Nigerian women turn to the old ways to give birth during pandemic

When Junaid Barakat’s waters broke just after midnight, instead of going to hospital she sought assistance from a non-medically qualified traditional birthing attendant.

She is one of many Nigerian women turning to the old ways of giving birth during the coronavirus pandemic, driven by fears of contracting the virus in large health centres and a general mistrust of government hospitals.

“Unlike doctors in health centres, Alhaji Sulaiman Junaid [her traditional birth attendant] is always available to attend to us anytime we come here,” Ms Barakat said. “And the spread of coronavirus is making things more difficult because most of these hospitals have attended to Covid-19 patients unknowingly.”

Nigeria has for years had a weak healthcare system, within adequate investment and poor management. The pandemic has put the system under even greater pressure.

More than 250 doctors have been exposed to the virus and several have died, while doctors in state-run hospitals walked out over inadequate personal protective equipment.

Many hospitals were closed or converted into isolation centres to handle Covid-19 cases, with closed maternity wards causing a fall in antenatal visits.

Nigeria only has about 32,000 confirmed coronavirus cases, with a little more than 700 deaths. But in a country of more than 200 million, the low number is probably a result of limited testing.

Birthing assistants have only basic training, but in Lagos, government data attributes thousands of deliveries a year to the few hundred registered TBAs. Many operate out of small clinics with rudimentary equipment.

Mr Junaid’s birthing home in Epe, Lagos, has a delivery room and antenatal care room as well as a small office and a room to prepare agbo, a local term for herbs they brew that they believe will help with the delivery or to relieve abdominal pain or other pregnancy-related issues.

While there is no medical evidence that agbo helps, many mothers swear by it. Agoro Mariam, an eight-month pregnant health worker at a private hospital in Epe, said she liked Mr Junaid’s agbo with fish because “this helps to make child delivery easy and quick. I come every week for my agbo”, she told The National.

She said she preferred the traditional clinics to a hospital for her delivery because they offered psychosocial support, flexible payment methods and were more patient.

“I come here because it is safer and less expensive, unlike the hospital where you pay so much and you struggle to get the doctor’s attention. They are impatient and don’t care like Alhaji Sulaiman,” she said.

Since the pandemic began, Mr Junaid follows the Nigeria Centre for Disease Control’s guidelines for pregnant women. He checks the temperature of everyone entering his clinic and ensures social distancing. But he said he was worried.

“The rising numbers of pregnant mothers visiting my birthing home due to fear of the pandemic isn’t something I should be happy about,” he said. “I am worried by the prospect of having several pregnant mothers in labour at the same time.”

He is assisted by six other TBAs but with more mothers coming to him for care, he worries about fatalities.

Giving birth in Nigeria is dangerous. It accounts for 14 per cent of the world’s maternal deaths and is the second-largest contributor to global deaths of children under 5.

Rose Elijah, a resident of Ikorodu, just outside Lagos, was turned away from her local hospital while in labour because doctors said they could not guarantee they had not treated anyone infected with coronavirus.

After her husband Daniel insisted she was admitted, he was told to buy new PPE equipment for the doctors from a nearby pharmacy at a cost of 6,000 Nigerian naira (Dh57).

She was attended to and gave birth to a boy.

Dr Laz Ude-Eze, a public health physician and convener, said financial barriers, a lack of transport, lack of PPE and the need for social distancing caused a sharp decrease in hospital visits.

“Few pregnant women want to visit the healthcare facility for fear of being exposed to Covid-19, so most of them would have no option but to go to a TBA,” he said.