Pregnant and nursing mothers in Nigeria are angry with the Federal Government. They are not happy that public hospitals have increased the cost of Caesarian section operation. The women fear that if government fails to urgently subsidise the cost, infant and maternal death rates will worsen.
Before the sudden increase, expectant mothers in need of CS in public hospitals paid between N60,000 and N75,000. But the cost is now between N150,000 and N200,000, a rate that, some stakeholders say, is too high, especially for low-income earners.
At some private hospitals, women in need of the operation are charged between N300,000 and N1m. The hike, some women argue, is tantamount to a declaration of war against pregnant women.
Experts, including a Professor of Obstetrics and Gynaecology at the University of Benin, Edo State, Friday Okonofua, are also calling on governments at all levels to subsidise CS operation for women.
Another gynaecologist, Dr. Samuel Adebayo, describes a CS as an abdominal surgery performed on a woman by cutting through her abdomen and the womb to deliver the baby.
Adebayo says, “Babies can be born through the vagina or the abdomen. But a Caesarian section is performed if a woman has complications related to labour. Also, if she has had the procedure about two or three times before, doctors won’t let her go into labour. If the baby is not breathing and there is foetal distress, we do it to save the baby; we do same when the expectant mother is going to have multiple babies or a premature baby. Again, when the placenta is blocking the womb, if we do not do a CS for the mother, she may bleed to death.”
Adebayo also notes that a Caesarian delivery can be an emergency or planned, depending on how early a pregnant woman has been diagnosed to need the procedure.
However, mothers who spoke with our correspondent in various hospitals in Lagos and Ibadan, the Oyo State capital, express regret that government appears to be paying lip service to saving their lives during delivery, going by the cost of accessing Caesarian deliveries in public hospitals. In various interviews with our correspondent, they note that the government that is supposed to protect their lives and those of their babies is promoting a policy that constitutes a threat to safety during delivery. They say the cost of Caesarian section in government hospitals is beyond their reach when they need it.
According to them, the amount being charged for the operation in the state and federal teaching hospitals is so high that only the rich can afford it.
Their claims may not be far from the truth, as investigations conducted by our correspondent in some hospitals confirmed the sudden increase in the cost of Caesarian delivery. For example, at the Lagos University Teaching Hospital, Idi Araba, pregnant women who used to pay N75,000 now spend at least N150,000 for the total cost of the procedure.
Detained in the hospital
A mother, Mrs. Abiola Olowookere, who had her baby on July 5 at the hospital, through a Caesarian section operation, says that though she was told to pay N105,000 as initial deposit for the surgery, she eventually spent N200,000.
Olowookere says, “I had gone for my ante-natal appointment and after the doctor examined me, he said my blood pressure was too high and since I was 36 weeks and five days gone, I should have the baby on that day so as to save my life and that of the baby.
“I was induced, but they later said the only option was a CS, which my husband and I readily agreed to. However, you can’t imagine how shocked I was when I was told that I would have to pay N105,000 as the initial deposit, apart from the N28,000 I paid for my admission.
“This is not inclusive of drugs, suture, pack of gloves, cotton wool and other items that would be needed in the course of the surgery and my admission.”
Olowookere adds that though the doctors reassured her that she did not have to pay the whole bill before the delivery, a deposit was needed.
“I urged my husband to go and look for the money before I left for the hospital. The surgery was successful. The baby and I are fine, but I could not leave the hospital until I had offset all the bills we had accumulated. Even the N140,000 my husband brought initially was not enough, because we needed to buy other things the doctors needed in the theatre,” she adds.
Olowookere is not the only mother who had challenges offsetting her hospital bill. Two other young mothers who had their baby through CS say they were detained at the hospital when they could not pay their bills.
One of them, who spoke on condition of anonymity, explains that she has been ‘detained’ at the hospital since February. The mother, a petty trader, notes that she was rushed to the hospital in an unconscious state.
“When I woke up, I was told I had a CS and I lost a lot of blood and that I would have to stay in the hospital for at least a week. I realised that any time I wanted to go out, the nurses watched my movement surreptitiously. “After we had stayed in the hospital for three weeks, my husband told me that since he had yet to raise the N180,000 that was required for the surgery, I could not leave yet. My husband is a car mechanic. He is still struggling to feed us. Where will he get such money from?” she laments.
While another woman in the same ward was relating her story to our correspondent, she broke down in tears. According to her, she has been in the hospital since May after having her baby through CS.
She says, “I cry every time I see other women who had their babies through CS being discharged from the hospital. The hospital saved my life by doing it when I needed it without insisting that I pay first. But I cannot afford the charges. I wish I had not had the baby in the hospital, as I would have been home by now with my family.”
Olowookere, argues that if the government is serious about reducing the number of women dying during child birth, it should urgently reduce the cost of Caesarian delivery in government-owned hospitals.
“If government can give fuel subsidy, why can’t it subsidise child delivery, which will save two lives — that of the mother and the baby?” she asks.
At Ifako-Ijaye General Hospital, Lagos, women who need CS pay N100,000.
Another mother, Mrs. Aliro Tanmo, who has just been discharged from the hospital, says the fee does not include the cost of some medical items usually needed for the surgery.
Tanmo says, “You will pay N100,000 officially. But I bought everything, from the sutures, to gauze, gloves and surgical blade that they used for me. I also had to buy the drips. In fact, let us not even calculate the amount I paid to get the (donor) blood screened, as each pint was screened for N4,000.
