Health advocates have renewed calls on the Lagos State government to reinstate the suspended Guidelines on Safe Termination of Pregnancy for Legal Indications (STOP Guidelines), saying the policy could provide doctors with clearer clinical guidance and help reduce preventable maternal deaths.

The call was made by the Project Manager for Pamoja, Rumunse Obi, in an article titled “Dr Majek and the Ghost: Why Lagos Must Revisit the STOP Guidelines”, shared with PREMIUM TIMES on Tuesday.

The article accompanies Dr Majek and the Ghost, a narrative public health project exploring how stigma, misinformation and delays in accessing reproductive healthcare contribute to poor maternal health outcomes in Nigeria.

The project forms part of “ÀJOSE: The Stories That Bind Us”, an initiative that uses film and public dialogue to stimulate conversations around women’s reproductive health.

Earlier this year, the initiative brought together filmmakers, healthcare professionals, creatives and members of the public in Lagos to discuss how stigma, cultural silence and misinformation continue to shape women’s health outcomes.

Participants also previewed Dr Majek and the Ghost alongside other productions before engaging in discussions on maternal mortality, consent and ethical healthcare.

According to Ms Obi, the fictional story follows a physician confronted with deaths that could have been prevented if patients had received timely and lawful medical care.

Although fictional, she said the narrative reflects the experiences of many Nigerian women who continue to die from pregnancy-related complications despite the availability of lifesaving medical interventions.

Why the guidelines matter

Ms Obi said the STOP Guidelines, introduced by the Lagos State government in 2022, were developed to help healthcare providers interpret existing laws governing pregnancy termination in emergencies, particularly where continuing a pregnancy poses a risk to a woman’s life or health.

She explained that the guidelines were developed over several years with contributions from medical and legal experts to support doctors making time-sensitive decisions in high-risk obstetric cases without changing Nigeria’s abortion laws.

However, the Lagos State government suspended the guidelines in July 2022 shortly after their release following opposition from religious organisations and other groups, which argued that the policy could encourage abortion.

At the time, the government said the suspension would allow for broader stakeholder engagement and public sensitisation on the document’s objectives. Nearly four years later, the guidelines have yet to be reinstated.

Ms Obi argued that the controversy surrounding the policy stemmed largely from misconceptions about its purpose, while the clinical challenges it was designed to address remain unresolved.

Citing estimates from the World Health Organisation (WHO) and findings from the Nigeria Demographic and Health Survey (NDHS), she noted that Nigeria continues to bear one of the world’s highest maternal mortality burdens, with limited access to skilled birth attendants, emergency obstetric care and timely referrals contributing to preventable deaths.

Lagos’ maternal health efforts

Ms Obi’s call comes as the Lagos State government continues to implement measures to reduce maternal mortality.

In April 2025, the state partnered with the National Health Insurance Authority (NHIA) to launch the Maternal Initiative for Financing Access to Comprehensive Emergency Obstetric Care (CEmOC) to improve access to lifesaving obstetric services for women experiencing pregnancy-related emergencies.

At the launch, the Lagos State Commissioner for Health, Akin Abayomi, said the state still records about 400 maternal deaths per 100,000 live births, describing the figure as unacceptable for a megacity.

Mr Abayomi said the government was expanding Mother and Child Centres, strengthening referral systems, integrating traditional birth attendants into the formal healthcare system through regulation and training, and expanding health insurance coverage to ensure women receive emergency care regardless of their ability to pay.

The Special Adviser to the Governor on Health, Kemi Ogunyemi, also stressed the need to eliminate delays in emergency obstetric care, saying saving the lives of mothers and babies should take precedence over concerns about payment.

Clearer guidance

Speaking with PREMIUM TIMES on Monday, Temitope Adekanye, a senior registrar in obstetrics and gynaecology at Lagos University Teaching Hospital, said that although he had not reviewed the suspended STOP Guidelines and could not comment on their specific provisions, Nigeria had long needed clearer clinical guidance on abortion within the existing legal framework.

Mr Adekanye described abortion as a sensitive issue because Nigerian law generally prohibits the procedure except where it is necessary to save a woman’s life, creating legal and clinical uncertainty for healthcare providers.

