is pushing 200 million, Nigeria is estimated to overtake the United States by 2050. If the country continues to grow at its present rate, 1 billion people will live on land half the size of Alaska by 2021. The forecast spells disaster. The economy cannot support these numbers since more people already live in extreme poverty here than in any other country.
The timing of the UHC adoption provides the perfect opportunity for Buhari’s government to facilitate women-led conversations around reproductive health care. It is time for Africa as a whole to look inward and ask why 93 percent of our women live in countries where safe abortions are restricted. Countries like Zambia, South Africa, Tunisia, and Cape Verde have removed restrictions and also have relatively low maternal mortality rates, with Zambia’s declining year-to-year. Denying women the right to safe abortions pushes many to their deaths. Despite the cost of ignoring the Global Gag Rule, it is arguably more costly for Buhari to stand with the United States and ignore the evidence that Nigerian women will continue to opt for abortion, risk their lives, risk jail terms, and earn societal ostracization.
It is commendable that the Nigerian government has stepped up since US funds were reduced. The government has increased funding to local UNFPA, for example. It’s the way to go: Homegrown solutions are the only sustainable responses to Nigerian population and reproductive health issues. But there is more work to be done. “Nigeria is a middle-income country, and we are hoping that as the economy improves, the government will pick and will eventually fully take over contraceptive procurement,” Dr. Eugene Kongnyuy, UNFPA resident representative told Devex, a development publication, earlier this year.
But there is more work to be done, including appointing more women to leadership roles to ensure representation. Only 27 of 469 Nigerian parliamentarians are women. It may be too much to ask for outright removal of the abortion ban, but surely it is not too much to provide spaces for discussions on women’s reproductive health — discussions that must involve women.
By 2023, when countries report back on UHC, Nigeria should be clear on why Nigerian women opt for abortions, and we should be working toward providing policies and infrastructure to that effect. We should focus on dispelling cultural myths around family planning to make it more accessible. We should educate men — without whom no pregnancy would happen — about sexual and reproductive issues and strengthen legal systems that will prosecute sexual offenses effectively. And we should be clear with the United States and the other 18 UN nations that objected to the UHC, that Nigeria will not compromise when it comes to our women and our girls. In 2020, women deserve that and more.
Shola Lawal is the 2019 Elizabeth Neuffer Fellow at the International Women’s Media Foundation and a research fellow at MIT’s Center for International Studies.