Due to the financial barriers and limited access to quality healthcare facilities, some expectant mothers continuously resort to seeking care from unqualified or informal providers, commonly referred to as “quacks” or traditional birth attendants.
These individuals may not have the necessary medical training, equipment, or facilities to provide safe antenatal care. However, relying on quacks can pose significant risks to the health of both the expectant mother and the unborn child.
These informal providers may lack the skills and knowledge to address complications or emergencies that can arise during pregnancy. This can lead to adverse outcomes, such as maternal and infant mortality.
At 36 weeks of pregnancy, Ifeoma had earlier registered at a private hospital, she followed her mother-in-law’s advice who resides in Badagry and visited the traditional birth attendant (TBA), where they claimed to have helped reposition the baby for easy delivery.
On getting home back to Lagos, throughout the night she was uncomfortable. Very early the next day, she visited R-Jolad, Gbagada, the private hospital where she had registered for antenatal care. According to her, she was told by the doctor that the baby is bridged and an urgent Caesarean Section (CS) would be advised for the safety of her and her son.
Ifeoma survived to tell the story, which represents the ordeal of thousands of pregnant Nigerian women who visit TBA homes.
As Yebola Adediran’s due date drew closer, she began experiencing complications at her home in Ikorodu, Lagos. She went into labour prematurely, and Iya Agbebi’s remedies she uses, a traditional birth attendant (TBA), proved ineffective in providing the necessary care. With no access to medical equipment, it was a struggle to monitor the baby’s heartbeat.
Panicked and worried for her and her baby’s safety, Adediran’s husband finally rushed her to the nearest medical facility. By the time she arrived, her condition had worsened significantly. Unfortunately, it was too late to save her baby, and Adediran herself faced life-threatening complications.
More women have had the same experience. But the story did not end there. Nigeria has an extremely high maternal mortality rate with 1047 deaths per 100 000 live births, the country accounts for the second-highest number of maternal and child deaths globally. Every two minutes, one woman dies globally during pregnancy or childbirth, according to a recent report by United Nations (UN) agencies.
Haemorrhage, post-partum, pre-eclampsia and hypertensive disorders, sepsis and infections, and abortion complications are the main causes of maternal deaths in Nigeria.
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Madam Doris, a retired midwife, said: “I have witnessed many stories of expectant mothers seeking antenatal care from unqualified individuals, often referred to as ‘quacks.’ These stories are a glaring reminder of the dangers and challenges faced by women who are not aware of the importance of proper antenatal care.”
But TBAs are spread across Nigeria; despite accelerated reduction of Maternal and newborn mortality, some of these TBAs have been empowered and supported by strategic alliances while some may not have the necessary medical training or credentials to provide safe and effective prenatal care. This has continually put both the mother and the unborn child at risk and do more harm than good.
High costs associated with formal antenatal care services, such as consultations, ultrasounds, laboratory tests, and transportation, can deter expectant mothers from seeking proper care. These costs can include not only direct out-of-pocket expenses but also indirect costs, like lost wages due to time spent seeking care.
Prenatal costs can indeed create challenges for expectant mothers; limiting them accessing the important prenatal services, such as ultrasounds, blood tests, and medical consultations potentially pushing some expectant mothers to seek alternatives they can afford, even if they are suboptimal.
“Because of the amount I heard they pay for antenatal in the big hospitals, I used native way to give birth. It is cost of hospital bills that made me choose here and it is cheaper to patronise this herbal traditional birth attendants,” Iya Tunde, who lives in Somolu, Lagos said.
According to her, “We are being given herbs and aseje; concoctions as part of treatment to stabilise our delivery safely. Registration is between N5,000 and N10, 000 and I do go with scan results. If there is any issue like baby bridging, there is a way to position babies if they are bridged and if your baby is over- weight, the herb will help reduce the baby’s weight to avoid you having cesarean section and you have easy delivery.”
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Reacting to use of herbs in reducing neonatal birth, Akinsola Akinde, consultant obstetrician and gynecology and the past immediate chairman of Lagos sector of the Society of gynecology and obstetrics of Nigeria (SOGON) said the foundation of any child is made in the early days of pregnancy.