“We should have had a guideline on abortion a long time ago,” he said.

He noted that unsafe abortions continue to contribute to maternal deaths because many procedures are carried out by unqualified persons or in facilities that do not meet minimum medical standards.

The senior registrar, however, emphasised that unsafe abortion is only one of several factors driving maternal mortality in Nigeria.

According to him, postpartum haemorrhage remains the leading cause of maternal deaths, followed by hypertensive disorders such as pre-eclampsia, while sepsis, obstructed labour and unsafe abortion also account for a significant proportion of pregnancy-related deaths.

He attributed many maternal deaths to what health experts describe as the “three delays”—delays in deciding to seek medical care, delays in reaching a health facility and delays in receiving prompt treatment after arrival.

Poor road networks, shortages of skilled healthcare workers, weak referral systems and inadequate hospital capacity, he added, continue to worsen outcomes for pregnant women.

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Call for reinstatement

Against this backdrop, Ms Obi argued that although haemorrhage, hypertensive disorders and sepsis remain the leading causes of maternal mortality, unsafe abortion also contributes significantly to pregnancy-related deaths, particularly in countries with restrictive legal environments.

She said uncertainty over the legal interpretation of emergency reproductive healthcare can delay treatment and increase the risk of preventable deaths.

“The suspension of the STOP Guidelines did not remove these clinical realities. It removed a structured framework intended to help clinicians navigate them safely within existing law,” he wrote.

Ms Obi noted that many countries with restrictive abortion laws rely on detailed clinical protocols to guide healthcare providers without changing the law.

She maintained that reinstating the STOP Guidelines would complement Lagos State’s investments in maternal healthcare by providing clinicians with greater clarity in managing complex pregnancy-related emergencies.

She added that restoring the guidelines would not amend Nigeria’s abortion laws but would improve how existing legal provisions are interpreted and applied in clinical practice.

The association’s President, Nosa Orhue, announced the ultimatum on Tuesday in Abuja after a meeting of the union’s National Executive Council (NEC).

Mr Orhue said the government must conclude negotiations within the next 21 days, warning that the union would reconvene after the deadline to decide its next course of action if there was no meaningful progress.

According to him, the association had engaged government through dialogue for more than 24 months without meaningful progress.

Mr Orhue said the association was dissatisfied that negotiations on the renegotiation of the 2009 agreement had remained stalled since 9 April, in spite of repeated engagements.

He alleged that while improved welfare packages had been implemented for other university unions, NAMDA members remained excluded, resulting in non-payment of earned academic and professorial allowances and worsening brain drain among medical academics.

The NAMDA president attributed the dispute largely to salary disparities between university-based medical lecturers and hospital consultants performing identical professional duties.

He explained that medical academics combine teaching, research and clinical responsibilities, including patient care, surgeries and hospital administration.

According to him, they earn less than their counterparts in the hospital system despite maintaining the same professional qualifications and practising licences.

Mr Orhue said the federal government had previously recognised the unique status of medical academics through their placement on the Consolidated Medical Salary Structure (CONMESS). He added that the Minister of Education, Tunji Alausa, had supported salary parity and communicated the position to the National Salaries, Incomes and Wages Commission.

He, however, alleged that some government agencies were frustrating implementation of the agreement.

Mr Orhue reaffirmed that CONMESS remained the only acceptable salary framework for medical and dental academics.

He warned that any attempt to replace it with another structure could trigger industrial action.

He also rejected what he described as the forced migration of members above 65 years from CONMESS to the Consolidated University Academic Salary Structure (CONUASS).

According to him, the move amounts to a demotion and results in financial losses for affected academics.

He said the association was also demanding implementation of special pension benefits for retired hospital-based academics and opposed the National Universities Commission’s requirement for medical academics to obtain PhD qualifications.

In spite of the dispute, Mr Orhue commended President Bola Tinubu’s administration for efforts to improve university education and hailed the Minister of Education for supporting salary parity for medical academics.

He also lauded the federal government’s preparedness for a possible Ebola outbreak and pledged the association’s support toward strengthening the country’s public health response.

(NAN)