How economic downturn is forcing teenage girls out of school and into unwanted pregnancies and early marriage.
Taiwo Alimi reports that recession is forcing more teenage girls out of school, and into early marriages and unwanted pregnancies.
THE room was somewhat stuffy; the air filled with the smell of baby urine and dirty clothes. Its main occupant 45-year-old local guard, Kabiru Mohammed, pointed at a corner of the small and grimy space. “Mariama, are you awake,” he said, addressing his wife.
Mariama, apparently taken aback by the visitor’s intrusion, struggled to get up from the multi-cultured mat on the floor where she laid with their newborn.
“Good morning, sir,” she greeted and quickly returned to her corner while her husband hurdled into a squatting position by their baby who was still enjoying his sleep.
The visitor-this reporter- had called under the guise of gifting the baby money.
Soon, Mohammed calmly launched into the story of how he and Mariama, young enough to be his daughter, became husband and wife, adding gusto into the tale like a warrior boasting about his conquest.
“I am from Katsina and I have been living in this place (Mowe Ogun State), for more than 10 years,” he said.
“Mariama’s father is a friend to my brother.”
As he adjusted his position where he sat beside me, I glimpsed a smirk on his face, the kind reserved for tasty meal.
Mariama was barely 12 when her parents accepted Mohammed’s proposal.
Two years later she parked in to become a full housewife.
He continued: “I used to send money to her parents to pay for her school fees, because I wanted her to understand and speak English.
“I also attended secondary school before coming to Lagos. Her parents asked me last year to come for my wife because they could not afford to send her to school any longer.”
Religion, custom and tradition
Mohammed does not see Mariama as a child. “My mother had me at the age of 13,” he announced.
“In my tradition and religion, as soon as a girl starts menstruating she is ready for marriage.”
It is such written and unwritten religious laws, diffusing into age-long custom and traditions, that the Nigerian Child Rights Act (2008) has to contend with.
The Act considers such relationship between Mohammed and Mariama illegal.
Legality is conferred only on marriage or betrothal for those from 18 years and above.
The International Labour Organisation (ILO) also frowns on the practice of giving out under aged girls out in marriage. Modern-day slavery, that is how the ILO defines it.
In some parts of the country, however, the Nigerian Child Rights Act and the ILO definition of child marriage amount to nothing more than exercises in futility.
Mariama, who turned 15 this January, recalled the joy and pain of having a baby at 14.
Joy: for delivering without any health complication, and pain: because she feels lonely.
Nothing prepared her for this new life as wife and mother.
“My mother is not here to help with the baby,” she said
“My husband is out most of the time. I fend for the baby all alone and have to go to market too to cater for the home.”
That Mariama did not suffer a rupture or vestico vagina fistula (VVF) at delivery was a miracle to Dr Demola Adewusi, the lead doctor at Broadland Hospital Ogun state, who took delivery of her baby.
She also got help from their landlord and the private hospital.
Interjecting, Mohammed said: “My Oga (master) tried for us. When my wife got pregnant, he took us to the hospital his family uses and handed her to the doctor. He used to give us money too so that she could go for antenatal all the time and so, when she was due, the baby came and her delivery was not complicated.”
Dr Adewusi called Mariama’s case a special one from the day she was brought in by their landlord.
“He told me that his security man travelled home, up North, and came back with a 14-year-old girl as his wife.
“The man was scared and told me to do whatever we needed to do to deliver her safely and put the bill on him.
“He said the girl must not die. Therefore, all through pregnancy, we monitored her. Even on the day of delivery, we had assumed surgery and we were ready. Interestingly, she delivered by herself and the baby was a bit short of 3KG.”
Mariama was lucky to go through without a scratch, Silifatu wasn’t so lucky.
She also dropped out of school at 15 to wed the man her father choose for her as husband: a twice married, 52 year old man.
Silifatu ended up at the reserved wing of University Teaching Hospital Ibadan (UCH), joining a long list of those suffering from fistula, a common disease among child mothers.
It occurs when the womb ruptures caused by prolonged childbirth ,leading to leakage of urine.
Growing up in Damaturu, Yobe State, under the care of peasant parents, she is accustomed to hard work and life.
The family owns three farms and all year round, there is a farm to be cultivated, harvested or prepared for the rainy season.
“I was always with my mother,” she recalled, “and if we were not preparing food for the family of nine, we would be on the farm harvesting.”
Thin and disheveled , she looks older than her official 16 year-old.
