Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria
Open accessAbstract
Context. The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. Methods. Three hundred and twenty‐three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. Results. Twenty‐four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D&C). Nearly 28% reported the use of MVA followed by D&C in the first trimester. Fifty‐seven percent reported their lack of expertise in managing second‐trimester abortions, while those admitting that they manage second‐trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. Conclusions. These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.
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In a Nigerian survey, 90% of 323 interviewed doctors stated they were frequently attended by pregnant women requesting a clandestine induced abortion, and 24% reported they did terminate unwanted pregnancies when requested.
“More specifically, 90% of 323 Nigerian doctors interviewed stated they were frequently attended by pregnant women who requested a clandestine induced abortion and 24% reported that they did terminate unwanted pregnancies when requested to do so by the women (15).”
From Unsafe abortion and postabortion care - an overview (2011) · cites this paper as [15]
The ‘Attitudes towards unwanted pregnancies and abortion complications’ section reports that 90% of the 323 surveyed private practitioners saw women requesting induced abortion and that 24% said they terminated unwanted pregnancies on request. It does not establish that the requested abortions were clandestine; that qualifier is unsupported. (LLM, conf=0.85)
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“(1) Providers have poor knowledge of MA regimen due to lack of training, i.e. most Nigerian doctors are only familiar with misoprostol as a drug for stomach ulcers as it is not licensed for MA [38, 39]; and India has non-standardised MA treatment as providers often rely on their intuition or personal experience to det…”
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“[1] In the developing world, lack of access to family planning results in some 76 million unintended pregnancies, with 19% ending in induced abortion of which 11% are unsafe.[1,3]”
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“…studies as about 1/30 of the private practitioners in Enugu, Nigeria, used MVA alone for the routine management of abortion in the first trimester compared with 1/5 of doctors in Calabar, Nigeria [1], and half of those in a multi-center study carried out in Benin, Warri, and Kaduna; Nigeria [22].”
Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria
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“Okonofua et al. (2005) in a survey of private medical practitioners in three states in Nigeria showed that 57% of them reported lack of expertise in managing second-trimester abortions, and those who managed such women reported use of nonstandard methods and procedures.”
BackgroundPostabortion care counseling practiced by health professionals in southeastern Nigeria
Adinma, J. I. B., Ikeako, L. C., Adinma, E. D., Ezeama, C. O., & Eke, N. O. (2010) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2010.06.003 · Cited by 7 · see citing works
“This is in contrast to other studies conducted in Nigeria that revealed a poor "practice" of PAC services among healthcare providers [13,14].”
ResultAdera, A., Kassaw, M. W., Yimam, Y., Abera, H., Dessie, G., & Tinsae, F. (2015) · doi:10.11648/j.sjph.20150305.14 · Cited by 8
“In Pakistan, postpartum hemorrhage, ante partum hemorrhage, puerperal sepsis, obstructed labor, eclampsia and complications related to unsafe abortion have been identified as the leading causes of maternal death (13, 14, 15).”
BackgroundPéritonite aigue généralisée par perforation utérine post abortum à propos d'une observation
Ka, I., Diop, P. S., Niang, A., Faye, A., Ndoye, J., & Fall, B. (2016) · The Pan African Medical Journal · doi:10.11604/pamj.2016.24.98.9307 · Cited by 7
“Le moyen le plus utilisé est la sonde intrautérine [3,4,7].”
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Menakaya, U., Otoide, V., Agboja, L. O., Odunsi, K., & Okonofua, F. (2005) · Journal of Obstetrics and Gynaecology Research · doi:10.1080/01443610500239354 · Cited by 7
“To date, most practitioners in Africa have relied on the use of an infusion of high dose oxytocin for the management of missed abortion (Okonofua et al. 2005).”
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“This is comparable to studies in other parts of the country, some of which reported even lower contraceptive usage [60,48,74,63,54] .”
ResultFactors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico
Küng, S., Ochoa, B., Avendano, G. A. O., López, C. M. M., Zaragoza, M., & Zuniga, K. P. (2021) · Women's Health · doi:10.1177/17455065211029763 · Cited by 5 · see citing works
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Unsafe abortion and strategies to reduce its impact on women's lives
Shannon, C. S., & Winikoff, B. (2014) · Cambridge University Press eBooks · doi:10.1017/cbo9781107784758.012 · Cited by 1 · see citing works
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“…that have been proffered for the law practice of safe abortion care by health professionals in Nigeria include limited knowledge of the abortion law; perceptions that all abortions are prohibited in the country; religious and moral concerns; and the fear of legal and social retribution [4–8].”
BackgroundSelf-citationAyelotan, M., Adebayo, A. M., & Omokhodion, F. O. (2022) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2022.2070839 · Cited by 2 · see citing works
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“In Africa, nearly 50 % of all abortions occur under the least safe conditions [11,12].”
BackgroundComprehensive abortion care in the Tain District of Ghana: an analysis of DHIMS2 data for 2010-2016
Adjei, M. R., Asante, K. P., Baafi, J. V., & Letsa, T. S. (2018) · Ghana Medical Journal · doi:10.4314/gmj.v52i4.5 · Cited by 2 · see citing works
Karamura, L. N., & Wright, A. (2006) · Journal of Obstetrics and Gynaecology Research · doi:10.1080/01443610600940331 · Cited by 1
“Whereas there are guidelines for termination of pregnancy at different gestations in the UK with few or no late surgical evacuations, the same does not apply elsewhere, especially in African countries (Okonofua et al. 2005).”
BackgroundAfolabi, A. (2020) · doi:10.21522/tijph.2013.08.02.art003
“These finding are similar to findings in South-southern and Northern part of Nigeria where practice was high among providers but contrary to findings in South-eastern Nigeria which both revealed low post-abortion contraception practices ([10,15,18,19]).”
Result
- Authors
- Okonofua, F. E., Shittu, S. O., Oronsaye, F., Ogunsakin, D., Ogbomwan, S., & Zayyan, M.
- Affiliations
- Ahmadu Bello University (NG)
- University of Benin (NG)
- Corresponding author
- Okonofua, F. E.
- ORCID
- Okonofua, F. E.
- Venue
- Acta Obstetricia et Gynecologica Scandinavica
- Publisher
- Wiley
- Published
- 2005-02-16
- Volume
- 84
- Issue
- 3
- Pages
- 270-280
- ISSN
- 0001-6349 (ISSN-L)
- 1600-0412
- OpenAlex
- W2116496003
- Cited by
- 41
- References
- 0
- Citations by year
- 2024: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 5 · 2013: 2 · 2012: 1
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
- Keywords
- abortion, post-abortion care, family planning, private physicians, physician attitudes, unsafe abortion, manual vacuum aspiration, dilatation and curettage, second-trimester abortion, medical curriculum, Nigeria
- MeSH terms
- Abortion, Induced, Adult, Aftercare, Aged, Attitude of Health Personnel, Counseling, Family Planning Services, Female, Health Services Needs and Demand, Humans, Male, Maternal Health Services, Middle Aged, Nigeria, Practice Patterns, Physicians', Pregnancy, Pregnancy, Unwanted, Private Practice, Surveys and Questionnaires, Vacuum Curettage, Women's Health Services, Reproductive Medicine
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