Impact of abortion laws on women's choice of abortion service providers and facilities in southeastern Nigeria

Background: The liberalization of abortion laws in Nigeria has been an interesting debate for a long time. Both proponents and opponents have defended their positions with similar vigor. However, the opinion of the Nigerian woman on the subject matter has received little attention. It is important to understand the opinion of the Nigerian woman, especially with regard to the potential impact of any abortion law on unsafe abortion.Objective: The objective of this study is to determine the impact of abortion laws on women’s choice of abortion service providers and facilities in Southeastern Nigeria.Methods: Women attending the gynecological clinics of two tertiary hospitals in Southeastern Nigeria were interviewed with interviewer‑administered questionnaires. Questions were asked on awareness of abortion laws, opinion on liberalization of abortion laws, and the impact of abortion laws on women’s choice of abortion service providers in situations of unwanted pregnancies.Results: A total of 1120 women were interviewed. More than half (57.7%) of respondents were aware of the abortion laws of Nigeria. About 59.2% of respondents had previously done abortion for unwanted pregnancies. Some (78.3%) of respondents indicated that abortion laws will not influence their choices of abortion service providers in cases of unwanted pregnancies. Majority (78%) do not support liberalization of abortion laws.Conclusion: The abortion laws in Nigeria do not influence women’s choice of abortion service providers and facilities. Factors other than the contents of abortion laws influence women’s choices. The findings of this study open a newvista toward the search for the factors that drive unsafe abortion in Nigeria.Keywords: Abortion laws, Abortion service, Nigeri

Lancet HIV

BACKGROUND: Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. METHODS: We did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially </=350 cells per muL and <500 cells per muL from January, 2015; control). Participants and investigators were not masked to treatment allocation. We used dried blood spots once every 6 months provided by participants who were HIV negative at baseline to estimate the primary outcome of HIV incidence with cluster-adjusted Poisson generalised estimated equations in the intention-to-treat population after 58 cluster-years of follow-up. This study is registered with ClinicalTrials.gov, number NCT01509508, and the South African National Clinical Trials Register, number DOH-27-0512-3974. FINDINGS: Between March 9, 2012, and June 30, 2016, we contacted 26 518 (93%) of 28 419 eligible individuals. Of 17 808 (67%) individuals with a first negative dried blood spot test, 14 223 (80%) had subsequent dried blood spot tests, of whom 503 seroconverted after follow-up of 22 891 person-years. Estimated HIV incidence was 2.11 per 100 person-years (95% CI 1.84-2.39) in the intervention group and 2.27 per 100 person-years (2.00-2.54) in the control group (adjusted hazard ratio 1.01, 95% CI 0.87-1.17; p=0.89). We documented one case of suicidal attempt in a woman following HIV seroconversion. 128 patients on ART had 189 life-threatening or grade 4 clinical events: 69 (4%) of 1652 in the control group and 59 (4%) of 1367 in the intervention group (p=0.83). INTERPRETATION: The absence of a lowering of HIV incidence in universal test and treat clusters most likely resulted from poor linkage to care. Policy change to HIV universal test and treat without innovation to improve health access is unlikely to reduce HIV incidence. FUNDING: ANRS, GiZ, and 3ie