Cultural aspects of abortion
As discussed in Chapter Five, in the Yoruba culture as in many others (WHO Task Force, 1981), women view menstruation as a physiological occurrence indicative o f general good health. Its absence indicates an upset in the balance o f the body and may be a sign of, or can lead to, serious illness. The notion o f 'removing female irregularity' and 'bringing down the period' is widespread in many cultures (Mohr, 1978; Newman,
1985) and a wide range o f emmenagogues (menstrual inducers) has been found in studies o f fertility regulating methods throughout the world (Dixon-Mueller, 1988). The term fo rm or 'washing the womb' is commonly used in Ado-Ekiti and the surrounding area to refer to dilatation and curettage (D&C). However, the origin o f this expression and its fundamental usage is to describe any procedure to remove impurities from the womb. Thus the term is also used to describe procedures undertaken to rid the womb o f substances which may lead to infertility, such as worms or 'black blood', and those used to remove retained products o f conception.
How pregnancy is determined and when life is perceived to begin differs between cultures. It is these perceptions which dictate whether an action is perceived as being
2 O f 127 sexually active secondary school students 56 (44.1 per cent) had been pregnant; o f 253 sexually active university students 102 (40.3 per cent) had been pregnant; and o f 74 sexually active non-students 50 (67.6 per cent) had been pregnant.
carried out to achieve a healthy state or as a deliberate act to avert a birth. For instance, among rural Chinese in Malaysia 'an abortion can take place only after the foetus is formed, which in local beliefs may take up to 2 months after a missed menses' (Ngin,
1985:35), Evidence from rural Ekiti (Renne, 1993) suggests that for many villagers, the child is only considered alive after the fourth month. The majority o f women who acknowledged having an induced abortion in Renne's study had it in the first three months o f pregnancy. Renne argues that not only was this to avoid the pregnancy's exposure in the community and the recognised increased danger to health with increased gestation, but also it reflected the belief that before this time the foetus was not a 'reai child'.
The armoury o f methods possessed by practitioners o f traditional Yoruba medicine for menstrual regulation and the avoidance o f unwanted births indicates that it is definitely not a new phenomenon and that, as in other cultures, sucl> methods have long been widely known among the Ekiti Yoruba.
Review of hospital records
As part o f the preliminary investigations made before the Ado-Ekiti survey was conducted, a review was made o f the out-patients department records at Ado-Ekiti State Specialist Hospital (AESH) for the period July 1988 to July 1990. All non-booked patients who present-at the hospital are registered and examined at the Out-patients Department before being referred to other departments within the hospital or to other institutions. A total o f 22 women were recorded as attending the Out-patients
Department for complications associated with induced abortion in the two years for which records were examined.3 Most were in the age range 16-24 with only two older women (30 and 32 years o f age). Twelve were school girls or students and three were apprentices. All 22 women were suffering from septic, incomplete abortion. The methods o f induced abortion procured before attending the hospital were as follows:
M ethod Provider Number
D&C Private doctor 11
Not stated Private doctor 5
Not stated Nurse 1
Herbal medicine Traditional healer 2
Patent medicine Self 3
3 Only women whose medical records reported an induced or 'criminal' abortion were categorized as having received an induced abortion. However, it should be noted that there were a number o f records o f 'incomplete abortion' where it was not specified whether the abortion had been spontaneous or induced. Where any doubt existed as to the nature o f the abortion it was categorized as spontaneous.
121 The out-patient records showed that two per cent of all women aged 15-49 registering at the Out-patient Department, did so for abortion-related conditions (this includes both spontaneous and induced abortions) The lack of data on abortion-related conditions as a proportion of hospital admissions makes this finding difficult to compare with findings from other studies. However, it would suggest that the number o f women attending AESH with abortion complications was low There are several possible explanations: the incidence of induced abortion in the community was low, the number o f induced abortions leading to medical complications was low, complications arising from induced abortion were misreported by patients; complications associated with induced abortion were misreported by hospital staff; women suffering from postabortal complications turned to other sources o f health care. By examining the evidence from the population survey it is possible to get a clearer picture of the level o f abortion in Ado-Ekiti than is offered by medical records.
Induced abortion as reported in the Ado-Ekiti survey
Respondents in the population survey were asked if they had ever had something done, either by a doctor or some other way to end a pregnancy early. Seventy-five women (16.4 per cent o f all respondents, 17.7 per cent o f respondents who had ever had sexual intercourse) reported ever having had an induced abortion. The percentage o f reported pregnancies (including current pregnancies) resulting in an induced abortion was 7 7 The distribution o f women by number o f induced abortions experienced is shown in Table 7.1. It is important to note that nearly 35 per cent o f women who reported ever having had an induced abortion had had more than one abortion.
Table 7.1
Number of abortions reported by respondents who had ever had an induced abortion, Ado-Ekiti, 1991.
No of abortions
No. of women
Per cent
1 49 65
2 20 27
3 5 7
4 1 1
Total 75 100
Source: Ado-Ekiti data tape 1992