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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

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Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

By: Michael Mike

In the bustling emergency ward of Jahun General Hospital’s maternity department, the rhythm of activity beats with urgency and determination, like a pulse in the air. In this hospital, Médecins Sans Frontières (MSF) collaborates with the Jigawa state Ministry of Health to provide comprehensive emergency obstetrics and newborn care and fistula care. Since commencing services in 2008, MSF teams have assisted 90,000 deliveries.
Nigeria is the third country in the world, after South Sudan and Chad, where a woman is most likely to die giving birth, according to the World Health Organisation. With an average of more than 1,000 maternal deaths per 100,000 live births each year, Nigeria is far from the global target for 2030 of less than 70 maternal deaths per 100,000 live births, as set under the UN Sustainable Development Goals.
Maternal mortality rates far exceed the country average in northern Nigeria, where more than half of the country’s estimated 200 million people live. In Jigawa state, the most significant factor is the limited access pregnant women have to antenatal care and delivery care for complications in childbirth, which frequently occur.
Unity Enuebuke, MSF Nursing Activity Manager, has been working in Jahun General Hospital for more than 10 years. “We see a lot of women with serious complications, with the most common ones being anaemia, haemorrhage and eclampsia,” she explains. The high number of patients means the maternity wards are often fully occupied, if not over capacity. Unity says, “We regularly have up to two women sharing a bed, and depending on the type of complications we see, things can escalate very quickly.”
Ramatu
Ramatu, a mother of two, suffered life-threatening eclampsia—seizures due to high blood pressure—when she delivered her first baby in Jahun hospital. This is her second time here, overcoming the considerable distance from home. “I live five hours away from Jahun General Hospital. There is no hospital where I live, and the closest one does not open at night,” she explains. In Jigawa state, many of the estimated 749 primary healthcare centres do not have the drugs, healthcare workers and medical equipment to serve the thousands of women of childbearing age, despite efforts from public health authorities, the current healthcare infrastructure does not come close to meeting the needs of the population.
This dire situation leaves pregnant women who want to attend a healthcare facility with limited choices such as giving birth at home, and if complications arise, embarking on a treacherous journey to try to reach one that is functioning.
It is also not enough that healthcare facilities are available, they must also be affordable. The economic reality in this region, worsened by soaring inflation rates, makes it difficult for people to afford hospital fees, drugs or even transportation to health facilities.
The result is that women become hesitant to go to the hospital, preferring to give birth at home with the help of more affordable traditional birth attendants, hence increasing the risk of experiencing complications.
Khadijah
Women have given birth at home for centuries, but mother’s and baby’s survival can hinge on preparing and planning for managing complications, which may also occur without warning. In Jigawa state, health professionals and facility-based delivery rates remain low with up to around 80% of deliveries occurring at home.
Nurse Unity says, “Most times, family members don’t bring the mother to the hospital until they see that the baby is not coming out and the mother herself is having seizures.”
Khadijah, a 58-year-old traditional birth attendant in Aujara community, Jigawa state, understands the value of hospital care if she can’t manage a complication, but has experienced women’s hesitation firsthand. “Some women take my advice when I say they should go to the hospital, while some refuse to go to the hospital because they say that they are used to giving birth at home.”
In many communities in Jigawa state, pregnant women often require permission from their husband or mothers-in-law to visit hospital. This practice is compounded by a trend of early marriage, at an age when women are not fully informed about pregnancy and are not physically ready to carry a child.
Khadijah explains that for some, “it is their husbands that prevent them from going to the hospital. Some men don’t see the relevance of antenatal care, while others don’t want another man to treat their wives.”
1.

