Complications during pregnancy and childbirth are the leading cause of death and obstetric fistula popularly known as VVF for women of childbearing age in Nigeria. VICTOR OKEKE in this report writes against the practice of seeking medical care in spiritual homes.
According to Lord Macmillan in his celebrated description of a reasonable man in Glasgow Corporation v Muir (1943), “Some persons are by nature unduly timorous and imagine every path beset with lions; others of more robust temperament, fail to foresee or nonchalantly disregard even the most obvious dangers. The reasonable man is presumed to be free both from over-apprehension and from over-confidence.”
The above quote by the renowned English jurist, perhaps enjoys universal acceptance. Whatever activity one engages in, it should not be fraught with unreasonable risk of danger to oneself and other around them.
This is even more true when it comes to religion which so many Nigerians hold so close to heart. The truth is, religion affects people’s daily lives by solving social problems, but still it creates others.
In this context, female sexual and reproductive health are among the issues most affected by religion in Nigeria. Most Pentecostal churches in Nigeria today advocate and advertise all forms of faith healing sessions including instances where pregnant women who have been scheduled for caesarean section have been able to deliver their babies in defiance of such time-tested medical advice.
While not questioning the veracity or otherwise of such claims, evidence abound to prove that such spiritual homes serving as alternative maternity homes is antithetical to everything which modern medical sciences stand for.
For example, several studies have shown that the Apostolic church members in Zimbabwe have been associated with higher maternal mortality because this form of worship promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care.
And this true of Nigeria wherein both religion and culture affect the utilisation of maternal and new-born health services from a motivational and supply perspective.
In Igbo land for example, health, disease and sickness all have spiritual foundations. In fact, some traditional people believe that ancestral spirits influence the health of the living and they are not alone. Most religious people, including Christians, believe that health is a blessing from God and disease a curse from the devil. The Apostolic display maternal practices that are significantly different from most other religious groupings. For example, their pregnant women display a higher propensity to deliver outside the formal health system and without skilled medical attendants.
According a study by Dr Dodzo Kenneth of the Centre for Population Studies, University of Zimbabwe, Harare, some religious women reject modern medicine and therapeutics, preferring instead to get services from spiritual birth attendants (SBAs). Here, they are offered prenatal, intra-partum, postnatal and emergency care in the best way a spiritual health system can afford.
A claim to offer emergency obstetric care (EmOC) from a spiritual perspective sounds fatal, and it may indeed be. It is known that EmOC can reduce maternal mortality, particularly when deliveries are conducted by skilled birth attendants in controlled and appropriate conditions. Both of these are absent in spiritual health systems.
The danger of this is that child delivery done without the attendance of skilled birth attendant and in a clinic are fraught with risk for the mother and child in the event of any complications. Such risks include that of developing obstetric fistula.
Fistula is one of the most devastating injuries of child birth. It occurs mainly as a result of prolonged obstructed labour, without timely medical intervention – such as a caesarean section. The sustained pressure of the baby’s head on the mother’s pelvic bone causes damage of soft tissues creating a hole – or fistula – between the vagina and the bladder and/or rectum.
This means that, the wall of the birth canal gets compressed by the baby’s head during an obstructed labour. The pressure causes blood to stop flowing, and the tissue dies. The vagina then leaks urine and/or faeces.
The result is continuous leaking of urine and feaces. When this occurs, a woman has no control of this unnatural phenomenon and if not assisted may suffer isolation, social stigma, neglect and humiliation.
However, obstetric fistula is preventable and can largely be avoided by delaying the age of first pregnancy, the cessation of harmful traditional practices; and timely access to obstetric care.
According to EngenderHealth Nigeria Country Project Manager for the USAID-funded Fistula Care Plus (FC+) project, Chief Iyeme Efem, fistula is one of the most devastating consequences of neglected childbirth.
Through the Fistula Care Plus project, the largest U.S. government-funded effort to-date dedicated to treating and preventing fistula, EngenderHealth works to restore dignity to women with fistula and to prevent other women from developing the condition.
The Fistula Care project covers the costs of treatment, equipment, and supplies. It also supports training for providers in fistula repair, nursing, counseling, and quality improvement.
Efem said “When I see a woman who goes to the church to deliver her baby, I asked the woman if it was a spirit that she was giving birth to. If it was a spirit, you go to the church and they will do deliverance but if it is a baby, then you go to the hospital for delivery. We should begin to differentiate between these two things.”
For Efem, there must be a separation of labour. “Let the churches do deliverance (spiritual) and let the hospitals do the delivery (medical).”
This was exactly the story of Lucas Oluwaseyi, 27 years, who was repaired of fistula last week at Obafemi Awolowo University Teaching Hospital Complex in Ilesa, Osun State, one of the 13 fistula centres supported by EngenderHealth.
