Bose Akinlolu, 36, got pregnant after she had waited for 12 years to have her second pregnancy. After she was confirmed pregnant, she registered with a Traditional Birth Attendant (TBA) centre close to her house in the Orile-Imo area of Ogun state.
Mrs Akinlolu claimed to have registered at the TBA due to financial constraints. She couldn’t go to the hospital, instead she registered where she was given local concoctions that will keep her and the unborn child safe.
During pregnancy, she never attended ante-natal nor did she receive the important vaccines during her pregnancy. It occurred to her that she registered with an unskilled Traditional Birth Attendant after she lost her child during delivery.
According to her, the birth attendant eased her visits by requesting she bring N500, which was used to provide “radio medicine” to ensure a safe delivery.
Mrs Akinlolu only visited the hospital to get her scan done to know her baby’s gender, and she never went back to the hospital. If she had any concerns during pregnancy, she visited the attendant from her first through third trimester.
Aside from Mrs. Akinlolu, Jamila Abdulrahman, a resident of the Odogbolu area, narrated her twin pregnancy experience which resulted in the loss of one of her twins, while the other couldn’t walk.
Jamila, couldn’t register for ante-natal during her twin pregnancy because she was unemployed.
According to her, it was her sister that gave her the reason to register at the hospital despite carrying a twin pregnancy. While she was pregnant.
‘‘I lived in Benue state in the early stage of my pregnancy. I relocated with my elder sister who came to pick me up from Benue. During my early stage, I couldn’t register in the hospital because I had no job. It was after I relocated that my sister made it compulsory for me to go to the clinic.
‘‘Until I did the scan, I didn’t know I was carrying a twin pregnancy. Few days later, I fell into labor. In the process, I lost one of my babies. After delivery, I refused to go back to the hospital because of the experience I had. Until this moment, the second boy has refused to walk; he crawls instead”.
Maternal and Infant Mortality Rate
Maternal mortality refers to the death of a woman while pregnant. Women die as a result of complications during and following pregnancy and childbirth. According to W.H.O, complications develop during pregnancy and most are preventable or treatable.
Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care.
Data trends between 2016 to 2020 shows about 82,000 women of child bearing age lost their lives in 2020 due to pregnancy and postnatal complications in Nigeria.
Nigeria leads the world in rates of maternal mortality in terms of maternal deaths per 100,000 births, Nigeria ranks third only to Chad – its neighbour to the north – and South Sudan.
Infant mortality is also high. According to the Multiple Indicator Survey (MICS) 2021, Ogun state has the highest Infant mortality ratio cases among the southwest states with 68 per 1,000 births.
The World Health Organization (WHO) defines the Infant mortality rate as the probability of a child born in a specific year or period dying before reaching the age of one. It is the number of infant deaths for every 1,000 live births.
Ibidero Initiative: Saving Mother and Child
The Ibidero Initiative was launched to save the lives of expectant mothers and reduce infant mortality rate in the state by empowering healthcare providers. It also ensures comprehensive antenatal and postnatal care..
It serves as an intervention scheme which offers free healthcare delivery services for expectant mothers between the first trimester to third trimesters and offers postnatal care to ensure the safety of mother and child.
It was drawn up to assist the less privileged pregnant women in Ogun state before and after birth. The scheme is an all-inclusive one for all expectant mothers residing in Ogun state.
The initiative’s coordinator and Executive Secretary of the Ogun State Health Insurance Agency (OGSHIA), Dr Afolabi Dosumu, told Dataphyte that Ibidero has provided free maternal health services to 15,000 pregnant women, reducing maternal mortality rates.
He also mentioned the offers the initiative has for expectant and nursing mothers residing in the state. Aside from the free treatment, beneficiaries will be given the sum of N5,000 as a post-natal token.
Mrs Obaike Ruth, an indigene of Benue state, registered for the Ibidero Initiative when she noticed the offer was on due to an awareness drive in different areas. She registered to benefit from the program.
‘‘The initiative has been a helpful one for me. When I came to the primary health care hospital, I was asked to register under the Ibidero, and I thought they would ask me to pay. To my surprise, everything has been going on smoothly. I enjoy free services such as drugs and other upkeep to protect and prepare me ahead of the delivery date.’’
Ogunsanya Kikelomo, a resident of Iworo, also registered under Ibidero at the Iworo Health Center in the Ijebu North East Local Government.
She narrated her experience on how the free healthcare delivery helped her during her pregnancy and how convenient it was to lodge complaints during her pregnancy period.
“The scheme really helped me because I never thought I could have a normal delivery because of my past experience with my first child. During my pregnancy, I enjoyed free drugs and other benefits”
Adenike Victoria Modupe resides in Lagos state, but relocated with her husband to Tajala community area in Ijebu East Local Government in Ogun state. She is one of the beneficiaries of the free health program.
She said there was no discrimination when she registered. “Everyone was treated equally, and I received quality care both before and after delivery,” she shared. “They even promised to provide us with financial support as well.”.
Mrs Cecilia David, a resident of Makun, Sagamu under Sagamu Local Government explained that, despite the distance between her house and the clinic, she finds joy in attending the clinics because of the benefits of the program.
‘The program is a helpful one because it’s free. I come from my house with joy because there are lots of benefits that I’m enjoying each time I come around.’’
