Lagos health advocates want suspended pregnancy guidelines back

Health advocates are calling on the Lagos State government to bring back the suspended Guidelines on Safe Termination of Pregnancy for Legal Indications (STOP Guidelines). They believe this policy could give doctors clearer guidance and help lower preventable maternal deaths.

This call came from Rumunse Obi, Project Manager for Pamoja, in an article titled “Dr Majek and the Ghost: Why Lagos Must Revisit the STOP Guidelines,” which was shared with PREMIUM TIMES on Tuesday.

The article is part of Dr Majek and the Ghost, a public health project that looks into how stigma, misinformation, and delays in getting reproductive healthcare hurt maternal health in Nigeria.

This project is also part of “ÀJOSE: The Stories That Bind Us,” an initiative that uses film and public talks to spark conversations about women’s reproductive health.

Earlier this year, the initiative brought together filmmakers, healthcare workers, creatives, and the public in Lagos. They talked about how stigma, cultural silence, and misinformation affect women’s health.

Participants also got to see Dr Majek and the Ghost along with other films before discussing maternal mortality, consent, and ethical healthcare.

According to Mr Obi, the fictional story follows a doctor facing deaths that could have been avoided if patients had received proper and timely medical care.

Even though it’s a fictional story, he said it reflects the experiences of many Nigerian women who die from pregnancy-related issues, despite having access to lifesaving medical help.

Why the guidelines are important

Mr Obi explained that the STOP Guidelines were introduced by the Lagos State government in 2022 to help healthcare workers understand the laws around pregnancy termination in emergencies. This is especially important when continuing a pregnancy could endanger a woman’s life or health.

He said these guidelines were created over several years with input from medical and legal experts. They were meant to help doctors make quick decisions in dangerous obstetric situations without changing Nigeria’s abortion laws.

But in July 2022, shortly after their release, the Lagos State government suspended the guidelines due to pushback from religious groups and others who felt the policy might promote abortion.

At that time, the government said the suspension would allow for more discussions and awareness about the guidelines' goals. Nearly four years later, the guidelines still have not been brought back.

Mr Obi believes the controversy over this policy comes from misunderstandings about its aim, while the clinical issues it was designed to tackle remain unsolved.

He pointed out data from the World Health Organisation (WHO) and the Nigeria Demographic and Health Survey (NDHS), showing that Nigeria still has one of the highest maternal mortality rates in the world. This is due to limited access to skilled birth attendants, emergency obstetric care, and timely referrals.

Efforts to improve maternal health in Lagos

Mr Obi’s call comes while the Lagos State government is still working on reducing maternal mortality.

In April 2025, the state joined forces with the National Health Insurance Authority (NHIA) to launch the Maternal Initiative for Financing Access to Comprehensive Emergency Obstetric Care (CEmOC). This aims to improve access to lifesaving obstetric services for women facing pregnancy-related emergencies.

At the launch, Lagos State Commissioner for Health, Akin Abayomi, said the state still reports about 400 maternal deaths per 100,000 live births. He called this figure unacceptable for a megacity.

Mr Abayomi said the government is expanding Mother and Child Centres, improving referral systems, and training traditional birth attendants to work within the formal healthcare system. They are also increasing health insurance coverage to ensure women can access emergency care regardless of their financial situation.

Kemi Ogunyemi, the Special Adviser to the Governor on Health, also highlighted the need to remove delays in emergency obstetric care. She said saving mothers and babies should be the top priority over payment issues.

Need for clearer guidance

In an interview with PREMIUM TIMES on Monday, Temitope Adekanye, a consultant obstetrician and gynaecologist at the Lagos University Teaching Hospital (LUTH), said he hadn’t seen the suspended STOP Guidelines, so he couldn’t comment on them. But he believes Nigeria has long needed clearer guidance on abortion within the current legal framework.

Mr Adekanye described abortion as a sensitive topic since Nigerian law typically bans the procedure, except to save a woman’s life. This creates confusion for healthcare providers.

“We should have had a guideline on abortion a long time ago,” he said.

He added that unsafe abortions continue to cause maternal deaths because many are done by unqualified people or in places that do not meet basic medical standards.

However, he stressed that unsafe abortion is just one of many problems causing maternal deaths in Nigeria. He said postpartum haemorrhage is the top cause of maternal deaths, followed by hypertensive disorders like pre-eclampsia. Sepsis, obstructed labour, and unsafe abortion also contribute to many pregnancy-related deaths.

He linked many maternal deaths to what experts call the “three delays”, delays in deciding to seek care, delays in reaching a health facility, and delays in receiving treatment after arriving. Poor roads, lack of skilled healthcare workers, weak referral systems, and limited hospital capacity worsen outcomes for pregnant women.

Push for reinstatement

Given this background, Mr Obi argues that while haemorrhage, hypertensive disorders, and sepsis are the leading causes of maternal deaths, unsafe abortion is also a major factor, especially in places with strict abortion laws.

He said uncertainty about the legal interpretation of emergency reproductive healthcare can delay treatment and raise the risk of avoidable deaths.

“The suspension of the STOP Guidelines did not remove these clinical realities. It removed a structured framework meant to help doctors handle them safely within existing law,” he wrote.

Mr Obi noted that many countries with strict abortion laws rely on clear clinical protocols to guide healthcare providers without changing the law.

He believes that bringing back the STOP Guidelines would support Lagos State’s efforts in maternal healthcare by giving doctors better guidance in dealing with complex pregnancy-related emergencies.

He added that restoring the guidelines would not change Nigeria’s abortion laws but would improve how current legal rules are understood and applied in medical practice.