꧁❊ Raffy❊ ꧂

Why does the fight over "pregnancy is a death sentence" refuse to end? (2/2) Because the dead do not quote-tweet. Each survivor is a witness for the defence, and the women who did not make it cannot testify. A grandmother with every birth behind her is the defence's favourite witness. Any neighbour who died in her own second labour left no story to tell. Surviving is a lower bar than it sounds. Doctors have a name for the woman who nearly died but survived, the maternal near miss. Hospital studies in Nigeria have counted between two and ten of them for every woman who died. Not all of them heal. Some lose the womb. Across Nigerian teaching hospitals, emergency removal of the womb runs at around two to six in every thousand deliveries, most often to stop bleeding that would not stop. Others leave with a heart that failed late in pregnancy or soon after, a condition Nigeria records at the highest rate in the world, and not every heart recovers. In one Zaria hospital, half the women put on dialysis for kidney failure after childbirth were still dialysis-dependent at discharge and could not afford more. Rarer still, surgeons in Kano have reported a new mother who lost parts of both legs to gangrene. Each year about 12,000 women leave labour with a fistula, a hole between the birth canal and the bladder or rectum left by labour that went on too long, and leak urine or faeces until it is repaired. In one Sokoto study, more than half of the women with fistula also had foot drop, nerve damage from the same labour that leaves a foot dragging. As recently as 2017, repairs fell about 7,000 a year short of new cases. Every one of these women goes into the record as a woman who lived. The danger is unevenly shared. Just 172 local government areas, about one in five in the country, account for 55 per cent of maternal deaths. In Lagos, 86 per cent of births take place in a health facility. In Kebbi, fewer than one in ten do. A woman in Lagos and a woman in Kebbi are describing two different countries, and each is telling the truth about hers. Since 2000 the world has cut maternal deaths by 40 per cent. Nigeria's figures improved by 13 per cent. The federal government proposed about 4 per cent of this year's budget for health, against the 15 per cent Nigeria signed up to in 2001. That shortfall is one reason the hospital costs more than families have. Where is the other 11 per cent? I gave the word "sentence" one paragraph in part one. Every year the timeline gives it a week, and that week spares the government that question. Those gaps are the verdict, and the first defendant is the federal government. Years before any timeline fought over these words, a Nigerian state government vowed that pregnancy would no longer be a death sentence for its women. A government does not promise to end something that does not exist. The phrase was a confession before it was ever a tweet. 🐝🐆

"Pregnancy is a death sentence for women in Nigeria." (1/2) Once a year somebody posts that line and the timeline burns for a week. Out come the stories of parents and grandparents who had six children, some eight, and lived. Then the statistics and the insults. Then silence until the next round. The stories are real, and they come from another generation. Women in urban Nigeria now average fewer than four children. The line is wrong by one word, and the word is "sentence". It convicts every pregnant woman in the country. Most women survive their pregnancies, but by UN estimates about one Nigerian birth in a hundred ends with the mother dead. What each pregnant woman carries is a risk, and no nation on earth buries more mothers. In 2023 an estimated 75,000 Nigerian women died from pregnancy and childbirth, about 29 per cent of all maternal deaths worldwide. In their 2017 estimates, WHO and its partner agencies put a Nigerian woman's lifetime risk at 1 in 21, against 1 in 5,400 in high-income countries. Over a lifetime, her risk is more than two hundred times higher. I spent almost ten hours in the room before my son arrived. It shook everything in me, and it looked like nothing I had ever seen. I was only the one watching. Our mothers knew before the data told them. In Yoruba homes, a prayer said over a woman in labour runs A ó gbọ́hùn ìyá, a ó gbọ́hùn ọmọ. We will hear the mother's voice, we will hear the child's. A prayer that asks for both to come through tells you what people fear. The fear shows in the habits too. Many women hide their bumps, skip parties and keep the pregnancy off social media until the baby arrives. Some fear that the more people know, the more evil can reach the pregnancy. Others would rather grieve quietly if the baby is lost. There are women who will not walk in the sun at a certain hour of the afternoon, and women who hook a safety pin to the underwear over the bump. One ties a mantle around her stomach, another anoints herself, and another takes holy communion for the pregnancy. Those are the ones I know, and other faiths and cultures bring more. Swap the faith or the culture and you get a different guard on the same fear. A people does not build habits like these around something safe. Medicine keeps its own list of guards, starting from the first test. Iron tablets, malaria prevention, tetanus injections. Blood pressure checked, blood sugar tested, scans booked, fruit pushed onto her plate. Almost every item exists because something can kill a mother or her baby. The latest national survey found that more than a third of women with a recent birth never saw a skilled provider during that pregnancy, and only about half made four antenatal visits. When the hospital costs more than families have, they fall back on what they can reach and afford. Poor women end up with the chemist, the unqualified hand, the prayer house or the traditional birth attendant, or give birth at home. The same survey found that more than half of Nigerian births happen outside a health facility. Among the poorest 20 per cent of households, the figure is more than eight in ten. The federal health ministry's own report says deaths recorded in health facilities fell from 904 in 2024 to 460 in 2025, and that progress deserves its credit. Now set 460 beside the 75,000 estimate. The years differ and the counting differs, yet the gap is more than a hundredfold. The 75,000 is modelled, so some of that gap may sit in the model. Not a hundredfold of it. Either most of these deaths happen outside the building, or the building is failing to count them.