What needs to be done?
To tackle maternal mortality, a multitude of factors must be addressed. State authorities and international organisations must scale up their activities and increase funding to healthcare in the region, ensuring that budget allocations for primary healthcare centres are properly utilised and thorough planning and strict implementation processes are in place. In 2023, MSF teams assisted 15,754 deliveries, performed 1,911 caesarean sections and completed 43,785 antenatal consultations. Yet, it is still a drop in the ocean when looking at the needs of women in Jigawa state.
Primary healthcare facilities, which are often the first point where pregnant women seek healthcare, need to be equipped with trained personnel, equipment and resources to manage childbirth-related complications. “Eighty two percent of the cases we receive at Jahun General Hospital are complicated cases that could have been prevented at the primary healthcare level.” says Abdulwahab Mohamed, MSF medical coordinator. “Women, especially those of childbearing age, also have to be informed about their health and wellbeing through health empowerment programmes led by state authorities or other health stakeholders”.
Pregnant women must be encouraged to go for antenatal care where they can be informed about their pregnancy journey and what to expect. Efforts must be made to mitigate cultural practices that hinder women from seeking care in medical facilities. Women should be allowed agency and given freedom to make decisions for their health.
MSF supports the Jigawa state Ministry of Health in providing comprehensive emergency obstetrics and newborn care. Our support started with vesicovaginal fistula repair in 2008, however, the project evolved into a 161-bed facility to care for pregnant women and newborns experiencing complications. MSF teams also provide maternal and neonatal healthcare in the states of Kano, Benue, Cross River, Zamfara and will open a large maternity hospital in Maiduguri in June 2024.

Accessing healthcare: An arduous journey for pregnant women in northwest Nigeria

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Violent clash in Sabon-Titi area of Tunga Minna leaves one dead, several arrested

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Violent clash in Sabon-Titi area of Tunga Minna leaves one dead, several arrested

By: Zagazola Makama

A violent confrontation among rival youths in Sabon-Titi area of Tunga, Minna, Niger State, resulted in the death of one person and the arrest of several others, security sources confirmed on Saturday.

According to sources, on Friday at about 8:00 p.m., a group of youths armed with dangerous weapons were sighted causing havoc along David Mark Road. Security operatives quickly intervened and dispersed the group.

However, at about 1:00 a.m. on Saturday, the same group engaged in a violent clash among themselves using matchets and daggers. Twelve suspects, including Ibrahim Musa, Abbah Hussaini, Babangida Gambo, and Abubakar Bala, were arrested, by the police and their weapons recovered.

Later at about 8:30 a.m., Bello Mohammed of Farm Centre, Tunga Minna, was found lying in a pool of blood. He was rushed to General Hospital Minna but was confirmed dead on arrival.

Sources said that preliminary investigations indicate that the deceased was among the suspected thugs terrorizing residents in the area.

Violent clash in Sabon-Titi area of Tunga Minna leaves one dead, several arrested

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Young fulani man killed, six cows poisoned in separate farmland incidents in Plateau state

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Young fulani man killed, six cows poisoned in separate farmland incidents in Plateau state

By: Zagazola Makama

A 25-year-old Fulani man, Yakubu Salisu of Tenti village, Bokkos Local Government Area, was killed in a violent attack, while six cows were poisoned in a separate incident in Riyom Local Government Area of Plateau State on Saturday, authorities confirmed.

According to sources , Salisu was stabbed at the back by yet-to-be-identified assailants suspected to be locals of Bokkos. He died instantly at the scene.

Before the attack, a farmer, Josiah Joshua, 28, said he reportedly confronted six herders rearing cows on his farm. According to him, herders allegedly refused to remove the animals and attacked Joshua, resulting in injuries.

In retaliation, Joshua mobilized his friends to attack Yakubu Salisu, stabbing him multiple times on his before and killing him instantly.

Local leaders told Zagazola that the claims by some parties suggesting the Fulani victims “invaded farmlands” are false and appear to be an attempt to justify the attacks. Investigations indicate both incidents were unprovoked and targeted.

The police, however stormed the scene, photographed the corps and later released to relatives for burial according to Islamic rites, as the family declined an autopsy. The Authorities said they have commenced investigation, and efforts are ongoing to apprehend the perpetrators.

Meanwhile, in Riyom LGA, six cows were poisoned in Kwi village without any apparent provocation.

Authorities have commenced investigations into both incidents, and efforts are ongoing to apprehend the perpetrators.

Security officials warned residents to remain vigilant and urged communities to avoid taking the law into their own hands.

These incidents illustrate the rising tensions in Plateau State, drawing attention to the need for swift intervention to prevent escalation of communal violence over farmland disputes.

Young fulani man killed, six cows poisoned in separate farmland incidents in Plateau state

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Silent Changes, Big Impact: Adeola Ajayi’s Transformation of the DSS

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Silent Changes, Big Impact: Adeola Ajayi’s Transformation of the DSS

By: Sunday Oladapo

Leadership in the security sector often reveals itself not through grand speeches or public displays of authority, but through quiet, deliberate decisions that gradually shift systems, culture, and outcomes. Adeola Ajayi’s stewardship of the Department of State Services (DSS) exemplifies this subtle but powerful form of leadership. Though he rarely seeks the spotlight, the changes unfolding under his watch are reshaping the DSS in ways that many insiders describe as the most meaningful transformation the agency has witnessed in years.

