HEALTH CHECK: Unsafe abortion and maternal mortality in Nigeria

That’s the headline of the Daily Trust article.

The World Health Organization defines maternal death as any death of a woman during pregnancy, childbirth or up to 42 days after birth. These deaths exclude accidents. 

“Unsafe abortion is a procedure of pregnancy termination either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards or both,” the WHO says.  

Salami told Africa Check that the Daily Trust quoted him correctly. He referred us to Nigeria’s national guidelines on safe termination of pregnancy for legal indications, published by the federal health ministry in 2018.

The guidelines say unsafe abortion “alone” accounts for “about 10 to 14 % of maternal morbidity and mortality in Nigeria”. Africa Check asked the ministry for the source of the statistic. We have not yet received a response.

Most recent estimate

Ann-Beth Moller, a technical officer in the WHO’s department of sexual and reproductive health, referred us to a 2020 journal article on unsafe abortions in Nigeria. 

“In Nigeria, various studies have quoted unsafe abortions to be responsible for up to 30% of overall maternal mortality,” the article reads. 

The study cited as the source of this statistic was conducted in 2013. It looked at the medical records of 102 patients admitted for complications from unsafe abortions over five years, in a rural part of south-west Nigeria. 

The researchers found that sepsis – a dangerous condition where the body's response to an infection damages its own tissue – accounted for almost 80% of the complications. 

“The case fatality rate was 16.6% and unsafe abortion accounted for 30.8% of all maternal mortality during the period,” the 2013 study reads. 

Africa Check spoke to Dr Oluwatosin Wuraola Akande, a public health physician and lead author of the 2020 article. She said she wasn’t aware of any recent studies that had found 11% of pregnancy-related deaths in Nigeria were caused by unsafe abortions. 

Without recent, publicly available and nationally representative data to support it, we rate the claim as unproven.

For this claim, Salami directed us to the 2013 Nigeria demographic and health survey. He also said it was more accurately 576 maternal deaths per 100,000 live births.

The survey is conducted every five years– most recently, in 2018. “Maternal mortality continues to be a serious problem in Nigeria,” the 2018 survey notes.  

For the survey, 106,590 women aged 15 to 49 who had sisters were interviewed across the country from August to December 2018. They were asked if any of their sisters aged 12 or above had died, and if the death had been pregnancy-related. 

The study estimated maternal mortality at 512 deaths for every 100,000 live births in the seven years before the survey. 

This means that for every 1,000 live births in Nigeria in that time, about five women died during pregnancy, during childbirth or within two months after the birth.

“I was referencing Nigeria and extrapolating the maternal mortality rate for people to appreciate the magnitude of the deaths,” Salami told us. He added that he was “saying that at the minimum, about 200 women die every day”.

The WHO’s Moller referred us to the Maternal Mortality: Levels and Trends report for 2000 to 2017. It is published by the WHO, Unicef, the United Nations Population Fund, the World Bank and the United Nations.

The report’s country estimates are based on several sources, including civil registration and vital statistics systems, population-based household surveys and specialised studies on maternal mortality.

According to the report, Nigeria had 67,000 maternal deaths in 2017. This suggests there are  184 pregnancy-related deaths every day. 

The report said Nigeria accounted for 23% of global maternal deaths in 2017. This was the highest of any country