How FG’s ban on midwives’ employment spiked maternal, infant mortality
•As traditional birth attendants enjoy patronage
For long, traditional birth attendants have established their presence in rural areas, catering to the needs of pregnant women and other health-related issues. However in recent times, their services have extended to urban communities with an alarmingly increasing patronage. KEHINDE OYETIMI, SOJI EZE-FAGBEMI, YEJIDE GBENGA-OGUNDARE, HAKEEM GBADAMOSI, YOMI AYELESO and HAKEEM GBADAMOSI report that with the ban on employment of midwives and nurses by the Federal Government, the consequences have been disturbing with the advent of many unskilled birth attendants.
Mope (surname withheld) had had to struggle with an unstable health while she was pregnant. She looked pale and always appeared as though in need of some sort of medication to pull through the pregnancy. But her mother repeatedly assured her that it was only a short while and her baby would be out. However, Mope had trusted that her mother’s judgment on the appropriateness of patronizing a traditional birth attendant would be in her own good. She therefore went along with her mother to the home of the birth attendant. While the pregnancy was in its last trimester, Mope had complained repeatedly of pains in her stomach. Her mother and the birth attendant only administered some herbal concoctions for her to drink.
“My mother always told me that she gave birth to my siblings and I under the supervision of some traditional birth attendants who lived in our community. She always prided herself in the efficacy of their methods and the potency of their herbs. I was unsure but I decided to trust her. Yet I had my misgivings,” she told Nigerian Tribune.
“She would always tell us that the reason we grew up strong and healthy was the herbal mixtures she drank while she carried us in her womb,” she continued.
However, Mope said that she was supposed to have known better, given her level of exposure. “When I got pregnant, I decided to stay with my mum. It was my first pregnancy and so, I was scared,” she said. Her mother encouraged her and therefore she visited the birth attendant while the pregnancy lasted.
“Unfortunately for me, I lost the baby. I had taken the herbal mixtures religiously but on the day of delivery, the pain became excruciating. I was at the home of the birth attendant. I bled and passed out. When I woke up, all I remembered was that I was in a dark place and now I was in another place. It was at one of the hospitals. I enquired about my baby but I was told that I was brought in late and that the baby had died. The doctor said they had to quickly take out the baby. It was a very sad day for me,” she said.
A woman (names withheld), who got married at the age of 38, got pregnant immediately after the wedding. During pregnancy, she enrolled in a mission house belonging to a religious organisation for delivery. Up until the time of delivery, there was no scan, no medical test or whatsoever for both the mother and the unborn child.
Unfortunately, she didn’t have the idea of childbirth and after dilating for more than four days, the baby had eventually died in the womb, unknown to the birth attendants and the mother, while the woman was asked to continue to “push” for the “baby” to come out.
The woman later became unconscious and taken to a hospital for medical attention. The test conducted on her showed that the dead fetus had decomposed and had perforated the linings of the uterus, a development that made it very unlikely for the woman to conceive again.
Till date, in the aftermath of the incident, the woman has not been able to conceive, almost 20 years after.
Upsurge in traditional birth attendants
The growing patronage of traditional birth attendants has moved from rural settlements to urban centres. In Nigeria, maternal and infant mortality rate has been a source of worry with various levels of government paying largely lip service. Various reasons have been adduced to the patronage of this. Poverty, belief, and inaccessibility to primary healthcare facilities are a few of the reasons for this.
By 8 a.m. every Wednesday morning, the compound of 55-year-old Mojisola (surname withheld), is already a beehive of activities as pregnant women with different sizes of protruding tummy are already seated in clusters in front of the bungalow where Mojisola lives in Alakia area of Ibadan. Though it is not unusual to see trickles of pregnant women enter this compound daily, on Wednesday, the convergence is massive.
The reason for this is not farfetched, Mojisola is a local birth attendant and Wednesday is the day she has set aside for antenatal engagement for her patients. And on such days, she checks them, listens to their complaints, give advice and lead them in prayers. Also, she creates a home away from home setting for them and often, many sleep on her sofa or the veranda of her house till evening before going home.
For her, local birth attendants are a key part of the health sector. She told Nigerian Tribune that many women would have died if not for the quick intervention of local birth attendants in their neigbourhood.
“I know many people think we are a menace but the truth is we deliver a huge number of babies, much more than the government hospitals around and we make life easier for pregnant women. Many of these women will not register with any hospital or birth attendant and when they fall into labour, they will rush them to us, most times, in the dead of the night; but unlike in hospitals, we don’t demand for exorbitant amounts of money before attending to them, what is paramount is the safety of both mother and child.
“But these kinds of cases are the ones that cause trouble for us; it is a risky venture because you do not know the condition of the woman. We also have issues of people that do not have adequate knowledge aside the use of herbs; that is where we have issues, many of us are not registered with the general body because of the basic difference of belief; some of us work for churches and do not like mixing with traditionalists,” she stated.
“Our challenge is more on lack of adequate support from government which causes harassment, arrest and extortion by security agencies who label us as illegal operators. What happens when Primary Health Care Centres are not functional, we come to the rescue; we are life savers and should be seen as such. What government needs to do is regulate our activities, not make us look like criminals. It is true some take unnecessary risk and fail to follow medical advice but many have gone through training and will not take unnecessary risks
“We are an integral part of the country’s health care system; many of us have gone through diverse training to keep abreast of the trade, most have been trained to detect early signs of danger in pregnancy and to provide basic family planning services,” she said.
Bisola Abegunde, a retired nursing sister, who had been running a birth attendant business in her home in Ido Local Government Area of Oyo state for over 10 years, explained to the Nigerian Tribune that local birth attendants are an important part of the health sector, adding that, “we cannot be ignored or sidelined; what government needs to do is integrate us and supervise our activities. It is not by registering us and having a figure that is not even accurate, they should integrate us, give us training and supervise activities,” she said.
