By Okolo Ekene Peter

Nigeria is losing far more than lives to unsafe abortion. It is losing money, labour, and the productive futures of hundreds of thousands of women every year, and the economic damage compounds with each year the crisis goes unaddressed.

Abortion in Nigeria is legal only when performed to save a woman’s life. Yet abortions remain common, and most are unsafe, performed clandestinely by unskilled providers or in conditions that fall below any medical standard. The Guttmacher Institute estimates that 456,000 unsafe abortions occur in Nigeria annually, and unsafe abortion accounts for 40% of maternal deaths, making it the second leading cause of maternal mortality in the country. Nigeria accounts for 28.5% of the world’s maternal deaths, a burden no single country should carry, and one that speaks directly to systemic failure rather than medical inevitability.

The direct healthcare cost is well documented. Post-abortion care in Nigeria costs an estimated US$103 per patient, amounting to approximately US$19 million annually. The average per-case hospital cost is US$132, of which 72% is borne by women and their households. Public hospitals in just three states, Ogun, Lagos, and the FCT, spend over US$807,000 on post-abortion care every year, with moderate complication cases costing 60% more than simple cases. Nationally, the burden stretches into tens of billions of naira, drawn from a health system already stretched beyond its capacity.

The indirect costs are larger still. A Nigerian woman faces a 1-in-22 lifetime risk of dying from pregnancy or post-abortion complications. In most developed countries, that risk is 1 in 4,900. Each preventable death removes a woman from the labour force, typically between the ages of 15 and 45, the years of peak economic contribution. Unsafe abortion undermines the ability of women to participate fully in economic, social, and political life, perpetuating a cycle of gender-based inequality that the broader Nigerian economy cannot afford. Long-term complications, including infertility, chronic pelvic infection, and organ damage, lock surviving women out of sustained economic participation, generating invisible losses that never appear in any budget line but accumulate across communities and households year after year.

The savings from reversing this trend are substantial. A 60% reduction in unsafe abortions through expanded contraceptive access and harm reduction programming would cut the annual post-abortion care bill by over US$11 million at current rates, while the productivity gains from retaining women in the workforce would dwarf that figure many times over. Both unintended pregnancy and unsafe abortion could be significantly reduced if Nigeria and its partners increased investment in family planning programmes and comprehensive sexuality education. Investment in contraception consistently returns between four and six naira in averted treatment costs and productivity gains for every naira spent, making it among the most cost-effective public health interventions available.

If Nigeria does not act between now and 2029, the consequences will compound in three directions.

 First, as economic development expands across the North, unmet contraceptive need will rise and the incidence of unsafe abortion will increase unless access to contraception and safe care also expands. 

Second, with over 9 million pregnancies occurring annually and nearly half reported as unintended, the pipeline of women at risk of unsafe abortion is growing faster than any corrective infrastructure being built. 

Third, community death reviews consistently show that women are dying not because complications are untreatable, but because health systems fail to respond in time, with cascading delays at every stage from recognition to treatment. Without deliberate investment, those systemic gaps will widen.

Nigeria does not need to resolve its legal debates on abortion to begin reducing this toll. It needs scaled investment in modern contraception, trained community health workers, outpatient post-abortion care infrastructure, and public health communication that reaches women before a crisis occurs. 

The economic case for doing so is as strong as the humanitarian one. By 2029, the cost of inaction will be measured not only in preventable deaths but in a workforce diminished, a health system overburdened, and a country that chose to absorb a preventable catastrophe rather than invest in stopping it.