Safe Termination of Pregnancy in Southwest Nigeria: A Critical Review of Legal, Policy, and Health System Challenges for Reform

Background: Unsafe abortion contributes significantly to Nigeria’s high maternal mortality rate, estimated at over 1,000 per 100,000 live births, with Southwest Nigeria facing persistent challenges despite advanced healthcare infrastructure. Restrictive laws, policy gaps, and sociocultural stigma drive clandestine procedures, exacerbating maternal morbidity. Objective: This narrative review critically examines legal, policy, and health system barriers to safe pregnancy termination in Southwest Nigeria, proposing reforms to enhance maternal health outcomes. Methods: A narrative review was conducted, synthesizing data from peer-reviewed articles (1990-2025), WHO/UNFPA documents, Nigerian laws, court rulings and anecdotal reports. Thematic analysis focused on legal frameworks, policy implementation, health system capacity, and sociocultural factors, with a specific emphasis on Southwest Nigeria. Key Findings: Nigeria’s Criminal and Penal Codes restrict abortion to life-saving cases, pushing 45% of abortions into unsafe settings (WHO, 2024). The suspended Lagos 2022 Guidelines offered progress but faced backlash. The 2025 ECOWAS Court ruling highlighted Maputo Protocol obligations, yet non-domestication stalls reform. Limited provider training, inadequate primary health center infrastructure, and stigma hinder access, particularly for adolescents. Community resistance and weak data systems further complicate reform efforts. Conclusion: Legal reform to clarify indications, state-level guidelines aligned with WHO standards, and integration of safe abortion into reproductive health services are critical. Capacity-building, improved data collection, and community engagement with faith-based groups can reduce stigma and enhance access, positioning Southwest Nigeria as a model for national reform. With resolute political leadership, Southwest Nigeria can pioneer national reform, ensuring equitable, safe reproductive healthcare.