On the morning of 11 April, 2008, Rakiya Ibrahim walked into Dalhatu Specialist Hospital in Lafia, Nasarawa State, to access ante-natal services. She had gone to the hospital following advice from her pregnant neighbour on the benefits of ante-natal care for her and her unborn child.
Ms Ibrahim was already 18 weeks pregnant at the time she made the decision she later considered a life-changing one. At the hospital, as is done for every pregnant woman, Ms Ibrahim’s blood sample was taken for regular screening.
“About 30 minutes later, a female nurse dressed in a combination of white and blue uniform called the women into her office one after the other, until it got to my turn,” Ms Ibrahim, who resides in the Angwan Gayam area of the state, narrated to this reporter in Hausa. “After giving a lengthy preamble speech, the nurse said I have contracted a disease called HIV,” she said.
According to Ms Ibrahim, the nurse further explained the implication of living with the Human Immunodeficiency Virus (HIV) and its effect on her unborn child which by the way, was her first child. When the child was eventually born, he tested negative for the virus. “Receiving the news that my son Umar was not infected with the virus is probably the happiest news of my life,” she said.
In the absence of intervention, Ms Ibrahim had a 15 to 45 per cent chance of passing the virus on to her child, according to the World Health Organisation (WHO). After Umar, Ms Ibrahim delivered five more children. Sadly, her last child, Asmau, tested positive for HIV, due to Ms Ibrahim’s actions. Of all six children, Asmau is the only one born positive for HIV and the reason for this is obvious.
While pregnant with Asmau, Ms Ibrahim shunned the health facility and opted for the help of a Traditional Birth Attendant (TBA). This means she never enjoyed pre-natal services throughout her pregnancy. She also stopped taking her medications in the mistaken belief that she was no longer living with the virus.
“I thought the virus was no longer in my blood since I was feeling good and all my first five children were born negative,” Ms Ibrahim said. That one wrong move by Ms Ibrahim not only put her life at risk but also jeopardised the life of little Asmau.
Before the advent of modern obstetric services, TBAs were popularly known to render services to pregnant women, especially in the African region. With major progress made around the globe, it is anticipated that women will give birth in approved health clinics, but some women, especially those in rural communities, still patronise TBAs.
Like in many low and middle-income countries, many pregnant women in Nigeria continue to give birth at home with the help of TBAs, putting their lives and that of the child at risk. Ms Ibrahim, while carrying Asmau’s pregnancy, fits into this category. Nonchalance as was the case when Ms Ibrahim was pregnant with Asmau is not the only reason some pregnant women prefer to use TBAs.
Deborah Yakubu, a woman living with HIV and residing in Igu, a community in Bwari, a suburb of the FCT, said she prefers the TBA in her community to health workers at the Primary Health Centre (PHC). Ms Yakubu’s reason is that health workers most times make pregnant women feel neglected. She initially commenced ante-natal at the health facility but stopped halfway due ‘to ill-treatment’ from the nurses.
She also said it is far cheaper going to a TBA because they mostly accept wrappers or food items as a form of payment. “It is easier to communicate with the TBA than those nurses, although I regret infecting my child with the virus,” she said.
Ms Yakubu also said at the health centres, “we are forced to make payment for different forms and antenatal services/requirements. I can’t always afford that,” she said. Research has shown that the obsession of pregnant women with TBAs contributes majorly to increased maternal and child mortality rates. It has also frustrated the efforts to Eliminate Mother to Child Transmission of HIV (EMTCT) in Nigeria.
Despite proven medical interventions in place to prevent a mother from transmitting the virus to her child, many children are still born with HIV every year. “A large number of these babies contracted the virus because their mothers failed to access health facilities for ante-natal care,” the National Prevention of Mother to Child Transmission (PMTCT) lead at the National AIDS and STIs Control Programme (NASCP), Gbenga Ijaodola, said.
Mr Ijaodola said some pregnant women opt to deliver at home or other birthing locations instead of approved health centres. He said data from the 2018 National Demographic Health Survey (NDHS) indicates that a larger percentage of pregnant women still patronise TBAs. He said this is due to some factors, which include socioeconomic status, long distances to the health facility, and the current economic situation in Nigeria.
“The intention is not to harm any mother or child but just to help them deliver safely,” Mama Aisha said in Hausa. Helping pregnant women deliver their children is what Mama Aisha knows how to do best. But she is ignorant of HIV or any implication it may have on the child.
Four years old Asmau is one of the millions of children born with HIV globally every year. At least one child globally was infected with HIV every two minutes in 2020, according to the United Nations Children’s Fund (UNICEF).
A UNICEF report also shows that at least one child between the ages of 0-9 years was infected with HIV every 30 minutes in 2020. This means that about 20,695 children in Nigeria were newly infected with HIV in 2020.
Nigeria contributes the largest burden of babies born with HIV in the world. In 2016 alone, the country accounted for 37,000 of the world’s 160,000 new cases of babies born with HIV. “The statistics don’t lie, the numbers keep increasing,” Mr Ijaodola said.
Ms Adamu, who resides in Angwan Alhamdu, Nasarawa eggon in Nasarawa State, said she delivered Hajara at home with the help of a TBA popularly called ‘Mama’ in the community. She, however, regrets her decision of avoiding the health facility. “Whenever I remember my child is infected with HIV because of me, I cry,” she said in Hausa.
More than one million women globally infected with HIV are estimated to deliver babies without professional help each year. Asmau and Hajara’s mothers contribute to this figure. Estimates from the Joint United Nations Programme on HIV/AIDS also show that 21.58 per cent of HIV-infected pregnant Nigerian women transmitted the virus to their children in 2016 because they failed to seek prenatal services.
The assistant director of NASCP, Jamiyu Ganiyu, said MTCT is preventable through tracking the delivery of a proven set of health interventions but nothing can be done when pregnant women fail to present at the health facility. Mr Ganiyu said the preference for TBA is a major challenge as more than 50 per cent of women who attend antenatal care end up delivering at home. He said most pregnant women opt for TBAs majorly due to the high cost of healthcare services and distance to health facilities.
Although TBAs play an important role in the provision of care to pregnant women, especially in rural communities, they are barely recognised by the formal health sector. Health experts have repeatedly advocated the integration of TBAs into health services by providing them with HIV counselling and other training.