Eight months ago a state of emergency was declared across northeast Nigeria due to internal conflict. Residents have had their movement, mobile phone and internet use restricted. Last month, I went to Gombe state to collect data about the local context that might explain or account for any positive or negative changes in the health outcomes of mothers and their newborns.
I was sure the conflict must have already had negative health impacts: What if a pregnant woman goes into labour in the middle of the night? How will her family call for help if they can’t use a mobile phone and don’t own transport to get her to a health facility? How do you get a trained frontline health worker to come to the house to deliver the baby after curfew? Under such a fragile environment, surely there must be many “what ifs”?
With this wondering mindset I traveled to Gombe wanting to find out from the frontline workers how the ongoing conflict affects their work. But my visit led me to uncover some far older barriers to good health care practices: ancient myths and superstitions.
Into the field: fear, superstition and myths
I tagged onto the quarterly frontline worker supervision visit of Society for Family Health, an indigenous NGO, working to improve maternal and newborn health in Gombe state – with funding from Bill & Melinda Gates Foundation. Traveling far into the rugged depths of rural Gombe, I met frontline workers – Traditional Birth Attendants (TBAs) and Federation of Muslim Women’s Associations in Nigeria (FOMWAN) volunteers – in a village in Akko Local Government Area (LGA). They were not comfortable speaking about the conflict. Some said it didn’t affect them as all the families under their care were in the village so they didn’t have to leave and break curfew. But some said there were other, more pressing challenges, based on superstition and myth.
In a village in Funakaye LGA, one of the TBAs, Asibi*, took the supervisory team to visit two young mothers, Hauwa* and Mairo*, both under 18 years old, and their newborns (19 and 22 days old respectively). Asibi wanted to show the challenges she faced in her work and her achievements in overcoming them.
Tradition: The first child should be delivered at the mother’s parents’ home
As is traditional in northern Nigeria, Hauwa had come to her parents’ house in Funakaye LGA to deliver her firstborn child. Here she would have the support of her mother and other relatives to advise and guide her through delivery and the first 40 days after birth. After her birth Hauwa started to lose a lot of blood, the leading cause of maternal death worldwide. Luckily, due to Asibi’s frontline worker visits and advice during pregnancy, Hauwa had gone to a health facility to deliver and she was able to get a blood transfusion. Sadly, Hauwa’s husband was not happy with the facility delivery. He thought women who gave birth in a health facility were not brave enough and he refused to donate his blood to save his wife. Thankfully, Hauwa’s father stepped in, donated his blood and saved Hauwa’s life. Although both baby and mother are doing well, since the birth of their child Hauwa’s husband has not turned up, literally abandoning her and their newborn child.
Myth & superstition: Don’t eat THAT, it will make your baby sick
The second mother, Mairo, told the frontline worker Asibi she was visiting her cousin, because she was not well. Mairo looked malnourished and her baby was inactive, had a weak pulse was severely malnourished with a swollen stomach and looked like it might not survive the day. Mairo had come in desperation. She had already lost her first child in this way. Mairo wanted to get traditional medicine to help her produce more breast milk. When Asibi asked Mairo what she was eating, it was clear that her problem was nutritional. Asibi discussed what locally available foods she could eat to solve the problem and asked if Mairo had the money to buy the food. To Asibi’s surprise, Mairo said she could afford the food but had been told not to eat most of the food Asibi was recommending due to local myths and superstition.
During my time in Gombe I learned a long list of myths, including (see end of blog for a longer list):
Myth #1: Pregnant women and breast feeding mothers should not eat eggs as the baby will be sick more frequently as a result and the woman will get jaundice.
Truth #1: Eggs are important source of several key nutrients necessary during pregnancy, such as protein, fats, minerals (such as zinc and selenium) and vitamins A, D and some B vitamins. However, the Salmonella bacterium can grow inside fresh unbroken eggs. Eggs should therefore be stored and cooked well and not eaten raw.
Myth #2: When a pregnant woman takes the yellow and red tablets provided or recommended during ANC visits, the baby in her tummy will get very big and delivery will be painful and difficult.
Truth #2:The red tablets are Iron tablets and the yellow Folic acid tablets. The iron and folate tablets are prescribed to prevent and treat anaemia (decrease in the number of red blood cells) during pregnancy.
Myth #3: Not bathing the baby immediately after birth will cause the baby to have body odor.
Truth #3: A newborn baby should not be bathed until at least 6 hours after birth so that it is able to regulate its body temperature and stay warm.
Myth #4: A pregnant woman should hide her pregnancy for as long as she can so no one can cast an evil spell on her that will cause a miscarriage.
Truth #4: A pregnant woman should not hide her pregnancy because there are symptoms the pregnant woman may assume are normal, which are actually a sign for concern, and require proper medical attention. For example, mild to severe one-sided pain in the lower abdomen or pelvis which may come on gradually or suddenly early in pregnancy could be due to a pulled or stretched ligament, a common occurrence in pregnancy, or it may be a sign of an ectopic pregnancy. Ectopic pregnancy is a medical emergency and can be fatal if not treated.
Where do these myths and superstitions come from?
While trying to understand the truth behind these myths and superstitions, I realised that some might have been borne out of real life experiences. Take the myth around eating eggs during pregnancy: we know eating eggs is safe as long as the eggs are cooked well to avoid salmonella infection. In rural Gombe where the likelihood of egg contamination is high, such myths and superstitions might have been perpetuated to prevent the mother getting ill. We should not disregard these myths and superstitions, but aim to understand why they exist and to educate the women properly so they and their newborns live healthy lives.
More frontline health workers are needed to reach remote communities
The work Asibi and the other frontline workers do is clearly essential to the health of Gombe’s mothers and babies, especially given the current health manpower shortages in this region. They were enthusiastic, driven by concern for the women and children in their villages and were recognized and supported by their communities. Society for Family Health is supporting the frontline workers well, as shown by Asibi’s enthusiasm to show us her achievements. But even if you have the best intervention to improve the health of mothers and babies with lots of scientific evidence to support it, the success of that intervention will depend on the context where factors such as cultural beliefs, myths and superstition might still affect acceptance of the interventions: if people believe not bathing the baby immediately after birth will cause the baby to have body odor, it is a hard sell to tell the mother to delay bathing the baby.
My trip to Gombe showed me that there are still communities who believe in false health practices and have minimal or no contact with frontline workers. While these superstitions continue to exist, we need more myth busters like Asibi to continue to promote good practices at home.
*Names have been changed.
This article was originally published by IDEAS on their blog.