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Soc. Sci. Med. Vol.42, No. 4, pp.

483-494, 1996

Pergamon

0277-9536(95)00171-9

Copyright 1996ElsevierScienceLtd
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0277-9636/96$15.00+ 0.00

THE P R E G N A N C Y THAT DOESN'T STAY:


THE PRACTICE A N D PERCEPTION OF ABORTION BY
EKITI YORUBA WOMEN
ELISHA P. RENNE
Office of Population Research, Princeton University, Princeton, NJ 08544-2091, U.S.A.
A~tract---Ekiti Yoruba village women in southwest Nigeria make use of traditional and 'patent'
medicines as abortifacients as well as D&Cs performed in urban centers to terminate unwanted
pregnancies. This paper examines present day abortion practices and attitudes and relates them to
traditional beliefs about conception, fetal development and infertility. These beliefs, along with factors
of economy and access, help to explain the continued use of abortion as a form of birth control, despite
the presence of other options. The paper concludes with a discussionof the current debate about legalizing
abortion in Nigeria and a recommendation consonant with everyday village practice.
Key words--abortion, Yoruba, infertility, legalization

INTRODUCTION
For many--though not all--rural Ekiti Yoruba
women in southwestern Nigeria, abortion is considered to be one among a continuum of birth control
options, which include the use of traditional medicines prepared by local herbalists and 'patent' medicines obtained from pharmacies. Such substances
come under the general name, oogun ti won l e f t se ki
oyun maa d u r o - - ' m e d i c i n e that keeps a pregnancy
from staying'. As this general name suggests, such
medicines--and associated activities--may include
some which terminate a pregnancy as well as those
that can prevent one. Thus the distinction between
contracepting and terminating a pregnancy is not
always clearly made.
Most people are aware of this distinction, generally
associated with medicines taken before intercourse
and those taken after. However, as one babalawo
(diviner-healer) pointed out, "It is easier to bring
down a pregnancy than to prevent one." His comment suggests a technological explanation for the
local prevalence of medicines that terminate a pregnancy over contracepting types and explains, in part,
why this distinction is not emphasized.
Further, the blurred line between what constitutes
contraceptives and abortifacients--both referred to
at times as oogun baje, 'medicine that spoils', reflects
a particular reproductive ideology in which the ethical distinction between abortion and contraception is
not the revelant one. According to the traditional
ideal, a woman during her reproductive life should
have as many children as two years of post-partum
abstinence allows. One should welcome pregnancy,
not prevent it.

This paper considers the persistence of abortion as


a form of birth control, despite the presence of other
options and the well-known dangers associated with
this procedure. Specifically, the practices and perceptions of abortion for a group of rural Ekiti Yoruba
women are discussed, indicating who aborts and
why as well as who performs them and how. These
practices are then related to cultural beliefs about
prenatal development, infertility and conception.
I suggest that these beliefs, along with factors of
economy and access, help to explain the continued
reliance on abortion as a means of birth control.
Finally the paper concludes with a discussion of the
current national debate about legalizing abortion in
Nigeria, a policy advocated by the present minister of
health. While national figures continue to argue over
this issue [1] and the national press seems to generally
be against legalization [2, 3] women at the grass roots
level in rural Ekiti and elsewhere in Nigeria consider
their options and continue to get abortions.
RESEARCH SETTINGAND METHODS
The Ekiti Yoruba comprise a sub-group of the
Yoruba-speaking people of southwestern Nigeria,
residing mainly in the northern half of the present day
Ondo State. Traditionally, men were farmers and
women were traders and weavers. Today many Ekiti
women and men have secondary school certificates or
some higher education and are employed in schools
and government offices in towns and cities. Others,
remaining in rural areas, combine farming and trading with semi-skilled occupations such as carpentry
and hairdressing, practiced on a part-time basis.
While relatively isolated in the past, nowadays Ekiti

483

484

Elisha P. Renne

villagers attend school, visit family, and travel to


major urban centers such as Lagos and Ibadan. Thus
many of the women and men questioned in this study
were exposed to trends and fashions in Nigeria more
generally.
The village in which I lived for nine months
was located in a rural area northeast of Ado-Ekiti.
It had a permanent population of approx. 3500
inhabitants, its numbers bolstered during holidays by
family and friends. Situated along a paved Federal
highway plied by numerous taxis, villagers (and
myself included) took advantage of this easy transport, frequently travelling to nearby towns and
markets. Villagers also had access, if intermittently,
to electricity and pipe-borne water. There were three
primary schools, one secondary school, a post office,
a police station, a maternity clinic and dispensary,
and a new hospital, jointly constructed with a neighboring town. In addition to these modern health
centers, many villagers also consulted any of 15 local
diviner-healers (babalawo) and herbalists (onisegun)
about medical problems, as well as travelling to see
such practitioners in neighboring towns and villages.
Research for this study, conducted from June 1991
to March 1992, began with a household census and
open-ended interviews of 70 women (ages 15-39) and
66 men (ages 20-44) selected by age and availability,
on attitudes toward family planning and government
population policies, use of birth control methods,
and associated health concerns. These interviews
were conducted primarily in Yoruba by research
assistants (a woman and a man) whom I alternately
accompanied. The recorded interviews were then
translated into English. They were supplemented with
interviews of diviners (5), herbalists (3) and clinic
owners (2) queried about various aspects of
reproductive health.
Through these qualitative interviews I gained a
general sense of the attitudes and vocabulary associated with birth control, including the pervasiveness of
knowledge of abortifacients. This information was
used to devise a DHS-like survey of birth control use,
D&Cs, and infant mortality of whom 300 women,
ages 15-49 (Table 1) randomly selected by residence,
were questioned. These interviews were conducted by
two women research assistants and myself in the early
part of 1992.
Before examining the results of this survey, I would
like to discuss the use of abortifacients as birth
control in this Ekiti village more generally.
KEEPING

A PREGNANCY FROM STAYING


AN EKITI YORUBA VILLAGE

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Historically, Ekiti women sought to have many


children, spaced by birth every two to three years
attained through sexual abstinence [4]. This cultural
ideal was reinforced by beliefs, still relevant for some,
that semen from intercourse will affect the nursing
infant through its mother's milk, causing illness and

