Northern Nigeria, Falling Short on Maternal Health

Sign boards point the way. Image by Ameto Akpe. Nigeria, 2013.

Mama Mubarak (in red), an unpaid volunteer, visits with members of the community. After receiving some training from health workers, she serves as a conduit through which the Maternity Clinic can reach women and children in the conservative district where western health services have not yet been fully embraced. Image by Ameto Akpe. Nigeria, 2013.

Julie Kwasba, (R) chief nursing officer at Yelwa Domiciliary Maternity Clinic recalls that in the beginning women in the community would run away when they saw the nurses coming and refused to come to the clinic for antenatal care. Most pregnant women still give birth at home. Image by Ameto Akpe. Nigeria, 2013.

Nurses on their way to visit a woman that just gave birth in the community. Image by Ameto Akpe. Nigeria, 2013.

Patients and nurses seated in front of the clinic. There are no doctors. “We used to have a doctor come visit once a week but he stopped a while ago. I don’t know why,” Kwasba says. There is a huge skilled manpower shortage in the health sector particularly in this region where illiteracy rates are very high. Image by Ameto Akpe. Nigeria, 2013.

When the tear is too severe the fistula sufferer must undergo surgery to try to repair the hole. There is a critical shortage in surgeons able to perform this procedure in Nigeria. Image by Ameto Akpe. Nigeria, 2013.

A handbook on "standard of practice on obstetric fistula" in Nigeria. A joint study by USAID and the Nigerian government estimate that there are almost 200,000 women in the country suffering from VVF—the highest occurrence in the world. Image by Ameto Akpe. Nigeria, 2013.

Dr. Yola peeps into one of two wards that house patients at the Laure Fistula Center. Shame and poverty prevent most sufferers from accessing the help they need, particularly in the conservative Muslim north where fistula most occurs. Image by Ameto Akpe. Nigeria, 2013.

A family comes visiting at the Center. This is considered a major step forward as many men divorce their wives when they develop fistulas. "They say they are afraid of contracting the disease from their wives; others say it is witchcraft. But with more people getting surgery and enlightenment campaigns going on, we are seeing a drastic reduction in divorce rate among the [fistula] sufferers," says Yola. Image by Ameto Akpe. Nigeria, 2013.

Women wait outside the counseling room at the Center. Image by Ameto Akpe. Nigeria, 2013.

Mercy Wasa (L) holds her sleeping one-year-old. Though her baby was born HIV-negative, Wasa stopped participating in the PMTCT program after a prophet claimed to have healed her. Tests now show that her baby is HIV- positive. Image by Ameto Akpe. Nigeria, 2013.

Linda Alkali 26 (seated on desk), Ruth Aliyu 28, Mercy Wasa 41 and Helen Momoh 29 (left to right) are part of a support group for HIV-positive pregnant women in a community where stigma remains a big impediment to the fight against the disease. Image by Ameto Akpe, Nigeria, 2013.

Samples of some of the fake drugs seized during a raid of a factory in Kano state that duplicate popular brands. Image by Ameto Akpe, Nigeria, 2013.

The fundamental issue with antenatal care in Nigeria is two-pronged: the lack or inadequacy of antenatal facilities and the non-utilization of available ante-natal services usually due to cultural and religious beliefs.

Millions of pregnant women in the country trek for miles to get to a health facility. Some endure labor for days which leads to birth complications like Vesico Vagina Fistula (VVF).

The statistics are sobering: The national ratio that 630 Nigerian women out of every 100,000 die while giving birth. Excessive bleeding is blamed for a quarter of this.

Meanwhile, HIV screening, along with five other blood tests, is offered to all pregnant women as a routine part of their ante-natal care. But because utilization of antenatal care is particularly low, among other factors, the transmission of HIV from mother to child continues at an alarming rate; accounting for more cases of new infections of the virus in infants.

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