Free C-sections: Now what?

You gotta love politicians. They always try to sensationalise everything, to make every little thing even more grandiose than it seems. They make bold statements like: Education is free! Only for you to go to the school and find out that you have to pay for books, uniforms, stationery and even chalk! They will tell […]

You gotta love politicians.

They always try to sensationalise everything, to make every little thing even more grandiose than it seems. They make bold statements like: Education is free! Only for you to go to the school and find out that you have to pay for books, uniforms, stationery and even chalk! They will tell you that healthcare is free but not that you will have to buy the medicines yourself, or 10 per cent if you are under insurance. They will tell you that delivery is completely free, only for the parents to look utterly confused when a list of consumables is given for them to buy.

I recall a boxing match that broke out in a busy specialist hospital years ago because a husband was given a list of things to purchase by a nurse. His wife was in labour and the nurse asked him to buy gloves so that she could be examined. The man was perplexed: Was this not the same government hospital that the commissioner was boasting over the radio that ‘everything’ was free? The overworked labour room nurse simply turned her attention to other patients and ignored his wife. The poor woman, plagued by pain, pleaded with her husband to go and buy the gloves. Other men and women quickly chimed in. The husband was adamant. His commissioner and governor had said over the radio that delivery was completely free, so why was this fraudulent nurse trying to dupe him?

After much pleading, another pregnant woman who had come in with a pack of gloves gave some to the nurse to attend to his wife. The nurse, who all the while had remained calm, took the woman in and checked her. She gave the husband the news – the woman was about 8 centimetres dilated, and so, needed to be given a bed as she was in the second stage of labour. She explained that ‘free’ meant free services; example, bed space, admission and conducting delivery. The term ‘Free’ at the hospital did not include consumables and medicines. She told him that her labour ward was only given two packs of gloves per month! In a hospital that sees almost a 1000 patients per day!

You know that feeling when someone is spoiling for a fight? I think the unfortunate chap was already angry and brimming over because before you could say ‘Jack Robinson’, the man had started hurling abuses at the nurse, calling her a prostitute and thief. Her offence? She had handed him over the prepared list of all the things birthing mothers were supposed to come with, example, sanitary towels, wrappers, mackintosh, detergents and olive oil, et al. The nurse in turn raised her voice and the two engaged in verbal assault until someone (I honestly don’t know who) threw the first slap. After that, the fight descended into a full-blown fist fight between the enraged husband who foolishly believed his governor when he said everything was free, thereby coming to the hospital empty handed and the hot-headed nurse who had taken enough disrespect, while the poor wife in pain cried herself hoarse.

Pain of labour and her husband’s foolishness.

Security men came and took him away. Alhamdulillah, the woman delivered safely.

Truth be said, one of the reasons behind assault against healthcare workers is miscommunication. There is a gap between what the patient hears and comprehends, versus what is really going on in the hospital system. As healthcare workers, we are constantly trying to improve our communication skills so that we do not appear haughty, arrogant or even brash. But what about the politicians passing half-truths and grandiose statements?

Recently, the Nigerian government, through the Minister of Health and Social Welfare, Muhammad Pate, announced that caesarean sections would now be available at no cost to women in need as part of its efforts to reduce maternal mortality rate in the country. A tweet from the official X handle of the Federal Ministry of Health and Social Welfare stated, “In a powerful move, the coordinating minister @muhammadpate just announced that caesarean sections (C-section) for all Nigerian women who need them will now be FREE!”

On his X handle, the minister noted that a key aspect of the initiative was the provision of free C-sections for poor and vulnerable women who meet the eligibility criteria. He said this coverage extended to services offered in both public and private facilities accredited by the National Health Insurance Authority (NHIA).

“By removing financial barriers to this life-saving procedure, we ensure that no woman in need is denied critical care due to cost,” he said.

This free caesarean policy aims to reduce the maternal mortality rate and improve the quality of healthcare services for pregnant women in Nigeria.

As we all know, a C-section is a surgical procedure used to deliver a baby through an incision in the abdomen and uterus, typically when healthcare providers determine it’s safer for the mother, baby, or both.

Despite its necessity in many cases, the high cost of a C-section in Nigeria has long been a major barrier, preventing many women from accessing this critical care during childbirth.

The cost of a C-section in some private hospitals in Nigeria ranges from N500,000 to N1,000,000, an amount that is often out of reach for women, particularly those from lower-income backgrounds.

Meanwhile, a C-section in government-owned hospitals also costs about N200,000. This financial burden not only jeopardises the health of mothers and babies but also perpetuates the inequality in access to maternal healthcare services.

Over the years, Nigeria has recorded high levels of maternal mortality across its 36 states and the Federal Capital Territory (FCT). The situation is yet to improve significantly due to the underlying issues facing the health sector. About 100,000 women lost their lives during birth and after birth complications across different parts of Nigeria in 2023.

And while this is a laudable policy and seemingly brilliant solution, this policy may not be feasible in Nigeria due to the Nigerian health sector’s underlying issues. Issues such as understaffing, low budgetary allocation, insufficient funds, inaccessible healthcare facilities due to bad roads, low literacy levels and other important policies that are needed to strengthen the Nigerian healthcare system have not been implemented.

When we have not achieved the Abuja declaration in healthcare funding, how can we provide free C-sections? When doctors are Japa-ing left, right and center, who is going to section these women? Is it the already overworked and under paid doctors?

When you declare free C-sections, please specify who and who meets the criteria and what exactly you mean. It pains me to say this publicly, but the mainstream and social media have illustrated that comprehension is not a skill many Nigerians possess. What are the components of “free C-section”? Is it the operation itself that is free? Who is going to fund this policy? Does it include medication and consumables? Does it include postnatal care? Does it include complications of the procedure itself?

So many questions; so many gray areas, and even many more confused, ill-informed husbands who will storm hospitals targeting their anger at unsuspecting health workers.