According to gynecologists, when a child’s growth is limited, they are more or less limiting their potential.
“The baby comes out malnourished, what those herbs do is to reduce the supply of adequate nutrition to the baby while in the womb. So, the baby comes out growth-restricted which most likely will affect the baby’s brain developments.
“It is dangerous and at the worst end if the growth restriction is very severe, the baby might even die in the mother’s womb,” he said.
However, antenatal care is an important component of maternal healthcare that helps ensure the well-being of expectant mothers and their unborn children.
“We know how important antenatal is for an expectant mother,” Erutu Rose, a trained midwife, said.
“Because the hospitals are too far from us, which is about 3kilometres, one at Badeku and the other at Butubutu community. These are government health centres, but because of the distance we hardly get to see staff to attend to them. Most of the workers stay far, this has left many of our women giving birth with us,” an auxiliary nurse who lives in Jago community, Ibadan, Oyo State, said.
According to her, “Some of these women don’t have the money to access care, because they believe big hospitals are expensive. They prefer coming to midwives so that we can be of help to them and we do receive a token from as low as N10,000 for delivery,” Rose said.
However, there is a subsidisation of antenatal costs by the Nigerian government currently, registration for antenatal in a government/general hospital is between the range of N30,000 and N35,000.
At the private hospitals, the cost range for antenatal registration or delivery costs is between N100,000 and N1,500,000.
Akinde pointed out that quackery in maternal health has continually been a serious issue in Nigeria’s health care, adding “we still have a lot of ways to go.”
According to him, “Government cannot totally ban them; I have been an advocate of the government banning quacks, but looking at Lagos State, they don’t have enough facilities for its population.
“We have to provide quality services, which will reflect an obvious difference between the old services and what the quacks provide to convince people, but due to poor attitude of health workers, lack of infrastructures, low remuneration and others have hindered the services rendered across Nigeria’s Healthcare sector. So, because of that they have options to go to quacks, not minding that they are putting their lives in line.”
Akinde further said that the government cannot do much. According to him, even if the government makes proclamations, people will still want to make their choices.
“We need to intensify in educating women against quacks and some processes during pregnancy. These women need to know why they shouldn’t indulge in some practices.
“If the government says free healthcare services, people will still ignore it, but if they are educated and enlightened, it will help them to be empowered and liberated. So we need to emphasise on education,” he said.
Over time, experts have also emphasized that addressing the issue of quackery which spikes maternal deaths, it’s crucial for governments, healthcare systems, and societies to work together to make prenatal care more accessible and affordable.
This could involve measures such as subsidizing prenatal care, expanding healthcare coverage, and improving public awareness about the risks associated with seeking care from unlicensed providers.
Pregnant individuals should also seek assistance from reputable healthcare professionals and explore options for financial assistance or insurance coverage if they are facing challenges with prenatal care costs.
Investing in healthcare infrastructure, including the availability of qualified healthcare workers and well-equipped facilities, is essential to ensure that expectant mothers can access quality antenatal care.
DELTA
Despite the free healthcare programme run by the Delta State Government, some pregnant women and expectant mothers choose to take other options, including patronising quacks, for ante-natals and delivery of their babies.
While some of those interviewed by BusinessDaySunday alleged that the programme is not truly free, others claim that low quality medication are given, hence they prefer to give birth at the Traditional Birth Attendants’ homes to save cost.
However, some of those who have benefitted from the programme said they received fair treatment from the government-owned hospitals where they attended ante-natal clinics and delivered their babies successfully.
Magrette Ogenna, a petty trader and mother of three, said: “I had gone to one of the General Hospitals in Asaba but one thing led to another, I was referred to the Federal Medical Centre (FMC) where we spent exorbitant amount of money to have my baby delivered. That was my first baby.
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“When I had my second baby, Things were so tough economically and I never thought that a situation would arise demanding for CS by hospital.
“I went home and began to call God to intervene and save me and my unborn baby. At that moment, my pastor called and began to pray for me. That was how I delivered my baby at home without going back to any hospital.
