The maternal health care system in Nigeria is pluralistic. It is characterised by orthodox, faith-based and traditional health providers. While the faith-based ones are commonly called “Ile Agbebi”, the traditional birth centres were tagged “Ile Abiye”. Because of the increased spirituality of Nigerians, there has been an upsurge in the number of women that take to churches, as maternity centres. In spite of the reports from Nigeria Demographic and Health Surveys that each day, about 109 Nigerian women die at childbirth, placing the country among the top 10 most dangerous countries in the world for a woman to give birth, more pregnant women have been observed to have continuously chosen either faith-based or traditional maternity centres above orthodox hospitals. While some live to tell their stories, many do not just die during or shortly after childbirth, most of the babies are also stillborn writes Yemisi Olusina.
Few weeks ago when Abibat, 37, went into labour, she had no inkling of any danger ahead. It was neither her first nor second attempt. As a matter of fact, it was her third pregnancy; so, she was very familiar with the terrain.
She had earlier on registered for antenatal at the private hospital where her husband works but during one of the check-up days, the doctor told her of the peculiarity of the unborn child. The baby, according to her husband, Mr. Yusuf Agboola, was lying transversely and so might not come the normal way like the first two. “She told me the doctor said she should prepare to have the child by a Caesarian Section should the baby not change position before the ninth month,” Agboola told The Nigerian Xpress.
That, according to Agboola, was not good news but they both quietly prayed that the baby would shift to a normal position before the delivery day.
Unknown to the husband, however, Abibat had a ‘Plan B’. “She had gone to register at a faith-based maternity centre around us. There, they assured her of normal delivery with the right prayer and fasting. I was not aware of this until her death,” Agboola said in an emotion-laden voice.
Findings by The Nigerian Xpress revealed that Abibat kept her plans away from her husband and the rest of the family.
“In the early hours of the day she died, she had fallen into labour before I left home in the morning and I had told her to carry me along as soon as she got to the hospital,” he further said.
Corroborating him on this was their grandmother, Alhaja Rabiat Agboola, who added that she did not even know that Abibat was going through child labour when she came to her place that morning.
“She came to my house that day with her children and only told me that she would be back soon. It was not her first time of keeping her children with me whenever she was going out, so, I never even suspected anything,” she told The Nigerian Xpress.
A call, however, came in later that day to inform her of an additional boy to the family. “We were all happy and I immediately assigned two of her husband’s sisters to go and check on her, as we were given a different address.”
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Sadly, their joy was to be short-lived. According to the kwara-indigene woman, “My daughter told me that when they got there, it was a maternity centre operated by some spiritual group. They met a dead person by the entrance of the place already wrapped up inankara, they never knew it was Abibat, they just went straight in to ask after her. They were first given the baby before telling them that the baby’s mother died because she was bleeding profusely. It was one sad day for us all,” narrated Rabiat.
Abibat’s husband was worst hit. He was inconsolable and at the same time very angry. Lamenting his plight, Yusuf said, “Why on earth would she have made such a decision behind me? How could she have been so gullible, as to feel she could have a transversely lying child without a CS? It was my money she was going to spend and I was not complaining. Now, she had gone and left three children for me to cater for. How would I cope? I wanted to take it up with those people but I changed my mind, especially as that wouldn’t bring her back. But I made so much noise when I got there such that they shut down the place for a long time. I am not sure they are still doing anything there again because I actually threatened to make trouble if they do.”
Kikelomo Anjorin was another woman who lost her life and that of her baby at another faith-base maternity centre. She was about to have the fourth child when tragedy struck. She had her first three children at a Christ Apostolic Church of which she was a member. It was, therefore, natural for her to head there when it was time to be delivered of the fourth baby. As it had been on different occasions in the past, she was promptly attended to. But something went wrong and poor Kikelomo, who had a prolonged labour, put to bed, but the baby was stillborn.
Bleeding profusely after she was delivered of the baby, she soon gave up the ghost. The case of Kikelomo was very pathetic. She did not only lose her baby, she also lost her life.
The case of Madam Patience Amos, a traditional birth attendant, who is popularly known as Madam Easy in Ayegbami community of Isaga, Ifako Local Government Area of Lagos State, was one that still lingers in the memory of the people in the environment. Madam Easy, according to one of her neighbours, Mrs. Funmilayo Idris, has been taking deliveries in the area for over 12 years and has a record of proficiency, which scores of women in the community readily attested to.
