By Adie Vanessa Offiong
In Nigeria’s capital, many women and their families choose the services of a traditional birth attendant rather than the Primary Healthcare Centre’s because they trust the knowledge and experience that they provide and are much more affordable.
Huraira Hussaini is a resident of Paikon Kore in Gwagwalada Area Council in Abuja, Nigeria. The mother of three was delivered of her children at home with Hajara, or ‘Mama’ as she is known by. Mama is the community’s most dependable traditional birth attendant (TBA), who lives two houses away. Her delivery suite is a mat in a poorly lit room with a small window.
Mama, who is in her 80s, showed off her knowledge, saying, “I can tell from the look of their ‘stomachs’ and the way they drop, whose husband will soon be inviting me” [to help his wife give birth]. There are clay pots filled with dried herbs, leaves and various concoctions lined up in Mama’s compound which she administers to the women.
Huraira gave birth to her three children with the aid of a traditional birth attendant
It was easier and cheaper option for Huraira to pay Mama for a little below N500 than to go to the community’s Primary Healthcare Centre (PHC) run by a male community health worker. The cost of the PHC is five times Mama’s amount, where there is no toilet, no water and no medicine. Huraira’s, husband, a commercial motorcyclist, earns N17,000 monthly, and she supports him by growing vegetables and grains.
For another member of the community, Mary Isaac, a young mother of two boys, the cost of the PHC would have meant she could not afford the ‘other’ basics, such as clothing and school fees. Her mother cut the umbilical cords of her sons with a razor blade. Her mother also provides food for the family in the absence of a father.
Mary takes the view that since her deliveries went smoothly, and her sons were healthy and continue to be, the routine immunisations at birth were unnecessary. Now three months into her third pregnancy, Mary has no intention of changing her patterns.
Naomi Abubakar explains that when she went into labour her first child seven months ago the PHC was not even open. She said, “I went into labour at about 3am and my husband took me to the health centre. But it was locked. We waited a short while for the security man who then came to open the centre, as I sat waiting on the pavement. Not too long after, he arrived and let me in. No sooner had I sat on the bed than my baby was born.”
The security man got on a motorcycle to collect the health worker, who arrived ten minutes later, only to cut the umbilical cord and clean up Naomi and her newborn.
The delivery cost Naomi N2,500 more than it cost Huraira at mama’s place. Although she was given a mosquito net and a piece of fabric which she was told to wrap her baby in, Naomi said she does not know what the N3, 000 payment was for as no form of medication was administered to her.
Huraira, Mary and Naomi are all unaware of Nigeria’s National Health Insurance Scheme (NHIS) set up in 1999, designed to cushion the burden of healthcare. They are not alone. Only a handful of Paikon Kore’s residents are aware of the scheme which ordinarily should be available in allPHCs based on the mandate establishing them.
Speaking on the issue, Director of Policy and Advocacy, Nigeria Health Watch, Dr. Ifeanyi Nsofor, said the major mandate of the NHIS was to provide health for all Nigerians, regardless of location, through different pre-payment mechanisms, otherwise known as health insurance. Unfortunately, so far it has only covered one percent of Nigerians.
For Naomi she considers it to be “a long journey” to achieving healthcare if when she went into a labour at 3am nobody was available to attend to her. “It was my first time and I was scared. I was worried my baby would catch a cold in that harmattan.” PHCsshould ordinarily be equipped to support mothers giving birth and others for their health needs. But for the likes of Huraira and the rest of her community, this seems to be a tall order.
Photos: Adie Vanessa Offiong
Adie Vanessa Offiong is a 2018 HSG Media Fellow based in Abuja, Nigeria.