Adie Vanessa Offiong

 Accessing healthcare on a normal day is difficult for many pregnant women in Nigeria. COVID-19 has made it a tougher battle for them to stay healthy and alive, even as they struggle to keep their babies safe. And their difficulties worsen during the pandemic. With poverty, lack of adequate information and failed system, many women in resource-poor settings resort to self-help. Yet, many are at the mercy of Nigeria’s rogue security agents. Freelance journalist, Adie Vanessa OFFIONG, reports.

FOR Helen Agbo, 33, four children were already a lot to care for. Finding out she was pregnant, despite being on the contraceptive, was a rude shock.

Broke, but in good health, Helen, who lived in Karimo, one of Abuja’s urban poor settlements, decided she would seek alternative prenatal care – an inexpensive option. This meant drinking agbo [local cocoction of herbs and roots] and ‘eating well.’

Regardless, she registered for antenatal at seven months because time was getting close for her delivery. This would be her saving grace when she began to bleed soon after.

At the Noble Hope Clinic & Maternity where she went for a test,  the scan revealed she was carrying twins.

“I wanted to have an abortion because I knew it would be difficult to take care of them. I don’t work and my husband has been jobless since the beginning of the pandemic when the bicycle he used for selling ice-cream was stolen,” she said.

But learning that one of her babies was a boy, she changed her plan because she had only one son at the time.

Then the lockdown began on March 30, and she became extremely worried because her expected delivery date was near and she still was broke.

In Oba-Ile, Ondo State, Nigeria’s southwest, Opeyemi Babajide, another pregnant woman currently bears the same concern.

In January her husband lost his marketing job with a Chinese company after receiving his last salary – ₦10, 000. The following month, she received a ₦3, 000 parting stipend from the NGO she had worked with.

Balanced diet vs a food crisis

Since then, staying healthy has become an issue of grave concern for her especially, and the family.

“My diet as a pregnant woman and caring for my three-year-old son, are what worry me the most. I can’t eat the kind of food that I should be eating during pregnancy,” she said.

With daily meals mostly consisting of rice, or garri made into eba or soaked, the family tries to balance their diet with vegetables and peppers from their backyard.

Helen, who ‘eats well,’ said her meals are predominantly carbohydrates – garri, tuwo from rice or maize – with vegetable or okra soup, but rarely with fish or beef. Eggs and dairy products are luxury menus, especially during COVID-19, she added.

Poor diet is a common experience of low-income households during the lockdown.

According to the International Food Policy Research Institute (IFPRI) in an April publication, poor households in Low and Middle-Income Countries, like Nigeria, would have dramatic income effects due to “widespread unemployment resulting from COVID-19 mitigation measures.”

Also reflecting both women’s current situation, the publication noted, “The poor will respond by purchasing the cheapest calories they can find to feed their families.” Findings from earlier research by IFPRI, revealed that “in poor countries calories from nutrient-rich, non-staple foods like eggs, fruits, and vegetables are often as much as 10 times more expensive than calories from rice, maize, wheat, or cassava.” This, the research noted, happened during Indonesia’s 1998 financial crisis, “when real wages fell by 33 per cent between August 1997 and August 1998 due to rising unemployment and a food price crisis.

“Strikingly, even as rice prices skyrocketed by almost 200 per cent, rice consumption continued to rise during this period.”

In Abuja’s Deidei Market, between late February and early March, a 50kg bag of rice sold for ₦14, 000 to ₦15, 000. As of June 3, it was selling at ₦27, 500. In the same period, garri went from ₦10, 000 to ₦16, 000 for 70kg in Madalla Market.

A not so pleasant surprise

Labour came for Helen on April 2. With only ₦2,000, with which she was to buy charcoal for her sister, the decision was that she would have the babies aided by her husband.

She said, “we trekked to a farm. I went with a razor blade, wrapper and some baby clothes and hoped that I would deliver in the bush, while ‘exercising.’”

When this failed, she trekked back home aided by a stick and intermittent rests. She ended up at the Maternity Home when the pain became unbearable.

At 10 am on April 3, the Agbos welcomed Sarah, and then Samuel at 4 pm. Amidst the joy of the children’s torturous but safe arrival, Helen received the shocking news that there was a third baby.

“The doctors and nurses waited and waited for this baby but nothing was happening and at some point, I thought the doctor was mistaken,” Helen said.