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485

Practice and perception of abortion by Yoruba women


possible death. One village man, for example, who
recently lost two children as infants insisted that he
would not have sexual intercourse with his wife after
she had given birth until the child was weaned. He
had been blamed for the death of his children because
it was assumed that he had had intercourse with his
wife while the children were still nursing.
Since all other forms of birth control fall short of
this ideal of two years of abstinence--both those
preventing as well as those terminating a pregnancy-these methods have been considered morally suspect
[5]. It is not only abortion that should be hidden; the
use of 'family planning' methods more generally
should be hidden as well. It is not surprising, then,
when I asked the nurse's aid at the local maternity
clinic about the types of contraceptives available
from the clinic (condoms, foaming tablets and family
planning pills), she said that few villagers took advantage of this service because they wouldn't want others
to know and would rather purchase such things
outside.
However, not all women and men live up to the
ideals of their society. The practice of universal
post-partum abstinence in the past is belied by the
presence of other types of birth control [6] (p. 243).
Traditional diviners (babalawo) and herbalists
(onisegun) have an arsenal of medicinal and spiritual
devices which, with varying degrees of success, are
said to 'keep a pregnancy from staying'. As several of
these men said they had learned of these medicines
from their fathers, it is likely that these practices are
not new [7]. Presumably, some of these medicines
were used to cover any indiscretions during the two
to three year 'abstinence' period as well as premarital
dalliances [8]. Further, now that the government
has sanctioned family planning [9] (p. 422) and postpartum abstinence is practiced for a shorter period
(around one year, on average), traditional and patent
medicines (Table 2) as well as Family Planning
contraceptives are used to maintain the spacing of
children, still considered culturally correct.
It is when these medicines are ineffective that
women most often go to private clinics or hospitals
where abortions by D&C are performed. One clinic
owner in a nearby town estimated that two-thirds of
the ten abortions he performed monthly (on average)
were a result of women using other things which had
not completely worked. However because of this

Name
Bee-Codeine tablets
Dr. Bonjean's t a b l e t s
M & B tablets
Andrew's liver salt
'Alabukun' powder
Menstrogen
Panadol
Phrensic
Tetracyclincapsules
Family Planning tablets

tendency to self-abort and the potential illegality of


clinic abortions, it is difficult to get precise figures
on their number and types. When I suggested to the
above-mentioned clinic owner that abortion was
common, he said he did not think it was; yet a woman
diviner (iyalawo) in the same town said she had
~performed uncountable abortions'. One man in the
village, a teacher described as a 'social' diviner
(babalawo) because he performed abortions to help
people rather than as his primary occupation, said
that abortion was very common. He attributed its
prevalence to economic hardship associated with the
Structural Adjustment Program (SAP), instituted by
the Federal Government in 1987.
Figures from Nigerian health sector sources are
equally vague, with estimates of 200,000 to 500,000
pregnancies aborted annually. Further, an estimated
10,000 women die annually as a result of botched
abortions [1] (p. 18). One study based on hospital
admissions in Lagos estimated that 51% of maternal
death was due to abortion complications [10]. Smaller
studies in Lagos [I 1, 12] estimated that 5% and 5.6%
of the women surveyed had aborted pregnancies.
These figures may be low because of the reticence
of women to admit to having abortions. However,
Nichols et al. [13] found a 40% abortion rate among
young women (mainly secondary and university
students) surveyed in their 1982 study in Ibadan.
In her 1991 survey of women in the urban center
of Ado-Ekiti, Jo Erwin found that 16.4% of
women surveyed had had abortions (personal
communication).
Based on survey interviews of 300 women in the
Ekiti village where I worked, 15.6% of these women
said they had aborted a pregnancy by D&C at least
once in their lives. An additional 5.7% said they had
used patent medicines in the attempt to 'bring a
pregnancy down' (Table 3). I believe these relatively
high figures likely reflect the fact that my research
assistant was a local woman, that I resided in the
village for five months before asking such questions,
and that we conducted follow-up interviews.
Initially, I did not directly ask about personal
abortion histories, but rather asked women what they
knew about other women who had done so. Of the
70 village women questioned in the early interviews,
58 knew of examples, often friends, family members
or neighbors with whom they were acquainted

Table 2. Common 'patent" medicinesused as abortifacients


Intended use (ingredients)
Headache, rheumatic pain, colds (aspirin, codeine phosphate)
Emmenagogue
(ergot and ferrous sulfate)
Headache (sulphthiazole)
'For inner cleanliness'(magnesiumsulfate)
Headache (acetylsalicylicacid)
Irregular menstruation
Headaches (paracetamol)
Headache (aspirin)
Antibiotic
Contraceptive(tevonorgestrel)

Dosage/taken with:
2~, tablets w/local gin
1-2 tablets w/water
2-4 tablets w/water
I packet w/Sprite
1-2 packets w/water
2 tablets w/water
4 tablets w/salt, water
2 tablets w/Panadol, Sprite
4 capsules w/water
2 tablets w/water

486

Elisha P. Renne
Table 3. Women using patent medicineand getting D&C for abortion
Patent
Age (n = 300)
medicine only*
D&C only
Both't
15 19 (n = 111)
20-24 (n = 64)
25-29 (n = 33)
30-34 (n = 16)
35-39 (n = 28)
40-44 (n = 21)
45~,9 (n = 27)
Total by method
Percentage of total women surveyed

6
6
3
I
---1
17
5.7%

8
14
2
1
5
3
-33
11.0%

8
3
2
I
---14
4.6%

Total
by age
22
23
7
3
5
3
I

64
21.3%

*Patent medicines include Bee-codeine, Menstrogen, Dr. Bonjean, Tetracyclin and Panadol with
Phrensic.
"l'Figureincludestwo casesin which traditional medicinewas unsuccessfullyused first~followedby D&C.

personally, who had aborted a pregnancy. For


example, a married 32-year old woman, a secondary
school graduate who worked as a trader, described
one such xllcident:
One of my aunts used medicine [on an unwanted pregnancy]
without telling her husband.
(Q: How did you know?)
She told me and I was the one who helped her to buy it.
(Q: What did she use?)
She used Bee-codeine and Andrew's Liver Salt.
(Q: After buying these things, how did she take them?)
She bought 7-UP and dissolved the Bee-Codeine and
Andrew's Liver Salt in it and drank them.
(Q: What happened to her then?)
T h e pregnancy was aborted but it affected her so she went

to the hospital where she was treated very well.