“Lagos State government says it provides free maternal and child health care. Yet, the cost of Caesarian delivery is not covered, even when they say they do not want women to die during labour.”
Between N200,000 and N1m
Private hospitals charge the highest fees when it comes to giving birth through the CS. Here, charges range from N200,000 to N1m, depending on the status and location of such facilities. In specialist hospitals in Abuja, investigations reveal, women pay between N100,000 and N300,000, while the private hospitals in the Federal Capital Territory charge between N200,000 and N1m for Caesarian delivery, depending on the location.
Also, in Port-Harcourt, the Rivers State capital, the cost of CS in private hospitals is between N100,000 and N500,000, while the same operation costs between N100,000 and N150,000 in government hospitals.
A nursing mother, who was delivered of a baby boy through a Caesarian section in May at the University College Hospital, Ibadan, Oyo State, says she was slammed with a bill of N100,000 for the procedure.
The mother, who spoke on condition of anonymity, notes that she was referred to the hospital from another hospital on Ring Road.
She says, “When we got to the UCH that night, we only had N20,000 on us. Of course, the money was small, but the medical personnel said we should start with that. They provided everything, including drugs. But by the time I was to be discharged after a week’s stay, I paid more than N100,000, which we borrowed from our pastor.”
The cost of CS, however, appears low in some states in the North, though. For instance, at the University of Maiduguri Teaching Hospital, women can undergo a CS for between N20,000 and N25,000, excluding the cost of drugs; while the state hospitals charge even lower fees.
Also, at the Aminu Kano University Teaching Hospital, Kano, the procedure costs
between N25,000 and N40,000, while private hospitals in the state charge between N50,000 and N100,000.
Lucky pregnant women of Jigawa
Pregnant women in Jigawa State can be described as being lucky, as the free maternal health policy of the state government covers the CS.
A physician/First Vice-President, National Association of Resident Doctors in Kano State, Dr. Askira Mohammed, says the free maternal care policy became necessary as statistics show that the North East and North West geo-political zones record one of the highest maternal deaths in the country.
Mohammed says, “The government has to subsidise the cost in Borno, Yobe and Jigawa states because, before then, about 800 to 1,000 women were dying out of 100,000 deliveries.
“Yobe’s maternal mortality rate is three times higher than the national average at 1,000-1,500 deaths per 100,000 live births. Women do not go to the hospital here because of the perceived high cost of surgery, cultural bias and poverty. Even at N20,000 and N25,000, they still shy away. How many women can afford to pay that? The majority of the residents in these states are relatively poor.”
Experts have also raised the alarm that the rising cost of Caesarean section may drive pregnant women who need this surgery away from the hospitals.
Okonofua says that a research conducted by him and his colleagues in Ile-Ife, Osun State and Benin, Edo State, published in an international journal, Lancet, revealed that pregnant women who should have had Caesarian delivery to save their lives and those of their babies refused it because of the high cost of the surgery.
Okonofua says, “Research has showed that the cost of Caesarian section is the reason why mothers who need it do not access it. That is why they will stay at home or go to quacks where a complication can arise and they will die. It is a life-saving procedure for the mother and her baby.”
Ibeju-Lekki, Alimosho: World’s highest maternal mortality rate zones
The professor, who was one of the advisers on health to ex-President Olusegun Obasanjo, blamed governments at all levels for the poor maternal and health insurance policies, which, he notes, can worsen what he calls the already embarrassing maternal and infant mortality statistics that Nigeria records.
Nigeria has the second highest number of women and children dying in the world, after India, according to the United Nations Children Education Fund.
Okonofua says, “When I was with Obasanjo, we agreed that every woman should be delivered free of charge in cases of emergency to reduce our maternal mortality statistics. But I’m now told that though some state governments claim to offer free health care policies, CS is not part of it.
“We know that many women cannot afford to pay N100,000 out of their pockets. Indeed, no woman should be paying for surgery at the point of delivery. It should either be through health insurance or, in the absence of that, government should have a safety net to offset the bill after the surgery.”
He calls on private health care providers to see themselves as stakeholders in reducing maternal deaths by providing subsidy on Caesarean sections for women in cases of emergency.
However, in some parts of Europe, especially in United Kingdom, the cost of a Caesarian section is over £2,500, while in the United States of America, depending on the hospital, c-section costs between $10,000- $20,000. But the mother does not have to pay more than 20 per cent of this amount as the procedure has been covered under the national health insurance.
In Nigeria, however, those who need to undergo C-section pay from their pockets as there is no social security policy to help them.
The professor adds, “I had a personal experience in a private hospital in Lagos, where they charged N750,000 for a CS. It was absurd to me. Access to affordable Caesarian section is a problem in Lagos and it’s a challenge the state government must find a way to handle.
Ibeju-Lekki and Alimosho local government areas have the highest maternal deaths globally. Lagos has the resources to make CS free for pregnant women. These prices will cause more deaths and worsen the situation.”
On why this procedure is so costly, Adebayo says it is because about 90 per cent of the medical supplies needed for the procedure are imported.
He says, “Most of the supplies we use are not produced in Nigeria; not even the surgical blade that is used to severe the umbilical from the mother. The anaesthetic pack alone goes for N35,000 in some areas, though it used to be N15,000. Ordinary Paracetamol injection is imported. That is why you see that even teaching hospitals have to increase their price.
“Again, absence of regular electricity supply is another challenge because we must sterilise all the surgical instruments we use and we must also ensure that we are on generator when doing the operation because you cannot afford to experience power failure during a Caesarian delivery. It is a multi-sector problem which government must address.”
