“Nigeria operates a dual criminal system on abortion…Both treat abortion as a crime against the state, not a medical decision between a woman and her doctor. Both are silent on rape. Both are silent on incest. Both are silent on the mental health of the woman.”
In June 2025, Hon. Justice Olotu of the Federal High Court in Abuja delivered a ruling that should have changed everything.
A young woman — impregnated by rape — had sought to terminate the pregnancy. Under Nigeria’s criminal law, she had no right to do so. The court disagreed. Justice Olotu held that forcing a survivor of sexual violence to continue a pregnancy violates her fundamental rights to physical and mental health.
For the first time, a superior court in Nigeria recognised that access to safe abortion for rape and incest survivors is not a crime. It is a human right.
One year later, that woman still cannot walk into most Nigerian hospitals and obtain lawful care.
Because the ruling is not the law. And the law is not on her side.
The Abortion Paradox
Nigeria operates a dual criminal system on abortion. In the South, the Criminal Code Act punishes abortion with up to 14 years’ imprisonment for the provider, seven for the woman, and three for anyone supplying instruments. In the North, the Penal Code permits abortion only to save the woman’s life — nothing more.
Both statutes date from the colonial era. Both treat abortion as a crime against the state, not a medical decision between a woman and her doctor. Both are silent on rape. Both are silent on incest. Both are silent on the mental health of the woman.
Yet, Nigeria also has the National Guidelines on Safe Termination of Pregnancy for Legal Indications (2018), issued by the Federal Ministry of Health. These guidelines list an array of conditions — cancer, kidney disease, psychiatric disorders, severe heart conditions — under which abortion is medically indicated to preserve the woman’s health and well-being. They require a second opinion. They permit medical abortion. They are, in substance, a clinical manual for lawful care.
But the guidelines are not law. They are policy. A doctor who follows them can still be arrested under Sections 228 or 232. The Ministry of Health says one thing. The Criminal Code says another. And when a prosecutor knocks, the doctor faces 14 years.
Then there is the Violence Against Persons (Prohibition) Act 2015. Section 38 entitles victims of sexual violence to comprehensive medical care. The June 2025 ruling built on this: if a rape survivor is entitled to medical care, and pregnancy from rape destroys her mental health, then denying termination is denying care.
The ruling is binding precedent. But it applies only to survivors of sexual violence. It does not reform the Criminal Code. It does not amend the Penal Code. It creates a narrow corridor of rights in a vast prison of prohibition.
And here is the cruelty: even within that corridor, most doctors will not walk. They are afraid.
The Human Cost
The numbers are not abstract. They are daughters, sisters, and mothers.
Nigeria records an estimated 1.25 million induced abortions annually. More than 60 per cent are unsafe — performed by untrained providers, with dangerous methods, in unhygienic conditions. Approximately 142,000 women are hospitalised each year with complications. Many do not survive.
The Population Reference Bureau estimates that roughly 5,000 Nigerian women die annually from unsafe abortion — about 14 every day. Other estimates go higher. What is certain is that the vast majority of these deaths are preventable.
The burden falls hardest on the poor. Wealthy women fly to London, to Dubai, to South Africa. Poor women go to backstreet clinics, drink bleach, insert sticks, or bleed out in silence. Criminalisation does not stop abortion. It only makes it dangerous, and it makes danger a poverty tax.
Even when women survive the procedure, the health system often fails them. A 2023 survey of public health facilities across seven states found that only 7.6 per cent of primary-level facilities could deliver a full package of post-abortion care. Only 29.6 per cent of referral hospitals could provide comprehensive care. Some facilities refuse treatment entirely, citing hospital policy or the nurse’s personal morality.
A woman who has just survived an unsafe abortion is turned away at the door — not because the law requires it, but because stigma permits it.
The Constitutional Paradox
This column has explored the tension between Section 17 of the Constitution — which directs the state to ensure adequate medical facilities but is non-justiciable — and Sections 33 and 34, which protect the right to life and the dignity of the human person and are enforceable in court.
In the abortion context, this paradox becomes a battlefield.
