A Professor of foetal medicine at Olabisi Onabanjo University, Ago-Iwoye, Ogun State, Olufemi Oloyede, has called for a review of Nigeria’s abortion law to address emerging ethical and medical challenges arising from advances in foetal medicine.
Oloyede made the call while delivering the university’s 130th inaugural lecture, titled: ‘To Live or Not to Live: Navigating Ethical Dilemmas in Foetal Medicine’.
He said advances in prenatal diagnosis had enabled doctors to detect serious abnormalities before birth but had also created difficult questions involving the rights of the unborn child, maternal autonomy, medical ethics, religion and the law.
According to him, doctors in foetal medicine have obligations to both the unborn baby and the mother, whose interests could sometimes conflict.
‘The society is unique because it has dual obligations, primarily to the foetus, but secondarily to the mother. Sometimes, we run into conflicts where the wellbeing of either of them conflicts with the other.’
Oloyede said Nigeria’s legal framework must keep pace with developments in medical science, particularly in cases where prenatal diagnosis reveals severe or life-limiting abnormalities in an unborn baby.
He noted that the Federal Ministry of Health’s 2022 guidelines on termination of pregnancy had recognised some foetal conditions in considering termination, but said clearer provisions were needed to guide doctors and families confronted with difficult cases.
The donor proposed the establishment of multidisciplinary committees in healthcare institutions to review complex cases involving termination of pregnancy.
He said such committees should include foetal-medicine specialists, perinatologists, clergy, sociologists and other relevant professionals, to ensure that decisions were considered from medical, ethical, religious and social perspectives.
Oloyede also called for wider access to genetic counselling and prenatal diagnosis for sickle cell disease.
He explained that where both parents carried the sickle cell trait, each pregnancy had a 25 per cent chance of producing a child with haemoglobin SS, a 50 per cent chance of AS and a 25 per cent chance of AA.
He advocated greater use of chorionic villus sampling and molecular testing to establish the unborn baby’s genotype early in pregnancy, while warning that laboratory errors could lead to incorrect diagnoses and serious reproductive decisions.
The professor also challenged the perception that Down syndrome was uncommon in Nigeria and called for improved screening for chromosomal abnormalities and congenital defects.
He particularly urged better detection of abnormalities affecting the unborn baby’s heart through quality obstetric ultrasound.
Oloyede urged stronger regulation of obstetric ultrasound practice, including minimum certification requirements, periodic retraining and recertification of practitioners.
He warned that poor-quality scans and inaccurate diagnoses could result in inappropriate clinical decisions and jeopardise the health of mothers and their babies.
The don also called on health maintenance organisations to cover routine and diagnostic obstetric ultrasound, arguing that access to prenatal diagnosis should not depend solely on a patient’s ability to pay.
He urged government and professional bodies to develop national guidelines on prenatal screening, abnormalities in unborn babies and preterm birth.
Oloyede further called for the revitalisation of OOU’s molecular laboratory at its Sagamu campus to support advanced diagnosis and research.
Reflecting on the challenges faced by the unborn child, the professor said, ‘The foetus goes through a lot of war in the womb,’ describing foetal development as a continuous struggle for survival.
He said Nigeria must ensure that advances in foetal medicine were matched by appropriate legal, ethical, regulatory and healthcare frameworks to improve care for women and their unborn children.