F r o m these descriptions, from in-depth abortion
'histories' o f five women, and from quantitative
survey results, a picture emerges regarding who
aborts, how, and why in an Ekiti Y o r u b a village.

WHO ABORTS AND WHY

F r o m both the qualitative and survey interviews,


two groups o f w o m e n were found to be the most
likely candidates for a b o r t i o n s - - u n m a r r i e d school
girls and married w o m e n who had outside partners.
The p h e n o m e n a o f adolescent schoolgirls getting
abortions is well d o c u m e n t e d in West Africa [13-15].
A recent W H O study o f maternal mortality estimated
that 60% o f the d e m a n d for abortion in Nigeria
comes from these w o m e n [1] (pp. 17-18). The most
c o m m o n reason for aborting a pregnancy is the desire
to finish school, though their unmarried status is also
a factor.
A n o t h e r reason, most often given by married
women, is to terminate a pregnancy obviously not for
one's husband. However, some married w o m e n have
other reasons for aborting pregnancies mentioned
in the early interviews which included, in order o f
frequency cited:
1. The desire for child s p a c i n g - - p r e g n a n c y too
soon after earlier childbirth;

2. The husband not caring for welfare o f wife and


children;
3. The desire to limit family size; and
4. The desire to remarry a wealthier man
('hypergamy strategy').
A n example o f a 'hypergamy strategy' was given by
an 18-year old secondary school student:
I only heard [of someone using medicine on an unwanted
pregnancy], I didn't see it. There was a woman who formerly
had a husband whom she had left when she saw another
person who was richer. But she was already pregnant for the
former husband so she aborted the pregnancy and lied to the
husband that she had miscarried. This caused conflict
between them and she later left this man to marry the richer
one. I learned that she used Bee-codeine with alcohol.
The incident happened in Ado-Ekiti.
The above-cited reasons for abortion are similar
to the findings of the later quantitative survey o f
300 village w o m e n (Table 4). These findings are also
similar to those o f Bleek's [15] 1973 study o f abortion
in a rural Akan town in southern Ghana. Like the
Ekiti Y o r u b a w o m e n discussed here, unmarried
schoolgirls and married women having extramarital
affairs were the most likely to abort [15] (p. 338), the
adverse economic and social consequences o f bearing
children in these situations given as the reasons their
actions. A k a n w o m e n often self-aborted, relying on
a range o f locally available patent medicines some
o f which were also used in Nigeria (e.g. Dr Bonjean's,
Menstrogen and Ergometrine tablets) as well as
traditional, herbal medicines. Further, in both
societies, traditionally, a child was not considered
a social being until eight days after birth, when

Table 4. Reasons cited for going for D&C for abortion


No. of women
(n = 47)
17

Reason
Schooling
Did not want pregnancy at the time
Boyfriend denied or did not want pregnancy
Pregnancy not for husband or fiance
Pregnancy interferes with business, profession
Father unknown
No money to care for child
Had enough children
Parents did not want her to have child
Incestuous relationship
Rape

Practice and perception of abortion by Yoruba women


'out-dooring'
(Akan)
and
'naming'
(Yoruba)
c e r e m o n i e s were p e r f o r m e d . W h i l e these attitudes are
c h a n g i n g with W e s t e r n e d u c a t i o n , C h r i s t i a n belief,
a n d lower infant m o r t a l i t y , they seem to have s o m e
influence o n the a t t i t u d e s a b o u t the ethics o f a b o r tion. A b o r t i o n was c o n s i d e r e d a clandestine, i m m o r a l
activity yet it was m o r e o f t e n c o n d e m n e d b e c a u s e it
t h r e a t e n e d w o m e n ' s lives a n d r e p r o d u c t i v e h e a l t h
r a t h e r t h a n t h a t o f the fetus. Bleek a n d A s a n t e - D a r k o
[15] (p. 341) also e m p h a s i z e that while A k a n schoolgirls f r e q u e n t l y used m o r a l i s t i c language to c o n d e m n
a b o r t i o n , they were the ones w h o m o s t frequently
p r a c t i c e d it, for practical r a t h e r t h a n ideological
reasons.

Abortion histories: five Ekiti women


T h e r e a s o n s a n d practical a c t i o n s Ekiti Y o r u b a
village w o m e n t o o k u n d e r specific c i r c u m s t a n c e s
m a y m o r e clearly be seen in the following a b o r t i o n
'histories'. D e s p i t e the secrecy s u r r o u n d i n g a b o r t i o n ,
it is difficult to keep this k n o w l e d g e f r o m family, close
f r i e n d s a n d n e i g h b o r s , particularly w h e n there are
c o m p l i c a t i o n s . T h e s e interviews, o b t a i n e d t h r o u g h
a n e t w o r k o f m y closest w o m e n i n f o r m a n t s in the
village, reflect these w o m e n ' s experiences o f a b o r t i o n ,
expressed in their o w n w o r d s as p a r a p h r a s e d f r o m
m y field notes. While n o t a r e p r e s e n t a t i v e sampling,
t h e r e is n o t h i n g u n u s u a l a b o u t the b a c k g r o u n d or
experiences o f these w o m e n to suggest that they are
anomalous.
Abigail: 23 years old, c o m p l e t e d s e c o n d a r y school,
s t u d e n t , u n m a r r i e d , three a b o r t i o n s

Abortion 1: The first time, this happened when I was in


secondary school, class 3; I was 15 years old. I didn't know
that I was pregnant but was thin and sick (vomiting) so my
parents took me to a nearby clinic. The doctor tested and
confirmed that I was pregnant. My parents said that since
I was a still a student that I should abort it so the doctor
charged N75 (he was talked down from N150). So he did a
D&C (I was two months pregnant at the time). After that
he gave me some drugs to use, like ampicillin, also some
other medicine. My parents didn't want me to marry my
boyfriend and I didn't tell him that I was pregnant and had
aborted. ! spent one day at the clinic and my mother paid
for the abortion.
Abortion 2: Three years later when I was completing
secondary school, I was worried when I didn't see my
menses. I went to a doctor who tested me and told me to
wait six days, to see if the pregnancy was strong. But as it
didn't come down on its own, I went back after telling my
boyfriend that I hadn't menstruated, so we went together
to let the doctor know that the child was still there. My
boyfriend wanted me to keep the pregnancy but I refused
because I was still schooling. After the abortion I was given
ampicillin and Septrin. My boyfriend paid the N30 for the
abortion.
Abortion 3: In 1991, when awaiting entrance into university,
I became pregnant by one boyfriend whom I later decided
not to marry in favor of another. Since I did not want my
chosen fiance to know of the pregnancy, I decided to abort
it. I first used (3) Bee-codeine tablets, Andrew's Liver Salt,
and Sprite, mixing them together and then drinking them.
When this did not work, I went to a clinic in a neighboring
SSM 42/~-B

487

town for D & C The abortion cost N80 and was paid for by
my boyfriend. There were no after effects.