Oyo’s Tọmọtìyá initiative
Prior to Ogun state’s Ibidero, the Oyo state government set up an intervention known as ‘Tọmọtìyá’ in 2020 to reduce infant mortality.
‘‘Tọmọtìyá’’ means ‘‘of and for mother and child.’’ It was initiated to bridge the gaps in maternal and child healthcare delivery in the state and to continue existing reproductive maternal, neonatal, child health programmes.
It is one way through which the government hopes to meet the Sustainable Development Goals (SDG) number three, which targets improving maternal health and ensures that quality of maternal and child health services are offered at a minimal cost.
According to the state government, the necessity for the initiative became apparent when measures were being considered to reduce maternal and Infant mortality in the state.
The former Deputy governor of Oyo state, Engineer Olaniyan said, “Before the administration was inaugurated last year, we had studied statistics on the various sectors in Oyo State which formed a basis for what our focal points would be. One of the sectors that we realised we had to focus on was the health care sector.
‘‘We knew there were huge infrastructural deficits in the sector. But something else that caught our attention was the quality and cost of healthcare and their multiplier effects on the vulnerable.’’ he added.
A Collective Responsibility Towards Health Care Delivery
A visit to some health facilities across the three (3) senatorial districts in Ogun state shows that the Initiative has spread across three healthcare provider categories in the state. The primary, secondary and private healthcare providers are involved in the discharge of free healthcare services to pregnant women in the state.
Doctor Tolulope Ige explained the importance of collaboration among healthcare providers towards reducing maternal and infant mortality rates in the state.
According to her, “The best way to reduce these cases in the state is through collaboration, and in the end, we would have a better result.
“When pregnant patients come around, we put in the best to ensure safe delivery with prompt attention.’’
Dataphyte, also visited Adehun PHC in Abeokuta North, where the Chief Nursing Officer (CNO) narrated how the program has brought expectant mothers and healthcare workers together.
Also, Mrs Fagbemi, the Chief Nursing Officer at the Obada health center, narrated how members of staff and patients have been relating well as the initiative creates a special bond between staff and expectant mothers.
‘‘Since the program started, our patients have been coming around and we, the health care provider, are happy that the initiative will bring together pregnant women from different areas in the state. It will help to reduce maternal and infant death in the state.’’
Challenges
One of the challenges of Ibidero so far is privileged people benefiting ahead of the poorer people who are the priority of the initiative at this stage. Dr. Dosunmu said: “our main targets are the less privileged. Once we reach out to their spokesperson, they get registered but we have some privileged people trying to manipulate the exercise.
‘‘We try to meet up with targets, and if these less privileged people can’t enrol for the exercise, the number of infant mortality will likely increase. We have begged the people to understand where we are coming from but we assure everyone that it will go round.’’
‘‘We have to ensure that all women in Nigeria have access to quality maternal care, irrespective of where you come from, whether they’re from rural areas or not, whether they’re educated or not so that we don’t leave any woman behind,” he stressed.
However, this initiative will help to reduce the number of infant and maternal mortality rates in the country.
Experts React
Dr. Ebun Soyinka, an Obstetrician, advised that to reduce maternal mortality rate in the country, both patients and health workers need to work together.
According to her, some of the causes of maternal mortality can be traced to lack of informed decisions, delay in reaching health care facilities due to lack of adequate transportation, inadequate manpower at the health facilities, and no effective referral of patients to a higher health facility where adequate care can be received.
‘‘The maternal mortality rate is an issue and some of the causes can be traced to Phase 1 delay when patients decide on where to receive care during pregnancy either at the health care center, birth attendant center or to stay at home. This majorly happens when pregnant women depend on their spouse’s before taking decision for themselves, especially those who strongly believe in their culture.’’
‘‘Also, the issue of lack of basic health equipment, lack of trained health workers in the health facilities, lack of resources and other things that can hinder proper management of patients”.
Dr Soyinka proffered solutions to how maternal mortality can be reduced. She recommended Girl-child education and empowerment; recruitment and training of health care professionals and upgrading health facilities to standard.
‘‘The way to curb these issues is to first educate the girl child. When the girl child is educated, she will be able to make informed decisions on her own. Also, it is important to restore the decision making power of women.
‘‘The government should recruit and train health workers in order to upgrade their skills towards ensuring quality health care delivery in the country. Also, all government hospitals should be upgraded in a way that will enable them provide basic and essential obstetric care services.’’
Similarly, a Pediatrician, Dr Hameedat Titilope Oyedeji, explained the causes of infant mortality rate in the country and how to curb it.
She said, ‘‘We have to educate the public on how to take measures, especially on proper hygiene and the importance of visiting health care facilities.
‘‘Also, improving the accessibility, availability, affordability and quality care especially at the primary healthcare level will most likely reduce the high rate of neonatal, infant and child mortality.’’
CONCLUSION
While maternal and child mortality have declined in Nigeria over the past many decades, those rates have not fallen as fast as they have in much of the world. Hence, it is crucial that initiatives like Ibidero that aim to improve health outcomes for mothers and children are not just sustained, but broadened to every area of the country. Investments in primary healthcare are central to ensuring a healthy populace who can then contribute to the advancement of not just themselves, but society at large.
This story was produced in partnership with Nigeria Health Watch through the Solutions Journalism Network.