Olaoluwatomi Lamikanra

By Olaoluwatomi and Ufuoma Lamikanra. Growing up in a rural area in Nigeria, the fear of childbirth was a frightening reality. Deaths during childbirth touched everyone in the village where I (Ufuoma) lived. Another death was another tragedy, another reason for the community to be thrown into deep mourning and a helpless acceptance of what was seen as an unavoidable fate. Fifty or so years down the line, the reality is not much different.Women still die from delivery and pregnancy-related causes and there does not seem to be much difference whether it occurs in the urban or rural areas. There are stories everyday of lives lost in teaching hospitals as well as in local health centers. Many more lives are lost when women give birth at home or when they do not have skilled birth attendants in labor.

What are the main causes of death in pregnancy? The same five leading causes of death found anywhere else in the world. Hemorrhage, sepsis, unsafe abortions, hypertensive disorders, and obstructed labor^aa.  Hemorrhage is one cause that has a particularly devastating consequence as we do not have reliable blood banks, and the blood supply is epileptic or many times non-existent. A pregnant woman who needs blood in many instances is at the mercy of friends and relatives who have to donate blood. If she has no friends, family, or compatible blood donors, her life is definitely at risk.

An event witnessed by my husband/my father 35 years ago and still true of the problems besetting the health sector in Nigeria today!

Amina (not real name) was a pregnant woman who was rushed into a general hospital after several hours in labor. Examination at the health facility revealed she had a ruptured uterus. She was wheeled into theatre almost immediately and her uterus was repaired. There was no blood available so even though she had lost a lot of blood she did not receive any. Following Amina’s operation, doctors warned her to lie on her hospital bed but she refused, saying it was strange for a woman to lie down on the bed doing no work. She insisted on getting up every morning to sweep the hospital compound. She did this for a few days and one morning she did not wake up!

Nigeria has a MMR of 840/100,000^a. This rate varies widely with the highest rates of 2420/100,000 in the northern regions^b. As in any other parts of the world, MMR in Nigeria are dependent on where a woman lives (urban vs rural areas) and the female literacy rate^c , which in turn determines her level of empowerment. Is she able to contribute to discussions about her health or are the health decisions left for her husband or in-laws to make? (more…)

By Ufuoma Lamikanra. Domestic violence is a sad scourge that is faced by many women worldwide irrespective of age, education, religion, class and ethnicity. Although a worldwide phenomenon, causes of domestic violence vary from place to place. In many African countries, the inability of a woman to bear children or infertility is a major cause of domestic violence. She must also bear the “right”kind of children. To have only females is considered an “offence” (son preference).that may lead to the “offending’ wife being replaced by another woman.

Although provisions related to domestic violence are included in several national policies and laws [and international laws], there are difficulties in implementing them. The problem is not the absence of laws against DV but in the enforcement of the existing laws. In Nigeria, female victims of domestic violence are reluctant to report to the police, because being over worked, the police hardly investigate reported cases. Such issues are usually regarded as domestic affairs which are better dealt with by family members and friends. But ‘one in every five women faces some form of violence in her lifetime, in some cases leading to serious injury or death’.

Why would any woman remain in an abusive situation that may cause her grievous harm or death? Fear of the future – loss of food and shelter, fear of losing societal respect, lack of parental support and threat of murder are some of the reasons adduced by researchers.

A new website shares the sad story of a Nigerian woman, Ogochukwu, who took her secret of domestic violence to the grave leaving behind a daughter who may one day be cursed with the same fate. Why did Ogochukwu remain in a marriage that led to her death? Read her story at http://www.ogorip.com/my-story.html.

By Ufuoma Lamikanra. In Nigeria, many politicians turn out to be poor leaders. This is mainly because most political office holders never prepare for governance. They were either pressurized to run for office or had pecuniary gain as a goal. Consequently, the political manifestos of such politicians are usually drawn to deceive or to cajole the electorate into voting them into office. Once elected, they pursue their personal agenda while making little or no effort to deliver on their electoral promises.

One of the exceptions to the scenario described above is the case of Dr. Olusegun Mimiko, Governor of Ondo State, Nigeria. He has clearly fulfilled a very important pre-election campaign promise that has positively impacted the lives of women in Ondo state. When he assumed office in 2009, he introduced the Abiye Safe Motherhood pilot scheme in a local government area in the State. The scheme was intended “to bring qualitative and accessible health care to women and children to reduce maternal and infant mortality.” The success recorded, referred to by the World Bank as one of the success stories coming out of Africa, led to the recent implementation of the programme in the other 17 local government areas. An interesting feature of the Scheme is the establishment of Health Rangers, specially trained community health extension workers, who effectively monitor the pregnant women and provide them with mobile phones linked to a toll free closed user group.

Another state leader in Nigeria also made strides in women’s health and gender equality in 2009. When Dr. Kayode Fayemi of Ekiti State, Nigeria assumed office, he had an eight point agenda with which he asked that his performance be assessed which included participatory governance, infrastructural development, modernizing agriculture, education and capital development, industrial development, tourism, gender equality and empowerment and health care services. The last item, health care services is of great importance, since Nigeria has the second highest maternal mortality rate in the world. Fayemi introduced a free health programme which takes care of physically challenged, pregnant women, children under the age of five years and adults over the age of 65 years.

Political will and redirection of resources, as evidenced by the success stories above, have led to marked improvement in the health status of vulnerable members of both states, including women. We believe that very soon, the life expectancy of women in Ekiti and Ondo States will rise above the national average of 54 years. Similar programmes implemented by the other 33 state governors (Lagos also has good health programmes for its citizens), will swing Nigeria back on track to achieving the Millennium Development women’s health goals.

By Ufuoma Lamikanra. Why do many people fear death? I believe that it is a fear of the unknown. If you do not know what will happen to you at the end of life, it is a normal feeling to be afraid. This fear appears to be common among both young and old persons. When my then four year old daughter (she is now about 33 years old) was bitten by a dog, she kept on asking if she was going to die. A colleague told me of a man who always left a gathering of friends whenever the discussion turned to issues on or related to the end of life. Others took advantage of his fears and regularly excluded him from their midst by discussing such “unpleasant” issues.

However, my grandfather was not afraid to die. He desired death instead. At about the age of 90 years (calculated, since there were no records when he was born), many of his age mates – friends and relatives, no longer visited him and he suspected that they had died.  He was always told that they were alive. Nobody was bold enough to tell him the truth. One of his almost daily wishes was to join them, as he could not understand what he was still doing on earth while all his contemporaries were gone.

Many Africans, especially men, loathe leaving the world without leaving behind certain “achievements”. A man is regarded as a failure, if he is unmarried, does not own a house and more importantly, has no male child at the time of death. The absence of a male heir means the tragic end of a lineage as that family name becomes extinct. The pain of death is somewhat lessened by the fact that the deceased left behind male children, to carry on the family name.

A notable feature of the end of life in many African cultures is the belief that most deaths are not natural, but occur through supernatural means. There is always a strong suspicion that someone, usually a close relative, must have been responsible for a death in the family. Sadly, wives are usually accused of killing their husbands, while husbands are rarely accused of ending their wives’ lives. So, who is responsible for women’s death? According to my auntie, women kill their husbands, while women die as a result of their sins.