She said that when her pregnancy was due for delivery, she went to an unnamed church in Ondo State for delivery. “When I was in labour, they didn’t even take care of me. Later I went to where I registered for antenatal but the hospital was angry that I went to the church before coming to the clinic. So they didn’t attend to me. So, later I was taken by an ambulance to another hospital- Mother and Child Hospital, Ondo,” she narrated.
It was after the long battle with pangs of labour for over five days that she was later operated on but by this time, the baby had died and that was how she developed fistula on March 21, 2016.
“I went back to the hospital where they did the operation and they said they were going to repair it. They later did it, but it didn’t work,” she said.
She recalled that the hospital where she had the unsuccessful fistula surgery had in 2017 during a pull effort referred her to the Fistula Centre in Ilesa but for fear of undergoing another surgical procedure, she stayed back and rather suffer in silence.
“This year again, they now called me again, that they are going to do the surgery and I was very happy. That was how I came.”
“I advise fellow women to go hospital and register when they get pregnant. They should not go to any other place to deliver their babies. It is dangerous,” she cautioned.
Data from a study by Dr Patricia Anafi of the Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana and her colleagues on the Motivations for Non-Formal Maternal Health Care in Low -Income Communities in Urban Ghana indicated that the main forms of non -formal health care that women in the study area used during pregnancy were spiritual and traditional birth attendants (TBA).
The spiritual care was sought mainly from the divine and faith healing churches. The form of worship in the divine and faith healing churches is a blend of Traditional African Religion practice and Christianity. According to participants, the women who usually attend these churches for spiritual care during pregnancy were young mothers and indigenous women.
The participants described the care that they received at the spiritual churches as prayer, counseling, anointing oil and holy water, where women could spend the whole day seeking care at the spiritual churches. According to participants, these functions were usually performed by leaders of the spiritual centers, some of whom are female pastors (priestesses) who were also TBAs.
A 29-year-old woman participant explained, “When they go to the churches, the women pastors pray for them and anoint the pregnancy; I mean the stomach….They use holy water and anointing oil to massage their stomach to ensure and maintain the baby proper position in the womb.”
The one of the main motivations for women’s preference for TBAs and spiritual care is cost associated with care at the public health care centers. Responses from the interviews indicated that although many women had registered for free maternal health at the public health centers, antenatal care and delivery care were not completely free. Pregnant women who sought antenatal and delivery care at the public health centres were made to pay for some of the services that they received and this was hard for some of them to do since they were poor.
On the contrary, the TBAs and spiritual churches had flexible payment arrangements for their services. According to the participants, unlike the formal health care system, which would demand immediate payment for service, payment for services provided by the spiritual churches and TBAs can be deferred to a later date or made by installments.
Another reason why the women preferred to use the spiritual churches and TBAs during pregnancy and delivery is the belief that these sources provided spiritual protection.
For some others, the fear of giving birth by caesarean section was cited as reason for preference for spiritual care. Some women often delayed at home when labour starts and to avoid the possibility of delivering through caesarean sections, as a result of complications that might be caused by the delay, they resorted to the spiritual churches with the belief that they would have their babies delivered there through normal delivery.
Again, women who used the spiritual churches were likely to be those who did not attend antenatal clinics during their entire pregnancy period. To avoid being reprimanded (or verbally abused) by the midwives and nurses for not attending antenatal clinics during pregnancy, they resorted to the spiritual churches and TBAs.
The results of these studies indicate that cost of pregnancy and delivery care is still a deterrent to many women who utilize antenatal and delivery care in the public health facilities. Therefore, it is important for government to be more explicit about antenatal and delivery care services that qualify for cost exemption under the free antenatal and childcare programme. Ideally, government should absorb the full cost of maternal health care for women who cannot pay to encourage women to use professional midwifery services in order to improve maternal and neonatal health outcomes.
Moreover, the study provides lessons for formal sector midwives and nurses to be more tolerant and friendly to all women who visit their facilities. Health training institutions should emphasize aspects of human relations in the training of midwives and other staff to improve on provider-client interaction, so that they will be more responsive to the needs of their clients.
For Professor Orji Ernest, the Head, Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospital, Ile Ife, the message for pregnant women is simple and straight; “We advise them to register early in a skilled clinic and not just booking at a clinic but also to deliver with a skilled personnel. Because we discover that some people will book at the centre just to apply for maternity leave but when it comes to delivery, they will go to the mission (church) homes.”
“They must have to come early for deliveries and not wait until it is has become complicated. Some of the pregnant women will only come when the fistula has already developed and in such a situation, what we will be doing is to save the life of the woman and not even that of the baby because the baby is gone and the woman is already leaking urine.”
“They must book early wherever we have trained nurse- midwives and medical personal. They must also come for labour early because some people because of fair of Caesarean section, they will run away from the hospital believing that it is the antidote to their problem but we will council them on CS before it is done,” he added.