“Restrictive laws are not saving women’s lives” — PHC Boss
Dr. Elija Ayowole Ogunusola is the Executive Secretary of the Ogun State Primary Health Care Development Board. In this interview, he speaks on the Safe Termination of Pregnancy (STOP) Guidelines in Ogun State, access to sexual and reproductive health rights, misconceptions around abortion, and the urgent need for legal reform in Nigeria.
You recently addressed judges on the Safe Termination of Pregnancy (STOP) Guidelines. Why was this engagement important?
Thank you for the opportunity. I want to first appreciate the organisers for creating a platform to engage judges on this very sensitive but critical issue. The engagement was important because judges play a crucial role in interpreting the law, and while they may not make laws, their judgments can protect women’s lives and also safeguard health workers who provide care within approved guidelines.
In Ogun State, we are grateful to have a very progressive Commissioner for Health, who is also a gynaecologist. This leadership has enabled us to create an environment where women, especially adolescents and women of reproductive age between 15 and 49—can make informed decisions about their reproductive lives.
How did Ogun State adopt and implement the STOP Guidelines?
The national guideline on Safe Termination of Pregnancy was developed in 2019. Ogun State took a deliberate decision to adopt it. With the support of IPAS Health Foundation, we began by conducting an institutional analysis to understand what policies already existed in the state.
We discovered that, apart from the national STOP guideline, there were also relevant frameworks from the Ministry of Women Affairs. We then convened a broad stakeholders’ meeting that brought together representatives from Women Affairs, law enforcement agencies, the Nigerian Medical Association, the Medical Women Association of Nigeria, religious leaders—both Christian and Muslim—and other critical actors.
Together, we examined the guidelines and collectively agreed that there are legitimate medical indications for terminating a pregnancy, particularly when the life or health of the mother is at risk or when there are severe foetal conditions. A zero draft was developed, validated, and eventually adopted. The guideline has since been disseminated and used to train health workers across the state.
What does the guideline mean for women seeking care in Ogun State?
What it means is that any woman in Ogun State who feels unable to continue with a pregnancy can now approach a government health facility without fear. A qualified doctor will assess the case strictly within the provisions of the guideline and determine whether the indication is medically justified.
However, it is important to clarify that guidelines alone do not change the law. In a court of law, guidelines are not superior to statutes. That is why we are currently working with civil society organisations, including the Women Advocate Research and Documentation Centre (WARDC), to engage on possible legal reforms that will align state laws with public health realities.
Why is legal reform necessary in this context?
Our restrictive abortion laws are not yielding positive outcomes for women’s health. Evidence from countries that have relaxed restrictions, though in different forms, shows significantly lower maternal mortality rates. In those countries, maternal deaths are in the hundreds, while Nigeria’s figures remain in the thousands.
Unsafe abortion contributes between 10 and 40 per cent of maternal deaths in Nigeria, compared to about 10 to 13 per cent globally. If we are serious about reducing maternal mortality, we must confront this issue honestly and pragmatically.
Some critics argue that such policies promote abortion. How do you respond to that?
That is a misconception. We are not promoting abortion on demand. Personally, I am pro-life. However, as a policymaker, my responsibility is to design policies that save lives.
If a woman is psychologically distressed, suicidal, or medically unfit to continue a pregnancy, the humane response is to protect her life. The guideline empowers health workers to act responsibly and ethically, without fear of prosecution, while prioritising counselling and informed decision-making.
Has the implementation of the STOP Guidelines improved healthcare outcomes in Ogun State?
Yes, significantly. Our data shows about a 45 per cent decline in reported unsafe abortions in Ogun State. Health workers are no longer operating in secrecy or fear. The Nigerian Medical Association has also taken a lead role in providing training and professional guidance.
Counselling is central to the process. Many women who initially sought termination later chose to continue their pregnancies after receiving adequate support. What women need most is information, counselling, and an enabling environment.
How can misconceptions about abortion and sexual and reproductive health be addressed?
Through sustained counselling and public education. Previously, many women arrived at health facilities after attempting unsafe procedures, sometimes injuring themselves or the foetus. Now, they come early, are properly counselled, and supported to make informed choices.
Sexual and reproductive health is not just about pregnancy; it is also about preventing sexually transmitted infections and safeguarding future fertility. Balanced information is key.
What advice would you give to states that are resistant to discussing safe termination of pregnancy?
Every state should adapt national policies to its local context and prioritise women’s health. States must ensure access to contraception, close unmet family planning needs, and provide comprehensive counselling services.
We cannot pretend that people do not have sex. What we can do is ensure that they have the right information, access to contraception, and safe healthcare services when needed.
Finally, what is your message to lawmakers, particularly at the National Assembly, in light of the Maputo Protocol?
The Maputo Protocol recognises circumstances such as rape and incest, yet these are still not adequately reflected in our laws. I am appealing to lawmakers to remove legal restrictions that endanger women’s lives.
I am encouraged by engagements with members of both chambers, especially those with medical backgrounds who understand that women’s health is foundational to national development. Legal reform will not promote immorality; it will expand choices, protect lives, and drastically reduce maternal mortality.
Nigeria must decide whether it wants to continue losing women to preventable causes or take bold, compassionate steps to safeguard their health and dignity.
