If life were truly equitable, everyone would have the same opportunities and access to resources, regardless of gender, race, ethnicity or beliefs. In Nigeria, this ideal remains far from the reality, particularly in healthcare for pregnant women.
While some women have access to quality care that ensures safe pregnancies and deliveries, countless others face significant barriers to basic maternal healthcare. These inequities highlight a sobering truth: access to quality healthcare in Nigeria is often determined by factors beyond one's control, leaving many women vulnerable to preventable complications.
Besides the horrifying experience facing Internally Displaced Persons (IDPs) in Nigeria's internally displacement camps, access to quality health facilities remains a challenging problem. According to a recent report, pregnant IDPs at Agagbe camp in Gwer West Local Government Area (LGA) of Benue State have turned toilets into delivery homes. These occurrences not only worsen the experience of childbirth but also expose them and their children to health issues, even death in the worst-case scenario.
A 2024 study conducted in Benue state found that the number of IDPs more than doubled, rising from 650,000 in 2021 to 1.5 million in 2022, and reached 2 million last year. This increase is due to decades-long farmer-herder clashes and land disputes.
Maternal mortality in the past
In the past, women gave birth independently in their rooms, bathrooms, and farms or with the support of traditional healthcare practices. This was due to a lack of healthcare facilities and technology. This often led to the high number of maternal and child deaths.
Fortunately, modernisation and advancement in healthcare have been instrumental in reducing maternal mortality.
According to the United Nations Children's Fund (UNICEF), from 2000 to 2020, the global maternal mortality ratio (MMR) declined by 34% -- from 339 deaths to 223 deaths per 100,000 live births. This translates into an average annual rate reduction of 2.1%. While substantive, this is only one-third of the 6.4% yearly rate needed to achieve the Sustainable Development Goals (SDGs) of 70 maternal deaths per 100,000 live births by 2030.
While available data shows that a few countries have achieved an MMR reduction of 15% or less in the past 20 years, bringing them closer to their target, the vulnerable condition of IDPs in Benue and other camps makes it evident that Nigeria is one of the many countries that is yet to achieve a significant reduction in MMR rate.
Maternal mortality in Nigeria's displacement camps
Nigeria's rate of 1,047 deaths per 100,000 births in 2020 is the third-highest in Africa. This figure highlights the country's struggle to meet the global target of fewer than 70 deaths per 100,000 live births by 2030. However, the situation in displacement camps mirrors a national crisis. Due to a combination of systemic issues, maternal mortality in displacement camps alone could double the national rate.
IDP camps are faced with the challenge of no functional hospitals, and women rely heavily on traditional birth attendants. While culturally accepted, these attendants lack the training to handle complications, significantly raising the likelihood of maternal and neonatal deaths.
The perception of healthcare quality also influences service utilisation. Many displaced women do not trust formal healthcare facilities, believing that their care will be substandard or unaffordable. This perception may discourage antenatal visits, with a significant number of displaced women attending fewer than the recommended four antenatal sessions.
The issue goes beyond the displacement camps in Benue and is widespread across Nigeria. Only six in ten pregnant women receive any antenatal care, and even fewer return to healthcare facilities for delivery.
The living situation of pregnant women in many IDP camps in Nigeria reflects the challenges of the past, when women gave birth without access to standard healthcare facilities. Studies show that women living in IDP camps have a higher risk of maternal death compared to those living in their homes. Terna Jacob, an IDP camp manager in Benue State, confirmed that there are high numbers of pregnant women in camps, who often experience high rates of stillbirths and deaths during childbirth.
Complications during pregnancy account for nearly 75% of all maternal deaths. These include severe bleeding (often occurring after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (known as pre-eclampsia and eclampsia), complications from delivery, and unsafe abortion.
Ways that could potentially reduce maternal mortality among IDPs
There is a need to leverage technology to enhance healthcare delivery. Mobile health (mHealth) initiatives that use mobile devices to provide health services and information have shown promise in resource-limited settings. These could be adapted in IDP camps to improve health education, facilitate remote consultations, and monitor pregnancies.
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Importantly, There is a need for political will and accountability. The government of Benue State should allocate a greater percentage of the state's budget to the healthcare sector and ensure the optimal release of funds and utilisation of these resources to improve the quality of service delivery. Additionally, engaging local communities in the planning and implementing health programs shoud ensure that interventions are culturally appropriate and address the specific needs of displaced populations.
Internally Displaced Persons (IDPs) remain the government's responsibility. While Civil Society Organisations (CSOs) can offer support, the government ultimately must provide quality healthcare for IDPs. This include conducting regular medical check-ups for women to during their pregnancy and ensuring they receive the needed assistance. Special attention should be given to pregnant women and children to ensure they live happy and healthy lives.
Implementing these practices should enable the reduction of maternal mortality rates, especially in IDP camps and contribute to achieving Sustainable Development Goal (SDG) target 3.1, which aims to reduce reduce the global maternal mortality ratio to less than 70 per 100 000 live births and ensure universal access to sexual and reproductive healthcare.
