Four years after a landmark medical document was pulled within days of its launch, doctors remain paralysed by legal ambiguity and women cancer patients, rape survivors, mothers are turning to back-alley remedies. A cohort of health journalists is now determined to change that
By Bunmi Yekini
The document existed for barely one week. forty pages, seven chapters, years in the making and then, gone. In June 2022, the Lagos state government launched its Guidelines on Safe Termination of Pregnancy for legal indications, a landmark public health document designed to standardized how medical professionals handle pregnancies that threatens a woman’s life. By July of the same year, Governor Babajide Sanwo-Olu had ordered its suspension. It has not returned since. And women, advocates say, are paying with their lives.
To understand why a medical guideline became a political flashpoint, and why it’s suspension continues to haunt one of Nigeria’s most progressive states, is to understand the deep, unresolved tension at the heart of Nigerian law: abortion is criminalised, yet legal. Prohibition in broad strokes, yet permitted on paper and it is inside that contradiction that thousands 0f women each year fall through.
The figures are not abstract. According to the Guttmacher Institute, an estimated 456,000 unsafe abortions are performed in Nigeria annually. The WHO’s 2023 Trends in Maternal Mortality report reveals that Nigeria accounts for nearly 28.5 percent of all global maternal deaths. A Nigerian woman faces a 1-in-19 lifetime risk of dying during pregnancy, childbirth, or the postpartum period. compared to 1-in-4,900 in most developed countries.
A document that changed nothing and everything
“What the guideline did,” explains Dr. Moriam Olaide Jagun, Executive Director of the Centre for Bridging Health Gaps (CBHGaps), “was bring law and medicine together. I call it a medical-legal marriage.” Dr. Jagun was one of the principal architects of the STOP guideline and has continued to advocate for its reinstatement. She insists the document created no new rights. It simply explained the ones that already existed.
“The legal framework is already existing. Nobody can change the law,” she says. “What the guidelines did was tell doctors: here is what the law permits. Here is what medicine recognises. Now do your job.” The document’s seven chapters covered the legal framework, medical indications, methods, post-abortion care, and monitoring and evaluation, a comprehensive clinical roadmap that had been absent from Lagos healthcare for decades. Several other states across the southwest, southeast, and parts of northern Nigeria have since adopted or are implementing similar versions of the national document. Lagos, the country’s commercial capital and self-styled model state, remains conspicuously absent from that list.
“Doctors are left feeling less protected by the legal system, less protected by their professional body, less protected by their institutions. So most times, they simply refuse.” Dr. Moriam Olaide Jagun, Executive Director, Centre for Bridging Health GapsWithout such guidance, medical professionals operate in a fog of legal uncertainty. A woman with chronic kidney failure whose organs are failing, can her doctor intervene? A cardiac patient whose pregnancy is driving her heart toward collapse? A teenager who was raped and is now twelve weeks pregnant? In each case, the law as written in Nigeria’s Criminal Code (Sections 228 to 230) and the Penal Code (Sections 232 to 234) permits termination to preserve the mother’s life. But it does not spell out how, or by whom, or under what clinical conditions. The STOP guideline was built precisely to close that gap. Its suspension reopened it.
What the law says and what it doesn’t
Nigeria’s abortion law is not contained in a single statute. It is embedded across the criminal codes that govern a country divided, geographically and legally, between north and south. There is no law in Nigeria called an “abortion law.” What exists are provisions scattered across colonial-era codes, largely unamended since independence.
The Nigerian Constitution, under Section 33, guarantees every person the right to life. Anti-abortion groups cite this provision to argue that an unborn child is constitutionally protected. Reproductive rights advocates argue the same provision compels the state to safeguard the lives of living women, a responsibility the state fails each time a woman dies from an unsafe, preventable procedure. Nigeria has never had a court case that resolved this contradiction.
On the continental stage, the picture is clearer. The Maputo Protocol, the African Union’s landmark 2003 treaty and the first legally binding international instrument to explicitly guarantee abortion rights, obliges member states to permit medical abortion in cases of rape, incest, threats to mental or physical health, and severe fetal anomaly. Nigeria ratified the Protocol in 2005. Lagos’s STOP guideline was a practical step toward honouring that obligation. Its suspension moved Nigeria in the opposite direction.
Why the guideline was pulled
Akin Jimoh, Programme Director at the Development Communications Network and editor-at-large for Nature Africa, speaks about what happened. “There are people hiding under the guise of religion,” he says. “There are situations of people not understanding what the issues are. And now we have social media, there’s misinformation, and so on, of people not really understanding what the issues are.”
When the guideline was launched on June 29, 2022, it was almost immediately mischaracterised, by religious groups, social media commentators, and some media outlets, as a state endorsement of abortion on demand. The nuance that the document addressed only legally permissible cases, that no new rights were being created and no new law passed, was lost in the noise. On July 7, Governor Sanwo-Olu ordered the suspension, citing the need for “adequate deliberation” and “stakeholder engagement.” The Commissioner for Health, Prof. Akin Abayomi, issued a retraction, promising the guidelines would not be implemented until the executive council had deliberated and public sensitisation had taken place.
“How many people have even seen the guideline? Everybody just talks about what they know, what they don’t know. We are running down processes put in place by committees and consultants.” Jimoh reiterates
That deliberation has now stretched to four years. The promised sensitisation never materialised in any meaningful public form. As of March 2026, over 150 civil society organisations have formally called for reinstatement. The Women Advocates Research and Documentation Centre (WARDC) has consistently warned that the suspension is costing lives and denying rape and incest survivors access to care they are legally entitled to. Groups like the Initiative to Resist Institutional Slavery Exploitation (IRISE) have been quietly training journalists, lawyers, and community gatekeepers on what the guideline actually says, because most Nigerians, they admit, have simply never read it.
