A Professor of Foetal Medicine at Olabisi Onabanjo University (OOU), Ago-Iwoye, Ogun State, Olufemi Oloyede, has advocated for a review of Nigeria's abortion law. He made this call during the university's 130th inaugural lecture, titled: "To Live or Not to Live: Navigating Ethical Dilemmas in Foetal Medicine". Oloyede stated that advances in prenatal diagnosis have created difficult questions involving the rights of the unborn child, maternal autonomy, medical ethics, religion, and the law.
According to Oloyede, doctors in foetal medicine have obligations to both the unborn baby and the mother, whose interests can sometimes conflict. He noted that the society has dual obligations, primarily to the foetus, but secondarily to the mother. Oloyede added that conflicts can arise where the wellbeing of either of them conflicts with the other. This highlights the need for a comprehensive review of the country's abortion law to address these complexities.
Oloyede pointed out that Nigeria's legal framework must keep pace with developments in medical science. This is particularly crucial in cases where prenatal diagnosis reveals severe or life-limiting abnormalities in an unborn baby. He noted that the Federal Ministry of Health's 2022 guidelines on termination of pregnancy have recognised some foetal conditions in considering termination. However, Oloyede emphasized that clearer provisions are needed to guide doctors and families confronted with difficult cases.
The professor proposed the establishment of multidisciplinary committees in healthcare institutions to review complex cases involving termination of pregnancy. These committees should include foetal-medicine specialists, perinatologists, clergy, sociologists, and other relevant professionals. This would ensure that decisions are considered from medical, ethical, religious, and social perspectives. Oloyede also called for wider access to genetic counselling and prenatal diagnosis for sickle cell disease.
Oloyede explained that where both parents carry the sickle cell trait, each pregnancy has a 25 per cent chance of producing a child with haemoglobin SS, a 50 per cent chance of AS, and a 25 per cent chance of AA. He advocated for greater use of chorionic villus sampling and molecular testing to establish the unborn baby's genotype early in pregnancy. However, Oloyede warned that laboratory errors can lead to incorrect diagnoses and serious reproductive decisions.
The professor also challenged the perception that Down syndrome is uncommon in Nigeria. He called for improved screening for chromosomal abnormalities and congenital defects, particularly better detection of abnormalities affecting the unborn baby's heart through quality obstetric ultrasound. Oloyede urged stronger regulation of obstetric ultrasound practice, including minimum certification requirements, periodic retraining, and recertification of practitioners.
Oloyede further called on health maintenance organisations to cover routine and diagnostic obstetric ultrasound. He argued that access to prenatal diagnosis should not depend solely on a patient's ability to pay. The professor also urged government and professional bodies to develop national guidelines on prenatal screening, abnormalities in unborn babies, and preterm birth. Additionally, he called for the revitalisation of OOU's molecular laboratory at its Sagamu campus to support advanced diagnosis and research.
Key points
- A review of Nigeria's abortion law is necessary to address emerging ethical and medical challenges arising from advances in foetal medicine.
- The establishment of multidisciplinary committees in healthcare institutions can help review complex cases involving termination of pregnancy.
- Improved screening for chromosomal abnormalities and congenital defects, particularly Down syndrome, is necessary in Nigeria.