At 8 am on April 4, a 4.5kg Samson was born through Caesarean Session with a ₦250, 000 bill, dangling over Helen’s head. This bill has now been cleared by a Good Samaritan.

For Opeyemi the narrative is slightly different

She is yet to tell her husband she is carrying twins. She is ‘afraid’ of how he would react and how they will manage when the babies come. Terrified of giving birth at home due to lack of money, she is worried about maternal death and even neonatal death, which she has experienced before.

Since the lockdown, she has not attended any antenatal session, even though she is now in her third trimester.

“I am scared of contracting the virus but money for transportation and finding a safe public means to the clinic, are more the reasons I have not gone.

“If they had phone consultation and I could afford it, I would have preferred it,” she said.

Telemedicine to the rescue?

Virtual healthcare solutions have now become an indispensable option due to the pandemic.

To ensure that pregnant women have unlimited access to healthcare during this period and as alternatives to physical hospital visits, there have been arguments advocating the switch to telemedicine and other remote consultations via various online and messaging platforms.

Institutions like the American College of Obstetricians and Gynaecologists have long endorsed its use for patients in rural areas. Telemedicine advocates believe that this could reduce the typical 14 required antenatal visits by half.

The Society of Maternal Foetal Medicine while speaking on telemedicine and pregnancy care, recommend that it is safe to reduce “routine” ultrasounds, due to the pandemic, without putting the pregnancy and health of the mother in jeopardy. They state that women carrying multiple babies or babies with possible birth defects may require more traditional checks. Clinical Assistant Professor, Hector Chapa opines that, “Pregnant women are able to do some at-home monitoring, such as for high blood pressure, diabetes and contractions, and telemedicine can even be used by pregnancy consultants, such as endocrinologists and genetic counsellors.”

While these may seem appealing and convenient, for the like of Opeyemi, their circumstances do not give room for them to access such.

An expert like Dr Toyin Adeyalo-Ogunadare, also cautions that for pregnant women, it may not be advisable to have phone consultations, except they want to.

During a phone interview with our reporter, she said “this is because you can’t hear the foetal heartbeat via phone. When they come for antenatal, these are one of the things checked.”

Adeyalo-Ogunadare who is the Special Assistant to the Ondo State Special Adviser of Health said the state has ensured “regular antenatal clinics an immunisation exercises” since the start of the pandemic.

“Also, pregnant women resident in the state can access healthcare through our Abiyamo Maternal and Health Insurance Scheme, even if they have lost income due to COVID-19. This covers them and children under age five. With functional healthcare centres in every ward, you really may not need public transport to get to the nearest facility.”

COVID-19, maternal deaths and being at the mercy of uniforms

Researchers at Johns Hopkins University envisage that, “between 42,000 and 192,000 more children worldwide, as well as between 2,000 and 9,450 more mothers, could die each month due to COVID-19’s indirect impacts on health and food access.”

These projections are based on statistical modelling and factoring in elements like vaccine availability, antenatal care and health coverage. According to UNICEF, in a May 13, 2020 publication, about 6,800 more Nigerian maternal deaths could also occur in just six months. It also said, “new mothers and newborns will be greeted by harsh realities, including global containment measures such as lockdowns and curfews; health centres overwhelmed with response efforts; supply and equipment shortages; and a lack of sufficient skilled birth attendants as health workers, including midwives, are redeployed to treat COVID-19 patients.” Women like Helen and Opeyemi, in poorest households, bear the brunt of these deaths.

In May 2020, a Lagos woman rescued by personnel of Nigeria’s Federal Road Safety Commission, while driving to the hospital amid labour pains, narrowly escaped being added to the maternal mortality statistics.

Also in May, another woman who had gone to the Asokoro General Hospital to give birth, could not be attended to because the hospital had been converted to an isolation centre for COVID-19. After some rigmarole, she ended up at Lona City Care, Karu where she was delivered of her baby by Dr. John Agbo, a family medicine expert.

Agbo who has worked in a government hospital explained that, “Patients are usually classified in government hospitals as very high risk and are also called ‘doctor-patients.’ They are those who have had Caesarean Section before and would need surgery again. These patients are referred to other hospitals. Then the rest are told to look for hospitals where they can give birth,” as was the case of this woman who came to him.