Bukky: 30 years old, c o m p l e t e d s e c o n d a r y school,


trader, married, three a b o r t i o n s .
Abortion l l had my first abortion in 1980. I had not
married then and as I was a student, I didn't want to keep
the pregnancy. My boyfriend knew and said that he wanted
me to keep it but since I was a student I decided to abort
it. There was a man who had a clinic in the village [who has
since died] who did a D&C for NS0--I paid for it. 1 was up
to three months pregnant. Afterwards I had stomach pains
and took Bee-codeine (to make the blood come out well)
and Septrin.
Abortion 2." Tile next year I got pregnant again and by the
fourth month, I went to a babalawo (diviner) in the village.
He made medicine which he wrapped and told me to put in
my vagina. After inserting it, it seemed as if I wanted to give
birth immediately and l felt very hot. I left the medicine
inside for two days, after that the thing came down. I felt
weak and had stomach pain so I took Bournvita [a chocolate drink mix] to settle my stomach. I didn't go to the
hospital.
Abortion 3." In my final year of secondary school, I became
pregnant again. I didn't tell my fiance at first, but when 1
was three months pregnant I told him. Since I was in school,
he told me that I shouldn't keep the pregnancy. He took me
to a doctor for a D&C but because he confirmed that I was
carrying twins the doctor refused to do it.
When I got back to the village, I took Bee-Codeine
(4 tablets) and Dr. Bonjean tablets together. I starting
bleeding and wanted to die. Then I fainted. My mother, who
didn't know what I had taken, rushed me to a hospital in
a nearby town.
The doctor gave me an injection and did a D&C.
My mother paid N350 for the abortion and medication.
I continued to go to the clinic for four weeks afterwards to
get injections.
Caroline: 28 years old, c o m p l e t e d s e c o n d a r y
school, hairdresser, m a r r i e d , two a b o r t i o n s .
Abortion 1: I was about 21 years old at the time (1982).
I knew I was pregnant but didn't know I was carrying twins.
I used traditional medicine which consisted of substances
(I didn't know what) that were molded together by a male
herbalist in l_,agos. 1 then put the medicine in my vagina.
I was a student then and had not married. I told my
boyfriend who asked me not to do it. I paid N30 for the
medicine with my own money. The medicine didn't work
after three or four months so after four months I went back
to the herbalist for another type, paying the NI5 myself.
Immediately after I used the drug, I started bleeding. The
blood that came down was up to a gallon. There was also
something that came down that was big like a fist. So
l thought that the pregnancy had come down. But then
1 contracted pneumonia and was rushed to a private clinic
(in Lagos) where it was confirmed that I was still pregnant
with two children inside. My mother paid up to N200 for
medicine and treatment. They gave me Bee-Codeine. I gave
birth to twins, the first was very strong and big, the second
was very small, couldn't cry and died almost immediately.
Abortion 2.' I had married by then but my husband and I live
in different towns. In 1991, I became pregnant by my
boyfriend so I decided to abort it. I went to a maternity
clinic at a nearby town for a D&C, which cost N50 for a two
month pregnancy. After five days, I saw blood so I went
back to the doctor and he gave me medicine "to wash out
the remaining thing" (he gave me Septrin). There was no
problem after that.

488

Elisha P. Renne

I decided to abort because the pregnancy was not for my


husband and since he was away, he would realize this. He
doesn't know that I was pregnant or that I had an abortion,
though my boyfriend did because he paid for it.

Deborah: 30 years old, completed


school, trader, married, one abortion.

secondary

Abortion 1. I am married with two children, the youngest


being four years old. When I realized I was pregnant (after
two months), I took four Bee-codeine tablets with agogoro
(native gin). Soon after I had stomach pain and then two
days later, there was bleeding and the pregnancy came
down. Except for the stomach ache, there were no other
effects and I didn't go to a clinic for D&C.
The reason I decided to abort the pregnancy which was
from my husband was that he was unemployed and we did
not have money to care for the child. He didn't know I was
pregnant and he didn't know that I aborted.

Esther: 33 years old, completed secondary school,


trader, married, one abortion.
Abortion 1: When I realized that I was pregnant after a
month in early 1991, I went to a diviner (babalawo) in
a nearby village. He gave me medicine which I inserted in
my vagina. By the third month, when the pregnancy didn't
come down, I went to a clinic in a nearby town for a D&C.
My boyfriend paid N65 for procedure. Afterwards, there
was some bleeding so 1 returned to the clinic and was given
additional medication.
I decided to abort the pregnancy because it belonged to
my boyfriend, not to my husband. I did not let my husband
know about it.

Analysis of abortion histories


These five histories display certain similarities,
relating to reasons for abortion, who pays, type of
abortion choice and preferred time for abortion.
In the instances involving women-students,
parents, particularly mothers, get (or are forced to
get) involved, both in treatment and payment. While
these women as students generally attempted to abort
with locally available medicines (either traditional or
'patent' types), in cases where there were complications mothers supported their daughters. Also in
the instances of the first two women, boyfriends paid
for these abortions, even while they wanted the
women to keep the pregnancies. Bukky's experience
is a particularly poignant example of the desperate
lengths ("I wanted to die") women will go to when
they have an unwanted pregnancy, despite the advice
of an authority and the lateness of the pregnancy.
Further, while these women sometimes paid for
patent and traditional abortifacients, in all but one
case, D & C procedures were paid for by someone else.
This fact suggests that economics and access play
a large part in the types of abortifacients women
choose. For example, Deborah, who aborted her
pregnancy because of economic problems, also preferred to use patent medicines because they easily
could be obtained locally, without arousing suspicion
and without her husband's knowledge. She paid N7
(U. S. $0.46, in early 1992) for her abortion using four
Bee-codeine tablets and alcohol while Caroline paid
N30 (U.S. $2.00) for a traditional medicine supposi-

