Huge numbers of poor Nigerian women are giving birth without the help of trained medical professionals. Rather than go to a hospital women are giving birth in churches and in their own homes because they cannot afford to get medical help, these women and their babies are at a high risk of dying.
In the first of a series of articles looking at the UNDP's 2006 development report Daily Trust examined the situation on the ground. The problem is not confined to remote rural areas in Nigeria. Even in the FCT, Daily Trust found, women are taking huge risks and if something goes wrong, help is far away.
The federal government is aware of the problem but continues to ignore its own advice and under-fund heath care in Nigeria.
For the poorest 20 per cent of Nigerian women, only 12 percent of them have access to skilled medical care during childbirth, the UNDP says. This is partly due to the fact that not more than 28 doctors are available for every 100,000 Nigerians thereby making the lives of new mothers and their babies exposed to higher risk of death.
In the Abuja suburb of Mararaba, Daily Trust visited Dr Chuks Asogwe's Blessed Trinity hospital. The experiences of the predominantly poor working class in the community tell a bit of the story behind the figures.
Located in an unplanned environment without laid streets, drainage and with hardly a feeder road for vehicles to find it easy to convey women who are about to give birth to the hospital for skilled medical attention, Private clinics like Blessed Trinity hospital are the closest places in that community women could go when it is time to give birth to their babies.
However, the number of women who visit the hospital has decreased in recent time. Dr. Asogwe said: "Unlike in the past where up to 3 women come to deliver their babies in this place, we hardly get 2 in a week these days".
The major cause of the problem is that poor women cannot afford to pay for their medical bills. "Poverty has heightened and a lot of our people cannot afford to get sound medical care" he said.
22-year old Mary Ann has just given birth in the Blessed Trinity clinic. She like many other women patronized the public hospital for two months for antenatal care. But she was not satisfied with the care she was getting. She said: "They were not teaching me anything there. I found out that I was not learning anything at the antenatal unit of the hospital and I know it is dangerous to my condition especially as is going to be my first experience".
She confirmed that many a poor women could not leave the public hospital, even though they were not satisfied with the care they were getting, because they do not have a source of footing the N5000 bill at the private clinic. She will have to find a way of paying the bill in installments.
Dr.Asogwe said it as come to his awareness that more women are rejecting the health sector entirely to have their babies delivered. He said: "Cost is the number one factor in women's choice of how to have their babies delivered. Many women cannot afford to come to a hospital at all. So many women patronize the church to deliver their babies"
Talking from his 15 years of medical practice, Dr. Asogwe said it is not always safe to take delivery in places like that. "So many of them are often time rushed to the hospital when they face complication in most of those places" he said.
Having been reliably told that a Christ Apostolic Church (CAC) in the community is one of the churches that take delivery for most of the women that could not afford the hospital bill, we visited the church to see the medical equipment and personnel used to take delivery for women in the community.
The assistant pastor of the church Joshua S. Ajosanmi confirmed that the church runs a 'faith home' maternity clinic for members of the church's 500-strong congregation. The midwife at the faith home, Mrs Victoria Oladele revealed that 59 women -over 10 percent of the church's congregation- delivered a baby in the church's clinic this year. Last year it was 49, she said.
She said: "We do not use drips, injections neither do we give blood here. If you have the belief that you will not have problem during delivery, then you could patronize faith home." Mrs Oladele says she has ten years' experience as a midwife, including two years training at the CAC maternity training centre. She has been working at the Sharp Corner church for three years. The Faith Home, is little more than a room with two beds, a cupboard and some plastic cups and bowls. "We pray for water" Mrs Oladele said.
Pastor Ajosanmi explained the procedures of taking delivery at 'faith home'. "We administer a three day prayer session on them every week before we would ask them to go for a medical test after which we take delivery for them" He added: "We used to ask them to go to Adoni hospital or Asokoro in case of complications in delivery"
Pathetic as the risk women in the cities are exposed to may seem, the UNDP report says it is worst for women and infants in rural villages. Of every 1000 babies born alive, 200 will die before their fifth birthday.
Karshi is 40 kilometres away from the FCT central area. It is served by a general hospital and at least two other clinics, but even here there was evidence of the poverty that keeps women from attending hospital when they go into labour.
A nurse in the town's other clinic said the doctor was in the city working at a private hospital and would return in the evening to attend to patients in Karshi.
She confirmed that many women still give birth in their own homes without trained help.
She was quick to inform us that "majority of the people in this village delivered their babies at home because of poverty since they would not be able to pay the N3000 we charge here. Many are some times rushed to this hospital in the pool of their blood with complications in delivery." She said women who gave birth at home risked dying from blood loss, infection or complications when the placenta did not detach from the womb.
She said: "Some women have to cut the umbilical cord themselves, and they do it wrong. If it becomes infected both baby and mother can die."
The nurse gave her name, but Daily Trust has decided to withhold it to protect her job.
She said: "I feel; pity for these women because they are dying because they can't afford to come to hospital."
The medical director of Karshi General hospital Dr. A O Anyebe said he could not talk about the workings of the hospital without clearance from the ministry of health. He said: "We can't speak because it would mean going into medical files for the correct statistics. Also we do not want to embarrass the authorities. Not that there is anything to hide of course."
A village chief Alhaji Saidu Makama said the medical attention people in the village receive was adequate.
He said: "Our people have the good culture of visiting the hospital for delivery and the personnel in the hospital are adequate". He said he is the father of 30 children, eight of them died in childbirth, 25 percent of his children did not survive infancy.
The Ministry of health told Daily Trust it would provide someone to be interviewed on this subject. The director of Public health said Daily Trust should come to the ministry. She then redirected the reporter to another office of an official who was not in.
But according to a ministry pamphlet produced in 2003 with the World Health Organisation: "Women take enormous risk to become mothers. Lack of decision making power and insufficient access to resources often prevent women from making the strategic decision to seek medical help at the crucial point where it will determine whether the mother and her baby will live or die. Often male members of the family who control these resources make these decisions."
It recommends that obstetric emergencies be treated free for the first 24 hours and says 15 per cent of the country's annual budget should be allocated to healthcare. Of this amount 10 per cent should be allocated to reproductive health.
In 2006 only 5.6 per cent of the government's budget was spent on health. Of a total N1.9 trillion, N106 billion was allocated to the health ministry.
In the 2007 budget N122,399,999,999 has been allocated for health, but it is only 5.4 per cent of the N2.3 trillion budget.
Meanwhile, the ministry says it plans to "increase by 30 percent the proportion of men and women advocating for increased and sustainable use of safe motherhood services nationwide by the end of 2008". It believes that it can cut maternal death through a 'behavioural change communication strategy' to by the end of 2008 increase by 50 percent the proportion of women and men who are able to recognize pregnancy related warning signs and seek medical attention.
I pity these women. They are dying because they cannot afford to go to hospital
___________________________________________________________________________