What Might the US Be Like Post-Roe v Wade? Look at Present-Day Nigeria

Yves here. This using Nigeria as a forecast for the US is hyperbolic, since even if Roe v. Wade is overruled or narrowed, it then becomes a states-rights matter, and quite a few states will allow for abortions and many are likely to strengthen their laws. Moreover, laws by states to criminalize abortions and facilitating abortions will have no effect outside their borders.

But part of how bad things become depends on how much activists to do undermine abortion restrictions. We’ll see how much courage soi-disant defenders of abortions have. Will they funds sites showing how to do “medical” research in ways that can’t be tracked? Help staff call centers in clearly “safe” states like California to advise women in outlaw state what their options might be? Organize transportation?

States that severely restrict abortions are unlikely to see Nigeria-scale rogue practitioners, since these, um, facilitators would be breaking the law and many of these punitive states are incentivizing bounty-hunting (as if the anti-abortionists themselves don’t already act like vigilantes). You are more likely to see botched self-administered coat-hanger type procedures as well as suicides.

The movie Vera Drake illustrated that even well-intended amateur abortionists can do harm. An intervention that went awry (left the young woman sterile) was her undoing.

By Lydia Namubiru, Africa editor for openDemocracy’s 50.50 team who has worked as a freelance editor, reporter, data consultant and documentary producer for a variety of news organisations in Africa and internationally, including Al Jazeera, the BBC, The Continent, The New York Times, Quartz Africa and Reuters, and Yetunde Adeyeri, a broadcast journalist and multimedia storyteller who works as a producer for one of Radio Now’s flagship programmes, Now Breakfast. Originally published at openDemocracy

Years after it happened, Tosin Falana still vividly remembers her friend Amara’s* traumatic abortion. They were in university. “She called me and said she was pregnant. She was so ashamed because we were still in school,” Falana says.

Ultimately, Amara decided to terminate her pregnancy. But abortions are illegal in Nigeria and can attract prison sentences of up to 14 years unless they are done to save a pregnant person’s life.

“In my view, those who mostly seek abortion are young girls and poor women,” says Falana, now a 38-year-old teacher in Ogun state, in the country’s southwest.

“When there is food for them, children are welcome. But if there is none, ladies go for abortion.”

Amara, like many others who are young and/or poor, was forced to have an abortion at a shadowy underground clinic. The next time Falana heard from her, Amara was calling to say there had been complications.

She told Falana that the health worker who performed the procedure had said it had not completely ended the pregnancy, so she would have to do it again.

It’s unclear whether this was true, or if the healthcare worker was simply scamming Amara. Either way, she was subjected to multiple visits to the clinic before finally being given a clean bill of health.

A Bleak Warning

In the coming months, the United States appears poised to overturn the 1973 Roe v Wade ruling, reversing the country’s federal protections for access to abortion. The experiences of many in Nigeria offer a bleak warning of what may lie ahead.

Some 1.25 million abortions are induced in Nigeria each year, according to a 2012 estimate, with most performed at facilities like the one Amara went to.

“If you want to procure abortion and you end up with a trained service provider, good. They will do the abortion very well. But most of the time, people end up with quacks,” says Okai Haruna Aku, the executive director of the Planned Parenthood Federation of Nigeria.

Aku has been practising medicine in Nigeria for the past 30 years.

He has seen many patients left with perforated wombs, foreign bodies stuck in their birth canals or sepsis after backstreet abortions – and others who have either overdosed or underdosed on abortion medication.

“After all this damage, they eventually come to the hospital in a terrible state,” he says.

The World Health Organisation says abortion is “safe when carried out using a method recommended by WHO, appropriate to the pregnancy duration and by someone with the necessary skills”.

But, as Aku says, this is often not the case when abortions are restricted. This contributes to Nigeria’s unenviable position of having the second-highest number of maternal deaths in the world.