tory. The cost of a clinic D & C varied from N30-80


(U.S. $2.00-5.30) for an abortion at one month with
no complications to over N300 ($20.00) for abortions
after with third month with complications.
Particularly when a boyfriend, who may or may
not want the pregnancy to go to term himself, is
involved and is paying, there seems to be a preference
for D&C. This preference is understandable considering these women's variable success with traditional
and 'patent' medicines used as abortifacients.
Nonetheless, some risk is associated with getting a
D&C as described by a 25-year old hairdresser:
Under perfect conditions, there are no ill effects but there
was one case of a lady who didn't have patience when the
operation was being carried out. Part of her womb was
affected and she cannot give birth to children again.
All women but one initially attempted to abort
before the third month of pregnancy. Presumably,
this can be explained in part by their desire to conceal
their pregnancy which would be difficult to do in
later stages. However, this practice also relates to the
idea that a pregnancy is fragile early on, which a
combination of patent drugs, alcohol and effervescent
drink can more easily "shake d o w n " [16]. Hence the
doctor's advice in the case of Abigail that she wait six
days "to see if the pregnancy was strong" before
performing a D&C.
Further, there is a preference for early abortion for
the sake of the woman's health. According to one
25-year old woman with a primary school education:
If the pregnancy was very late before the abortion was
conducted--three, four, or more months--it could be complicated. It can lead to stomach pain or it can lead to
bleeding. If such bleeding is excessive, it can lead to death.
The preference for early abortion is also related to
ideas about the stages of pregnancy development
itself. Whether one opts for an abortion depends, to
some extent, on the definition of when the life of a
child begins.
IN RELATION TO IDEAS ABOUT PREGNANCY
DEVELOPMENT, INFERTILITY AND CONCEPTION

ABORTION

In Ekiti villages, the reliance on abortion as a form


of birth control has a basis in economic, technological
and physiological factors. Yet there are other aspects
relating to traditional ideas about pregnancy, fertility
and the role of women and men in conception which
help to explain the acceptability of this practice,
relative to other forms of birth control. In particular,
indigenous ideas about when, in the course of a
pregnancy, the 'real child' is formed and a child's life
begins influence attitudes about the ethics and
efficacy of 'keeping a pregnancy from staying'.

Perceptions of fetal development


It is not simply the fragility of early pregnancies
and the health of the pregnant woman which influence women's preference for early abortion. The
belief held by some that the 'real child' is formed

Practice and perception of abortion by Yoruba women


sometime after the fourth month of pregnancy also
affects their behavior. The following three versions
of prenatal development, while differing in some
details, all describe a lizard-like being taking on the
appearance of a child around the fifth month of
pregnancy.

Version 1.
Two months after conception, something like a lizard with
a tail will be formed. When it is four months old, it will be
something like an amoeba, shapeless. (This is why it is
difficult to terminate a pregnancy in the fourth month.)
After four months, 1 week, the real child will be formed,
having the head bigger than the rest of the body. The real
child will grow and its size will be equally distributed when
ready to be born. The child will also be kicking then. When
it is about eight months, three weeks, the child will just come
very near the womb. During the day the mother will just see
water and have a general weakness of the body. She will go
to the hospital or get help to deliver. During the delivery,
the child will come out first, followed by the placenta [my
italics] (Teacher, "social' diviner, man, about 50 years).

489

involved in such cases in addition to medicines so


powerful (and deadly) that he could not reveal them
except to say they included part of a human body.
However, the same man and other traditional healers
gave me several recipes for traditional medicines 'to
keep pregnancies from staying' to be taken after
intercourse or shortly after a woman discovers she is
pregnant (see Appendix). In these cases, no overtones
of immorality were evident as the pregnancy during
this period was merely blood, water, or a lizard-like
creature [17] (p. 124), but not the 'real child'.
Not everyone had clear ideas about fetal development and furthermore, there was considerable variation as to when people believed that a child was
alive. Some said immediately after intercourse, some
said after four months, and others said after birth.
These different beliefs affect people's attitudes about
the morality of abortion though they do not always
determine their actions.

Ideas about infertility


Version 2
In the first and second months, it will be water. By the third
month, it becomes solid and just looks like blood. By the
fourth month, it will look like a lizard. By the fifth month,
it has arms, hands, and eyes and by the sixth month, there
will be certain movements in the stomach which will continue. This development continues until the child comes out
(Traditional diviner, man, about 75 years).

Version 3
The blood in the stomach will be in the form of a child, it
will be the first month child. When it is the second month,
the red color become whitish. The third month, it will be in
the form of a lizard (during this time it has no color and the
head will be in the form of a monkey and people will not
like how it is formed). In the fourth month, it will be in the
form of watery blood and semen. In the fifth month, the
thing will be shaking the woman's body, moving up and
down in the stomach and making stomach pains (but it isn't
stomach pain, it is just the moving around). At this time, the
tail will disappear. In the sixth and seventh months, the
thing will be shaking very well. But in the eighth month, it
can't shake, it doesn't have power again. It will be resting
and it's not good to abort during this time. If someone
aborts during this period, the person will die. It will take all
her blood so she will die. When nine months, it will be strong
again. It will turn the head down and shake the body very
well in order to have the chance to come down (Traditional
diviner, woman, about 40 years).
The last version is instructive as it suggests that
it is not good to abort so late in a pregnancy
because of excessive bleeding which will lead to
the death of the woman. She may also be suggesting
that it is not good in a moral sense to abort so late
as the pregnancy has clearly become a child by this
time.
The ambiguous morality of late abortion was also
implied by the 'social' babalawo mentioned above.
He said that he could not tell me about abortions
performed in the eighth month because only
witches and wizards--immoral, anti-social creatures
by definition---could know about such things.
He intimated that supernatural intervention was

