In Nigeria, women who are in their child bearing ages stand higher risk of developing fibroids. Fibroids are non-cancerous tumours that grow in, on, or within the walls of the womb. Fibroid is made up of muscle fibre. The cause of fibroid is yet unknown, but experts say when fibroid occurs, it may contribute to women experiencing painful sex, abdominal swelling, frequent urination and heavy menstruation. Some medical experts say that fibroids are common among black women. It has no symptoms and may grow one at a time or in clusters. Fibroids usually develop in women aged between 30 and 50 years and seem more regular in women who weigh over 70 kg.
Fibroids are widespread in Nigeria. According to medical experts, at least 1 in 4 women develops one or more fibroids in her lifetime. Fibroid contributes to the increase of unnecessary deaths and increased life expectancy in Nigeria. A good number of Nigerian women, including well-known artists, have lost their lives through complications of fibroid.
In Nigeria, provision of health care is never treated as a human rights issue. Individuals pay for any form of medication they may receive from medical outfits, even when health care provision is a concurrent responsibility of the three tiers of government in the country. In ‘Financing Health Care in Sub-Saharan Africa,’ Ronald J. Vogel states that the total expenditure on health care as percentage of GDP is 4.6, while the percentage of federal government expenditure on health care is about 1.5%. The mission of the Federal Ministry of Health is to develop and implement policies and programs as well as undertake other actions to deliver health services. According to the World Health Statistics of 2011, Nigeria’s overall life expectancy at birth is 54 years; infant mortality rate is 86 per 1000 live births, while maternal mortality ratio is 840 per 100,000 live births.
Currently, there is no program designed to tackle public health issues holistically. There is also lack of coordinated efforts among the various government ministries and organizations that are assigned various responsibilities to design programs to address health-related issues. Aside from the lack of coordination, the programs designed by federal government to address the numerous health problems in Nigeria are inadequate, and have led to the little improvement in the health status of Nigerians. As a result, there is no health policy addressing and countering the threats of fibroids on women’s health.
The continued negligence by the government to address public health issues in Nigeria make matters worse for poor Nigerians – most of who are women who are always at the receiving end. The first WHO Global Status Report on non-communicable disease listed Nigeria and other developing countries as the worst hit, with deaths from non-communicable diseases. However, my years of experience working with and living in the hostel of Young Women’s Christian Association exposed me to the threats of fibroids on the lives of women:
Ms Roseline was about 37 years old. She usually looked anaemic, sickly and found it hard going out when she was menstruating. My attention was called on a day she fainted in the bathroom. On getting into her room, she said to me, “please assist me, I need to survive. I have been living with this fibroid for some years. Each month I am in my period, my blood gushes as if a tap is opened. My level of bleeding is unbearable. A doctor once recommended surgery to me but I could not afford the cost.” I assured Roseline, even without knowing what to do to assist her.
The next day I took Roseline to Dr. Ifeanyi, a private medical doctor. On examination, Dr. Ifeanyi confirmed that Roseline had low iron level and was anaemic, and said the fibroid had developed inside her uterus and the best option for her was an operation. The operation was carried out on her the following week and it was very successful. Dr. Ifeanyi saved the life of Roseline at no cost. He did the surgery free of charge, but Roseline is unlikely to have a baby after the operation. Dr. Ifeanyi said that treatment with medication or surgery for fibroids patients is options, but could be complicated too.
Nnenna-- a 40-year old woman was diagnosed of fibroid in 2010. In the words of Nnenna, “I started noticing heavier menstrual flow some five months back. Gradually, I found out that I easily get very tired. I had no symptoms of any sort; I only notice that I feel full without taking much food. I am bothered, sick and emaciated. My sister who was assisting me financially was also diagnosed of fibroid during her pregnancy. She had the baby through caesarean. The baby died, even though the fibroid was removed. My sister became depressed having spent so much money and still lost her only baby. She can no longer support me financially. I am scared of going for medical surgery. Somebody I knew died at the course of fibroid operation, I am afraid I may also die. I am rather taking herbal treatment.” Nnenna lives in a rural area of Imo state.
Sister Cathy, a 34 year old woman was diagnosed of fibroid in 2002. She was still a virgin. She went to a Catholic rural hospital where she was operated. The operation was said to be faulty, and she went for another one. Months after removing the fibroid, she realized her uterus was gradually pushing out from her vagina. She said she is more confused by her complicated case because her friends linked the development of the fibroids to her virginity. She was advised that the moment she starts having sex, she will be free. Where that fails, she will have to go for a hysterectomy (removal of uterus), meaning that she will not have a baby in her life.
So many women do not have access to medical facilities and most of them do not have money to pay for treatment. In Nigeria, the current national health policy have concise statements on policies of health programs such as HIV/AIDS, Malaria, Immunization, Population, Tuberculosis and Leprosy, Blood Transfusion, Elimination of Female Genital Mutilation, Adolescent health, Child Health, Drug & Food hygiene and safety but none on fibroid, which constitutes a rising burden on the health of women.
Women who live in the rural areas are more likely to die of complications, which arise from the severe symptoms of fibroid. Majority women who are in the rural areas use traditional medicines. Despite the fact that patients pay for medications, the cost of medicines is never subsidized. The high cost is consequently unaffordable to most people especially women living in the rural areas. Traditional medicines-- known as indigenous medicines in some countries, are widely accepted in Nigeria. Traditional medicines receive more patronage of the people. Efforts are being made to properly integrate traditional medicine into the Nigerian health system.
In Nigeria one of the problems affecting the health sector is the lopsided distribution of health professionals in favour of urban centres. There is no equitable distribution of human resources between urban and rural areas. Researchers say, that over 70 percent of doctors are in urban areas where only 48 percent of the population live, leaving 52 percent of the population who live in the rural area at the mercy of private health personnel. Because Nigeria operates a mixed economy, private health care providers whose major aim is maximizing of profit, play a more visible role in health care delivery. The government, whose primary responsibility is supposed to be provision of health services to citizens as a matter of rights, limits its role to coordinating the affairs of the university teaching hospitals, Federal Medical Centres located in the cities. The state governments manage the various general hospitals also located in the cities. The local governments focus on dispensaries only.
Again because of the ‘brain-drain’ in Nigeria some categories of health manpower are in short supply. Depending on the geographic location and professional category, there seems to be an uncomfortable mix of under-utilization and over-utilization of the skills of health professionals in Nigeria. In the rural areas where the people are more conversant and focused to the use of traditional medicine, the little National Health Care facilities at the local government level, though not free, is under-utilized. Rural women are mainly ignorant of their existence or may have lost confident in the services.
While reflecting on the issues bothering around health of women with focus on fibroid, in connection with government lackadaisical attitude towards handling health care delivery -- an essential and fundamental issue, women’s involvement is critical for enhancing improvement of service delivery. Women’s involvement could be enhanced through knowledge sharing and information dissemination. Hence this will foster respect for procreative rights of women and sustenance of it.
The UN Universal Declaration of Human Rights, in Article 25 states that everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, which of course include the health and well-being of women as well.
The Nigerian women are expectant. They are expecting setting up of policies that will guarantee free and accessible medical attention as well as sensitization and awareness of available health facilities in the rural communities. It is women’s inalienable rights not to suffer and die of health complications or out of lack of policy, political will and weak health systems, poverty, ignorance, illiteracy and carelessness. The government has indivisible roles to protect the lives of both men and women and save the nation from extinction. The government has a duty to protect the lives of both men and women, and save the nation from extinction.
Take action! This post was submitted in response to eMagazine: Maternal Health .