Complications in pregnancy and childbirth kill around 23,500 Nigerians a year, according to WHO data on causes of death. Despite being home to only 2.64% of the world’s population, the country was responsible for 12% of the world’s pregnancy- and childbirth-related deaths in 2019, the latest year for which this data is available.

Nigeria’s public health system will deal with abortion patients only when they experience complications. All too often, that is when it’s too late, or nearly so.

In a 2019 study, researchers examined the 5,779 admissions for abortive complications at 42 major hospitals across Nigeria in a single year and found that 8% of these people nearly died (366 patients) or died (78 patients).

Despite patients with abortive complications representing only 5.8% of the admissions to maternity wards, they made up 18% of those that suffered severely and 8% of those that died.

Of all the patients admitted to the wards, the fatality rate was worst for those with abortion-related infections, with almost a fifth dying.

Abortions in the US

Already, despite Roe v Wade, “more than 1,000 laws or regulations restricting access to abortion were enacted in the United States”, say researchers from Tulane University, who have examined how these policies impact maternal mortality. Some “483 of these restrictions were enacted in the past decade”.

If Roe v Wade is indeed overturned, as a memo leaked last month suggested it will be, states will be free to set their own abortion laws. Recent trends suggest that many will pass very restrictive legislation.

This is likely to have fatal consequences. The Tulane researchers found that, between 2015 and 2018, states with higher abortion restrictions had a 7% increase in total maternal mortality.

“We found that two abortion restrictions – requirement for licensed physician and prohibitions against use of Medicaid funds to pay for abortion care – are particularly prominent potential contributors to maternal death risk,” the researchers’ report, published last September, says.

Today, around 800 people in the US die from pregnancy and childbirth complications each year, putting the world’s second-richest nation at 60th out of the 184 countries for which the WHO published mortality data in 2019. Clearly, this is not a situation that needs to get any worse.

*Names have been changed

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  1. PlutoniumKun

    The closer analogy is with Northern Ireland, where abortion is still technically illegal, or the Republic of Ireland a few years ago. Abortion will be easily available to anyone with the means to get a plane or ferry ticket, or access to a gyno who will perform a ‘medically necessary intervention’.

    It will, in other words, not be a big issue for women with the knowhow or resources to get one, and not all that difficult for most other women, but an absolute nightmare for struggling teens with unsupportive families or the very poor.

    In Ireland a decade or so ago there were other anomalies, especially immigrants who did not have the visas to easily travel for an intervention. The Chinese in Dublin had their own ‘clinic’ (in an apartment off Parnell Street in the north city – openly advertised for anyone who could read mandarin), while more conservative immigrant groups like from the Philippines didn’t have the same option.

  2. orlbucfan

    Abortion ends a basic natural process the female human body is designed for: reproduction of the species. The body, to point it bluntly, is shocked by the procedure. It must be done by trained professionals. Simple fact.

  3. Glossolalia

    Does anyone believe that the GOP will be content with abortion being outlawed in only some states? A full national ban is the next step in their long game, and they may be willing to end the filibuster to get it and willing to expand the Supreme Court to keep it. The ever undisciplined Trump also said the quiet part loud and gave away the plan we he said that they plan on going after the mothers, too, not just the abortion providers.

    1. marku52

      That’s my guess. As soon as the Pubs have all 3 branches, abortion is illegal nationally.

      Then what? The entire west coast and NE goes “Not happening”

      Then what???

  4. Tom Stone

    I have pointed out to some who are anti abortion that these laws only affect the poor and the helpless,not the upper 10%.
    And that abortions are often performed for economic reasons, another child will condemn both Mother and Child to lives of hopeless poverty and that a society that was based on Christian principles would have fewer abortions…

  5. CanCyn

    Isn’t it odd how many of society’s ills could be solved with compassionate development of policies and laws that create equitable, free universal health care, decent affordable housing, living wages (incl benefits and pensions), affordable food and other necessities of life. No matter your ‘gender’, sexual identity, ethnicity, religion or whatever work issue floats your boat, everyone benefits.

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