‘Herbs, roots are more reliable for labour, pregnancy care’
An aged male traditional birth attendant in Orile Sari-Iganmu, in Ajeromi-Ifelodun LCDA, in Lagos State, Pa Oloore Alaanu has been in the business of assisting childbirth for over 40 years using herbs, roots, chants and invocations.
In all his years of aiding pregnancies and births, Oloore, as he is known within his community, said he has handled many stillbirth conditions that would require surgical operations.
Commenting on the efficacy and reliability of traditional herbs and roots to pregnancy care, labour and child care over orthodox method, he said, “because of civilisation and science, we cannot forget our root because before the advent of orthodoxy, our forefathers have been attending to their medical needs.
“So, this is what I grew up to know and learn. At times, some labour conditions do not require surgical operations. All you need do is to invoke chants and apply roots and both the mother and child will be hale and hearty. But in this present time, we don’t appreciate ourselves anymore.
“We give preference to anything western over Africans. But as someone that has seen it all, in my over four decades of practicing as a birth attendant, I have never recorded pregnancy or labour related death. They would rather not bring the case to my office.”
Some people informed Nigerian Tribune that they would rather patronise traditional birth attendants than regular hospitals given the fact that it is cheaper to do so.
“Midwives, nurses in hospitals attend to us shabbily”
For 50-year-old Mrs Bola Olaoluwa, patronising traditional birth attendants was the best way to have safe deliveries of her children. The mother of three noted that she preferred them to orthodox health practitioners because nurses and midwives at the health centres were unwelcoming when attending to their pregnant patients.
“Even during ante-natal, these midwives and nurses treat us shabbily and without any respect. The last time I had a baby in the government hospital, I paid about N7, 500 for delivery compared to the N2, 000 I paid to a traditional birth attendant when I had my next baby. My friend introduced me to the traditional birth attendant. I had my first and third baby there,” she told Nigerian Tribune.
Mrs Caroline Uche, a 38-year-old mother of two said she was interested in patronizing a traditional birth attendant because she was not under the burden of paying until she could afford to do so.
According to her, “The traditional birth attendant was very nice and friendly. She treated me like her daughter and told me to pay at a later day when I would have the money.
“But when you visit the hospital to put to bed, you will not be released until full payment is made. It is usually too expensive and most of us are unable to afford that.”
More calls to regulate activities of TBAs
Given the rising cases of maternal and infant mortality, there have been spirited efforts to accommodate and train traditional birth attendants in the wake of their large following and patronage.
The Federal Government, through the Department of Traditional Complementary Medicine, Federal Ministry of Health, has revealed that the bill (legislation) to recognise traditional medicine practitioners, including the traditional birth attendants will be in place very soon, just as it confirmed the very invaluable role being played by them in the area of healthcare system.
The Director and Head of Department, Traditional Complementary Medicine, Federal Ministry of Health, Zainab Shariff, who spoke with Nigerian Tribune, said the only major challenge was regulation. She assured that when the bill comes out and becomes law, it would help to checkmate the practice and eliminate fake among the practitioners.
“I am sure you must recognise what has been established by the WHO that 80 per cent of the people that live in rural areas patronise traditional medicine, and that is why we tend to have high patronage at the rural area. But now with the coming of modern acceptability and with the approval by WHO to recognise three healthcare systems: traditional medicine, conventional medicine and complementary, alternative medicine.
“Look at the ratio of doctor to patient, it is very small. So, there is a shortage of manpower, there is the need to fill in the gap by qualified practitioners and we have recognized in terms of traditional medicine that this group of people has long been known to deliver services, but there is a need to regulate them so that we ensure they follow due process.”
FG’s ban on employment of midwives, nurses responsible for patronage of TBAs—NANNM
The National Association of Nigerian Nurses and Midwives (NANNM) has taken a swipe at the Federal Government’s ban on the employment of nurses and midwives, saying this has been responsible for the upsurge in the patronage of unskilled traditional birth attendants. This, the association noted, is responsible for the saddening increase in maternal and infant mortality.
In an interactive session with the Nigerian Tribune, the first national vice president of the association, Margaret Akinsola, argued that “Not until government recognises the importance of midwives, it is then we can stem maternal and child mortality. Midwives are not given the proper recognition; they are not enough. They talk of gaps every time. Unfortunately, midwives are being trained in the country but they are not being employed by the government which keeps talking about lack of midwives in their health institutions.
“How can the government of a country place embargo on the employment of nurses and midwives and by extension health workers in general? When you place embargo on the employment of such class of people, then the health of your citizens is not important to you.
“If you want to take the healthcare to the grassroots, it is not traditional birth attendants that can help us. It is the motivation given to the midwives that will help them. If I am to work in a primary healthcare facility domiciled in a rural area, my transportation must be properly taken care of by my employer. If I have to go through a hell of stress before getting to work, what do you think will be my level of productivity? What about remuneration? In many rural areas, even urban areas, electricity is a problem. There is no health institution in the country that can work perfectly without electricity and water. Except we do something drastic, we will keep on moving from maternal death to infant death and morbidity.”
A nurse in one of the government hospitals who spoke with Nigerian Tribune on condition of anonymity stated that many pregnant women use the hospitals for antenatal care and but would not come to the hospital for delivery.
“Many of the women attend antenatal here but when it is time for delivery, we don’t see them. We will only hear that they have been delivered or see them with babies. Sometimes when they have complications from the TBAs, they rush them to the clinic for proper treatment. This makes our work very difficult at times because we don’t know what the TBAs had touched or cut,” she said.