It was a bright Saturday morning when a team of volunteers, made up of nurses and medical corps from the Federal Road Safety Commission (FRSC), set out on a mission to take reproductive health, antenatal, and family planning services to a rural community called Kaida-Sabo village, in Gwagwalada area council of the Federal Capital Territory (FCT). They planned to distribute delivery kits, as well as to train Traditional Birth Attendants (TBAs), the only pregnancy and childbirth care providers for women in the village, on safe delivery practices.
Nigeria continues to lag in the area of maternal mortality, a United Nations Sustainable Development Goals (SDGs) indicator. The Nigeria Demographic and Health Survey (NDHS) 2013 puts Nigeria’s Maternal Mortality Ratio (MMR) at 576 deaths for every 100, 000 live births and the percentage of women of reproductive age (15-49 years) who have their need for family planning met with modern contraceptive methods at 16%. These figures are a far cry from the global targets. The survey also showed that only 8.5% of the 17,705 rural women surveyed used any contraceptive method compared with 26.8% of the 10,124 urban women surveyed, which means most of these gaps exist in rural, hard to reach areas. The unmet need for family planning was also higher for rural women at 14.5% than urban women at 10.4%.
Maternal care to rescue twins
The outreach team made their first stop in Kuje, at the Divine Heritage Children’s home located along the Kuje/Gwagwalada road. The children at this orphanage were rescued from communities that still practice the killing of twins because they believe they are evil. The home is run by Pastor Olusola Stevens and his wife, who discovered the practice 22 years ago. He has since rescued and raised over 132 children from 40 different communities within the FCT.
Team lead and founder of PeachAid Medical Initiative, Dr. Nkasim Nebo, said she learned about the practice in May this year, during another outreach programme when a young mother with newborn twins told her team that she didn’t want her children. She later met Pastor Stevens who, during their discussions, highlighted the two ways he needed assistance with his work. “He said they would love to know when a pregnant mother is carrying multiple babies so as to establish contact with her and follow up until delivery; this would help them rescue the children on time. Secondly, he would love for more Nigerians to donate food, structures, and other items that they can survive on, as they simply live off donations,” she said. But she added that the donations they received were inadequate because they saw a lot of malnourished children at the home.
In response to Pastor Stevens’ request, Nebo’s outreach team now incorporates ultrasound scanning during medical outreaches to help discover mothers carrying multiple babies before they deliver.
The team then set out for Kaida-Sabo. After a two-hour drive, they had to leave their vehicles behind and carry their outreach material and walk the remaining two kilometers to the project site, a primary school located in the agrarian community.
Within minutes after set up, the project site was filled with women, pregnant women, young girls, children and young men. Menstrual pads were distributed to the girls; vitamin A supplements administered to the children; and young men received condoms. Some of the married women also requested for condoms for their partners. The women were taught about modern contraceptive options. Some opted to receive the contraceptives immediately and were given supplies after receiving detailed instructions on how to self-inject. One of the beneficiaries was 32-year-old Victoria Sunday who already has four children. She said that she wanted to wait before giving birth to more children as she needs to be able to take care of the children she already has. “There is no money to take care of many children. I want to wait for five years before giving birth again,” she said.
Traditional Birth Attendants were re-trained on safe birth practices and received delivery kits with medication to control postpartum haemorrhage and other items. Pregnant women received free ultrasound scans to check the status of their pregnancies and to determine if they were carrying multiples. During this particular outreach visit, no pregnancies that were multiples were uncovered. Pastor Stevens said the Kaida-Sabo community had stopped the practice of killing twins after multiple advocacy efforts.
Bridging the huge access gap in rural FCT communities
Since 2015, PeachAid Medical Initiative has reached over 30,000 women and 400 TBAs through medical outreach programmes to rural communities in the FCT. These medical outreach programmes are not without their share of challenges, says Nebo. Accessing some of the communities, getting them to openly talk about and receive family planning services and security are some of the issues they continue to face. “There is a barrier to accessing some rural communities in our intervention sites because of the peculiarity of the communities we choose; we intentionally choose hard-to-reach villages who we consider are in dire need of our interventions,” she said. This lack of access also makes it impossible to follow up with women who have received the family planning services. However, it is still better than no service at all especially in communities like Kaida-Sabo, where there are no primary healthcare centres. Dr. Nebo said they encourage women in communities that have health centres to give birth where there are skilled birth attendants. They also provide incentives to encourage women to use the facilities.
Building on quick fixes to improve health outcomes
Advocating for family planning is best approached from an economic perspective. Having the number of children a family can take care of has tremendous economic benefits to both the family and the nation at large. Dr. Alex Ezeh, a visiting fellow at the Center for Global Development wrote in the 2018 Goalkeepers report: “The goal of family planning programmes is not to hit population targets; on the contrary, it is to empower women so that they can exercise their fundamental right to choose the number of children they will have, when, and with whom”.
Solving the hydra-headed issues in Nigeria’s health sector is not a sprint, but a marathon. It will take gradual but very intentional and calculated steps to fix. Being intentional also means recognizing the low hanging fruit and setting out strategies to grab them. If indigenous organisations with little or no funding are able to organise outreach programmes to reach very difficult locations with services, maybe the government should explore the same strategy even as efforts are being made to put more sustainable structures in place. Countries like Kenya are exploring medical outreaches to rural nomadic locations that are 12 hours away from the capital because there is evidence that they work.
The Kaida-Sabo community is under the Gwagwalada area council which is under the Federal Capital Territory Administration (FCTA). The FCTA has a statutory budget and health desk that oversees issues around healthcare in the FCT, but most of the time when issues around health arise, attention is shifted to the Federal Ministry of Health whose constitutional responsibility is first to the whole federation. The FCTA reportedly proposed a total of N271.53 billion in its 2018 budget and out of this, N22.8 billion was earmarked for health. The sum of N40.2 billion was also appropriated to it in the 2018 National Budget. Why hasn’t the FCTA budget been passed by the National Assembly? What is the status of the funds appropriated to it in the 2018 budget? How much has been released so far? How much health can it buy for rural dwellers where supply is scarce? How much of Nigeria’s health indices will it improve? These are important questions, and answers to them can make a real difference in the lives of the people in Kaida-Sabo and other rural locations. They must not be left behind.
Victoria Sunday didn’t need an economist to tell her that to properly manage her family’s resources, she needs to control the number of children she has. Intuition informed her decision. She and other women like her need to be empowered because as Dr. Ezeh wrote in the GoalKeepers report, “If the rate of population growth slows down…there will be more resources to invest in each African’s health, education, and opportunity—in other words, in a good life.”
Do you know of other organisations providing maternal health solutions to rural communities in the FCT? Leave a comment below.
Of course medical outreaches can help. They don’t have to replace standard hospitals but since they help reach areas that are often difficult to reach, they should be explored while we work towards strengthening our health system.