‘Nigeria Needs To Raise Awareness For Teenagers On Abortion Dangers’

Although maternal mortality rate (MMR) is a big issue in Nigeria, the complain of many researchers in this field has been lack of reliable statistics. But in this interview, Dr Ebunoluwa Jaiyesimi, a community health physician with the Centre for Research in Reproductive Health, Sagamu, Ogun State, throws more light on what is killing women in Nigeria. Jaiyesimi, who is also a reproductive health expert, is of the opinion that awareness campaign is needed to curb deaths from abortion cases among teenagers. 

What are the challenges of reproductive health in Nigeria? WHEN we talk about maternal health, we are interested in women as young persons and at the reproductive age, even though we have a later stage of their lives. We are more concerned with women between the ages of 15 and 49, which is the age of reproduction.

This is the age women get married, start sexual life, get pregnant, give birth to babies and take care of babies before they get to the age of menopause. Within that range, what kills our women more from pregnancy is post-partum haemorrhage (PPH) and pre-eclampsia/ eclampsia.

The first one has been controlled by community intervention which involves going to rural areas to find out the challenges of women in that age group who are pregnant. We found out that the lower level of care givers do not have the skills to manage post-partum haemorrhage.

That was quickly matched up with some interventions that helped us to bring down deaths as a result of PPH. We are now looking at how to combat the second killer disease, pre-eclampsia, using the same method.

We are trying to do a research at the community level to find out how we can use the kind of interventions, which are available within local level to bring down morbidity and deaths resulting from pre-eclampsia/eclampsia.

As a researcher, do you think that the rate of maternal mortality rate (MMR) is dropping in Nigeria? If you are in the city, you will think that everything is fine. But if you go to rural communities, you will see that it is not as we present it, even though because of the work that has been done with PPH, we have some reductions.

We have trained midwives, community health extension workers (CHEWS) and health assistants to stop bleeding before transferring women to the next level of care.

That has actually helped to bring down the figure. But some experts believe that abortion is also an issue in maternal deaths and morbidity.

Do you subscribe to that school of thought? Yes! Teenagers are having that problem. But most women of marriageable age are stable. PPH and pre-eclampsia/eclampsia are what kill most women of marriageable age. But we still have abortion as an issue.

Majority of our teenagers do not die immediately from abortion. But they die from post-surgical infections because majority of them go to quacks to do abortion. But that is something we need to look at when we start talking of statistics.

How many health facilities that do abortion report it? How much data do we have from private facilities? When researchers approach them for data, they keep mute so that they do not get exposed; so that people do not say, for instance, 20 people died in this hospital.

If abortion is also a challenge, what do you think Nigeria needs to do to overcome this challenge? I think the option of educating teenagers about havocs and outcomes of engaging in unprotected sex should be exploited.

We need to let them realise that unprotected sex can result into pregnancy, and that can truncate their dreams.

If you know you are pregnant, you do not need to abort such pregnancy. You can always have a child and continue life afterwards.

There are a lot of women who had children out of wedlock, but take care of those children for a period of time before going back to school. Their relatives take over the challenge of taking care of the children, while they are away in school.

That is a better option than committing abortion and dying in the process. A lady who had a child out of wedlock can still become someone important in life; she can still become somebody who can be reckoned with in terms of development.

Although it is a known fact that a handful of our pregnant women prefer seeing traditional birth attendants (TBA) to seeing healthcare workers, it is worrisome that nothing is being done to carry along TBAs in the fight against maternal deaths.

Is that not a challenge in the fight against maternal mortality? We are carrying TBAs along. But there is an issue between orthodox medicine practitioners and TBAs. That issue is however being resolved by community health physicians who are not seeing healthcare from the perspective of curative medicine, but from the perspective of preventing diseases.

As a result of that, they go to these TBAs and others to talk about diseases that are of public health importance.

On the pre-eclampsia community intervention, we are educating TBAs. We are also training them to identify symptoms and signs of lablour. We even train some of them who are educated to take blood pressure. We involve them in community engagement because they are part of our communities.

They are the first point of call for most of our women when these women cannot find anybody at the primary healthcare centre (PHC), because sometimes, pregnancy-related issues happen at night when skilled healthcare workers may not be readily available. We also educate them about the signs and symptoms of hypertension in pregnancy, train them to identify their limits in terms of care for pregnant women, and encourage them to refer pregnant women to healthcare centres.

Even at local government councils, there is a structure we call the primary healthcare ward committee (which is located at each ward within local government setting). Among the healthcare committee members is a TBA representative who also works with the primary healthcare unit within the local government council to ensure that things, which needed to improve the healthcare system, are done. So, they are not being neglected

. But I know that the TBAs, out of inferiority complex, do not want to do things with the orthodox medicine practitioners. For that reason, they withdraw.

So, when we call them for meetings, we do not see them. That is something we see as a challenge. Sometimes, they may be around for meetings, but will not buy the idea that is brought to the table.

Rather than say they do not buy those ideas; they will listen, but go home to continue doing those things they were doing before. I know that in some states, there is a body put in place to oversee their activities.

Ogun State is an example. The Medical Officer of Health (MOH) has the jurisdiction to sanction a TBA who is practicing something injurious to health of the populace in Ogun State. The MOH has the duty to call on the law enforcement agents to arrest any erring TBA. That has in a way improved the PHC units, TBA and mission birth attendants in Ogun State.