She and her husband had lost their jobs during the pandemic and did not have the financial power to decide on their fate. They first went to a maternity home where all she was given was a bed. A neighbour who had given birth at Lona, took her there where she was immediately attended to and delivered of her baby at about 3AM. This was possible because Agbo had relocated to the hospital since the lockdown, for such eventualities.

However, in Ogun State, Waidat Adedeji who was in labour and being conveyed by a commercial motorcyclist to give birth, was not so lucky. She was reportedly killed by a policeman at a checkpoint during the lockdown, because the cyclist refused to give a ₦100 bribe.

Alternatives and measures to be taken

Temitope Alale a member of the Institute for Dietetics in Nigeria and of the Association of Nigerian Dieticians, said, it is unhealthy for a pregnant woman and her growing foetus, to consume these too frequently.

She said, “Although vegetable is good, pregnant women need to eat a wide range of foods that provide nutrients to support their health and wellbeing as well as the growth and development of their babies.”

With the pandemic threatening the food security of many households, Alale suggests that Opeyemi, Helen and other mothers in their situation, can substitute food items.

“For example instead of meat which sells from ₦300 and above, she can use crayfish and locust bean which cost far less and she will get the necessary nutrients needed for that same amount of money.”

Alale also encourages the women to grow vegetables like tomatoes, okro, waterleaf, spinach, ugwu and bitter leaf around their homes, to avoid buying them.

In 2016, the Katsina State Government distributed 720 high breed goats worth N104 million to women under its Women Empowerment Scheme. Two hundred and forty women selected from the State’s 34 local governments received two female goats and one male goat. This might be an initiative worth replicating across the country, to alleviate the challenges of women like Helen and Opeyemi during this pandemic.

Dr Anthony Ajayi is a postdoctoral fellow in Population Dynamics and Sexual and Reproductive Health Unit at African Population and Health Research Center, Kenya. He shared his thoughts on what Nigeria could do to ensure safe motherhood during the pandemic.

Ajayi said, often to the neglect of other health priorities such as maternal health, resources are diverted to halt the spread of the virus.

“The lock-down is the most aggressive of all the interventions against COVID-19, that could have unintended consequences on maternal health if measures are not put in place to accommodate pregnant women.”

He advised that “access to maternal health care services must be made a priority during the lock-down and efforts should be geared towards providing free transportation services for all pregnant women to ensure no woman is unable to access services due to lack of transportation.”

This is in addition to the provision of free maternal health care for all pregnant women, “given that COVID-19 has devastated the earning opportunities of most families, with little palliative measures from the government,” he said.

Giving a recommendation on what government should do regarding maternal health and COVID-19, he added:

“The number of women and children who have died undocumented is more than the number of people who have died of COVID-19, said, Dr Agbo. He said if the government had made available resources in cash and kind in public hospitals for pregnant women, it would have helped. He added that this would, however, only be effective in an organised and structured environment.

He also advocates discounted healthcare costs for resource-poor pregnant women, “in order to reduce the complications of delivery.

“When I was in Kaduna State, there was a time we had free treatment for women and children. What they did was to give the hospitals a little overhead and supplies of consumables they needed.

Within that time, maternal mortality reduced drastically in Kaduna State about 10 years ago. Although there is a UNICEF Joint statement on nutrition in the context of the COVID-19 pandemic in Asia and the Pacific, Nigeria could benefit from its recommendations.

UNICEF advises health services to continue providing essential nutrition services for pregnant and breastfeeding mothers, newborns and sick children.

“They should also provide appropriate support for mothers to breastfeed, including those with COVID-19, and communicate accurate information on maternal, infant and young child nutrition,” it said. Nigeria is one of the countries with the expected highest numbers of births in the nine months since the pandemic declaration with 6.4 million new babies. Others are India (20.1 million), China (13.5 million), Pakistan (5 million) and Indonesia (4 million). With most of them already having high neonatal mortality rates prior to the pandemic, there is a worry that these levels may increase with COVID-19.

Stating that it is hard to imagine how the pandemic has recast motherhood, Henrietta Fore, UNICEF Executive Director, said, “Millions of mothers all over the world embarked on a journey of parenthood in the world as it was. They now must prepare to bring a life into the world as it has become – a world where expecting mothers are afraid to go to health centres for fear of getting infected, or missing out on emergency care due to strained health services and lockdowns.”

This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project.