- Expectant mothers lack access to healthcare, suffer hunger, prolonged pregnancy, miscarriages
- Cholera, malaria epidemics loom from open defecation, over-full latrines, mosquito infestation
Pregnant women in internally displaced persons camp in Logo, Benue State, have for many years lacked access to health care. Some of them have consequently had miscarriages and narrowly survived death. Minister of Health, Osagie Ehanire, recently attested to the fact that lack of access to healthcare is the main factor contributing to high maternal, infant and under-five mortality in the country. The United Nations Childrens Fund (UNICEF) in its report titled ‘Situation of Women and Children in Nigeria” stated that the country records 576 maternal mortality per 100,000 live births while approximately 262,000 babies die at birth every year. Nigeria may be saved from recording a further spike in maternal and infant mortality rate if urgent steps are not taken to provide medical care for the embattled expectant mothers. INNOCENT DURU reports.
ERZOO Denen, a 35-year- old mother, was delivered of a baby last week in Logo IDP camp, Benue State.
She said from the time she took in till after she put to bed, she had not had access to medical care. She told our correspondent that she had not been healthy after delivery.
“I have been having acute stomach ache and waist pain. I sleep on a mat in our tent. I don’t have the means of going to the hospital to see a doctor for treatment. Neither do I have money to buy soap for washing or bathing my baby and I.”
Erzoo, according to the camp secretary, Levi Otim, is one of the lucky women delivered of a baby without complications.
He said: “Our women don’t have access to ante-natal care. Some of the women have miscarriages here in the camp because they don’t have access to healthcare. Some have late deliveries. They deliver months longer than the usual nine months.”
“Babies are five times more likely to die and three times more likely to have low birth weight when mothers don’t get prenatal care,” Mom Life, an online publication on mothers, said.
Checks revealed that all the expectant women in the Logo IDP camp risk falling victims to the challenges identified by Mom Life for women who lack access to prenatal care.
Comfort Jude, a 20-year-old expectant mother, is carrying her first pregnancy. She is absolutely naive about how to handle her situation and has no access to medical care.
“I am carrying a six-month-old pregnancy. It is my first pregnancy but I have not visited or seen any doctor since I took in.
“We don’t have any clinic here in the camp. I also don’t have money to go outside of this place for medical care,” she said.
Before now, Comfort worked in farms for people and earned some income with which she fed and paid her bills. But all that has stopped and she now battles with hunger on a daily basis.
She said: “I used to get N1,500 per day working for people on their farms, but it was not enough for me to take care of my daily needs. Now I can no longer go and work for people on their farms because of my pregnancy. I am always here in the camp.
“As a result of not having daily income again, I have been battling with hunger.
“I quite know that this is not good for me and the baby I am carrying. I feel very bad about it but there is nothing I can do for now.”
The husband, she said, was working before they came into the camp but had not been doing anything since they migrated to the camp to seek refuge from attacks by murderous herders.
She said: “We ran to the camp after herders attacked us and vandalised our home. Feeding has been very difficult for us. We live inside these tents riddled with holes and we are always at the mercy of mosquitoes.
“We hardly sleep well all night because mosquitoes come to feast on our bodies. Unfortunately, we don’t have mosquito nets to prevent them from biting us.
“Whenever it rains, we are seriously beaten inside the tents because they are not in good shape.
“Imagine a pregnant woman being beaten by rain and feasted upon by mosquitoes. It really gives me cause to worry but I know that God will see me through.”
Comfort’s kinswoman, Blessing Solomon, is nine-month pregnant. The 21-year-old by now ought to have known her due date and prepare for it. But all that is alien to her.
For her, putting to bed is a matter of anytime and anywhere she falls into labour.
“I have no money to go to hospital to be delivered of the baby. I will deliver right here in the camp.
“I have not gone for ante-natal care since I took in. I don’t have the resources to do that.
“We don’t even have any clinic anywhere close to the camp.
“At the moment, I always feel very weak and I don’t have access to medications that could make my body strong.
“I equally don’t have good food to eat. I often eat guinea corn.
“I have serious challenge sleeping because there is no mattress for us to sleep on.
“We sleep on a mat, and that does not make me feel comfortable.”
For Lucy Emmanuel, a 29-year-old mother of two, the experience she is currently having differs from what she had during her previous pregnancies.
She said: “I went for ante-natal care when I carried the pregnancies of my two children before coming to the camp.
“The baby I am carrying now does not enjoy that privilege. I don’t have money to go to the hospital.
“When you go to the hospital, they request for money, and I don’t have money for food not to talk of paying medical bills.”
Currently, Lucy said, she feels very weak because she does not feed well.
She said: “I used to eat very well before we came to the camp, but I don’t eat regularly again since I came to this camp. I always have to go out looking for what to eat with my family.
“This is a big problem for me in this condition. I should be eating well at this stage so the baby in my womb can also feed well. But that is not happening because of the situation we have found ourselves here in the camp.
“I pray that God will see me through.”
