By Offiong Esop Akpabio 

I have not eaten, so they should not expect food.



The first time I laid my eyes on a set of severely marasmic Irish twins, I was determined to support them with all that I had. Up to this point, like most of us, I grew up believing that after the birth of a child, a woman by nature was given a considerate amount of time for postpartum healing, but I guess nobody really understands a lot of what happens in nature but one thing I knew for sure was this; I never expected a set of Irish twins to come from Mmanne , a fifteen year old girl from Ikoteno, a rural community in Cross River State in Nigeria. Further interaction with this family and community exposed the interplay of factors that define the vicious cycle of poverty in sub-Saharan Africa.

Ikoteno has a few basic social infrastructures (primary and secondary school, health care facility) and a stream as its primary source of water which is quite a distance from the community. A transient walk into the community revealed high poverty rates, teenage pregnancies, lack of faith in girl-child education, high birth-rates and subsequently, maternal deaths. Ikoteno has a greater population of adolescents and like every other adolescent girl who grew up in a typical disadvantaged community, Mmanne was a victim of her immediate society.

Mmanne was the first child of a mother of eight who was pregnant with her ninth child. She dropped out in primary four with her only source of livelihood being helping her mother at the farm. Like many sexually-curious 15 year olds living in a community where teenage childbirth is high and being influenced by her society, she became pregnant by her neighbour (who was not married to her) and was sent to live with him.  She gave birth to her first child in December 2017. Interestingly, nine months later, she gave birth to her second child. Mmanne gave birth to two babies under-one within the same calendar year. Unfortunately, Mmanne and her children suffered from gross malnutrition with her first child being on the brink of death before I intervened. 

The health worker who worked in the health facility a few blocks away from Mmanne’s house revealed that the young mother suffered from all forms of domestic violence including intimate partner violence. She also described the young mother’s hesitancy to opt for contraceptives as ignorance. As a result of her economic disadvantages, her children suffer neglect and deprivation.   

Sadly, this is one of the horrors of adolescent girls and young women in sub-Saharan Africa, shackled by the claws of poverty and ignorance. Furthermore, teenage pregnancy poses its own risks, even worse is the danger of having two babies in the same calendar year by an adolescent.

Mothers of Irish twins suffer from lacerations and tearing of the vagina/cervix. Exclusive breastfeeding becomes unachievable with the first twin being neglected and its development being slow compared to its development at birth. It takes a woman’s body some time to rebound and recover after birth which Mmanne never had; therefore, the second child of an Irish twin suffers endless problems including prematurity, a low birth weight and is likely to suffer from malnutrition as the first child after the breastfeeding stage is over.

Mmanne’s ordeal reflects greater societal issues such as the intergenerational cycle of malnutrition, poor utilisation of community infrastructures, poor family collective efficacy and a question of cultural and societal views of women and girls. These are more difficult to change but we must try, therefore, it is important that as individuals and advocates, we stress in communities the importance of child spacing in helping the pelvic floor regain some of its strength. The first three months after delivery are equally as important as the first, second and third trimesters and is what I like to consider as the “fourth trimester”. Also, we cannot neglect the role of girl-child education in sub-Saharan Africa; equally, we must embrace and encourage contraceptive use even as we teach abstinence especially in low-resource settings. We must give women and girls the opportunity for their voices to be heard and their echoes to be loud. Finally, we must learn to support all the girls and women in sub-Saharan Africa.