Professor Atiene Solomon Sagay - University of Jos Institutional ...

Known as recurrent pregnancy loss, repeated miscarriage is difficult for both partners
involved. It can also make fertility treatments particularly challenging.
Recurrent pregnancy loss occurs when a women loses three or more consecutive pregnancies.
The majority of recurrent pregnancy losses occur early in pregnancy, typically during the first
half of pregnancy. Recurrent pregnancy loss is very difficult for couples to experience,
especially because a cause for these miscarriages is often never determined. Nevertheless, by
undergoing specific fertility testing and treatment, there is hope that couples who have
experienced multiple miscarriages will go on to welcome a healthy child of their own.
Fortunately, recurrent pregnancy loss is relatively rare as fewer than 3% of couples go
through more than three miscarriages in a row. It is more likely to occur in older women who
have had two previous pregnancy losses and engaged in certain life-styles such as smoking,
heavy drinking and drug use.
Unfortunately, it is difficult to pinpoint the underlying cause of pregnancy loss. In fact, more
than 50% of couples that experience the problem never find out what is responsible for their
miscarriages. However, there are a number of conditions that do underlie some cases of
recurrent miscarriage. They include genetic factors, structural uterine problems, hormonal
imbalance and blood clotting disorders.
2. What if a pregnancy is unintended and unwanted?
Each year, thousands of Nigerian women have unintended pregnancies that end in illegal
abortion. Many of such procedures occur under unsafe conditions, contributing to maternal
morbidity and mortality. To highlight this challenge, permit me to share an experience
during my residency training.
It was about 9.00pm on a cold April night in mid-1980s, I was on my first call duty as a
resident doctor in the Jos university teaching hospital, Jos, and I was asked to review and
admit a young lady who was said to be having vaginal bleeding. She was a university
undergraduate. On the couch, I found a pretty, young lady with a stylish hair do, who was
very pale, cold, motionless and stiff. My examination confirmed that she was dead. I tried to
conceal my horror and politely told the porter to take her back to the casualty officer and
demonstrated to him that she was brought in dead and could not be admitted to the
gynaecology ward. The brief history suggested that she had a termination of pregnancy
somewhere in town that evening. That night, as I reflected on the scene, I realised I had just
witnessed an avoidable maternal death. This experience remained on my mind all through my
residency training and served as a constant reminder of how hazardous being a woman in
Nigeria can be.
Abortion in Nigeria is illegal except to save a woman‘s life. Of the estimated 6.8 million
pregnancies that occur annually in Nigeria, one in five is unplanned and half of these end in
an induced abortion. (Guttmacher Institute 2008) Abortion is therefore common in Nigeria
and most procedures are performed under unsafe, clandestine conditions. In 1996, an
estimated 610,000 abortions occurred (25 per 1000 women of childbearing age), of which
142,000 resulted in complications severe enough to require hospitalization. The number of
abortions is estimated to have risen to 760,000 in 2006 (Bankole et al. 2006). Unsafe
abortions are a major reason Nigeria‘s maternal mortality ratio – 1,100 deaths per 100,000
live births- is one of the highest in the world (WHO 2007). According to conservative
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