If traditional diviners and healers make medicines


that 'keep a pregnancy from staying', they also have
medicines which help women to become pregnant.
One group of such medicines is referred to as oogun
fi f o n u , 'medicine taken which washes (cleans) the
inside (womb)'. However, going to a clinic for a D&C
is also referred to as J"onu, 'washing the womb'. By
considering the ideas behind the use of these medicines which 'wash the womb', countering infertility,
one gets a better understanding of why aborting by
D&C might be viewed as a corrective action and
hence, as an acceptable form of birth control.
'Washing the womb' or literally insides (inu)
and removing impurities and 'dirt' (idoti) relates to
traditional ideas about alleviating infertility. Certain
types of infertility, believed to be caused by an
'excess' of sex, food, and worms within the body [18]
(p. 50) may be treated by medicines, referred to as
oogun a m'unu tuntun--'medicines which make the
inside new'. Such treatments cause disease, worms or
dirt to be expelled (in urine, feces or menses) thus
restoring the body to its original healthy state.
According to one village babalawo, many things
may cause dirt (idoti)--meant here in the sense of
a substance out of place--to accumulate inside a
woman which will prevent pregnancy. These things
includejedijedi (a disease caused by eating too many
sweet thingsh a type of worm (kokoro) in the stomach
known as oginisa, and eating things bad for the body.
By drinking a cup of oogun a m'unu tuntun, a woman
will eliminate the dirt (idoti), including worms and
germs, in her urine. Indeed, it is said that a woman
who has recently given birth can use this medicine
two or three weeks after delivery and immediately
after she uses it she may become pregnant.
The fact that women often refer to the process of
going to the hospital for a D & C in the same way, as
'washing the womb' (fo inu), is instructive regarding
women's attitudes toward abortion. It is possible

490

Elisha P. Renne

that the artificially-induced passing of blood from


the vagina may have been interpreted as 'cleaning
the inside'. Further, some women were referred by
doctors for D&C at clinics after miscarriage to 'clean
the womb'. Of the 71 women who went for D&C in
the survey of 300 women, 33.8% (n = 24) reported
they went because of miscarriage. In the latter case,
D&C, like ponu medicine, is clearly associated with
enhancing fertility.
Yet there may be something more to the use of the
phrase, ponu, when describing going for a D&C.
While the babalawo mentioned above clearly distinguished his own traditional abortifacients (oogun
baje--'spoil medicine') from medicine which makes
the insides new (oogun a m'unu tuntun), there was
some overlap of the ingredients of these medicines.
For example, the ingredients of one type of oogun
baje medicine used to bring a pregnancy down by one
babalawo were identical with the j'onu medicine for
cleaning the uterus prescribed by another. Similarly,
Bleek was told that Akan herbalists traditionally used
medicines to cleanse the uterus after childbirth or
miscarriage which were later used as abortifacients
[19] (p. 115).
It is not surprising, then, that getting an abortion
by D&C has been associated in other ways with the
more beneficial aspects of 'medicines which clean
the womb'. Like the substances (idoti) preventing a
viable pregnancy which are eliminated through the
use of oogunfif'onu, an unwanted pregnancy is like
dirt in the body, a substance (in this case, pregnancy)
out of (social) place. In this sense as well, going
for a D&C to 'wash the womb' may be associated
by some with traditional ideas about fertility and
renewal.

Ideas about conception


Finally, traditional ideas about conception may
contribute to women's sense that early abortion is
no worse ethically-speaking than other forms of
birth control which all come under a moral shadow
to some extent as traditionally, a married woman
of child-bearing age should either be pregnant or
abstaining from sex altogether. The following two
versions were given by the 'social' babalawo and the
woman diviner (iyalawo) quoted earlier, reflecting
duo-genetic models of conception.

Version 1
When the male and female meet, both of them produce eggs
which start eating each other as food. The last one, if it
belongs to the female, then the pregnancy will result in a
female child, while if it is a male egg, it will be a male child
(Teacher, 'social' diviner, man, about 50 years).

Version 2
When it is the time of menstruation, the child will be in the
left or right hand side of the stomach, the blood will stay
on the left or right also. So when it is a month, the menses
blood and the semen [will mix] (Traditional diviner, woman,
about 40 years).

These two versions agree with Buckley's findings,


that, "All the herbalists I spoke to agreed that a child
conceived in the womb (ile omo) is the union of blood
(eje) of menstruation (ase) and semen (ato)" [18]
(p. 55, 56).
Since it is generally believed that women contribute
equally to the formation of a child, it may be that
some women also believe that they have a certain
right in deciding whether to terminate a pregnancy.
There are several examples in the abortion histories
of women terminating pregnancies without the agreement or knowledge of men. For example, in three
instances when boyfriends wanted pregnancies to go
to term, the women involved insisted on an abortion.
And, in the case of the married woman who aborted
because of financial difficulties, she took responsibility for this decision without telling or consulting her
husband.
I am not suggesting that there is a simple oneto-one correspondence between explanations of conception and the belief in the right of women to get
abortions. Nonetheless, ideas about the contribution
of women and men to the creation of life are related
to beliefs about gender and power which in turn may
influence attitudes toward abortion [20].
DEBATING THE LEGALIZATION OF ABORTION

Many religious leaders--Christians and Muslims


alike--as well as some professional Nigerians,
are fighting the legalization of abortion in Nigeria.
Despite the fact that many women in rural and urban
Ekiti get abortions, unless performed to save the
mother's life, abortion is against the law in Nigeria
(see Sections 228, 229, 230, 297 of the Nigerian
Criminal Code which applies to Southern Nigeria).
However, as performing a D&C may well be the
only way to save a woman's life after taking an
overdose of patent medicine, clinic and hospital
personnel have considerable lattitude in deciding
what constitutes a legal abortion. Thus, in 1981, the
Committee on Law and the Status of Women for the
National Council of Women's Societies of Nigeria
came out against legalization of abortion, in part,
because members felt that there was sufficient
flexibility in existing legislation [21].
So despite the draconian tone of Sections 228 and
229 of the Criminal Code [22] which may be used
to convict a woman, "whether or not she is with
child", or any person who brings about miscarriage
using "poison or other noxious thing, or uses force
of any kind, or uses any other means whatever",
prosecutions are rarely initiated. When they are, they
are often brought to court after the death of a
woman. Six of the eight abortion cases which have
come to trial known to Okagbue [23] involved such
a situation. However such prosecutions are rare and
furthermore, convictions are infrequent and sentencing is often light. Of the eight cases cited above, the
defendants were acquitted in four cases, in two cases