Determined to learn how to write and read, she often walked over five kilometeres to attend the community school at Damaturu, from Monday to Thursday. Friday was set aside to join her brothers in the Quranic school, until she was married off at 15.
Condemned to Obey
In a resigned tune, she lamented that kicking against early marriage is like going against an entrenched custom and tradition.
“My mother used to tell me that I would be going off to my husband once I was old enough,” she said with a tone of regret in her voice.
“I was not part of the arrangement. The traditional is that my father would make the arrangement and my mother would convey the message to me and my own part was to go along with whatever decision they took.”
Education is not an option for Silifatu. Marriage is her primary assignment, and school is secondary.
Like Mariama, her marriage was quickened by the flood and subsequent poor harvest that affected her family two farming seasons ago.
Financial distress soon crept in.
Short of funds and food to cater for his large family, her father simply asked her husband to come for her hand in marriage.
For her parents, the bottom line was one less mouth to feed.
And she was not alone in her cycle of friends.
“Four of my friends also left school to get married at the same time I did,” she mourned.
What mother told me!
Silifatu got pregnant the second month she joined her husband’s harem and her health challenge began almost immediately.
“My mother did not tell me that sex or child bearing would be difficult. I observe basic hygiene but I did not know much about delivery,” she said.
“ She told me it could be painful, but it would go away quickly. That I must be brave and I can cry if I want to.”
Silifatu suffered multiple tears leading to fistula after prolonged labour and her husband sent her to the health center when the traditional birth attendant methods did not mitigate her suffering.
“The midwives in my village took care of my delivery. It was painful and thereafter my husband noticed that I was suffering and took me to the local clinic, but they did not have the basic equipment to treat my case. Therefore, I was referred to Kebbi VVF center. From there I was sent to the University College Hospital (UCH) Ibadan where free surgery is available,” explained Silifatu, who has undergone two surgeries and now in rehabilitation.
Teen pregnancy upsurge
While Mariama and Silifatu have been hounded out of school by a combination of tradition and hard time, the latter appears to be the root cause of teen pregnancy in urban cities and towns.
Mrs. Florence Sunday , an administrator in a private school, said more parents are withdrawing female children from schools since the country officially went into recession.
Girl child discrimination
Her words:”In my school, we have lost three girls from JJS 1 and JJS 2. They did not return for the second term in January. Their parents said they could not cope with the high fees because they lost their jobs and business was bad.
“ I see those children going wayward and getting pregnant in sooner than later. Girls are delicate and when they don’t find comfort at home, they turn elsewhere for it.
“ Yet, they may not be able to handle what is to come their way,” said the mother of three with tears swelling in her eyes.
Stella falls into this group mentioned by Mrs. Sunday.
Her father took to okada (motorcyclist) riding after losing his white-collar job last year. Her mother – a petty trader- also closed down her shop due to low funding.
“I had to stop schooling because my parents said I should allow them concentrate on my two brothers, who are also in school,” Stella complained in a vacant tone.
It is not uncommon in many parts of the country for poor and often uneducated parents to withdraw their female children from school during lean periods, while male children continue.
The decision, though unpopular with Stella, became her undoing as she sought compassion outside her home and today, at 16, is in the family way.
A 25-year- old artisan is responsible for her pregnancy. “I don’t know if I would be able to go back to school,” she said followed with a heavy sigh.
Biola, 17, is five months pregnant. She attends antenatal on Thursdays at Oke Afa Health Center Ogun State. She was a student of a private secondary school at Oke Afa until she dropped out a year ago to join her mother at her restaurant at Magboro market.
“My father said he had lost many customers in his welding business. He said he was not getting new jobs and so we hadto manage,” she recalled.
Biola was managing the food joint whenever her mum was away.
“That is how I met my husband. He owns a danfo (commercial bus), and promised to take care of me. I’m pregnant for him and we are making plans for marriage, but he wants me to have the baby first.”
Biola may never head back to school, she may never see the four walls of classroom again, her future mortgaged and truncated.
Fatal statistics
According to the Nigeria Bureau of Statistics (NBS), 2.6 million Nigerians became unemployed within the first and second quarters of 2016, bringing the figure to a scary 22.45 million, higher than the 20.7 recorded in 2015.
Expectedly, this is having an effect on the education index. The United Nations International Children’s Fund (UNICEF) says no fewer than 10.5 million Nigerian children are out of school and more will join the growing list of school leavers, mostly girls, due to the current hard times.
The Nigeria Population Commission (NPC) recons that , Biola, like many pregnant teenagers, stands a risk of not only losing her future, but her life and that of her unborn baby.
