Dr E.A Ogunsola & Mrs Atolagbe R.E
Background
Maternal mortality remains unacceptably high, and unsafe abortion is widely recognised as a preventable contributor. The state government of Ogun has affirmed that the Safe Termination of Pregnancy (SToP) Guidelines will be implemented to ensure access to medically-supervised and legally-permitted abortion services to reduce maternal deaths. CSOs e.g Gender Development Initiative (GEDIN)) are calling for legislative amendment in the state to allow safe termination of pregnancy in cases of rape, incest, or medical condition that threatens woman health.
There has been interventions to ensure deaths due to unsafe abortion are reduced and if possible prevented.Yet, despite this momentum, important gaps remain—in law, in awareness, in stigma, and in equitable access.
Why Reform Matters Public Health & Lives:
Unsafe abortion is a risk to women’s lives and health. If abortions are performed outside safe, regulated contexts—by unqualified providers, in unsanitary conditions, late in pregnancy—the potential for complications, disability or death rises.Reducing these deaths is not only a moral imperative—it is also a development imperative (healthier mothers mean healthier families, more economic participation, less strain on health systems).Rights, Dignity & Equity: Reproductive health is a matter of rights—bodily autonomy, decision-making, access to care.
When women and girls cannot safely access services—even in legally permitted circumstances—they suffer undue burdens.For example, survivors of rape or incest, or women whose health is jeopardised by continuing a pregnancy, may face forced choices, unsafe conditions, discretion and stigma.
Advocates argue that reforms would protect the dignity of vulnerable women. Moreover, access and equity matter: Many of the fatal outcomes from unsafe abortion disproportionately affect women in low- and middle-income, rural or marginalised communities.
1. Legal & Systemic Clarity:
Having guidelines is one thing—but without clear legal backing, resources, service-delivery, provider training, community awareness and stigma-reduction, reforms stall. In Ogun, though the SToP guidelines exist, the law remains restrictive and shifting, and many women may not know their rights or the safe options available. The call for legislative amendment by the Ogun State Assembly shows this gap.Key Gaps & Challenges1. Legal framework still restrictive: The national laws and state context permit abortion only to save a woman’s life or protect her physical health—but many other scenarios (e.g., rape, incest, severe foetal anomalies e.t.c) are excluded. Reform advocates say this pushes many into unsafe procedures.
2. Implementation and service availability: Even where guidelines exist, actual safe, accessible, affordable services may be limited—particularly in rural/underserved LGAs. Also, awareness of the guidelines among providers and communities may be low.
3. Stigma and cultural/religious resistance: Abortion remains highly stigmatised. Silence, fear of legal repercussions, moral resistance and misinformation mean many women delay or avoid safe care.
4. Equity and inclusion: Some groups—very young girls, survivors of sexual violence, sexual-minority women—may face compounded barriers (legal, social, economic) in accessing safe services.
5. Health system capacity & monitoring: For safe abortion services to work, there must be trained providers, safe facilities, referral systems, post-abortion care, data/monitoring, and resources. Without strengthening the health system, reforms will falter.
6. Awareness and rights education: Both women and healthcare providers need to know what is permissible, available, safe; counselling, contraception, follow-up care all matters.
7. What Good Reform Could Look Like in Ogun State.
Policy and programmatic features that could make a meaningful difference:Legislative amendment: The state could enact (or advocate for federal/state alignment) legislation that expands legal grounds for safe termination of pregnancy (e.g., rape, incest, severe medical conditions, foetal non-viability), while protecting provider and patient rights. The Ogun Assembly has signalled willingness. Translate guidelines into services: Ensuring the SToP guidelines are fully operationalised—facility accreditation, provider training, supply of safe medications/methods, referral pathways, emergency care.Ensure accessibility and equity: Target underserved areas (rural LGAs), subsidise costs for low-income women, include adolescents and marginalised groups, monitor disparities.Community engagement & stigma reduction: Use local leaders, religious institutions, youth/peer networks, to shift norms, raise awareness of rights and services, promote contraception and safe reproductive choices.Integrate with broader reproductive health/contraception: Safe termination of pregnancy policy cannot stand alone. It must be part of a continuum of care—including contraception access, maternal/child health, post-abortion care, sexual violence response.Data, monitoring and accountability: Track maternal mortality, abortion-related complications, service utilisation, cost burdens.
Use data to drive policy and resource allocation. Safeguards and ethical practice: Ensure that safe termination of pregnancy services are provided with full informed consent, confidentiality, protection from coercion; protect providers from punitive legal risk; embed ethical training.Public education and rights-based framing: Frame safe termination as part of the right to health, dignity, life—not merely as a “service.”
This helps shift from moral blame towards health imperative. OpportunityThe state already has SToP guidelines and reducing maternal mortality via access to safe termination of pregnancy . The policy window is favourable: maternal health remains on the agenda; the cost (human, economic) of unsafe abortion is increasingly recognised; evidence is accumulating.A Balanced Concern: Risks & ConsiderationsPolitical and religious: Abortion remains politically sensitive; any reform must engage faith and community leaders to mitigate backlash.Ensuring safety not just legality: Legalising or expanding access is insufficient unless safe, high‐quality services are available. If poorly implemented, the risk is the same unsafe outcomes just under a new label.Unintended consequences: If not properly regulated, expansion of services might lead to misapplication, untrained providers, or exploitation.
Good governance and oversight are vital.Resource constraints: Ogun State (like many Nigerian states) has competing health priorities; resources for safe termination of pregnancy services must not detract from but integrate with broader maternal health investments.Social acceptance and stigma: Changing laws is easier than changing behaviour and attitudes. Stigma may persist, delaying uptake or forcing clandestine choices.
Legal fragmentation: Nigeria’s federal structure means that state reforms may conflict with national criminal law; clarity is needed to protect both providers and patients.
Conclusion
Reproductive health policy reform in Ogun State—especially regarding safe termination of pregnancy—is both urgent and realistic. From a health-equity, rights-based, and development lens, expanding safe access to termination of pregnancy (within defined grounds) offers a way to save lives, reduce maternal mortality, and protect vulnerable women and girls.Ogun State has reached a moment where it can move from aspirational guidelines to tangible reform and service delivery.
But success will hinge on more than just legal language—it will require robust implementation, health-system investment, community engagement, and vigilance to equity, ethics, and quality.safe termination of pregnancy must be part of the reproductive health reform agenda in Ogun State.
And now is the time for legislators, health officials, providers, civil society, communities and women themselves to work together to turn policy into practice, to ensure that no woman dies or is debilitated because the law, the system or the stigma prevented her from accessing safe care.
Dr. Elijah Ogunsola is the Executive Secretary
Ogun State Primary Healthcare Board
And
Mrs Atolagbe R.E, is the Adolescent Health Officer, Ogun State Primary Healthcare Board.
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