Practice and perception of abortion by Yoruba women


defendants were sentenced to three to six months
imprisonment, and in two cases (both in which the
women died), defendants were sentenced to five years
imprisonment [23] (p. 199). Considering the lack of
enforcement of legal sanctions against abortion, it is
not surprising that they have little or no deterrent
effect. Indeed, if the relevant sections of the Criminal
Code are taken literally as they now stand, all forms
of birth control would be illegal in Nigeria [23]
(p. 198).
There have been several attempts to legalize abortion, including proposals presented in 1981, 1983 and
1990. In 1991, the Federal Minister of Health, Professor Olikoye Ransome-Kuti, who supports legalization, announced that a new proposal on abortion
was being formulated by the Federal Government.
Ransome-Kuti has argued that by making abortion
legal, maternal mortality will be reduced:
The need for abortion is there. It is clear. Because if there
is no need for it, people won't go for abortion. Then we
[the Ministry of Health] said, the only way to prevent these
deaths...is to make it legal. So that people who this
operation safely can offer it to people who need it. We are
not saying people should use it [24].
By regulating abortion clinics, the government will
be able to limit incompetent and unlicensed practitioners, making safe abortions available to Nigerian
women generally. Other arguments in favor of legalizing abortion come from medical and university
professionals. They support abortion for various
reasons which include:
(a) its contribution to the solution of Nigeria's
overpopulation problem,
(b) the belief that the morality of abortion is a
matter of individual concern; and
(c} the fact that abortion has been a part of
African traditional birth control which legalization will make available in more modern,
less expensive ways.
Christian and Muslim leaders, on the other hand,
argue against the legalization of abortion on the
grounds that a pregnancy is God-ordained and hence
immune from human interference. For example, according to a booklet entitled Pregnano'--A Christian
View:
Pregnancy is a condition of being with a child as a result of
the union between a woman's 'egg' and a man's 'egg'
following coitus or insemination. It is a condition peculiar
to women alone because the Creator designed (the first
woman) Eve's body for that purpose...How does pregnancy occur? There is no special format. God gives as He
wills and to whoever He wills. God is not limited like we are.
He has various ways of making pregnancy to happen [25]
(p. 12).
According to this argument, abortion counters
both Koranic and Biblical injunctions against killing
because it assumes the life of the child begins "following coitus or insemination". Taking this argument
a step further, some, but not all, Nigerian Catholic

491

and Christian fundamentalist leaders are opposed to


contraceptives as well because their use is viewed as
counter to God's will [1] (p. 14) [26].
Some professionals, including Dr Abdulkadir
Sulaiman, Director of Planned Parenthood Federation of Nigeria, argue against legalizing abortion on
the grounds that efforts should be made instead on
emphasizing contraceptive use and sex education,
that "prevention is better than cure" [2] (p. 9). Others
claim that legal abortions will compete with other
procedures in already strained health facilities, while
some argue that legalizing abortion will encourage
promiscuity. These arguments, rather than those
supporting legalization, appear to be reinforced in the
popular press.
While I have not done a systematic study of
references to abortion in the popular press, my
impression, and apparently that of others (see [1]
p. 18) is that abortion is often portrayed in a
negative light. For example, in an article [2] appearing in Poise (a magazine featuring stories on fashion,
celebrities and social issues) entitled, "Abortion:
The Controversy Rages On", only one side--that
opposing legalization--of the controversy was given.
In other publications, the dire effects of D&Cs and of
taking drugs which induce abortion are graphically
portrayed in stories with such titles as "Is This
Love?" [27] and "The Shattered Dream" [3].
Yet the effects of such stories on the actions of
school girls, their likely audience, are questionable as
most can already relate similar stories on their own,
as was described by one 19-year old schoolgirl:
I know of someone at school, she was living in a boarding
house and was also married. She had an alhaji [Muslim man
who has been to Mecca] as a friend then and she got
pregnant from the man. This alhaji advised the woman to
let them abort the pregnancy, but things went sour and she
confessed that the pregnancy was not from her husband.
Later. she died.
Many of these stories about abortion are expressed
in terms of the health consequences, rather than in
terms of anti-religious immorality or illegality. Yet
while the emphasis is on health literally--women who
self-abort or go for D&Cs do sometimes die--these
stories contain an element of moral approbation.
Abortion is associated with illicit behavior (e.g. having children before marriage, taking lovers outside
marriage), emphasized by the fact that women did
not speak openly about abortion in the village.
Indeed, some women belonging to 'gospel' churches
in the village (e.g., Deeper Life Church and
Redeemed Church) adamantly stated that they would
never abort a pregnancy. Other women believed that
one has a God-given, preordained number of pregnancies in her womb and that by aborting, a woman
risks using up her supply.
However, for those women who had terminated
pregnancies described in the abortion histories, who
were also Christians, there were no particular feelings
of guilt about their actions [28] (p. 18). Rather, they

492

Elisha P. Renne

were more concerned that their parents, teachers, or


husbands should not know of the pregnancy. Nor did
I ever hear any woman mention the national debate
over the legalization of abortion as a factor in their
decision to abort or not to abort a pregnancy. For
these women, abortion is part of a pattern of behavior, considered sub-rosa in the first place but necessary as well. The economic and social realities of
everyday life--in which boyfriends are needed for
financial support, either for school fees or caring for
one's children--as well as indigenous beliefs about
conception and when life begins, override conflicting
ideologies about the morality o f ' k e e p i n g a pregnancy
from staying'.
CONCLUSION
Abortion performed within the first trimester--by
using traditional and 'patent' abortifacients as well
as by D&C----continues as a primary form of birth
control (Table 5) in this Ekiti Yoruba village despite
its depiction in the popular press as immoral and in
the news media as illegal. There are several reasons
for this behavior, the most important being that:
(1) patent and traditional abortifacients, taken
only when pregnant, are perceived as more
accessible and less expensive than contraceptives which must be taken over a longer period;
(2) it is believed to be easier to bring a pregnancy
down than to prevent one; and
(3) for many villagers, the child is only considered
alive after the fourth month.
The problems associated with abortion as a form
of birth c o n t r o l - - w o m e n dying from overdoses of
patent and traditional medicines as well as from
badly performed D & C s - - c a n be addressed, it seems
to me, by taking these traditional attitudes toward
birth control into consideration.
The administration of the antihormone drug,
RU-486 [29], also known as Mifepristone or the
'abortion pill', is quite similar to the sequence of
taking patent medicine tablets presently followed
by village women. An RU-486 tablet is taken

