The Muslim woman and informed consent

It is usually a busy clinic run by qualified nurses and Community Health Extension Workers (CHEWS). On rare occasions, the attention of a doctor might be needed in the case of a difficult IUD insertion or missing implant, but in most cases, the family planning clinic is run by competent nurses and other HCWs. All […]

It is usually a busy clinic run by qualified nurses and Community Health Extension Workers (CHEWS). On rare occasions, the attention of a doctor might be needed in the case of a difficult IUD insertion or missing implant, but in most cases, the family planning clinic is run by competent nurses and other HCWs.

All around the world, women of reproductive age group visit contraceptive clinics voluntarily for their contraceptive needs. They receive health education and counselling on many health topics, including but not limited to different types of contraception, immunisation, cancer screening, menstrual hygiene and even tips on parenting. The women who attend these clinics always leave better informed and empowered about their health. 

The situation in northern Nigeria is a bit different.

Many years ago, as a medical student, I realised that married women in most parts of northern Nigeria, especially among the Muslim population, needed their husbands’ consent before their contraceptive needs were met. The husband’s signature was required on the family planning card.

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In 2025, this is still the case. A grown, mentally stable woman cannot decide for herself whether she should have babies or not.

And it is not just contraception alone. In some government facilities in northern Nigeria, medical and surgical procedures performed on women still require the consent of the husband. Many times, I see the husband asked to sign consent before his wife is taken for a caesarean section. A woman of sound mind and body who walked into the hospital herself for an elective CS is not deemed fit to give an informed consent. Instead, it is her husband who is asked to give consent. In simple terms, a woman does not have enough sense to give informed consent. 

What is informed consent, to begin with?

It is the process in which patients are given important information, including possible risks and benefits, about a medical procedure or treatment, genetic testing, or a clinical trial. This is to help them decide if they want to be treated, tested or take part in the procedure. The informed consent process is an ethical and legal requirement for medical treatment. It ensures that you understand and agree to have specific medical treatment. 

The informed consent process is important for several reasons. It protects your ability to make your own decisions about medical treatment. It also protects your legal right to ask questions about recommended treatments. The process also guides healthcare providers. It helps them to make ethical decisions about your healthcare, and it helps you and your provider make healthcare decisions together.

Therefore, in this day and age, women are still denied the right to decide for themselves whether they should have a procedure done or not.

Haba Jama’a!

In Islam, the highest governing body is Saudi Arabia. According to the Ministry of Health of the Saudi government, pertaining to women: “The informed consent is given by the pregnant patient herself if she has full capacity. It is not allowable to ignore her, and she has the right to choose the person who will give the consent on her behalf. For instance, her father, brother, husband or anyone of her relatives, whether it is a male or a female, as long as the authorisation was approved. In cases of medical abortion and the mother’s health is at risk or there was a risk of losing her life, it is enough to take consent from her personally or her representative. If the reason for abortion is life-threatening fetal abnormalities, the consent of both the mother and the father is required. If the father approved of the abortion while the mother rejected it, the mother’s opinion shall prevail.” (Saudi guidelines for Informed consent, page 15).

Toh Jama’a! What then is our problem?

Many years ago when we had a debate about this debacle, the usual arguments were thrown:  It is more cultural than religious, northern Nigeria is largely conservative, blah, blah, blah. The Hausa culture emphasizes the concept of patriarchy etc.

The funny thing is, especially where family planning is concerned, that women always have a way of meeting their contraceptive needs. From aborting pregnancies, forging their husbands’ signatures, to ingesting pills without medical guidance, women will always find a way. 

I have lost count of hundreds of women I have seen in my 15 years of practice that tell their husbands that they are visiting a neighbour, only to rush to the nearest pharmacy or primary healthcare centre to receive a shot of hormonal injections. Many times, it is even the neighbour (a hospital attendant posing as a ‘nurse’) that gives them the injections.

Instead of going to a health facility to get proper attention, a woman is forced to visit a quack, all because she is not deemed fit to give informed consent. But she is deemed fit for marriage and childbirth. Many times, while taking history, I meet women with uncontrolled hypertension who are on pill. When I ask them who prescribed it, the answer is usually a friend, relative or neighbour. Nobody checked her blood pressure, nobody asked for the history of cancer, and nobody checked her weight. The woman will just be taking contraceptive pills for years and years until she has a stroke. Then we will start blaming imaginary evil spirit.

A woman has a right to make an informed consent about her body and health needs. Informed consent is one of the components of respectful maternity care during the delivery process and the postpartum period. It is not only a voluntary consent or refusal of any process or procedure, it is a universal right of child-bearing women that ensures their right to know in detail and be well-informed about the services (before agreeing to any care) they receive. This right prevents the service providers from doing anything to child-bearing women without their knowledge and consent.

In northern (Muslim) Nigeria, Islamic clerics usually preach that religion supersedes culture, especially where there is a clear divide. Now, here is the divide: Lack of the right of women to give consent about their health leads to poor health decisions. And we all know that Islam promotes good health seeking behavior; hence the ban on smoking. Additionally, other Islamic countries have adopted the woman’s right to give consent.

So Arewa, what gives?

When are we going to ban the archaic law of demanding consent from individuals other than the woman herself?