- Nigerians complain of exorbitant bills at hospitals, beg governments to train TBAs
Amid worsening economic hardship which was partly necessitated by poor policies of governments, maternal and child deaths have continued to be on the increase in Nigeria, investigation by The Point has revealed.
It was revealed that many pregnant women now prefer to give birth at traditional homes, churches and their houses with the aid of quacks and unskilled healthcare providers where they would pay cheap bills.
Most of the nursing mothers who were lucky to have been delivered of their babies safely by these told The Point in their separate interviews that they opted for Traditional Birth Attendants (TBAs) and other community-based unskilled healthcare providers because orthodox hospitals charge expensive bills after delivery.
TBAs are prominent among those who attend to patients basically during pregnancy and childbirth mostly in hinterlands.
Despite their limitations in handling labour complications, these TBAs who are mostly untrained women, seem to be widely accepted and patronised in most rural communities across Nigeria.
According to the United Nations Children Fund, the new global maternal mortality report showed that 82,000 women in Nigeria die from pregnancy and childbirth related complications every year.
While the country’s maternal mortality rate, according to the Society of Gynecology and Obstetrics of Nigeria is 512 deaths per 100,000 live births, which is nowhere near the Sustainable Development Goals target of 70 per 100,000 live births by 2030, there is also a high density of unaccounted death of mothers during childbirth.
Some of these deaths occur in the homes of traditional birth attendants.
In Ebonyi State, postpartum hemorrhage, which is one of the complications from TBAs, contributed 36 per cent of recorded maternal deaths in 2022.
According to data from the Obstetrics and Gynecology Emergency, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, the statistics of unbooked patients referred to the hospital from TBAs when they were unable to handle complications, from 2021 to middle of July 2023 is alarming.
The report revealed that in 2021, 37 patients were referred to AE-FUTHA; in 2022, 61 patients were brought into the hospital owing to complications from TBAs. From January to June, 2023, there were 30 patients.
In summary, the statistics showed that 128 unbooked patients were referred from TBAs to AE-FUTHA within the space of two years and six months.
While some of these patients survived, others lost their lives and their babies on getting to the hospital, Dorathy Egbo, Chief Nursing Officer, O & G Emergency Alex Ekwueme Federal University Teaching Hospital, Abakaliki said.
Asking some married women the reason they still patronise the traditional birth attendants despite the huge risks involved and considering the alarming mortality rate, they explained how they had been confined by some hospitals and held for weeks after they could not pay up their medical bills.
Mrs. Chukwudolue Akam, a housewife and nursing mother, who delivered a set of twins on June 21, 2023, at the home of a TBA, narrated her ordeal of bleeding before and after the delivery of her twins which left her unconscious, following TBAs’ lack of necessary skills in handling complications.
She said, “I gave birth to my twins at the home of a Traditional Birth Attendant around PDP Secretariat axis of Abakaliki because I don’t have money to go to the hospital. Out of my six children, I delivered only one of them in the hospital and they charged me so much money, so, I stopped going to the hospital for childbirth.
“Before I went into labour, I started bleeding from my house and after considering how much it would cost me to go to the hospital; I decided to go to the house of a traditional birth attendant because I didn’t have money. The Traditional Birth Attendant charged me N10, 000, two chickens and two tubers of yam which I could not afford as well but it is cheaper than the hospital bill.”
A pregnant woman, Ola Okafor also recounted her experience during her first pregnancy and childbirth at a traditional birth attendant’s house and noted that she was not comfortable with the compound where the TBA conducted delivery, but patronised them based on recommendation.
“It is not about being cheap, I went there based on the recommendation of their efficient care and services. They put in their whole time and little knowledge to care for patients unlike orthodox medical practitioners who keep waiting for deposit till death of the patient,” Mrs. Okafor revealed.
Sharing her experience, Esther Utobo, a mother of five children and petty trader said Traditional Birth Attendants are living close to them in the villages and that they are also always available to render their services.
She also expressed worry that at the teaching hospitals, humans are allegedly used for “practical purposes” for student medical practitioners.
According to her, “I do not go to hospital to deliver my babies because they always use people as teaching specimens. Instead of attending to patients quickly, they use people to teach and most times leave patients in the hands of student doctors.”
Utobo, therefore, called on governments at all levels to provide opportunity for training of the Traditional Birth Attendants on modern trends in Obstetrics and Gynecology and make a law that would support them to practice alongside the medical practitioners without intimidation.
Ifeoma Nwobashi is a native of Agbaja community and a mother of six. She gave birth to all her children at the house of a Traditional Birth Attendant. She argued that TBAs are closer to rural people and as such, should be supported by the government through adequate training.
“I have never given birth in a hospital before but in this village, there is a traditional birth attendant that lives close by. Anytime I went into labour especially at midnight, the woman would be called. Immediately, she comes and it will not be long, I will deliver my child. Even when one of my children died in the womb, that traditional birth attendant delivered me of that dead child safely.
“I am pleading with the government to help these traditional birth attendants. It is always good to have the orthodox and traditional medical practice because many people in this village are not mobile and cannot afford a motorcycle if their wives go into labour especially at night.
“Before they will run around to find means of transportation, maybe a car or tricycle, any Traditional Birth Attendant living around will be called to salvage the situation. So, they are really helping us in this village,” she narrated.
A man, John Ede, whose wife was delivered of her four children in the house of a TBA, agreed that the skill is hereditary in some families that work as TBAs, pointing out that their services are quick, accessible and affordable.
He said, “There are families that specialize in traditional bone setting, once they touch you, that bone will heal, likewise, there are families that specialise in childbirth (TBAs) especially women, when they attend to you, they will attend to you like professional nurses because they are destined by God to work in that area.
“Yes, all the four children we have now have been delivered by a Traditional Birth Attendant. Within an hour, my wife had delivered safely; no death, no problem since I started living here in 1971.
“Inside the village, before a pregnant woman will be rushed to the hospital, it will take up to five or six hours and even transportation is a big problem. But these Traditional Birth Attendants are very close. The women will be rushed there and they will be attended to quickly and they will deliver safely.”
“So I am appealing to the government to assist these TBAs, give them training so that they will be equivalent to those trained nurses in government hospitals,” he added.