The expertise for which Patience Amos was nicknamed “Madam Easy” did not, however; work on this particular occasion. Joy, the pregnant woman, Mrs. Idris said, was experiencing a prolonged labour and was in excruciating pain for several hours. When suddenly, the baby seemed to be finding its way out, Joy started bleeding uncontrollably. Madam Easy and her aides tried all they could to arrest the situation but their efforts were in vain.
Scared and confused at the unusual turn of events, Madam Easy suggested that Joy be transferred to a nearby hospital but she gave up the ghost, even before they could move her from the birth centre.
Sad as Joy’s death was, there was a grim twist in the tale. She was Madam Easy’s first and only daughter. Needless to say the events of that day punctured Madam Easy’s record of success. The rumour mill was agog with all kinds of tales. This could only have been a demonic attack from the pit of hell.
Mrs. Ige, a concerned neighbour of Madam Easy’s, had this to say. “I believe this is the handwork of the devil. Madam Easy has been doing this thing, at least, for the past five years that I have been living around here. She even called other midwives around to help her out, but nothing worked.
“The girl really disgraced and spoilt business for her mother. It won’t surprise me if the girl in question was an Ogbanje. Why did she choose to die in her mother’s hands?” Another neighbour wondered aloud.
But Abiola Animasaun, a mother of three, who hails from Ifo, Ogun State, has a different story. She has benefited from the activities of a TBA in her vicinity and has been the envy of her fellow women.
She tells her story. “I do not know what I would have done or how I would have coped without Baba Oti, who made the delivery of my last two children very cheap and easy. I had my first child by a Caesarean operation and had to wait for four years before conceiving again. Although I had prayed fervently for a normal birth, the doctor still told me to get ready for another surgery for the same reason – a narrow pelvis. They said it could delay delivery and the baby might die in the course of finding its way out. I was scared and told my mother, who in turn told my father. My father sought help from Baba Oti, his herbalist friend of many years, and the man took it up from there.
“At first, when I told my husband, he kicked vehemently against the idea, saying it wasn’t ideal. We later agreed to do it by the side while I kept attending my normal clinic on antenatal days. We also agreed not to join other pregnant women, who troop into Baba Oti’s maternity home. We were initially meeting at my father’s house, later; we resorted to funding Baba Oti’s trip to our own house. He had given me lots of herbal concoctions (aseje) and some other things and I never experienced any problem throughout the period of pregnancy. I was already used to it. You may not believe it but I had my baby right inside my living room.
“It started like this. I was in the bedroom when I started to experience labour pains. It didn’t feel like anything serious, as I had envisaged, so, I was managing. When the feeling became consistent, I decided to inform my husband, who was then in the living room. By that time, however, it appeared rather too late to go to hospital. I wouldn’t know whether I was the one that did the pushing or it was the baby. I just felt something between my thighs. When my husband bent down to check what it was; it was the baby’s head. He was quick enough to bring a small mattress under otherwise the child would have fallen on the rug. I couldn’t move and the baby wouldn’t stop pushing, it just slipped out together with placenta. It was amazing. We just wrapped the child with a blanket and my husband drove me to the hospital. The nurses and everyone in the hospital couldn’t believe their eyes. They attended to me, cleaned me up and kept me under watch for a day. It was Baba Oti that God used to do the miracle. My son is two years old now and I can assure you that I have connected other willing women to Baba Oti.”
The Nigerian Xpress visited a number of these spiritual maternity centres and found some common characteristics. They typically consist of two rooms. One for consulting and delivery, while the other serves as the general ward. Inside the latter are usually two to three beds with mattresses. The beds are usually old, not very big and not with the company of a baby cot.
One of the attendants at a centre in Matogun area of Ogun State identified herself as Madam Julie Chinenye. She said she received her training in 1992 and has been practising since then.
“We have never had a refresher course, but we try to learn new things on our own. Worse still, government workers do not recognise our role,” she told The Nigerian Xpress.
Like modern midwives, these traditional attendants keep records. They have books where they write the names of the mothers to be they attend to. They also record the names of the children born.
“We keep record of our patients but I cannot remember all of them,” Chinenye said.
Ironically, in the same community, there is an orthodox health and maternity home. But it is deserted. There are no patients just as there are no nurses. A lone midwife received The Nigerian Xpress. Pleading anonymity, she said; “In a week, we have maximum, two women coming here to deliver their babies. It makes the job very boring. Most of these women prefer to go to traditional and spiritual homes to have their babies.
