Never Again...

I watched helplessly as 23-year-old Amina groaned in agony and breathed her last. Her first attempt at the fast becoming risky venture of childbirth had cost her life. She had been ‘courageous’ enough to commit her life and delivery process into the hands of an unskilled Traditional Birth Attendant (TBA) who fed her herbs and made her family chant ‘prayers’ as a remedy for obstructed labour. ‘Courageous’ enough to attempt to give birth in a community where access to skilled healthcare personnel was absent, ‘Courageous’ enough to attempt delivery where there was no real care before, during and after pregnancy, where there was a dearth of information and exposure. Amina had little choices opened to her and made the best choice given available circumstances, information and resources.

A look at Amina’s still face sent my thought on a spiral journey. Here lies another needless and avoidable death. Here lies another woman who will never have the joy of watching her baby grow. Here lies another woman who is silenced forever.

The perception of the community towards accessing and obtaining skilled care in pregnancy became clear in my interaction with them. Amina’s death was, sadly, not an unfamiliar occurrence. A woman has to make the choice between having an unskilled hand in delivery and walking miles to healthcare facilities with no guarantee that skilled personnel will be available. Where she is fortunate enough to meet skilled personnel at their duty post, she may have to fetch her water in advance for medical treatment, face nurses hostility and in some other cases, buy kerosene for the health facility’s lanterns or provide torchlight if she is ‘unfortunate’ enough to give birth at night. Where complications after birth arise, in many cases, she is as good as dead. Ambulances for immediate evacuation to bigger facilities are not available and where they are, the petrol to power them is not.

Amina’s story is the story of thousands of women who die yearly at childbirth in Nigeria and the potential story of the over 54 Million women of Nigeria’s 80.2 Million women who live and work in rural areas where health care facilities and skilled health personnel’s presence are a luxury. More than 70% of deliveries in these rural areas are taken by Traditional Birth Attendants with absolutely no skills that fill in the vacuum of skilled health personnel and poor health facilities. For many women, the role of the ‘gods’ and ‘destiny’ in childbirth cannot be ignored, while many others think of it as a rolling lottery number which could fall on anyone.

Curbing the menace of Traditional Birth Attendants and putting them to good use in the face of poor facilities, shortage of healthcare workers, rising poverty lines and absence of education and awareness has become increasingly difficult but not impossible. In many communities, locally created interventions such as the TBAs in response to the absence of health facilities have turned into tradition. However, within our challenges also lie our solutions. While the government may not be all responsive to our needs, we must endeavour to ‘work out our own salvation’.

Over the years, there has been rising argument in favour of eradicating the TBAs. The big question is, ‘Are their enough skilled hands to meet our health needs? With doctor, patients ration in Nigeria being as high as 1:35,000, I say a big NO!

Discarding TBAs in the face of shortage of healthcare personnel across many states in Nigeria where mortality rates are high does not seem a wise option. Traditional Birth Attendants can be trained and converted into Community Extension Workers to deal with shortage of healthcare personnel, transformed into complication referral agents to encourage the people to open up to skilled health officials on routine visits to communities where infrastructures are lacking as well as provided with clean delivery kits to take simple deliveries.

To be successful at the above, committed skilled healthcare workers from the few available should be linked up with the TBAs in the villages and incentives should be provided to encourage the skilled attendants play their advisory and monitoring role effectively. Limit should also be drawn on the activities of TBAs by providing borderlines for referral as well as providing a comprehensive database of TBAs in communities to encourage easy monitoring, and responsibility building. Community engagement, town hall meetings and other forms of advocacy in order to ensure that maternal and child health is taken seriously in communities across Nigeria.

As I close my writing, Amina’s young still face flashes before me and I undertake silently that as long as it depends on me, my work and actions, I say ‘Never Again’ to avoidable maternal deaths. I hope you will make that decision too.

Remember, change starts with YOU.