Its latest report indicates that not less than 50,000 teenage girls die yearly in Nigeria because of early pregnancy. It painted the ominous danger posed by pregnancy by any girl below the age of 20. “For instance, about 44.5 million of Nigeria’s population is made up of young people and adolescent births are prevalent among the poor, less educated and rural populations. It is projected that this number will shoot to about 60 million young people largely as a result of early marriages, early sexual exposure, and pregnancy, coupled with poor healthcare services,” the report read in part.
“Statistic derived from World Health Organisation, (WHO) states that about 16 million girls between 15 and 19 years of age and two million girls under the age of 15 give birth annually and Nigeria alone account for 10 percent of global maternal mortality.”
It means that Nigeria will lose more than 50,000 teenagers at childbirth unless the scourge is quickly checked.
Medical challenges
Dr Opeyemi Akinajo, a consultant and specialist in maternal medicine has surplus concern for the girl child, a passion that makes her voice reverberate and quake when she talks about it. She lamented that parents living under extreme poverty often send out their children to hawk goods or use them for petty trading. “Because they are not experienced, men take advantage of them and they are impregnated. This happens in both rural and urban centres. Illiteracy is one of the key factors responsible for child marriage. People that are not educated follow tradition blindly, ‘because my mother married at 16, I must follow the tradition, even though it is a faulty one.’
“Other would say: ‘I have four children already and I can’t take care of them, why don’t I marry her off so that there will be less mouth to feed’.
Due to the delicate nature of a girl child and the complexity of child bearing, Dr Adewusi said teenage pregnancy is a risky and costly business.
“There is a time that the body of a woman is matured enough to successfully go through the stress of pregnancy and delivery, but a child or teenage girl is yet to attain this especially the pubic bone which is still undergoing development . They are at risk of lower genital tract laceration during sexual intercourse and delivery.”
Dr Akinajo recollected the case of a girl child that suffered severe lower genital tract laceration during sexual intercourse. “She was brought in bleeding profusely and too late. The girl bled to death.”
Emotional trauma
There is also emotional trauma, physical trauma and abuse. “A child cannot think well. You expect a matured woman to take her decision, when to wake up, what to cook and how to take care of the home. But, because she is a child, her husband has to tell her everything. So, it brings violence, abuse, marital stress and a whole lot into the home,” Dr Akinajo added.
At pregnancy stage, she added, “such a girl would not even know when to go for antenatal or where to go to and cannot talk to her husband about it, so, throughout she may not go to hospital. Due to poor feeding, nutritional disorder arises, leading to anaemia; shortage of blood. This problem would affect the baby too because, the baby depends on her for feeding and so would be affected since mother has blood shortage. Also, the pelvic region (pubic bone) is not developed and so she may develop complications during labour.”
The risk of death is also high in teen pregnancy, Dr Adewusi stressed. A pregnant teen is prone to pre-eclampsia; high blood pressure, sometimes with fluid retention. “This condition can lead to eclampsia; seizure or convulsion, and can lead to coma and death.”
“It is one of the top five causes of maternal death.”
The unborn baby is also at risk, Dr Akinajo informed. “A baby can die from prematurity following premature delivery, also known as premature birth. Most time they attend traditional birth attendant who administer herbs and so during delivery, they go through prolonged labour and after performing all sorts of atrocities on them and it is too late, they would now bring them to the hospital. Meanwhile, the baby is in distress, and if severe may suffer brain damage or death. Even after delivery, she is not out of danger.
Even after delivery, she is not out of danger.
Dr Akinajo’s tone rose in fervent distress as she delivered this part: “Because she is a child, she cannot show real care and love to the child. She may not even breastfeed due to so many factors like depression, and non-challant attitude. She does not even understand her situation. If Fistula occurs, she smells, develops skin rashes on the perineum, upper and lower genital tract infection, social factors like deprivation and isolation, stigmatization, suicidal ideation amongst others. And at the end of the day, her husband pushes her out and she ends up in her parents’ home.”
Access to Healthcare
Because teenage pregnancy in Nigeria is associated with poor and illiterates in rural and urban homes, accessing Nigeria’s costly and unorganized heath care system is a bigger problem.
On the average, a fee of N150, 000 is charged for surgery in a government hospital while it is higher in private hospitals.
“How do you expect these people to get access to adequate health care? Dr Adewusi asked rhetorically.” Realistically the families of Mariama, Silifatu, Stella, and Biola cannot afford the humongous fee.
“These people,” he added, “therefore go to untrained or quack personnel that will bill less. Don’t forget also that she cannot feed well or access the right drug. These can lead to anaemia.