“God used the man of God to save me. When doctors, nurses deny you because you cannot afford to pay the bill they give, God will never deny you.”
According to her: “I don’t believe the pastor that helped me is a quack. I believe he is a messenger of God and that God’s finger passed through him to deliver me and my baby.”
Loveth Christian, a farmer and mother of three, said she ran to a spiritualist when she was pregnant of her third baby. Since the hospital I attended ante-natal clinic could not handle my matter, I had no other choice. I delivered safely and the charges were minimal.”
A cleric, who wouldn’t want his name in print said that he had encountered women who were full of lamentation over issues of finances and poor ante-natal care in the state.
“I have people in my area (Ogwashi-Uku) who frown at going to give birth in the General Hospitals because of huge monetary involvement. They said that due to the treatments are said to be free, the actual drugs needed were not given to patients. Here, they give them list of drugs to buy.
“Secondly, the doctors are not patient with the pregnant women. Little thing, they would book for Caesarean Section (CS) and that has contributed in making them prefer other options of which most of the times they end up delivering their babies safely,” he said.
Another woman, Blessing Nworie, who sells African Salad (abacha) and bread-fruits (ukwa) to support her family economically, said: “My husband works with a welding and construction company that pays him a paltry N25,000 monthly salary.
“He would have been self-employed and be making huge sum if he had money to buy equipment. Due to lack of money, he is continually enslaved by the company to the detriment of our family. The salary only helps in paying our rent and pay one or two bills in the family.
“My first child, a boy, is 12 years old, the second child, a girl, is seven while the the third who is also a girl is five years old.
“Because of harsh economy, we opted for a family planning method that could allow us at least five years before having another baby.
“Now, the five years is here and I’m scared again. Yes, the three children we had, were born in hospital and we pray that as we expect another baby, the birth should also come through natural method to enable us pay hospital bill that would be presented to us at the end.”
Ndokwu Nkiru, a community health worker, on her part, thumbed up for the state government for helping women through the healthcare programme.
I don’t know if there is any other state in the federation that does it like Delta State, she said.
“I delivered my first baby in this hospital – Okwe General Hospital and the medical personnel here we’re caring. My second baby was delivered in Warri because that was where we lived then. Now, I’m six months pregnant of my third baby and by next week, I’ll come to register here.
“I encourage pregnant women and expectant mothers to go General Hospital. They are in every local government area of the state.”
The commissioner for health, told BusinessDay that: “Our ante-natal clinic is 100 percent free not just for pregnant women but also for children under the age of five.
“If you know any case, you bring it up for the state government to deal with decisively,” he said.
KOGI
Rikiyatu Usman, a business woman and mother of three in Kogi, said: “Even though the state government is helping us, things are still very difficult. What the Federal Government is telling us now is that we must first of all make plans; keep our houses in order before becoming pregnant. Then, talking about baby’s food, that one is another hurdle to pass when you finally put to bed. It’s not easy; things are getting tougher and tougher every second,” she said.
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Helina Audu, a mother of six, who is in her seventh pregnancy, also disclosed that looking at how she delivered her sixth child, she has been following every advice given to her by her friend, who happens to be a midwife in a private clinic.
She said that When it was time for her to put to bed, it was around 3 a.m, and there was no motor to take her to hospital. What she did was to rush to the midwife’s house . Woke every body up .
“Iya Nurse has no option than to prepare her things because when she checked me I was already eight centimetre due. Before 45 minutes I put to bed. She gave me treatment. And when my baby reached six weeks, we went to hospital. And I thank God there were no complications after delivery. My payers now is for God to see me through. And I will say bye bye to the institution called child bearing.
“We are pleading with the federal and state governments to see the plight of the citizens and redress certain implementation. My fear now is I will be putting to bed by November, and look at what political parties in Kogi State are doing. What if labour commenced and I have to pass through the area they are doing rally . The order of the day now is disrupting rallies and killing or causing innocent people to sustain injuries when they carry out their deadly activities in the name of campaign.”
