Chinonso Kenneth (Lead writer)
When Cecilia Ahmadu began bleeding heavily, three days after performing a self-induced abortion, she knew something had gone wrong. “I was using more than three pads [daily] a few days after my abortion, I did not have anyone to talk to. I was worried and afraid,” Cecilia recalled.
Abortions remain illegal in Nigeria and unsafe termination of pregnancies have resulted to an estimated 40% of pregnancy-related deaths. Recently, the Senate considered a bill proposing a 10-year jail term for anyone supplying drugs or instruments used to perform abortions, an increase from the previous three-year sentence. However, further consultation was recommended, as there was no alignment on the clause, with dissenting voices raising concerns.
Yet, while Nigeria criminalises abortion procedures, data from the Federal Ministry of Health and Social Welfare revealed that safe and clinical post abortion care (PAC) should be accessible to all women and girls in Nigeria.
However, Cecilia was not sure whom she could trust, after the abortion due to the prevalent social harassment and seven year jail term prescribed by the Nigerian law for women who elicit an abortion, and so she ran an internet search for answers.
She eventually found Komfot Health, an online service that provides free sexual and reproductive healthcare services including PAC to women in Nigeria. “I found them [Komfot Health] on TikTok when they made a video of what haemorrhage after an abortion looks like. I sent them a message on Instagram because their TikTok was restricted, explained my situation and I was asked to book a session with the sexual health counsellor,” she explained.
According to Sanasi Amos, Co-founder of Komfot Health, the national PAC guidelines mandates the provision of life saving PAC for all. However, “the fear of being judged or finding a provider who will not report limits women from getting care. The goal is to help people with access to easily access care and on time, so they do not deal with adverse complications,” Sanasi explained.
Since 2024, Komfot Health has been providing a range of PAC services from evacuation of incomplete or missed abortions, sepsis treatment, contraceptive counselling, Sexually Transmitted Infection (STI) testing, cervical cancer screening, as well as treatment for pelvic inflammatory disease and therapeutic counselling for women who have gone through traumatic pregnancy loss.
Connecting with those in need through social media
Access to safe and clinical PAC services can reduce abortion-related deaths. This is because 56% of Nigerian women who reported having an abortion also reported experiencing a complication, and less than half of the primary healthcare centres (PHCs) across the country provide PAC services, according to a 2020 study by Performance Monitoring for Action.
To this effect, Komfot Health connects women to verified non-judgemental healthcare facilities with comprehensive post-abortion services for free and charge a subsidised price for Human Papillomavirus (HPV) screening and vaccination.
Using social media platforms like TikTok and Instagram, Komfot Health connects with women and girls who require their services. A sexual health counsellor gets relevant information regarding their health issues, including asking them to do a pelvic scan.
The Komfot Health counsellor Cecilia messaged on Instagram replied immediately and sought information on the process she undertook to perform the abortion. This trained health counsellor then advised Cecilia to do a pelvic scan, which eventually revealed she had an incomplete abortion.
With her scan results, Cecilia was referred to a PHC that was equipped for PAC. “I felt welcomed after I reached out, I was afraid that they will be rude to me, but they were not. I got an evacuation,” Cecilia said.
According to Sanasi, “a pelvic scan is the only way we can confirm if it’s an incomplete, missed or septic abortion. If the pregnancy is still viable, then there is nothing we can sadly do as the law does not require us to do anything.”
The result from the pelvic scan is used by the counsellor to refer the patient to a vetted healthcare provider for post abortion care. This includes primary healthcare centres, general hospitals, teaching hospitals, and even private clinics.
What the law says
According to Ifechi Aleke, a legal officer at Lawyers Alert Nigeria, there are no clear statutory provision on PAC in Nigeria “this silence means that in practice, treatment of complications of abortion is a recognised public health service guided by policies of the Federal Ministry of Health.
“There is also no statutory requirement that mandates health workers to report to the authority after dispensing post abortion care or report a person for seeking post- abortion care,” Ifechi added.
So far, Komfot Health has assisted over 3,000 women like Cecilia across Nigeria. Despite these gains, the organisation still experiences drawbacks. For instance, Sanasi noted that staff experience cyberbullying routinely because of their services even though they do not help patients procure abortions.
Another limitation is the absence of offline presence for less educated women and girls in rural communities who do not have digital access. This demography who might have the highest need are shut out due to Komfot Health’s digital only solution.
Furthermore, patients are often scared to work with their vetted PAC providers, particularly public health facilities, due to a fear of being reported to the authorities for carrying out an abortion. “There are people who will come, and they are already septic but because of fear and stigma they will say they are asking for their friend when they are the one that needs the care,” Sanasi explained.
Recently, Komfot Health launched a WhatsApp bot to enable patients reach out more easily and covertly. The use of artificial intelligence (AI) and technology is aimed to reassure patients of confidentiality and speed up response time.