Socioeconomic determinants of access to safe abortion and experiences along the care trajectory: A survey of women with a five-year abortion history in Abuja and Lagos, Nigeria

Background: Unsafe abortion remains a significant cause of maternal morbidity and mortality in many African countries, including Nigeria. There is limited evidence on abortion safety or experiences of abortion care in Nigeria. This study aims to fill gaps in understanding of how abortion safety has evolved since previous estimates and provide new insight on pregnant people’s experiences along the abortion care trajectory and how sociodemographic factors correlate with these experiences and the overall safety of abortion. Methods: Data presented are drawn from a larger study that was conducted in Lagos and Abuja, Nigeria in 2023 using a total market assessment approach. This analysis drew exclusively on data from a quantitative survey of women of reproductive age with a 5-year history of induced abortion(s). Abortion safety was operationalised based on two dimensions in line with a previous analysis of Nigeria PMA survey data: (1) whether the method(s) used included any non-recommended methods and (2) whether the source(s) used were clinical or non-clinical. Analyses include frequencies of abortion safety and experiences along the abortion care trajectory and bivariate and multivariate assessments of sociodemographic and reproductive history correlates. Results: Two hundred women completed the survey of which 197 reported their abortion method and were included in this analysis. Almost half (44.7%) of respondents’ reported abortions were categorised as most unsafe involving non-recommended methods and non-clinical source(s). Those living in rural areas and those who were living in severe poverty were significantly more likely to have had the most unsafe abortions. Those living in poverty were also at increased likelihood of being unable to access an abortion from their preferred source and of experiencing any complications. Conclusion: These findings confirm that abortion in Nigeria is a public health concern and an issue of social inequity. Efforts to improve equitable access to in-facility services, particularly surgical procedures and post-abortion care is critical to ensure management of complications from unsafe abortion. Simultaneously, increasing awareness of the availability of quality-assured medication abortion drugs for self-management and/or training of lower-level providers on management of medical abortion can help mitigate the toll of unsafe abortion-related morbidity and mortality.