More than 80,000 Nigerian women died from pregnancy-related complications in 2020, a statistic activists say reflects a lack of political will to fix a broken medical system
THE GUARDIAN UK
by Kasia Strek in Lagos
Despite having the largest economy in Africa, Nigeria also loses more women to death in childbirth than most other countries in the world. In 2020, about 82,000 Nigerian women died due to pregnancy-related complications, a slight improvement on the previous year, but an increase on previous decades.
The causes of death included severe haemorrhage, high blood pressure (pre-eclampsia and eclampsia), unsafe abortion and obstructed labour. Doctors and activists say high maternal mortality rates reflect a lack of trust in a broken public healthcare system and little political will to fix it.
The World Health Organization recommendation for a functioning healthcare system is one doctor for every 600 people; in Nigeria, the ratio is one for every 4,000-5,000 patients. The federal budget for healthcare in 2024 is 5% , a record high, but far short of the 15% suggested by the UN.
Most Nigerians live in areas without well-equipped medical centres or have to pay upfront for treatment. During pregnancy, women skip prenatal check-ups, choose traditional healers and often don’t resort to seeking professional medical help until it is too late. Nigeria’s rate of 1,047 deaths per 100,000 births in 2020 is the third-highest maternal mortality in Africa and far from the UN goal of 70 deaths per 100,000 to be reached globally by 2030.
The patient
Lawal Arinola, 31, arrived at the Lagos Island maternity hospital early in the morning. Her uterus was not contracting after a caesarean section at a private health centre the previous day. She was losing blood and had acute renal failure. The hospital lifts had been broken for months and ground-floor theatres were unavailable, so as she went into cardiac arrest she was carried on a stretcher to a second-floor operating room. An anaesthesiologist started heart massage, shouting for adrenaline to be delivered as the machine monitoring Arinola’s heart bleeped out a flat line.
It was five minutes before she was resuscitated and Dr Olusola Togunde and his team could perform an emergency hysterectomy. The room was hot and several times a nurse wiped sweat from Togunde’s forehead. He was checking for remaining sources of bleeding when the lights went out for the third time that day. In theory, every theatre in the hospital has a constant supply of energy from a generator, but this time the connection failed. The machines monitoring Arinola’s vital signs fell silent and the lights went off. Togunde made the post-operative stitches using the torch from a phone held by one of his assistants.
Despite all efforts of hospital staff, Arinola did not wake up from the surgery. The septic shock that she arrived with turned into multiple organ disfunction. She died in the hospital’s ICU eight days later.
The doctors
“The road to maternal mortality is filled with delays,” says Togunde, obstetrician and gynaecologist, and the head resident of the Lagos Island maternity hospital. In his 17 years of working he has seen tragedy after tragedy. He describes women being brought to the hospital unconscious after waiting for hours or even days before seeking medical help, because they fear the costs, or have to wait for husbands or male family members to take action.
Accessing healthcare is a problem around the country. In densely populated Lagos, with its unreliable public transport, even ambulance sirens don’t make the heavy traffic move.
There are delays too in the hospital itself. Togunde deals with patients shifted from one facility to another due to lack of space. The Lagos Island hospital has rigorous protocols. It has reduced the number of maternal deaths in the past 10 years from 93 in 2013 to 38 in 2023.
Where an emergency caesarean is required, the patient has to reach surgery within 30 minutes. Posters outlining the hospital rules and its efforts to fight maternal mortality adorn the walls of the hospital. Medicines are kept ready in the emergency room, so relatives do not need to go to a pharmacy to buy them, as often happens in other hospitals; and there is an emergency fund for the poorest, paid for by donors and sometimes doctors too. Yet, still the hospital struggles.
The dire state of healthcare prompts many medical professionals to emigrate, exacerbating the problems.
“Manpower is a problem,” says Togunde. “We have space, but sometimes we don’t have people to operate. The hospital does not employ staff [they are employed by the government], it is beyond our competence, and doctors emigrate. The young ones don’t even stay. Sometimes people just leave without notice, so you cannot guarantee the number of staff you will have the next day.”
“I understand that people are dying from lethal diseases, but pregnancy is not a disease,” says Dr Moses Olusanjo, a senior consultant at the maternity ward of Lagos State University teaching hospital, the principal referral centre for patients in Lagos with complications. Olusanjo has worked there and at Lagos Island hospital for more than 11 years, but is now planning to continue his education – and possibly his career – abroad.
“When you go to countries like the UK, women don’t die like here,” he says. “The problem of maternal mortality is a reflection of how our society works. Until the standard of life increases, this will not go away. The reduction of maternal mortality is solely within the power of our leaders. The problem is too vast for doctors alone to handle. It takes political will to say that our women will not die.”
The activist
Abiola Akiyode-Afolabi runs the Women Advocates Research and Documentation Center (WardC), an organisation aimed at combatting maternal mortality and gender-based violence. She had two very different experiences giving birth to her own children, one in the US and one having an emergency caesarean in a public hospital in Lagos.
“After the surgery in Lagos, I was left on a bed in a corridor while I was still bleeding,” she says. “For two hours, I was screaming for help.”
