16 months after FG’s free C-section launch, states lag
Sixteen months after the Federal Government announced that Caesarean sections (C-sections) would be provided free of charge to poor and vulnerable women nationwide, implementation of the programme remains uneven, with wide disparities across states, Daily Trust findings reveal. While some tertiary hospitals have begun offering the service under specific conditions, others are yet to commence […]
Sixteen months after the Federal Government announced that Caesarean sections (C-sections) would be provided free of charge to poor and vulnerable women nationwide, implementation of the programme remains uneven, with wide disparities across states, Daily Trust findings reveal.
While some tertiary hospitals have begun offering the service under specific conditions, others are yet to commence the programme, leaving many women to bear the financial burden of surgical childbirth.
In separate chats with Daily Trust, medical experts explain that a Caesarean section is a surgical procedure in which doctors make incisions through the abdomen and uterus to deliver a baby, along with the placenta and membranes. Unlike vaginal delivery, which occurs through the birth canal, a C-section involves abdominal surgery.
Dr Godwin Ekuwke, a gynaecologist, said the procedure is recommended in cases such as obstructed labour despite adequate contractions and cervical dilation, when a baby is unusually large – particularly for first-time mothers – or in abnormal presentations such as breech position.
Another gynaecologist, Bello Abdullahi, explained that caesarean deliveries are classified into four categories: elective (planned in advance), scheduled, urgent, and emergency procedures carried out to save the life of the mother or child.
Background
In November 2024, the minister of health and social welfare, Ali Pate, while announcing the free C-section programme in Abuja at the launch of the maternal mortality reduction initiative (MAMII), said the move was part of the government’s push to tackle Nigeria’s maternal and neonatal mortality rates, which rank among the highest globally.
He noted that the initiative aimed to improve access to quality healthcare for mothers and newborns, with a particular focus on primary health services and community engagement.
The initiative targets 172 high-burden LGAs across 33 states of Nigeria, aimed at reducing maternal and newborn mortality.
However, findings across selected states show varying levels of compliance.
A visit to the Kubwa General Hospital in Abuja revealed that none of the women receiving postnatal care after undergoing CS procedures had benefited from the government’s free CS initiative.
An official of the hospital, who was seen recording patients’ details, explained that the free service is not regularly available.
According to the official, beneficiaries are usually women who cannot afford basic hospital registration fees.
The official recounted the case of a woman who arrived at the hospital unaccompanied. When asked about her husband, she reportedly said he had travelled, and she had no means of contacting him. She was subsequently enrolled under the free C.S service.
However, when some of her relatives later arrived, they were requested to donate blood and purchase prescribed medications, the official said.
Among the women in the postnatal ward was Sa’adatu Muhammad, who underwent her fifth CS at the facility. She disclosed that her husband had paid approximately N270,000 to cover the cost of surgery, medications, and other related expenses.
Another patient, Sonia Hedjo, said she paid approximately N300,000 for her procedure. Her husband, Pedro Emenike, said the full payment was required before his wife was taken into the labour ward.
Emenike suggested that the hospital should consider offering a general discount to all women requiring Caesarean sections, rather than limiting the free service strictly to the most vulnerable patients.
Borno
At the Specialist Hospital in Maiduguri, findings indicate that the free C-section scheme is being implemented, although some women claim they were required to pay before undergoing surgery.
A hospital staff member, who requested anonymity, told our correspondent that the state government had been offering free C-sections even before the federal government announced its initiative.
“We cannot say for certain whether the current free C-sections are funded by the state or the federal government, because both C-sections and dialysis were already free in this hospital before the federal announcement,” she said.
However, some pregnant women interviewed alleged that not all indigent patients benefit from the free service. They cited cases where payments were made prior to surgery.
Halima, one of the respondents, said her sister paid N60,000 before undergoing a C-section at the hospital.
“Only a few people are fortunate to get it free. My sister had to pay N60,000. She was initially scheduled to have the procedure at the University of Maiduguri Teaching Hospital, but the cost there was too high—about N120,000—so she came here instead,” she said.
Benue
In Benue State, women who recently gave birth through surgical operations in public hospitals in the state said their deliveries were not free but paid for.
Ella Johnson told our correspondent that she was delivered of her baby through C-section in October last year at the Muhammadu Buhari Mother and Child hospital, an annex of the Benue State University Teaching Hospital (BSUTH) in Makurdi.
Johnson said her husband paid about N80,000 as charges for the procedure carried out on her.
Similarly, Mnena Tyough said she paid as much as N120,000 at the BSUTH for the same procedure because the hospital provided most of the things she ought to have brought with her for delivery.
“I could have paid less, like N80,000 or N85,000, if I had brought my materials with me. I had my second baby through C-section,” she said.
For Veronica Denen, the sum of N85,000 was charged for her baby birthed through CS at the Federal Medical Centre (FMC) in Makurdi recently.
“There are other charges, but I paid N85,000 for the CS. It’s my first child, so I don’t know how much the hospital charged for the same process previously,” Denen said.
