Birth kits help women having safe deliveries

The things Precious Alfred takes for granted could very well make the difference between life and death for countless other women pregnant like her. It is a birth kit—a pack of all she will need once she goes into labour—and one she’s spent thousands of naira buying in gleeful expectation.Seven months along, and several antenatal care attendance in an Abuja private hospital under her belt, she is not worried.But this is not so for hundreds of pregnant women from Mabushi and Kogo to Chigo and Byazhin, city slums and rural areas around Abuja that look on but are cut off from the capital city’s affluence.The kit contains items recommended by the World Health Organisation for childbirth, in hopes of cutting down infections at point of delivery and make the birthing process cleaner and safer.Disposable delivery mat, a towel to receive the infant, sterile gloves, cord clamps, mucus extractor, scalpel, methylated spirit, antiseptic soap, cotton wool, olive oil, disinfectant, gauze, baby napkin and maternity pad.First thingEvery woman who can afford them takes joy shopping for them, because hospitals will not offer them—at most, ever, and at least, without money.“That thing is very important,” says Grace Atabor, one of nearly a hundred pregnant women coming to terms with attending antenatal clinic in Kogo. “That is the first thing we need to have. Without those things, you can’t deliver a baby. And even though you can deliver, they [hospitals] will charge you for it.”Women are required to buy a birth kit or pay hospitals between N4,000 and N8,000 before childbirth, said first-time mother Nkechi Okeiyi.And hospitals charge for everything from soap to razor blade, women have complained. One woman recalled her visiting her friend who’d given birth to discover the new mother paid for detergent used to wash the hospital bathroom. “And it is not like they return the remnants to you when you leave hospital or refund you,” she complained.Breaking pointSundry charges are among reasons many women will not visit a hospital to have their baby. Regardless of age, at least one in two women in Nigeria give birth at home. Nigeria’s demographic surveys consistently attribute the figures to low economic status, poor education, age, no antenatal clinic attendance, even misplaced confidence after several births and a measure of trust in a traditional birth attendant.“High rates of home deliveries by people with little or no training in hygienic delivery practices and of shortages of suitable clean delivery materials all contribute to the problem of perinatal infection” (infections at least five months before and one month after birth), says Chinomso Peters, trained nurse/midwife and founder of Traffina Foundation.Experts estimate up to 23% of deaths in newborns come from severe infections, some from unclean birthing practices that proponents increasingly believe a simple birth kit can avert. In Byazhin, Chinelo Amaechina asks women at a local clinic why their neighbours do not like going to hospital when they are pregnant.“They like to patronize people who deliver at home,” said Amaechina, a programme officer for Citizen’s Health and Education Initiative. “When that person that is helping you to give birth is doing that, does that person take into cognizance, for instance, the infection that might be transmitted between you and the child? They have no knowledge of that.”Starting with simple washing and gloving of her hands, Amaechina demonstrates how to use each item in a birth kit—in the event that a delivery does occur at home. She also explained how any woman around could assist another in childbirth. Sticky situationsIf things are dicey at home, hospitals haven’t made them easy. “Some women walk into the hospital, and they don’t have anything,” says Peters. Traffina, the foundation that Peter has run for a couple of years, is hoping to use birth kits to cut down maternal and newborn deaths in a country with the world’s second largest burden.The kit “makes it possible for them to have facility delivery,” she says. “It is going to reduce self delivery at home, reduce [the rate of] them going to traditional homes where they have very unclean and unsafe environment.”The absence of delivery kits has been stopping women going to hospital. Traffina over the next two years hopes to distribute 50,000 of such kits to local clinics where women can use them, in turn saving up to 100,000 mothers and babies.Women of Kogo, like Atabor, for instance, first learned about the kits given to their local clinic—and are told unequivocally that the kits are free. A woman attending antenatal clinic comes in for birth, simply signs for one kit and gets it.“Nobody takes any money from them. She goes there at the point of delivery and they [hospital] assigns the kit to her,” Peters explains.Free airtime on popular radio shows like Berekete helps echo the message that women insist on the kits and not pay a kobo.Some of the items in the kit are among interventions that could save newborns, but the kit brings them all together in one cute, handy collection. But it is yet to catch the wave of funds that go into healthcare. Nigeria is ranked seventh highest recipient—a tie with Indonesia—of donor aid for newborns. But the newborn aid the country got in 2008, for instance, amounted to $9 million: only $1 per newborn in 2011, when the country had 8.6% of global burden of newborn deaths. In comparison, the amount is only 4% of total aid for maternal and newborn child health.One year into its cycle, support for birth kits is gaining traction, with small civil society organisations like CHEDI and big names as Amina Sambo—wife of Vice President Namadi Sambo—supporting Traffina’s 1-Kit-Saves-2 project. The traction is not fast enough, proponents worry, to push beyond a lean target of 50,000. “We can’t keep on sitting down and waiting for funders to help us solve our problems,” says Peters. “If MDG funding stops, that means our women will continue to die?”Written by Judd-Leonard Okafor. This article won one of the Accountability Mechanism for Maternal and Child Health in Nigeria (AMHiN) media awards organised in collaboration with MamaYe! Nigeria, CHR, CISLAC and other development partners who are members of AMHiN. Judd-Leonard writes for Daily Trust in Abuja. First published in Daily Trust, edited for MamaYe! Nigeria blog.