More lamentations from expectant mothers
The gale of lamentation is not restricted to the earlier respondents. All the expectant mothers in the camp have unpleasant tales to tell about their inability to access healthcare .
Faith Mgboho, a 25-year-old, is worried about the nutritive value of the food she eats.
“Hardly do I get balanced diet. I eat dry okro without fish and meat,” she said, adding: “There is no way of getting money to buy meat or fish. I don’t feel strong because I don’t feed well.
“I had two children before I came into the camp. I went to the hospital when I had those ones.
“I have not been able to access antenatal care since I became pregnant here in the camp. The feelings before and now are not the same.”
Also decrying her predicament, Catherine Ochom, in spite of her condition, still struggles to work for people on their farms in order to have something to eat for her survival and that of her baby.
“I always go and work for people outside the camp in order to get money to feed. I get about N1,000 per day.
“I endeavor to go out to work every day in order to have something to eat. If I don’t go out to hustle, I will stay all day without food.”
Though her dint of work enables her to have money to eat, Catherine said: “I don’t feel happy going to work as a labourer order to have something to eat in this my condition.
“There is no doctor or nurse to attend to me. I still defecate in the over filled latrine. I know it is quite unhealthy for a pregnant woman, but what do I do when there is no alternative?”
Naomi Teyem, a 31-year-old, said she resorts to self-medication anytime she feels sick and has money to buy medications.
Her words: “Mosquitoes bite us mercilessly at night in the tent. I always have body aches.
“When this happens and I have some money, I would go to the chemist to buy medications. But if there is no money, I will endure the pains like that.”
Speaking about her pregnancy, she said: “My pregnancy is four-month old. I used to be a farmer but I have been doing nothing since I came into the camp.
“Since I have not been going out to work and earn income, I may not be able to take proper care of my baby.”
Camp management flay pregnant women’s predicaments
The management of the camp bemoaned the conditions of their pregnant women, describing them as pitiable.
The secretary, Otim Levi, said the conditions of the nursing mothers in the camp was very bad. Levi said: “They are suffering a great deal. They don’t have enough food to eat for the womb to be conducive for the baby.
“There is also no clinic or maternity for them to treat themselves or go for test.”
He noted that “no doctor or nurse comes around to see them.”
The camp scribe noted that “some women do have miscarriages here in the camp because they don’t have access to treatment. Others experience late delivery. They always feel very bad about it.
“One of them you spoke with said her pregnancy was nine months old, but because of improper feeding, she may not be able to deliver on time. She may deliver many months after.”
Levi also noted that some of the women have their pregnancies going beyond nine months. “They have the problem of delayed delivery because of the unpleasant conditions in the camp aggravated by lack of access to health care.
“Nothing is being done by the government to solve the problem. We have reached out to them for help to no avail.”
Making reference to an inmate who put to bed last week, Levi said: “The woman put to bed inside the camp and there was nobody to take proper care of her. We had no money to take her to the hospital.
“The medical team brought by an NGO that was helping the women in the camp has left for Makurdi. They were here for a while and have completed their project and left.
“The inmates are left without access to medical care, and that is highly condemnable.”
On the challenge caused by lack of toilet in the camp, he said: “We have informed the revelant authorities but there is no answer from them.
“The last time the state government provided food for us was on December 24, 2022. The federal government doesn’t bring any food item to us.”
How lack of access to ante-natal care spikes maternal, infant mortality – Dr Adesanya
A public health physician, Dr Rotimi Adesanya, has expressed concern over the predicament of the expectant mothers.
The physician said it is mandatory for expectant mothers to have ante-natal care.
He said: “It is during ante-natal care that one would be able to establish if they have pre-existing conditions like high blood pressure or diabetes. These are the things that are common and it is during ante-natal care that one would detect these things that I have mentioned.
“These challenges can lead to maternal mortality, that is the death of the mother while pregnant.
“The whole world frowns at maternal mortality. This particular development that you mentioned could add to our maternal mortality rate in Nigeria.”
Without adequate ante-natal care, he said, “some things could affect the mother while pregnant and they are what we call eclampsia and pre-eclampsia.
“Pre-eclampsia is also high blood pressure in pregnancy coupled with protein in their urine. Eclampsia is when a woman that has high blood pressure gets to a stage of having seizure.
“Because the blood pressure is not controlled, the person will move from the stage of pre-eclampsia to eclampsia.
“Anytime eclampsia happens, it can take the life of a woman. That is why if a woman would have eclampsia at any point during the ante-natal care, they have to bring the baby out irrespective of the age.
“Whether it is one week, nine months or six months old, the baby has to be taken out so that the life of the mother can be saved.
“These things may happen if there is nobody checking their blood pressure, urine and sugar level while they are pregnant.
“These are basic things. Some of them can be done under the primary health care by sending the community health workers and midwives that are trained.”
Going down memory lane, he said: “There was a community programme that the federal government launched some years ago. It was about sending some midwives that are trained to communities to help to reduce mortality.
