Nigeria contributes significantly to the number of maternal deaths in not only sub-Saharan Africa, but the world as a whole.  Transmission of HIV/AIDS from mother to child during pregnancy, labour, delivery and nursing is a significant contributor to the prevalence of HIV/AIDS in Nigeria, but it can, fortunately, be mitigated.

Stemming the tide of vertical HIV transmission requires a multifaceted approach, including the use of maternal health facilities by expectant parents, and the arrangement for all childbirth to be managed and attended by a skilled midwife.  Despite studies done in different parts of the country that indicate the expansive knowledge women on the significance of delivering with a skilled birth attendant, statistics show that just less than 40% of births take place with a skilled midwife present.  Many women do not make use of these services for a number of different reasons, some of which are reflected in my own experience recently.

Nnena* was 8 months pregnant when she was newly diagnosed as HIV-positive.  She decided to give birth at home, even though she understood the significance of her diagnosis and had agreed to keep using her HIV drugs. The question is: Why?

The first public health facility (a Primary Health Center) that Nnena had contact with didn’t want to accept her for antenatal care (ANC), stating that she was too close to term to just commence antenatal with them and that her HIV status increased the risk of delivering her safely, and also the PHC had no emergency services just in case they may be required.  Unfortunately, this rejection wasn’t so tactful, and in addition to the stigma surrounding her HIV status, she felt unwanted and pushed away.  Some concerned members of her support group and health professionals stepped in to help the situation, but the situation proved insolvent with the Primary Health Center as they have had previous bad experiences with individuals too close to term just commencing ANC.

Determined to seek appropriate medical support, Nnena decided to contact a General Hospital.   The hospital had some laid down bureaucratic rules that made it difficult for her to register, all newly registering pregnant women needed to bring a family member usually the husband to donate a pint of blood to complete the registration process, and also requesting another money (General hospitals are more expensive than PHCs) for ANC will arouse his suspicions from him as she had not disclosed her HIV status to him.  The private hospitals that could take her were too expensive for her to afford admission.

She decided to make arrangements for her delivery at home with a midwife.  With no centralized monitoring of midwifery qualifications available, it was not verifiable if the midwife was a traditional birth attendant, a nurse with midwifery training, or a midwife in earnest, but she had to trust that she was receiving the best care she could.  After much discussion, persuasion, and coercion, a private facility with affordable services was found for her at last.  Nnena was lucky that she had collective support from concerned people who were persistent in helping her secure a good outcome.  A lot of women out there do not have this opportunity, and rarely do they have anyone who can help them attain clarity on their health decisions.

This story points out some of the major barriers we have in Nigeria in safe, respectful maternity care for women with HIV:

1. Poor health worker attitudes to service delivery


2. Unclear health service delivery methods​ and rules


3. Stigma against people living with HIV


4. Poverty as a barrier to accessing healthcare


6. Limited access to health information

Solving these problems will require concerted effort from all stakeholders in healthcare, and these efforts must be led and driven by the government.  This will include increased investment in primary health, improving access to requisite health information​, improving the conditions of human resources for health, and most of all, achieving universal health coverage.  Universal health coverage will go a long way in removing some, if not all, of these barriers.  There will also be a need to invest more in education for the girl child and general female empowerment, as this will enable increased female autonomy to make better decisions for themselves not only regarding healthcare, but in all aspects of their lives.  These achievements will elevate standards for health across Nigeria, with improved positive outcomes in maternal and child health that will also contribute to preventing the spread of HIV/AIDS.

Bibliography

  1. Perception of quality of maternal healthcare services among women utilizing antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria Obiageli et. Al.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003719/

  2. Barriers to utilisation of maternal health services in a semi-urban community in northern Nigeria: The clients' perspective Suleman et. Al.http://www.nigeriamedj.com/article.asp?issn=0300-1652;year=2013;volume=54;issue=1;spage=27;epage=32;aulast=Idris

  3. UN Data. http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A570

 

 

* Names have been changed to protect identities

 

About the Author.