While our political elite can seek quality health care services in some of the best hospitals abroad, while their spouses can afford to give birth in choice American and British hospitals, Nigeria’s bottom poor are left to die in our run-down public hospitals under perpetually irritated medical workers who often vent their frustrations on their patients. In recent times, I have heard and witnessed enough maternal deaths that have left me wondering why life means nothing to us as a people. Experiencing those tragedies have left me scared and scarred. This latest one was painful because I witnessed the couple’s wedding three years ago.
I remember the joy of the bride and groom. The bride was the happiest on her wedding day but now she lies in a morgue, a victim of Nigeria’s decayed health system. With her death, she has become another victim in the endless statistics of maternal death that stalks Nigerian women. The story was as pathetic as it is shocking. On a certain night when my friend’s wife began to experience the signs of labour pain, they headed for the hospital where she registered where she was wheeled into the labour room. But she did not return home alive. In the labour room, events took a different turn.
After several hours of trying to deliver her baby, the woman died in the process. What went wrong? How did a woman who walked to the hospital on her feet end up being wheeled to the morgue with an unborn baby? The husband told me that after several hours of trying to be delivered of the baby, his wife became too weak that she could push no more. But the nurses kept admonishing her to push until she became weakened from the long hours of prodding.
He lamented that in spite of the pleas by family members that his wife be allowed to deliver the baby through Caesarean section, the nurses reprimanded them for attempting to teach them their job. And in any case, there was no gynaecologist in sight. After several hours, the labour room went quiet as her cries stopped. The nurses emerged wearing long faces and avoided breaking the news of his wife’s demise. He stormed into the labour room and only to meet the lifeless body of his wife–with the baby also dead. He passed out momentarily and was only revived later.
He is still devastated.
In recent years, more Nigerian women are dying from childbirth. The worst cases are those that also affect the babies. Unfortunately, no one seems to be paying attention. Hapless and helpless Nigerian women are dying every day in various hospitals and maternity homes across the country. While only a few cases are reported, many maternal deaths never make the headlines. When women die from childbirth, children are orphaned and families are devastated. I have heard stories of women who die with their unborn babies. Yes, people die, some deaths are inevitable, but statistics of maternal mortality points to negligence, unprofessional conduct and in some cases ignorance by the victims.
Across the country, there exist clandestine delivery homes and rogue maternity homes operated by charlatans. Some of these privately run so-called health facilities are known to health regulatory agencies. Our public hospitals are also some of the worst places for pregnant women today. Expectant mothers often have to endure the negligence of abusive and aggressive nurses and other health workers. I have been in a public hospital where agonising heavily pregnant women were left unattended to for hours. Once, I heard a nurse yell at a heavily pregnant woman, “Madam, stop shouting here, na me give you belle?”
Maternal death is also caused by other factors. According to experts, severe bleeding and infections (usually after childbirth), High Blood Pressure during pregnancy known medically as pre-eclampsia and eclampsia, complications from delivery, unsafe abortion, HIV and malaria pose great risks to expectant mothers. But these conditions are preventable if well-managed. According to a study by Boniface Oye-Okediran et al, published in the Annals of Tropical Medicine and Tropical Health, risks such as obstructed and prolonged labour, which killed my friend’s wife, also account for over a third of the deaths that occur during childbirth.
According to the study, skilled practitioners can recognise and deal with slow progress before labour becomes obstructed and if necessary, ensure that Caesarean section is performed on time to save the mother and the baby. But for women to benefit from those cost-effective interventions, they must have antenatal care in pregnancy, and in childbirth they must be attended to by skilled health providers. But a majority of women could hardly afford quality antenatal care and these conditions degenerate or are not detected during childbirth. In many public hospitals, the Obstetrics and Gynaecology section is chaotic with only a few gynaecologists on hand to attend to pregnant mothers. The attitudes of hostile nurses in public hospitals who abuse and harass mostly poor expectant mothers also drive them into the hands of charlatans.
The Maternal Mortality Rate report 2013 updated in 2014 by the World Health Organisation rated Nigeria among five countries in sub-Saharan Africa with the highest number of maternal death in the world. According to WHO, there were an estimated 289,000 global maternal deaths in 2013 with sub-Saharan Africa accounting alone for 62 per cent (179,000) of the deaths. Africa is considered the riskiest region in the world for dying of complications in pregnancy and childbirth.The MMR was calculated by taking into consideration the deaths of women while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. India and Nigeria are reported to account for one thirds of global maternal deaths in 2013. About 40,000 pregnant women died in Nigeria in 2013. It is worse in Northern Nigeria. Maternal deaths occur particularly in areas where women have many babies in short time spans under malnutrition, poor hygiene conditions and lacking access to medical treatment. The last National Demographic Healthy Survey placed the National Maternal Mortality rate at 545 per 100,000 live births. UNICEF’s estimation of the incidence of maternal mortality in Nigeria is from 800 per 100,000 to 1,100 per 100,000 live births. Most maternal deaths are preventable, as the health care solutions to prevent or manage complications are well-known.
Nigerian women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. Government and stakeholders in the health sector must work to end maternal mortality in the country.
By Bayou Olupohunda