The human cost
In practice, the suspension sends a chilling signal through Lagos’s health system. Doctors who were already uncertain of their legal standing now have explicit government cover for inaction. Women who cannot access care at formal facilities turn to informal providers. The results are predictable, and deadly. The anecdotes are not isolated. Just recently, a woman died from an unsafe procedure in Ogun State, and advocates note that such deaths routinely go unreported and undocumented.
Globally, unsafe abortion causes approximately 23,000 deaths per year, accounting for around 8 percent of all maternal deaths worldwide. In West and Central Africa, approximately 1 in every 200 abortions results in the woman dying. Safe abortions, by contrast, have mortality rates below 1 per 100,000 procedures. The difference is not ideology. It is access.
Dr. Jagun points out the medical indications the STOP guideline would have addressed in clinical detail: cancer requiring chemotherapy or radiotherapy, cardiac failure, chronic kidney disease, severe hypertension with convulsions, ectopic pregnancies. “If someone has a chronic kidney failure and the organs are going, and the person may die, will you tell the person to keep the pregnancy?” she asks. “There are a hundred conditions where continuation of the pregnancy may lead to termination of her life.”
She also addresses the fear, often voiced by opponents, that guidelines will be abused. “Will you say because someone is going to abuse malaria drugs, people with malaria should not benefit?” she responds. “If there is abuse, there is another institution, the police, that handles that. Nobody should hold our hands in the discharge of our duties.” The separation between clinical responsibility and legal enforcement, she argues, is fundamental: doctors treat.
Jimoh shares insight on what the suspension mean for women, “These are women who are up to 50 percent of the population of Nigeria. These are women who provide for us. These are our mothers.” He pauses. “The Yoruba will say we hear the voice of the mother and the baby. But a number of times we hear the voice of the baby, and we don’t hear the voice of the mother. Those are the issues.”
Journalists as the last line of advocacy
It was the recognition that medicine and law alone cannot move policy that brought a group of journalists to a two-day training in Lagos, convened by CBHGaps in collaboration with the Network of Reproductive Health Journalists Nigeria. The logic was pragmatic: if training every Lagos doctor on the legal provisions is logistically impossible, then training journalists who can carry these stories to millions may be the more effective intervention.
“Journalists are like the eye of the government, the eye of the populace,” Dr. Jagun told the room. “Stories that have been written decades ago, people still bring out the publications. So we thought: let’s bring journalists to the table.” The training covered the legal framework, the constitutional provisions, the Maputo Protocol, the criminal and penal codes, and the clinical indications the guideline was designed to address, equipping reporters to cover the issue with the depth and accuracy it demands.
“We are more empowered now. We will go back to our constituencies and come out with stories that will speak to the issues, to policymakers, to the state government, and to the public. The important thing is that we want to save the lives of our women and our mothers,“ said Sola Ogundipe Health Editor at Vanguard Newspaper
Ogundipe said the training reconnected the network with a story that had faded from news cycles. “These issues have been out of the news for some time,” he said. “This will give us a better, fresher perspective.” He noted that even the constitutional and criminal law dimensions of abortion, long considered the province of lawyers, are now terrain that health journalists must navigate and explain to a general audience. The network, he said, leaves the training more equipped and more determined to do exactly that.
“No woman, adolescent, single, married, widowed, should die a preventable death due to pregnancy,” said Kikelomo Oduyebo, the Lagos State Coordinator, Network of Reproductive Health Journalists Nigeria. “The fanfare around the STOP guidelines was not necessary. These services should be made available at government-owned, recognised health facilities, not the quacks within communities where girls go and they die.” She added
In light of the electoral calendar, Akin Jimoh assesses the political stakes. Lagos State heads toward elections in 2027. The current administration, which suspended the guideline in 2022 and has let the suspension stand for the duration of its term, will be accountable to voters. “This guideline was suspended in 2022. Now 2026, going to 2027, when are we going to act on behalf of those who are going to vote for us?” he demands. “Are they serious about saving women’s lives? Are they serious about ensuring that when there is a medical complication, and the only solution is to introduce a procedure that is already legal, that they give legal backing to that procedure?”
The ask is simple
Advocates are not asking Lagos State to liberalise abortion law. They are not asking for rights that do not exist. They are asking for a medical document, developed over four years, by legal scholars, gynaecologists, oncologists, cardiologists, nephrologists, and psychiatrists, to be returned to the health workers who need it. They are asking that the gap between what the law already permits and what doctors feel empowered to do be finally, formally closed.
“Lagos is a model state,” says Oduyebo. “It has done well in combating sexual and gender-based violence, going so far as to establish an agency that addresses it directly. We need the government to take a second look and see that in the interest of women not dying, women not patronising quacks, these services should be made available at government-owned, recognised health facilities.”
Dr. Jagun’s closing appeal is to the governor directly, and to every journalist leaving the training room. “He’s a responsible governor. I’m sure that if journalists raise their voice on safe termination of pregnancy in this state, we will add to the number of people already talking. And in no time, I’m sure he is waiting to lift the ban.”
The women who have already died while that ban endures cannot wait any longer. But the ones alive today still can be saved. The question is whether Lagos State, and Nigeria as a whole, will act before another mother becomes another unreported statistic in a crisis that has gone on, quietly and catastrophically, for far too long.