immediately after a period is missed, much as patent


medicines such as Bee-codeine tablets are taken.
A follow-up prostaglandin tablet or injection should
also be given 2 days after the initial treatment [29]
(p. 210), its timing similar to the taking of antibiotics
after a D&C which is believed 'to make the blood
flow'. The use of RU-486 could alleviate some of the
stress on an overburdened health care system and
could be administered more discretely and safely than
D&C procedures.
However there are several potential problems [30].
Because of the controversial nature of the abortion
issue, the manufacturer of RU-486, Roussel-Uclaf,
will not market it in countries where abortion is
illegal, hence most of Africa. (The only known trial
of RU-486 presently taking place in Africa is in
Zambia where abortion is legal.) W H O has acted as
an intermediary for distributing the drug on a trial
basis but health officials of the interested country
must actively solicit W H O help. Further, there is the
possibility of abuse, with health risks to women
obtaining RU-486 or prostaglandin tablets and not
properly using them. Since both tablets should be
administered under medical supervision and followed
with a check-up, in case a D & C is necessary, this
procedure would not be easily available to many rural
women. Finally, the cost of RU-486 and associated
hospital treatment--approximated at 75 in England
[29] (p. 112), make its use, unless subsidized, prohibitive for Nigerian village women. However, none
of these problems are insurmountable, A small-scale
pilot project could be organized with a major teaching hospital, with women given instruction, medical
assistance and subsidized doses of RU-486.
Such an effort would be worth trying [31, 32] (p. 9)
for while it is doubtful that Ekiti village women will
go so far as to say, as did one young Lagos woman
that, "In Nigeria, a virgin is a girl who hasn't had an
abortion" [1] (p. 13), it is clear that many will
continue to use medicines and procedures that 'keep
a pregnancy from staying' despite government policies,
religious strictures, and knowledge of the dangers
involved. By their actions, these women are relying
on 'practical strategies" rather than 'official' ones.

Table 5. Birth control ever used by women, by age and method*


Only
D&C and:
Contra &
All
Age (years)
Trad
Contra
Abortif
D&C
Abortif
Contra
Abortif
methods
15-19 (n =44)
1
15
8
3
4
5
4
4
20-24 (n =41)
-11
9
7
4
5
1
4
25-29 (n = 17)
1
5
6
1
1
I
2
-30-34 (n = 7)
-4
1
--1
I
-35-39 (n = 11)
2
3
1
3
--I
I
40-44 (n = 6)
-2
I
2
-I
--45--49 (n ~ 4)
I
-3
.
.
.
.
.
Total by method (n = 130)
5
40
29
16
9
14
8
9
%
4
31
65
*Birth control used, by method: (1) Trad=Traditional medicine: rings; (2) Contra=Contraceptives: Family Planning tablets.
Family Planning injection, condom, safe period, withdrawal, sterilization; and (3) Abortif= Abortifacients (taken after intercourse):
(a) Patent medicines: Bee-codeine,Menstrogen, Dr. Bonjean's tablets, Tetracyclin, Panadol, Phrensic, M&B, and E.P. Forte tablets;
(b) Effervescent,lemony, or salty drinks: Sprite, 7 Up, Coca cola, Krest, Andrew's Liver Salt, lemonjuice with potash, salt and water,
epa ljebu, native gin.

Practice and perception of abortion by Yoruba women


Acknowledgements--This study was conducted under the
auspices of the Health Transition Centre and the Department of Demography, The Australian National University,
and the Department of Sociology, Ondo State University,
Ado-Ekiti, with funding from the Mellon Foundation.
I would like to thank Miss Comfort Ajayi for research
assistance and Mr Kehinde Ajayi for translation. Additional
thanks go to Jo O'Toole Erwin, Pat and John Caldwell,
I.O. Orubuloye, LaRay Denzer, and my colleagues at Ondo
State University, Ado-Ekiti, and to Barbara Rylko-Bauer
and Pat Antoniello for editorial assistance.

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493

hidden in the diviner's house until just before delivery,


when it is taken out and moved back down the woman's
body, thus 'untying' the pregnancy.
Evans-Pritchard E. E. Heredity and gestation as the
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Buckley A. Yoruba Medicine. Clarendon Press, Oxford.
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and Stoughton, London, 1962~

APPENDIX

Some Examples 0[ Traditional Medicines Used


as Abortifacients
(1) Ewe ~Tinrin--leaf from Momordica cucurhitaceae.
Mix with salt, then kept in a bottle. Wait then remove the
leaves, with salt and water remaining. Take one small cupful
after meeting a man. The pregnancy won't stay.
(2) Certain types of plants used to bring a pregnancy
down after lt: to 2 months: Enupokure-Oie re (Pedilanthus
tithymaloides)--Type of succulent plant.
White water comes from this plant. Cotton wool is used
to collect the water. Take a ball of eko funfun (cornstarch
paste), take half and put it in a clean cup. Add small water
to this and mix together. Then squeeze the cotton wool to
extract the plant juice into the cup (there should be 2 spoons
full of this juice). The pregnant woman will drink this
mixture very early in the morning around 5:30 a.m. At the
very latest, by evening, the pregnancy will come down.
(3) Osun buke, ground camwood; Konun potash [33]
(p. 392); Oson wewe, small lime (Citrus lemonis) [18] (p. 272).
Grind oson wewe and konun together. The limewater
should be put in a bottle, then drop in the ground osun buke
and konun. Take 1 tablespoon of this mixture morning,
afternoon and evening. By the 2nd day, the pregnancy will
come down.

494

Elisha P. Renne

(4) To spoil a pregnancy: lieu eta, skin of the civet cat;


lleu ekun, skin of the leopard.
Use a scissors to cut pieces of leopard and civet cat skin.
Put the two together, wrap them with cotton thread, and tie
the thread. The woman should insert it in her vagina and
immediately she will see her menses. (It has to be small; it
can be tied with either white or black thread. I can't explain
how it works in the vagina, but I am sure that within a short
time, the pregnancy will spoil.)
(5) To bring down a two month and five month
pregnancy: Orisode, a type of plant Enupokure (Pedilanthus
tithymaloides) a type of succulent plant.

For five month pregnancy: Take the juice extracted


from the leaves of both types of plants and mix with
the contents of a newly laid egg (removed by carefully
cutting off the pointed end). Put the mixture back in
the eggshell and seat it on a small head tie placed in
the bottom of a pot. Put some water in the pot on the
fire and cook. When solid, give to the woman to eat.
If she doesn't immediately vomit, her womb will be
going up and down and within three days the pregnancy will
come down. For two month pregnancy, use the same
procedure but only use the enupokure plant juice with the
egg.