Why most pregnant women cannot access antenatal care in Nigeria

The birth of quadruplets to the family of Gora Zubairu brought about joy and celebrations in Gora Dansaka village in Katsina state; they were the first of the kind in the community.

However, the felicitation turned sour when one of the quadruplets died days later. Another tragedy struck when the mother of the quadruplets, Gaje, died too.

Medical enquiries revealed that Gaje never attended antenatal because her husband restrained her and that she suffered malnutrition.

Gaje is a needle in a haystack of 1000 women who die every day in Nigeria from preventable pregnancy and childbirth-related complications.

Antenatal care, also known as prenatal care, is preventive healthcare provided to pregnant women in the course of their pregnancy. It encompasses medical screening to identify high-risk pregnancies, natal education to inform pregnant patients of a healthy lifestyle, prenatal nutrition and danger signs during pregnancy, and prevention and management of health complications. Besides medical care, antenatal care also offers pregnant patients psychological, emotional, and social support they need in their pregnancy.

Antenatal care is necessary to ensure the health of mother and child during pregnancy and childbirth. Women who attend antenatal care are less susceptible to becoming victims of maternal mortality, infant mortality, neonatal infections, congenital disabilities and other health complications. Babies born to mothers who do not get antenatal care are five times more likely to die and three times more likely to have a low birth weight than those born to mothers who do get care.

During antenatal care, medical professionals can spot health problems early, advise the pregnant patient, and better prepare for any complications. Consequently, most of the complications are prevented and managed, and the safety of mother and child is guaranteed.

Many health facilities, especially government-owned hospitals, are ill-equipped to offer quality care to pregnant patients. The facilities are often either outdated, damaged or too few to cater to the teeming pregnant patients. Pregnant women have to wait for hours to see the doctor and are sometimes demoralised by the lack of empathy of health professionals.

Distance is usually a barrier for pregnant women living in rural and impoverished communities to attend antenatal care. The added transportation cost and bad roads are great impediments to the poor rural women who can barely afford healthy nutrition.

Given the high cost of medical services in Nigeria, many poor pregnant women are left with no choice but to forego antenatal care. Most of these families live below the poverty line and struggle to make ends meet. Consequently, these poor pregnant women would rather go to traditional birth attendants for advice and eventually deliver their babies.

We are in an age where inflation keeps soaring through the roof. Everyone is grinding hard to provide for their families. And this includes pregnant women, who also have to worry about the added financial responsibility of bringing a new child into the world. Consequently, most working pregnant women do not have time to spare to attend their antenatal appointments.

As in the case of Gaje, cultural beliefs have denied some pregnant women access to antenatal care. In cultures, especially in northern Nigeria, where the man makes all the decisions, and the woman is obligated to obey, pregnant women cannot make healthy decisions regarding their health. In fact, in some cultures, they forbid their women to adopt modern medicine; all sicknesses and complications are resolved using traditional medicines.

In some religions, modern medicine is considered taboo, which extends to pregnant women. Female adherents to these religions go to faith-based centres to deliver their babies. And even when complications arise, their attendants would resort to prayer than take the woman to the hospital.

The government should invest in constructing and adequately equipping federal, state and local hospitals to make quality healthcare more accessible to pregnant women living in rural and remote communities.

Notwithstanding the havoc traditional birth attendants have wreaked in communities, more pregnant women will continue going to them. This is because they are more accessible, charge less and are indigenes of the community, conversant with the language and customs of the land.

Government should liaise with local communities to organise training programmes to train and educate TBAs on best practices attach community health workers to assist, monitor and ensure they adhere to care standard protocol, especially in the case of complications. This will go a long way to ensure that poor women access affordable quality care during pregnancy and childbirth.

Government at all levels concerned health organisations (both local and international) should launch antenatal initiatives like free antenatal consultations, distribution of maternal kits etc., to reduce the financial burdens of medical care.

Hospitals should adopt affordable health packages like group antenatal care, telemedicine, virtual antenatal meetings etc., to reduce the cost of antenatal care for poor women and make antenatal care accessible to working-class pregnant women.

Government, at all levels, should leverage traditional and religious leaders to bring grassroots awareness on the benefits of antenatal care. The awareness programmes should be targeted at breaking the socio-cultural and religious beliefs that inhibit women from accessing modern healthcare.

If possible, the government should initiate policies that give women the right to make decisions concerning their health and every other aspect of their lives.

Research has shown that women whose husbands accompany them to antenatal care visits are more likely to commit to instructions given to them by the doctor. Their husbands become their accountability partners, and more importantly, they know what to do if a complication arises at home.

The Antenatal Accountability project by DO is a mobilisation campaign designed to ensure that pregnant women attend regular antenatal care visits to access and promote mother and child health, reducing maternal mortality. (NB: Accountability includes regular check-up calls on pregnant women to ensure they adhere to all guidelines such as rest, no lifting of heavy objects, medications, vaccinations, healthy eating, safe sex and no alcohol or smoke for a healthy mother and child).

To take action in curbing maternal and infant mortality in your community, click here.

To sponsor or donate to the Antenatal accountability projects in your community, click here.