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Dr. Caleb: Unwanted pregnancy is another major burden. It is still raging. As at 2009, 600,000 women have abortions every year in Nigeria. I expect the figures to be double by now. Out of these, 30,000 die from abortion related complications. Many others suffer long lasting damage even though they survive the incidence. Abortion complication figures are highest where abortion is illegal like Nigeria. Abortion is still the 5th leading cause of pregnancy related deaths in Nigeria.

PEA: This is a greater pointer to the failure of the condoms. Most of these people use condoms.

Dr. Caleb: Sir, condom use is very small, less than 50% in many studies. And I hope you are aware that imperfect use of condom may contribute to unwanted pregnancy as well. This figure is not the number of unwanted pregnancies ooo.
That will be much higher; these are just the ones that are bold enough to abort.

PEA: Concerning the non usage of condoms, I was surprised myself. A colleague of mine who is hyper sexually active (must have slept with close to 40 women in his life and still counting) told me most ladies he meets don’t care if he doesn’t use condoms.

Dr. Caleb: Very true Sir.

PEA: What are they thinking?

Dr. Caleb: They either are uncontrollably held in bondage by their desires or they are ignorant or just don’t care.

PEA: Jesus! Despite the humongous risks?

Dr. Caleb: The psychosocial burden of unwanted pregnancy is equally massive even if abortion is not considered. When the pregnant lady is even a teenager, the problem is worse.

PEA: What makes it worse for teenagers?

Dr. Caleb: In addition to the psychosocial tolls which are often magnified in teenagers, there is additional problem of the physical. Although the body seems mature, yet it is not ready for pregnancy (their bodies still developing); and so they are at risk of not having successful vaginal delivery, obstructed labor and genital fistula and risk of other complications associated with childbirth. Even children born to them are likely to suffer the same fate from poor social support and other psychosocial factors.

PEA: Hmmm, that’s serious.

Dr. Caleb: With abortion also comes the risk of recurrent pregnancy losses when the fellow decides to get pregnant in future.

PEA: That’s the rhesus factor stuff shey?

Dr. Caleb: No, this is due to cervical incompetence. Rhesus is another problem on its own.

Cervical incompetence is inability of the womb to hold advanced pregnancy because the door of the womb (the cervix) is too weak. The commonest modifiable cause of this weakness is damage from abortion especially through D&C and other crude methods.

Risk of ectopic pregnancy (pregnancy implanting in the falopian tube instead of the womb) is quite high among women who have had previous pelvic infections with tubal damage should they get pregnant at all.

PEA: How is pelvic infection and tubal damage related to abortion and associated with ectopic pregnancy?

Dr. Caleb: Pelvic inflammatory disease is infection of the uterus and/or fallopian tubes and/or ovaries as a result of ascending infections from the vagina. This can damage the tubes and block both tubes resulting in infertility. Some other times, it may narrowly allow the sperm cell to move through the blockage whereas the fertilized eggs will be unable to pass (the sperm is a lot smaller than the egg) this may result in pregnancy being in the tube rather than inside the womb; that’s what we call ectopic pregnancy.

Someone that has risky sexual behaviors is exposed to these infection and someone with unsafe abortion can have introduction of infection through unhygienic practices by the quacks those people patronize.

PEA: Mehn, these consequences are too much Sir.

Dr. Caleb: Very well Sir.

Rhesus negative women who have illegal abortion are very unlikely to have proper treatment with Rhogam (anti D immunoglobulin). So they may suffer rhesus iso-immunization which results in death of recurrent babies and it keeps getting worse. They can only get babies with rhesus negative partners if it gets to the extreme.

PEA: Some people haven’t heard this rhesus issue before. So I want you to break it down Sir.

Dr. Caleb: Just like blood group, all of us are either rhesus positive or negative. If a woman being rhesus negative is pregnant with a rhesus positive baby, she needs to take an injection during her pregnancy. She will require the injection at 28wks and then after delivery (for straightforward cases) or if she had a termination of pregnancy, earlier (whether spontaneous or induced).

If she fails to do so (take the injection) and gets pregnant with another rhesus positive baby, then her body MAY react to the baby and intensity of the reaction increases with subsequent pregnancies. In severe cases, such responses from the mother’s immune system can kill the baby!

So if she marries a man that is rhesus negative like herself, baby cannot be rhesus positive; so no risk. However if she marries a rhesus positive man; baby can be rhesus positive or negative (it’s an autosomal dominant trait).

Now the problem is Rhesus negative women who have illegal abortion are very unlikely to take that injection mentioned above. That would then mean if they marry a rhesus positive man later in life and get pregnant with a rhesus positive child, they may suffer rhesus iso-immunization which results in death of recurrent babies and it keeps getting worse. They can only get babies with rhesus negative partners if it gets to the extreme.

PEA: I’ve met women who had this issue during a time when I marketed supplements for female infertility. Some of them told me they’ve had abortions in the past. They kept having repeated miscarriages after they got married. The problem is how they’ll get a rhesus negative partner when they were already married to a rhesus positive partner. It would mean they’ll have to divorce or have an extra marital baby.

Dr. Caleb: ??. Most cases aren’t this bad though, this occurs quite rarely.

PEA: What’s the solution for such women?

Dr. Caleb: They will need proper review. Many of them are having repeated abortions from other means though. If rhesus isoimmunization is the established factor, they will require expert care, complex expert care getting to need to transfuse baby with blood while still in the womb. Some of those things aren’t even done in Nigeria. Complex topic with details beyond the scope of this discussion.

PEA: ??Lord have mercy! The safest way to stay clear of all these possible complications still remains abstinence as several people who have had to abort in the past thought they could never had gotten pregnant.

Dr. Caleb: Absolutely.

Your brother,

Peniela E. Akintujoye.


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