Bauchi
In Bauchi, hundreds of pregnant women have benefited from the programme.
One of the beneficiaries, Habiba Abdullahi from the Karofi area of Bauchi metropolis, said she was rushed to the Abubakar Tafawa Balewa University Teaching Hospital (ATBU-TH) when labour for her third child commenced.
“My husband and I were not aware of the free Caesarean section programme when I was taken to the emergency unit of ATBU-TH for the surgery. It was only after the operation that health personnel informed me that I needed to present my National Identity Card for the documentation,” she said.
Habiba explained that she did not spend a kobo throughout her labour, the caesarean section, and the three days she spent at the hospital.
“Unlike my second child, for whom I paid N35,000 in 2022 for a caesarean section at a private hospital in Bauchi, everything this time was completely free,” she added.
Another beneficiary at the Bauchi Specialist Hospital, Sadiya Sunusi, told Daily Trust that she was only asked to present a National Health Insurance Scheme (NHIS) letter and her National Identity Card as requirements for the free caesarean section.
“I didn’t pay anything for the surgery. All medical services, including drugs and consumables, were provided by the hospital,” she said.
Sadiya noted that it was her first time undergoing a caesarean section, as she delivered her first child at a primary healthcare centre four years ago, where she spent N9,000.
“Apart from the free caesarean section, the hospital also provided free care and other necessary medical services for my newborn. I was not charged anything after discharge. Everything done for me during my stay at the hospital was free,” she added.
Lagos
A staff member of the Federal Medical Centre (FMC), Ebute Metta, Lagos, told our correspondent that the hospital organised talk shows in markets to increase awareness and turnout since the commencement of the programme.
“We went to Oyinbo Market to organise a talk show in an effort to raise awareness because people have not been coming since last year,” the staff member, who doesn’t want his name in print, said.
He noted, however, that only a few women have so far benefited from the scheme, adding that strict measures have been put in place to identify indigent women.
“We have to scrutinise them very carefully because some people may try to manipulate the system. We also provide free antenatal care here,” he added.
Kano
In Kano, eligible patients admitted to the Aminu Kano Teaching Hospital (AKTH) with emergency or complicated conditions are entitled to free CS.
Contrary to the widespread impression that the services at the hospital are entirely free, the procedure is not automatic and is only provided at no cost when patients meet specific eligibility criteria.
According to the hospital, patients qualify for free CS if they present with conditions such as ante- or post-natal eclampsia, ante- or post-partum haemorrhage, puerperal sepsis, post-partum anaemia, obstructed labour, ruptured uterus, and post-abortal complications.
Other requirements include a National Identity Number (NIN), a birth certificate, and two passport photographs.
Ummu Salma Iskayu, 24, a patient from Tsaure-Badume in Bichi Local Government Area, said she was referred to AKTH 25 days after undergoing a Caesarean section at Bichi General Hospita l, following persistent pain.
“When they saw the extent of my condition, they ordered a CT scan and later concluded that I had to undergo another Caesarean section. Alhamdulillahi, it was carried out successfully, and I am now recovering,” she told our reporter from her hospital bed.
Asked if she paid for the operation, Ummu Salma said the procedure was free, but she paid N50,000 for a hospital bed upon admission.
She added that she lost her baby during the first Caesarean section at the previous hospital and disclosed that she would soon be discharged.
Another patient, Charity Abah Owole, 35, from Benue State, said her Caesarean section was carried out on Tuesday morning without any payment for the operation.
“I underwent CS this morning (Tuesday), and the baby is fine. I am recovering fast and taking my medications. We did not pay for the CS, but my husband is in a better position to confirm whether we paid for drugs or not,” she said from her hospital bed at the Tsohon Gabas Post-Natal Ward of AKTH.
Information available to our reporter indicates that a CS at the hospital ordinarily costs N150,000. Spinal anaesthesia costs an additional N50,000, while general anaesthesia costs N80,000. Laboratory investigations, accommodation, and utility services attract separate charges.
A hospital official disclosed that more than 70 per cent of patients in the post-natal ward were emergency cases, which qualify them for the free Caesarean section programme.
Bayelsa
Findings indicate that many hospitals in the state are yet to comply with the directive.
At the Bayelsa State Specialist Hospital, Okolobiri, some hospital staff who spoke with Daily Trust said the free programme had not started at the facility.
Efforts by our correspondent to locate the Caesarean section ward were unsuccessful, as hospital security personnel insisted on official approval before access could be granted.
Similarly, at the Federal Medical Centre, Yenagoa, the Public Relations Officer, Akpedi J. Bernard, said he was away on official duties but promised to confirm whether the programme had commenced upon his return.
He added that the recent strike by the Joint Health Sector Unions (JOHESU) had significantly affected operations at the hospital.
Efforts to get an official response from the Federal Ministry of Health and Social Welfare were unsuccessful.
When contacted, the Assistant Director of Press at the ministry, Ado Bako, said he would revert to our correspondent but had yet to do so as of press time.