ROLAND OGBONNAYA AND STANLEY NKWAZEMA TOOK on THE COUNTRY DIRECTOR OF IPAS IN NIGERIA, DOCTOR EJIKE ORJI, ON THE ISSUES OF ABORTION AND REPRODUCTIVE HEALTH IN NIGERIA
Doctor Ejike Orji is a gynecologist. He temporarily dropped the stethoscope to go into the advocacy side of health some few years ago. Today, he is the Country Director of Ipas, an international organisation focused on women's right and health globally. At present, he said that Ipas works in 40 countries including Nigeria. "Our main work is to make sure that no woman dies from complications of unsafe abortion," he told THISDAY in Abuja recently.
"In other words, we want to make sure that women are able to manage their fertility, having contraceptive information and services to prevent deaths. We also work to make sure that the reproductive health space of the Nigerian women is taken care of. They have right to access whatever information on reproductive health and services that they need. So that's generally what we do globally," he emphasised.
In Nigeria, Orji said, "we have trained a lot of doctors and nurses in post abortion care, how to treat women who have had complications of abortion and to also make sure that they don't have another abortion. They are led properly to family health planning clinics. We are also working with nine women groups nationally, giving them information ranging from advocacy and legislative process management skills, programme management skills, fund raising skills, and even how to monitor their progress.
"We have four programme monitoring officers to be with these women groups and associations. We have also trained 410 journalists in reproductive health issues. We have also worked and are still working with the young people. We are working with the National Association of Medical Students in Nigeria and are doing this to make sure that the young medical officers key into what we are doing. To make sure that as they grow up they are responsible adults either as service providers or citizens," Orji explained.
He further said that Ipas has also done a lot of work in supporting women groups to engage in community sensitisation of other women. "We support these nine women groups to go to the villages to propagate the issues of family planning and quality of life. Also, we work with the legislators and lawyers. We set up the network of the Bar, the Bench and the Police, to keep abreast on women sexual and reproductive health."
Of course, in doing this kind of work there are lots of challenges. One such concern is that there is no Nigerian pharmaceutical or Drugs Company that has been certified by the WHO to manufacture reproductive health materials or medicaments. "I know that a few years ago when Professor Dora Akunyili was saddled with the mantle of leadership of NAFDAC, she did try to encourage Nigerian pharmaceutical companies. Some of them did take up the challenge and a lot of drugs were being manufactured in the country and even exported to the West African sub-region. It is still a big source of worry. Occasionally, I don't know whether to say it is political or not. But it is important to note that once an organisation is given a GMP stamp, it can take away jobs and also work from other countries.
"However, I do believe that there is some level of international standardisation and transparency. If they meet it, I am sure they are going to get it. So what we need to do is to have them meet those standards. It is government that actually has to help them. There must be some kind of financial incentives and SOPs (Standard Operating Procedures) development. There are no short cuts, its an international standard and they must be met before we can say we have gotten there," he said.
Orji also looked critically at VVF health challenge. He said VVF is a very good indicator of the poor antenatal care services available in the country. Regardless of the age of the child or woman, he said if there is a good health care system in place, peoples' health needs can actually be taken care of. He said VVF occurs when the pelvis of the woman is not properly developed, and too narrow for the baby's head to pass through.
In good health centres, he said the girl or woman could be sectioned. "So this is a very good indicator that our health care system is not optimum.
So in terms of prevention, what we need to do is to make sure that we are encouraged to do what we are doing now. The midwifery service scheme, which we are part of conceptualising was to seek, to make sure that skilled attendants attend to our women when they are about to have a baby.
"So the way forward now, on the interim is to make sure that we redistribute the number of nurses that we have. Send them to rural areas where only 35 per cent of them have skilled attendants to attend to women when they want to have a baby. And that is what the midwifery service scheme is all about. Nigeria has just won an award on that. So we have to build on that. And the most important thing is to make sure that the scheme is implemented.
Abortion is one health issue so many people try as much as possible to shy away from. The Ipas boss admits it's a huge problem. "Abortion is an emotive problem so there will always be a huge outcry by anti-choice people who believe that a woman does not have a choice to terminate the pregnancy that she does not want. And it will continue to be a problem because of religious injunctions. But the truth of the matter is that whether we like it or not, abortion is still a killer.
"There is a recent study that just came out from Lagos. If you look at the demographics of where the doctors are in Nigeria, you will find out that the Southwest has the highest number of doctors per capita in the country, in terms of doctors' ratio and population. If you look at that, you will see that even though that there is a high level of doctors in Lagos, abortion related deaths contributed to the 45 percent of the maternal deaths. And that is quite huge.
"So, no matter what anybody says, whether you want to hide it or not, women will continue to seek terminations of pregnancies they don't want. Some might be out of rape; some might be out of sexual relationship in the family. Or some might be socio-economic or whether they are still in school. Women look for abortion for all manner of reasons. So the most important thing here is to first of all prevent it and that is why the family planning conference is key to make sure that women are taught to keep the pregnancies they want and not terminate it.
"However, the most important thing is that we must make sure that if they get pregnant and they don't want it, they can terminate it, I am for choice, the law should be liberalised. There is no need pretending and every day we still have abortions. About 45 per cent out of every woman that died in Lagos State was because of abortion related consequences. That is too high," he regretted.
This is coming from the mouth of a man who has been in practice as a physician for 32 years and 20 years out of this have been on reproductive health. Before coming to Ipas, Orji had worked with a German organisation. "But my passion to do this work is actually from home. I come from a family of six siblings with one of them being a man. Am the man in the house, others are girls. So I am a man amongst women.
"In making sure that women don't die from abortion, I have always looked at things that are different from other people. I like to focus on where the problem is. So that is why, when I was a kid, I lost a relation who had abortion complications. It was only when I became a doctor that I realised that it could have been mitigated or avoided. So, based on that, I became conscious that no woman that I know would die of complications of abortion," he told THISDAY.