“These are cost-effective measures that can be done because it doesn’t require the wall of a big hospital or special equipment, but the skills of those midwives to help the mother.”
Talking about the effect of lack of access to ante-natal care on the unborn child, he said: “This could also make prenatal mortality, that is the death of new born around birth, to be high. Normally, if a woman should have challenges like diabetes in pregnancy, high blood pressure in pregnancy, the babies normally die towards the end of the pregnancy, except there is an intervention from a doctor.
“ Some of the babies could have birth asphyxia, and this can lead to cerebral palsy which is a form of disability.
“It may make the women to give birth to children who right from birth are already having one problem or the other.
“The recommendation I will make is that starting from our primary health centre, health workers should be sent to those IDP camps.
“These health workers are readily available in the primary health centres and at times they don’t have much to do. They can be sent there on a daily or rotational basis.
“If they have any issue during the ante-natal care, they can now refer them to the nearest general hospital. Leaving them without any skilled medical personnel is actually dangerous and it will continue to increase our maternal mortality.”
Dangers of suffering from hunger
Speaking on the women’s complaint that they are often lacking food to eat, Dr Adesanya said: “Pregnant women eat a lot because the babies have to take from what they have eaten.
“If they are not eating well, they will have what is called hypoglycemia, low sugar. Such babies will not be able to grow well inside the mother. We call it intrauterine growth restriction.
“By the time the children are delivered, some of them will have what we call low birth weight- children who from birth are already having stunted growth, and the mother, who is the carrier, will have challenges of low sugar and will not enjoy that pregnancy period because it will be so stressful.
“There may be fainting attacks. I am sure you must have heard of pregnant women fainting on the road. They need more energy.
“If those women are not having food, it can actually add to the mortality rate we are having.”
Challenge of mosquito bites for pregnant mothers
He also frowned at the menace of mosquito infestation in the camp, saying: “Actually, in this part of the world, malaria in pregnancy is actually one of the causes of maternal mortality and the mortality of the new born.
“Insecticide-treated nets have been established for life saving, especially in this part of the world.
“The women we are talking about are likely to have malaria, and when there is malaria in pregnancy, the immunity of the people who are affected is normally low.
“Those who are pregnant are badly affected. They will have children with intrauterine growth restriction: the baby will not be able to grow well.
“When the baby is born, he may have what we call congenital malaria. The child may have jaundice in the eye starting with malaria from birth.
“The mother’s blood level will also be affected by malaria parasites and she will be anemic. The blood will be so low and it may lead to the challenge of maternal mortality.
“Insecticide-treated nets can actually be obtained from well-meaning Nigerians. The government can also reach out to NGOs.”
According to him, Nigeria has one of the highest maternal mortality ratio, and “this maternal mortality, anytime it happens especially at the secondary and the tertiary stages, there is usually a clinical audit whereby the doctor will do a post mortem analysis to reveal what has gone wrong so that such mistake will not happen subsequently.”
Defecating in untidy toilet
Condemning the practice of open defecation and using over-filled latrines, Adesanya said: “The World Health Organisation has said there shouldn’t be anything like open defecation anymore.
“Like you said, because the pit latrine is filled they go for open defecation. That means we are still far far behind.
“As a result of the over-filled toilets, flies will be breeding in the place and spreading many diseases like cholera.
“We have had outbreaks of cholera many times. The common typhoid fever that people mention is also through contamination from faeces. Then we have what is called shigella, and we have dysentery.
“Worm infestation will start happening because the worm passed out by those who are infected, the eggs will develop and will from there get to those who are not infected.
“They will have a series of worm infestation and this worm infestation will drop the blood of the pregnant woman and make her anemic.
“This will contribute to maternal mortality of those women.”
‘Self-medication among expectant mothers dangerous’
For expectant mothers in the camp relying on self- medication, Dr Adesanya said: “That is very dangerous because where they are buying the drugs, those ones may not have been trained to diagnose sicknesses.
“To diagnose sicknesses you have to do tests. Even for malaria, you have to do test.
“If it is for blood pressure you have to check it, and the same applies to other health challenges too.
“What they are doing is self-medication. The truth is that most of the drugs are not used in pregnancy because it will have adverse effect on the unborn baby.
“We don’t use drugs indiscriminately for pregnant women. The drugs have to be prescribed.
“Many of the drugs could also make them to have miscarriages. That is why such should be discouraged.
“The government should come in.”
Recommendation
The physician recommended that “the government should have the political will to attend to the needs of the women.
“There should be primary health care. The issue is really under the purview of the primary health care.
“Staff of primary health centres should be drafted to the IDP camp. The NGOs should come in to support with insecticide-treated nets.
“Continuous health education should be carried out in the area so that the pregnant women there will not contribute to the maternal mortality and the infant mortality high rate that Nigeria is having.”
Efforts to speak with the state Commissioner for Health, Dr Ngbea Joseph was unsuccessful as his mobile number was not reachable. He was yet to reply to a text message to him.