Anti-abortion advocates invoke Section 33 to protect fetal life. Pro-choice advocates invoke Section 34 to protect the woman from forced pregnancy, unsafe abortion, and degrading treatment. The Supreme Court has held that constitutional provisions must be read together — the “whole or community reading rule” — not in isolation.
Justice Olotu’s ruling applied this logic. A rape survivor forced to carry a pregnancy to term suffers a violation of her dignity and mental health under Section 34. The Constitution does not merely protect life in the abstract. It protects the lived dignity of the person before the court.
But litigation is slow and narrow. It can free one survivor. It cannot reform the Criminal Code. It cannot train the doctors. It cannot stock the hospitals.
And when the Lagos State Government introduced its own Safe Termination of Pregnancy guidelines in 2022 — guidelines that would have given doctors clarity and women protection — conservative pressure forced their suspension within days.
The court grants dignity. The state takes it back.
The African Comparison
Nigeria is not the only African nation wrestling with this. But it is increasingly an outlier.
Ethiopia liberalised its abortion law in 2005. Within a decade, the proportion of maternal deaths attributable to unsafe abortion dropped from 32 per cent to less than 10 per cent. Ghana permits abortion on health, rape, incest, and fetal impairment grounds. Benin fully liberalised in 2021. Zambia has had broad social and economic grounds since the 1970s. Kenya’s 2010 Constitution permits abortion to preserve life or health — broader than Nigeria’s life-only standard.
Twenty-five African countries have liberalised their abortion laws since 1994. Nigeria has not moved since 1958.
Our maternal mortality ratio stands at 512 deaths per 100,000 live births. A Nigerian woman has a one in 19 lifetime risk of dying from pregnancy-related causes. In most developed countries, that risk is one in 4,900.
The difference is not medicine. It is political will.
Five Steps Toward Dignity
The June 2025 ruling opened a door. It is now the responsibility of lawmakers, ministers, and citizens to walk through it.
First, amend the Criminal Code and Penal Code to align with the 2018 National Guidelines and the June 2025 ruling. Abortion should be lawful when necessary to preserve the woman’s life or health, and for survivors of rape, incest, and sexual violence. The law should protect the doctor who acts in good faith, not imprison them.
Second, reinstate and implement the Safe Termination of Pregnancy guidelines in every state. Lagos suspended theirs. Ogun has adopted them. The other 35 states must choose between evidence and ideology. The cost of choosing wrong is measured in coffins.
Third, expand post-abortion care. Every public hospital must be equipped and staffed to treat complications without judgment. A woman bleeding from an unsafe abortion is not a criminal. She is a patient.
Fourth, train the police and prosecutors. The Ipas Nigeria model of training police officers on abortion law has reduced unjustified arrests of both women and providers. This should be national policy, not a pilot project.
Fifth, honour the Maputo Protocol. Nigeria has ratified the Protocol to the African Charter on the Rights of Women, which affirms reproductive rights. It is time to domesticate those obligations in statute, not just treaty text.
The Bottom Line
The Lunacy Act of 1958 treated mental illness as a crime. We repealed it in 2023. The Criminal Code of 1916 treats abortion as a crime. We have not touched it.
A law that forces a rape survivor to choose between a prison sentence and a septic ward is not a law of life. It is a law of death dressed in moral language. A law that permits clinical guidelines but prosecutes the doctors who follow them is not a law of health. It is a trap.
Justice Olotu’s ruling recognised what the Constitution has always known: the dignity of the human person does not end at the womb. It belongs to the woman in the examination room, the survivor in the police station, the girl in the village who cannot afford a flight to London.
Health law is not about preserving statutes written by colonial administrators. It is about protecting human dignity — especially when a woman is most vulnerable, most violated, and most alone.
She should not have to bleed to prove she is human. But in Nigeria today, sometimes she does.
And that is the silent epidemic no prayer can sanctify.
•Sanu is a Nigerian lawyer, researcher and health law scholar. This column examines contemporary health policy and legal issues through the lens of accountability, justice and human dignity.
