By Boris Nwachukwu 


Sitting across to me during one of our rural medical outreaches was Ibimina*, a 25 year-old mother of five who is currently carrying her 8th pregnancy.  She had had two stillbirths.  Her oldest child is a seven year-old girl who looks underweight and underfed.  As she tries adjusting her suckling six month-old infant from her right breast to left breast, her one year-old son tugs at her wrapper, crying for attention and food.  She has come to see a doctor at this outreach for complaints of headache and fever. She had her first pregnancy at 16, shortly after she got married.

This scene sparked so many thoughts in my head.  This young lady was roughly my age, but looked much like a woman in her late thirties; was pregnancy, childbirth, and motherhood really so wearing on an adolescent body? And how was she still falling pregnant pregnancies in this prevailing economic crunch, both nationally and for mothers? How often did one of the many children fall ill, only for the illness to tear through the family, and what would the children do if their mother became too ill?

Amidst the collective of crying children around their mother, I inhaled deeply and began my check-up.  Today, I had to attend to the mother and one of her children, who complained of fever. As I took temperatures and checked heart rates, I asked if she has registered for antenatal care, or knew much about family planning.  She explained that she couldn’t afford antenatal care, and that her husband and religion forbade family planning. Luckily, her husband had accompanied her on this day, and so I scheduled some minutes to talk to both of them about their health, the impact of such a large family size, and the wellbeing of their unborn child.  Having been a passionate debater who had represented my university at national events, I was delicate but firm in countering some of their less-accurate beliefs. When I began to see their certainty waver, I took a serious tone and, as their doctor, finally advised them to present at any government hospital facility the following week.  With wide eyes, they agreed.

The story of this family resonates across various communities within and outside the African continent.  As a victim of child marriage – as evident by her marriage at the age of 16 – my patient unfortunately experienced her first stillbirth during this pregnancy, as her young and fragile body strained beneath the pressure of a pregnancy that it was not equipped to carry.  Ignorance, generally enforced by religious and cultural norms, are indeed the barriers to achieving a sustainable sexual and reproductive health and rights in the majority of African countries, and health professionals are key to resolving this injustice.

In Nigeria, traditional medicine men are respected in the community; not because they perform the best services, but because they are closer to the people of the community.  As health professionals, it is very important that myself and other clinicians descend from our medicalized (and, occasionally, self-imposed) high pedestal in order to better engage with the community.  This is not just a recommendation for mental wellbeing or a comforted conscience, but a strategic need if we are to actualize the good advocacy already in place to try to perpetuate sexual and reproductive health and rights for all people across Africa.

Likewise, it is also important that we take this advocacy everywhere we go: churches, mosques and town hall meetings are all very effective places where people of low and high standing can convene with folks might otherwise who have poor health seeking behaviors.  By gaining the support of conveners or religious leaders to set aside 30 minutes of a meeting or service to deliver for advocacy on health, a wider audience can be reached at a low cost and with negligible stress. And the bonus? They’re more inclined to listen when the message is supported by a leader they respect.

Moreover, rural outreach does not, in and of itself, cost a fortune.  It just requires a team with willing hearts and hands and a community-oriented approach.  At the outreach, sensitization on sexual and reproductive health and rights should be advocated.

Through various professional associations for health professionals, we are also well-placed to assert diplomatic pressure governments and policy-makers to allocate more resources to the cause, whilst ensuring accountability of public funds in the health sector. 

Finally, as health professionals, we need to understand that advocacy on sexual and reproductive health and rights is one of our primary assignments as health advocates, and we should not restrict ourselves to the walls of our respective clinics.  A community-centered approach can and should be implemented where possible, so that we can go out into the community to create real impact.  

Not only are our voices needed for sexual and reproductive health and rights, they truly have the power to change the entire discourse.  We simply must open our mouths for those who need it the most: our patients.

* Names have been changed protect identities 

Learn more about the author here.