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“This is bad and demoralising for us. Some of them are really taking us for a ride. They would come and deceive us by saying they have come to register. They would on their own come with labour pain and inquire about the possibility of delivering safely. Then, they would disappear under the pretext of going to bring their baby’s things. But that would be the last time you would see of them that day. The next day or time you see them, they would be backing their babies. They would have gone to deliver their child at a traditional maternity home or church. I do not know why they prefer these people. It is not as if they are free and there are a lot of risks in their activities.”
Explaining the edge of spiritual birth centres over orthodox maternity centres, Chinenye, however, pointed that, “although I do not run a traditional home, mine is a spiritual home, we have many women coming to us because of the spiritual grace we have. Apart from performing the duty of a normal midwife, we also take up their different cases spiritually. We pray for them specially and consistently for safe delivery. This is why they have more confidence in us.”
Alhaja Kudirat Raji, a traditional birth attendant in Igando area of Lagos state also says TBAs are the best. Her words: “We give herbs to our pregnant women time after time, both drink and to use to bath. We do this stage by stage to ensure a safe delivery for them. We have our own way of judging the sex and position of the child and there are special herbal mixtures that can aid unhindered deliveries. Our services are affordable and our patients have so much trust in us.”
Mrs. Eucharia Joseph, a Head Nurse at the Ayodele Medical Centre, Fagba area of Lagos State, however, sees nothing to cheer about in the activities of TBAs and spiritual birth attendants.
“The popular perception that safe delivery is only ensured through traditional or spiritual birth is barbaric. No matter the level of training these people may claim they have received, there is an extent to which they can go. They are no experts on the job. This is why cases of pregnant women, dying at childbirth and number of stillbirths are on the increase. It is not all the complications that arise at childbirth that they can handle. For instance, a woman with swollen feet and body is likely to convulse at childbirth because it is an indication of hypertension. Hemorrhage is another complication that has been hard to handle by many of these TBAs and it has continued to kill many expectant mothers,” she says.
Mrs. Oluwakemi Olawale, a midwife at the Ladoke Akintola Teaching Hospital (LAOTECH), Osogbo, Osun State, expressed similar views with Mrs. Joseph. Quoting from the records of the United Nations Population Fund, UNFPA, she described maternal mortality rate in Nigerian as “unacceptably high” and stressed the need for active collaboration between all stakeholders to reduce the trend.
“According to UNFPA, Nigeria makes up about two per cent of the global population, but bears ten per cent of the global burden of maternal mortality,” she observed.
Olawale, who noted that maternal and infant mortality is higher in rural areas, blamed the upsurge on lack of health facilities, poor management of such facilities where they are available and the people’s suspicious attitude to orthodox health care delivery.
In her opinion, “close to 70 per cent of Nigeria’s population are rural dwellers that do not have access to adequate healthcare delivery. In places where health centres do exist; there is lack of funds to afford the necessary drugs and treatment, which is why many of them now seek solace in spiritualism instead of seeking medical solution to their health problems.
“The average African believes that it is a witch in the village, who is casting a spell on him or her and causing the medical problem. That is why the issue of education or enlightenment is so important. A lot of people, even though they are highly educated, still go back to tradition and this is unfortunate. We are not saying there is anything wrong in traditional healthcare, but it can be dangerous to people’s health unless it is refined and approved,” Olawale posited.
Nonetheless, she advised these alternative birth attendants to always work within their limitations. “We know that it is not easy for government to stop the activities of the TBAs, but they ought to know their limits. Once they feel a pregnant woman is likely to have a difficult birth, they should refer her to the hospital without a delay. From experience, we have seen that these TBAs, most of the time, want to be heroes, so, they keep trying all manner of tactics to deliver a woman, who can only be saved by surgery with different kinds of herbs. It is when the woman is almost dying that they will now refer her. By that time, it is always too late and both the child and mother’s lives are usually lost,” she regretted.
While acknowledging the efforts of government in stemming the tide of maternal mortality, the health officer charged the latter to do more. “It will be good for government to give top priority to the health sector when it comes to budgetary and personnel allocation. They should also train these TBAs more and post more health officers to the rural areas. Health is wealth and a healthy nation is definitely a prosperous nation,” she said.
