Some Harmful Traditional Birth Practices In Northern Nigeria and Making Child Birth Safer in Nigeria
Dr. Abdullahi Dahiru
Every society device ways of coping with its environment, these methods which are products of group experience becomes the tradition of the society and are passed on from generation to generation. Though these practices are detrimental to the health of the people that practice them, they are still retained with great vigour. This brings the question of dropping some of these practices after appreciating their hazardous consequences.
Although the incidence of these practices has been remarkably reduced during the last 50 years due to western education and civilization, those people that have low level of educational attainment are still practicing them. There is a positive correlation between formal education of females and non practice of these practices and vice versa.
One of the harmful practices a pregnant woman in labour may be subjected to is “Gishiri cut” or “Yankan Gishiri”. This is a traditional surgical cut performed on any aspect of the vaginal wall using razor blade or knife. The commonest site is the anterior vaginal wall or less commonly posterior and lateral walls. It is commonly practiced in many parts of Northern Nigeria especially during the first delivery as a ‘remedy’ to obstructed labour. It is usually performed by traditional birth attendants, local herbalist or barber. Complications include severe bleeding leading to shock, excruciating pain, vesicovaginal fistula, and spread of infections like HIV and hepatitis and painful intercourse later.
Perhaps, after delivery the predominant harmful practice is “wankan Jego”. These practices vary among different towns in Hausaland but include taking hot bath, lying on hot bed and taking large amount of ‘kunun kanwa’ [a lake salt rich in sodium]. This practice is still pursued with great vigour, although the occurrence of the practice is diminishing because of greater awareness of the hazardous effects of the practice, and also its economic consequences since a lot of money is spent on buying firewood that is used in boiling the water. This is the reason why the practice is more predominant in rural areas where literacy level is low and firewood is relatively cheap and available. Immediately after delivery and continuing for 40 to120 days, the new mother takes two scalding hot baths each day to keep out ‘the cold’ using a bundle of leaves to splash very hot water on her body. After taking the bath, the mother remains in a well-heated room with a fire or fire glowing underneath a specially constructed dried mud bed, which can retain heat for several hours. A special gruel or pap is prepared from guinea corn or millet with potash [kanwa] and peeper is taken regularly as medicine to increase the quantity and quality of breast milk. The potash has high sodium content but very little potassium and can cause hypertension and heart failure.
Complications of wankan jego include burns injury, severe hypertension, eclampsia and heart failure, and subsequent death.
Since there is positive correlation between formal education of females and non practice of these practices, increased enrollment of females into schools will help reduce the prevalence of these practices among our community. There should be more collaboration between heath workers, religious and traditional leaders to enlighten the masses on health implications of these practices. Government should intensify campaign in media and through the use posters, dramas e.t.c to sensitize people on dangers of these practices.
Finally, these practices do not have any benefit on the women who practice them and in contrast have hazardous effects, and hence our society should abandon them for the better.
Making Child Birth Safer in Nigeria
DR Abdullahi Dahiru
The desire to procreate and reproduce offspring is common to all human societies. In an attempt to fulfill this noble desire, many women lose their lives during childbirth especially in developing countries where medical care is still inadequate.
Maternal mortality ratio is highest in the African region, estimated at an average of 1,000 deaths per 100,000 live births. In Nigeria it is estimated at 800 per 100,000 live births with wide regional disparities. With our current maternal mortality ratio, these women are subjected to a life time risk of dying from pregnancy related complications of 1 in 8 compared to 1 in 10,000 in developed countries.
For every woman who dies, other women suffer injury, infection or disease. Pregnancy related complications are among the leading causes of death and disability among women in Nigeria.
When a mother dies, children lose their primary care giver, communities are denied her paid and unpaid labour, and countries forego her contributions to economic and social development. A woman’s death is more than a personal tragedy-it represents an enormous cost to her nation, her community and her family. Any social and economic investment that has been made in her life is lost. Her family loses her love, her nurturing and her productivity inside and outside the home.
One of the common causes of maternal mortality in Nigeria is Obstetric haemorrhage [or bleeding]. Bleeding can occur before the birth of the baby due to placental abruption or abnormally situated placenta on the lower uterine segment. Massive bleeding can also occur from the genital tract after the birth of the child from uterine atony or abnormally adherent placenta.
Hypertensive disease of pregnancy and eclampsia is another leading cause of maternal death. Pregnancy induced hypertension is more common during first pregnancy. It is also associated with multiple pregnancy and molar gestation. If pregnancy induced hypertension is not detected early and managed appropriately the woman can develop eclampsia. Eclampsia is one of the most serious complications of pregnancy and can occur before, during or shortly after delivery. It is characterized by the occurrence of major epileptiform convulsions. The mortality varies with the number of fits, the quality of treatment and the speed with which treatment is made available.
Another leading cause of maternal mortality is obstructed labour. It is a dangerous condition if left untreated and can be fatal to both mother and fetus. It can be caused by several factors which include contraction or deformity of the maternal pelvis, large baby, abnormal positions or presentation of the baby during labour like breech, face or brow presentations, locked twins; congenital abnormalities of the fetus like conjoined twins and hydrocephalus.
Unsafe abortion is another cause of maternal mortality. An abortion is said to be unsafe when it arises from the deliberate termination of the pregnancy resulting in complications like sepsis and severe bleeding. Unskilled persons, in circumstances where the pregnancy is not wanted, often carry out the procedure usually in an unhygienic environment.
Malaria in pregnancy is associated with 10% of all maternal deaths and is a leading cause of morbidity in pregnant women. After delivery, genital tract infection can occur especially if the delivery is not conducted in hygienic environment as in the case of home delivery. Genital tract infection can cause sepsis and even death if left untreated.
Other causes of maternal death include ruptured ectopic gestation, pulmonary and amniotic fluid embolism
Researches have shown that small and affordable measures can significantly reduce the health risks that women face when they become pregnant. Most maternal death can be prevented if women have access to appropriate health care during pregnancy, childbirth and immediately afterwards.
We should all realise that every pregnancy faces risk and the family of the pregnant woman and the health care providers must prepare against this risk. The family must save some money during pregnancy so that when complications arise, appropriate interventions like caesarean section can be offered immediately without being delayed due to lack of funds. Maternity units must be equipped with facilities and trained manpower to provide emergency obstetric services.
The community should be educated about obstetric complications and when and where to seek for medical attention.
There should be stronger political commitment from governments at all levels towards reduction of maternal mortality. More health care facilities should be provided especially in the rural areas. These facilities should be able conduct deliveries of pregnant women and refer complicated cases to superior health facilities for prompt management. Blood banks should be provided in all maternity units so that blood is always available for transfusion if the need arises. Relations of pregnant women must be willing to donate blood in case the need arises.
All health care facilities should ensure skilled attendant i.e. doctors and midwives at every birth. Doctors attending to pregnant women should be trained to be proficient in life saving procedures like caesarean section and manual vacuum aspiration. Continuous health education workshops should be organized routinely for doctors and midwives, so as to update both their knowledge and skills in management of pregnancy and labour related cases.
We should promote antenatal care attendance which aims to maintain the pregnant woman in health of body and mind, to anticipate difficulties and complications of labour, to ensure the birth of a healthy child and to help the mother rear the child. Women should have increased access to family planning and post abortal care services.
Government, health care workers, non governmental and corporate organizations, community leaders and all Nigerians must show more commitment towards reducing this high maternal mortality so that child birth can be made safer in Nigeria.