Home births are on the rise in Benue State, not because they are safer, but because public health facilities are broken beyond trust. Pregnant women are turning to unsafe havens of giving birth at home and even patronizing traditional birth attendance (TBA).
By: David Arome
For 22-year-old Martha Agur, living in the Ageraga – kohol community, Kwande LGA, Benue State, giving birth at a government-owned health facility was never an option to accept. The closest health clinic to her is a distance away with no functional delivery equipment, no midwives and no power supply.
Martha recalled her ordeal at the health clinic she once visited: “I have been there; the health worker told me they had no gloves, medicines or even delivery beds.” Her husband, Agur, a subsistence farmer, had once sold off their only goat to pay for Martha’s antenatal visit to the town. But could no longer afford to continue due to financial constraints.
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A cross-sectional survey carried out by Cherechi Nwabueze et al., 2023 reveals significant gaps in awareness and knowledge of focused antenatal care (FANC) among Nigerian women. Only 15% of study participants were aware of FANC, and just 7.3% had a good understanding of its components. The study identifies limited access to healthcare, especially in rural areas, and systemic challenges in healthcare infrastructure as significant barriers.
After weighing options for place of delivery, she settles with TBA. At her trimester, she enrols with the local TBA owned by Veronica Peter.
Peter had delivered babies for over two decades using herbal infusions, whispered prayers, and bare hands. Her small clay-walled hut doubled as a birthing room, its floor covered with old cement bags and raffia mats. She had no formal training, no emergency backup, and no access to blood transfusions. But what she had was trust—from women who had no alternatives.
In recent years, a growing number of women have turned away from labor wards due to a lack of space, staff, or essential equipment. Many facilities lack skilled birth attendants, basic medications, and even clean water.
On the night of her labour, the husband took her to the TBA with just two wrappers and no baby items. She screamed in pain in prolonged labour throughout the night. Dooshima drifted between consciousness and confusion. Peter worked tirelessly with hands steady but her eyes betraying worry.
Martha finally gave birth to a boy with no clean clamp for the umbilical cord. No sterile wrap. Only torn bedsheets and whispered gratitude that both mother and child were still breathing.
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Her order does not just end there. She continued bleeding that Peter could not stop with local herbs. She was exhausted and dehydrated and in pain for two days. It took the intervention of the community members to pool money together to get her a motorcycle to the nearest private clinic for treatment.
Martha Menace depicts the reality and challenges pregnant women went through in rural communities shrouded with infrastructural deficits.
Women in rural communities are left behind in a system that promises universal health coverage but delivers silence.
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31-year Rejoice Nyior, seven months pregnant, residing in the Ihonan community, Kwande LGA, Benue State, waited five years for a child. With the excitement of the arrival of the child, save some money for the small party naming ceremony from the farm sale.
One of the PHCs with Drug shortages & lack of Skilled birth Attendants: Photo Credit: Ihonan Primary Healthcare Clinic, captured by David Arome
Throughout her pregnancy, Nyior only visited the nearby Ihonan health clinic just once. She was disappointed at the first antenatal visit due to the near absence of basic facilities for antenatal service and drugs. Since then, she stopped going for antenatal care and joined the husband in farming activities.
John Terna, a community member, laments over the poor state of the health clinic, deterring pregnant women from going for antenatal services.
On 7th July, 2023, after a hectic return from farming work to have some rest. Though she felt pain around the abdomen while trekking, she ignored it. The pain intensifies with bleeding. She beckoned the neighbour for help, which they obliged, and rushed in to find her slumped on the floor soaked with blood.
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Nyior was rushed to the general hospital in Adikpo, a 8 km distance away from the village. “She moaned in pain in a weak voice, ‘Please don’t let me lose this baby.”
Arriving at the hospital two hours later, she was taken to the emergency ward. The nurse who attended to her shook her head and quietly disclosed to the husband that the fetus had been lost. The information was later related to her in the evening. Nyior cried all through the night. Her dream of becoming a mother of a child was dashed.
A study by Saturday Etuk etal., a secondary analysis across 54 referral-level hospitals in Nigeria reported that among 4,798 women who experienced pregnancy loss before 28 weeks, 49.2% were spontaneous abortions. Complications occurred in 14.6% of these cases, and there was a 2.1% mortality rate. Factors such as low maternal education, unemployment of the husband, grand multiparity, pre-existing chronic conditions, and referrals from other facilities were associated with higher risks of complications and death.
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Nyior experience is one out of the many challenges pregnant women face in remote villages. Infrastructural gaps in maternal health are not inconveniences but death traps for pregnant women.
Dilemma of Maternal Healthcare in Nigeria
In the absence of accessible healthcare facilities, traditional birth attendants (TBAs) have become the primary caregivers for many expectant mothers. An estimated 60–80% of all deliveries in developing countries, including Nigeria, occur outside medical facilities, often under the care of TBAs who utilize culturally familiar methods. While TBAs provide essential services, their lack of formal medical training can pose significant risks during complicated deliveries.
The shortfall in skilled health professionals in the health space has led to large-scale acceptance of traditional birth attendants for maternal healthcare services. The choice of maternal health services by women is majorly attributed to financial constraints, religion, and cultural belief systems. Their preference for TBAs, especially in rural communities, is occasioned by many factors, such as accessibility, affordability, being accommodating, tradition and culture, and proximity to their homes.
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Women who access public health facilities are vastly disrespected and are subjected to several forms of abuse during pregnancy and childbirth. Abusing pregnant women is a common phenomenon, particularly at government-owned hospitals and health facility centres that are offering maternity care services. Ask any Nigerian woman who has visited any government health facility during antenatal clinic visits, labour, and childbirth. They will confirm that at one point or another, they had to deal with some form of disrespect and abuse from maternity care providers.
It suffices to say that the fear of being mistreated keeps many Nigerian women away from seeking maternity services at public health facilities.
Health expert’s perspective
Health experts have consistently emphasized the need to overhaul the PHCs across rural communities. As this would enhance access of women to quality healthcare services.
Doofan John retired nurse at Adikpo faults the cosmetic approach of the government overtime, as it would in no way help fix the decayed healthcare system. The systemic failure has intensified the challenges faced by expectant mothers, exposing deep cracks in the state’s maternal care infrastructure and leaving women with no safe alternative but to risk childbirth at home.
The focus should be on how to urgently address the infrastructural gaps, improve antenatal services, inject more skilled birth attendants and regular supply of drugs and equipment. John enjoins “government to step up action to revamp the ailing health facilities”.
Credit Statement: This story was produced for the Frontline Investigative Program and supported by the Africa Data Hub and Orodata Science.