From the moment Ajayi assumed office, it was clear he was bringing a different kind of energy—one rooted in discipline, modernization, and strategic silence. Instead of sweeping pronouncements, he focused on strengthening the agency’s foundation: its people, processes, and purpose. And this approach, though understated, is now yielding visible dividends.

Reinvigorating Professionalism and Intelligence Capacity

One of Ajayi’s most significant achievements is the recalibration of the DSS’s intelligence framework. Recognizing that modern threats—from terrorism to cybercrime—require an intelligence service that is both proactive and technologically sophisticated, he initiated targeted reforms to upgrade analytical tools, digital surveillance capacity, and field operations coordination.

Training programs have also been revitalized. Officers are now exposed to global best practices in intelligence gathering, behavioral analysis, cybersecurity, and inter-agency communication. The goal is simple but transformative: build a DSS that can prevent threats before they materialize, rather than merely responding after damage has been done.

Ajayi’s emphasis on data-driven intelligence has contributed to more efficient threat assessment, improved crisis response, and a more agile internal structure that encourages innovation instead of outdated, rigid protocols.

Strengthening Inter-Agency Collaboration

A common weakness in Nigeria’s security architecture has been fragmentation—agencies working in silos, often competing rather than collaborating. Ajayi has worked quietly but effectively to change this dynamic. His leadership has fostered smoother cooperation between the DSS, the police, the military, and other national security institutions.

By prioritizing information-sharing, joint operations, and coordinated strategy development, Ajayi has positioned the DSS as a core driver of national security synergy. This shift may not be flashy, but its impact on operational success is already becoming evident.

Humanizing the Service and Rebuilding Public Trust

For many years, perceptions of the DSS fluctuated between respect and apprehension, largely due to concerns over transparency and human-rights practices. Ajayi has taken deliberate steps to address this by promoting a more professional, rights-conscious operational culture. Officers now undergo enhanced training on ethical conduct, community engagement, and communication.

While the DSS is not—and cannot be—a public-relations-driven institution, Ajayi understands that a modern security service must maintain a level of trust with the citizens it protects. His reforms are gradually helping to redefine the agency’s public interface, balancing its mandate for secrecy with an improved commitment to professionalism and accountability.

Internal Welfare and Institutional Stability

Security agencies perform best when their personnel feel valued, motivated, and well-equipped. Ajayi has strengthened internal welfare systems, ensuring officers receive improved support, clearer career growth opportunities, and the tools they need to perform effectively. This has boosted morale and reduced internal friction—two factors crucial for operational efficiency.

His quiet stabilizing influence has also brought a sense of predictability to DSS operations. Under his leadership, the agency appears more insulated from political turbulence, allowing it to focus squarely on its mandate.

A Leadership Style Rooted in Strategy, Not Spectacle

In a time when some leaders rely on bravado or theatrics to appear effective, Ajayi stands out for his disciplined restraint. His philosophy seems guided by a fundamental principle: a security agency’s success is measured in outcomes, not headlines. The calmness of his leadership style has enabled him to pursue reforms without unnecessary noise, distractions, or politicization.

And this may be the true hallmark of his impact—delivering change through consistency rather than controversy.

Looking Ahead: A Long-Term Blueprint for the DSS

If the momentum of Ajayi’s reforms is sustained, the DSS could emerge as a more modern, reliable, and globally respected intelligence service. His agenda sets a foundation for:

A culture of professionalism over patronage

A stronger intelligence-driven approach to national security

A more integrated and collaborative security environment

A service that balances secrecy with lawful, ethical conduct

A stable institution that prioritizes national interest above all else

His leadership demonstrates that meaningful reform does not always come with fanfare. Sometimes, it comes quietly—through silent changes that produce big, enduring impact.

In transforming the DSS with such strategic subtlety, Adeola Ajayi is not only redefining the institution but also showing that a new era of thoughtful, modern security leadership is both possible and already taking shape.
Sunday Oladapo is a public analysts from Abuja

Silent Changes, Big Impact: Adeola Ajayi’s Transformation of the DSS

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