“Lack of education also affects these people. They just don’t believe in coming to hospital because of their beliefs, Instead they go to religious homes and are delivered by pastors’ wives and quacks. Most of them don’t even go to hospital. They are ignorant, and have phobia for hospitals.”
The other problem is that skilled doctors, midwives, and trained birth attendants are few, there is acute shortage, and because of that, quackery strives.
Gender inequality
“Men are also part of the problem,” Dr Adewusi explained fumed: “We have been talking about family planning; it is only women that are trying in this aspect of safe sex. Men would kick against it. They would say ‘it is over their dead body’. They prefer flesh to flesh. This is a country where a legislator married a 13-year-old in the name of religion and custom. Some husbands don’t even allow their wives to work. ”
Therefore, what is the way out of this logjam?
National awareness
Dr Adewusi advises that the scourge has come to a tragic point where everyone must be made to be aware of its danger. “Government should create awareness for it. We should not shy away from sex education. Teenagers from mosque and churches get pregnant too. When you preach abstinence, safe sex must be taught too. Government at the state and government levels should also concentrate on teenage pregnancy. Free health care from antenatal to delivery should be available for pregnant people below 18 years. If this is done, I see them coming out and that will reduce mortality rate.”
“Prevention is better than cure,” Dr Akinajo added. “It is like eating baby chicken and think you are enjoying it. The key to opening our minds and legislation on the danger of child marriage is education. I know that the Nigerian Child Health Care (2008) act, was promulgated that a minimum age of marriage must be 18. Sadly, out of 36 states, only 23 have implemented it. The other states do not recognise it. That is a challenge.”
Primary health centre
She noted also and called for activation of primary health centres across the country. “They are closer to these people and easily accessible. The health-workers can be trained to recognise child pregnancy problems and quickly refer sufferers to hospitals nearby. They don’t have to come from the rural areas to Abuja, Abakaliki, and Ibadan, where there are VVF centres. They are far and not easy to access.”
Qualified Medical Personnel
On the issue of qualified medical personnel, spokesperson of National Association of Resident Doctors, (NARD) Ugoeze Asinobi was quick to react. “We don’t have enough hands. That is why the resident doctors are always going on strike. We need to be trained and retrained. Doctors are leaving the country in droves because they believed that things are not working here. It is like a doctor to 500 patients in Nigeria. Primary health centers need rehabilitating, equipping and staffing with requisite manpower.”
Investigation revealed that hundreds of doctors in public hospitals have stopped going to work due to a combination of unpaid salary, poor treatment, and fraud in the system and discriminating remuneration among health workers, nurses and doctors. Rather, they concentrate on their private practices at the detriment of patients who flock to government hospitals daily.
According to the President of the Nigerian Medical Association, Prof. Mike Ogirima, a sizeable number of staff of government hospitals are being owed two months salaries or more. He disclosed that some consultants, corps member, house officers, and cleaners who had not been migrated to the Integrated Payroll and Personal Information System were owed two months salaries while arrears of their colleagues, who were recently migrated, have not been paid. “I am aware that the ministry said ‘salaries envelopes’ had been exhausted, which means that there is no fund to pay workers,”
A consultant at the Healthgate Specialist Clinic in Lagos, Dr. Ebere Anomneze, is of the opinion that the Nigeria Government is not fair to its medical staffs. “It is a bit harsh and difficult to understand. The Federal Government prepares the budget every year, which includes payment of salary. It has to be all civil servants; it cannot be health workers alone. I heard earlier in the year that the allocation could not pay salaries of workers in the health sector but I had thought the ministry would be proactive about tackling such challenge.”
Former Medical Director of Ughelli Central Hospital and Orthopaedic Surgeon, Dr. Godwin Obanovwe, further urged the Federal Government to draw up a well-planned salary package for medical workers in Nigeria. “The level of job demand carried out by each professional in the field should form the basis for designing the salary scheme. Doctors should receive the highest pay because their job is more sensitive and demanding.”
Bottom line
Quoting figures from the Centers for Disease Control and Prevention (CDC), Dr Adewusi noted that the United States of America (U.S.A), a developed country with far lower maternal fatality rate, spends $9 billion dollars (N4.5 trillion Naira) annually to fight the plight. “If the U.S government can spend $9 billion dollars to attend to teen pregnancy every year, we should ask Nigerian government how much it is spending on this scourge taking away our girls every day,” he queried, with emphasis on ‘girls’. He is a father to two adorable girls himself.