Issues relating to abortions are complicated in Nigeria

Editor—Raufu's news item drawing attention to Nigeria, where 20 000 deaths are reported to occur every year as a result of mostly illegal abortions, calls for definite remedial action.¹ I commend the dean of the medical school at Benin University and the Society for Gynaecology and Obstetrics in Nigeria for drawing attention yet again to this important cause of morbidity and mortality in the country.

None of the responses to the news item on bmj.com considered the complex social and religious milieu in which Nigerians live. It is not the absence or paucity of medical expertise, health education, or activity by non-governmental organisations that drives pregnant girls to underground abortion clinics. Very strong cultural and religious stigmas are associated with extramarital sex in all regions of the country: not only Islam but also the Roman Catholic Church strongly oppose liberalisation of abortion. To legislate on abortion is a very tall order in Nigeria.

Islam presents particular difficulties because people who adhere to it are bound absolutely by the teachings of the Koran, which strictly forbids sex outside marriage. Most Nigerians are Muslim, but that is not the problem. Among Muslims, a large body of people well versed in both Western and Islamic education can promote better understanding of the Koran's injunctions and the teachings of the prophet Mohammed. Unfortunately, the religious agenda has been hijacked by a small body of ill informed fanatics who prefer to misinterpret the facts. For example, regarding the introduction of Islamic sharia law in Nigeria, nowhere is it mentioned in the Koran that people convicted of fornication should be stoned to death.

It is imperative to do something about the appalling annual death rate from abortion in Nigeria, but success can come about only if the matter is approached with due sensitivity and consideration for these cultural and religious factors.