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Health-ClinicCommunity hospital with no delivery facilities. Photo: BBF.

Interview with Adepeju Mabadeje, Founder, Brown Button Foundation (BBF)

by Lola Johnson, Safe World Student Writer, July 2012

With 80% of its revenue coming from ‘Black Gold’ (Oil), one would expect Nigeria to be a metropolis of health and wealth.

Adepeju-Mabadeje-BBFAdepeju Mabadeje - founder of Brown Button Foundation, NigeriaSadly, this is not the case. Although Nigeria is placed 30th out of 193 countries in terms of wealth, a United Nations report states that in quality of life, this ‘Giant of Africa’ “rates below all other major oil nations from Libya to Indonesia”.

Everyone but the rich suffers this injustice, with the most vulnerable – including women, bearing the brunt of the government’s corruption.

In 2011, Adepeju Mabadeje, Nigerian Lawyer and advocate for Women’s Health Rights, lost a friend to childbirth due to “delay in getting skilled help”. This drove her to start her own organization fighting maternal mortality in Nigeria. She is now Founder, President, and National Coordinator of the Brown Button Foundation (BBF), a foundation that promotes women’s sexual and reproductive rights in Nigeria.


 

Lola Johnson interviews Adepeju Mabadeje, Lawyer and Founder of Brown Button Foundation

A Hydra-headed Monster Called Corruption

The Nigerian government allocated about $264 million to health in the 2009 national budget. How much would you say actually filtered down to the people who needed it and how long has corruption such as this been going on?

70% of the total budget was spent in the urban areas leaving about 30% of the budget for the rural people who actually need healthcare facilities. Corruption is endemic in this part of Africa and no one can actually say exactly for how long it has been going on. All we know is that it is a hydra- headed monster hindering progress.

In rural areas, if a woman decided to use hospital services rather than traditional TBAs (traditional birth attendants) for ante-natal care and delivery, how expensive would it be?

Hospital-bedsLying-in ward for pregnant women in a public hospital in Ogun state. Photo: BBFThe cost varies and is especially high if the woman delivers through Caesarian operation. In some cases, the husband runs away and his relations will help to pay in order to secure the release of the woman, and in other cases, the family may be employed to work off the hospital debt by providing menial services like cleaning and washing the hospital surrounding for a specified period. In private hospitals –  which are viewed to be more efficient, the cost ranges from about 1,200 USD to 2,000 USD.

Save the Children, a charity that fights for the lives and rights of children, estimates that about 800,000 Nigerian children die before their 5th birthday, giving Nigeria the highest infant mortality rate in Africa. According to Adepeju, “it is a very critical problem receiving little attention from the Nigerian government”.

Dispensing-unitDispensing unit of public hospital. Photo: BBF.This is no surprise, considering that “the Nigerian government has spent less on healthcare per person than almost any other government in Africa” as estimated by Save the Children.

At the start of the millennium, Nigeria's leaders, along with other world leaders, pledged to eradicate global poverty, hunger and disease by 2015. It was called ‘The Millennium Development Goals’. Goal 5 is to “Improve Maternal Health” by reducing by three quarters the maternal mortality ratio and achieving universal access to reproductive health.

In Nigeria, a woman dies every 90 seconds during pregnancy or at childbirth. Progress seems slow.

 

Is poverty one of the leading factors of infant mortality in Nigeria? What else contributes to this?

Poverty eventually leads to poor eating habits which is also a factor; other factors include birth defects, low birth weight and prematurity, SIDS (Sudden Infant Death Syndrome), maternal complications, accidents/unintentional injuries, complications of placenta, cords and membranes, respiratory distress of newborn, bacterial sepsis of newborn, neonatal haemorrhage, and diseases of the circulatory system.

What is the most important thing that the Nigerian government needs to address first, to help reduce maternal and infant mortality rates? Do you think that once corruption is eradicated, the health service in general will greatly improve?

Toilet-at-Health-ClinicThe most important thing to address for the government is to improve the facilities at health centres in rural communities and build more health centres in these areas. Once corruption is eradicated, health services will definitely improve. The problem existing now is not that of lack of ideas, but that of capacity and sincerity to implement them.

Abortion: Legal but Taboo

Is abortion legal in Nigeria? What choices, if any, are there for victims of incest, rape and women with unplanned pregnancies?

Abortion is legal in Nigeria, but the law only allows for abortion in cases where the life of the mother is at risk. The choice left legally for victims of incest, rape, and women with unplanned pregnancies is to deliver the baby as abortion is punishable by law for up to seven years' imprisonment –  including for anyone who aids and abets abortion.

This surely encourages them to seek abortion from quacks in shanties.

Is abortion still a taboo in Nigerian society (especially in rural parts)?

Abortion is still a taboo in the Nigerian society. It is regarded as sacrilege in most religious circles for anyone to push for the liberalization of the law in order to restore to the victim the right of choice to determine whether or not she can survive the agony of keeping an unwanted pregnancy.

Sometimes, these pregnancies are the result of rape by a bunch of armed robbers who invaded her house and even ignorance of sexual health.

Denial of Reproductive Rights is the Norm in Rural Areas

In rural areas where traditional gender roles are the norm, how big an influence does community have on women especially in terms of maternity and reproduction? Do women face problems when trying to exercise reproductive rights?

BBF-TeamMembers of the Brown Button Foundation team.The rural areas are where gender norms affects women most because majority of them are not educated, and as such, do not know their rights in the family. The man decides when to stop impregnating the woman.

The men, usually poor and uneducated, see children as a gift from God –  having been denied wealth, and will not allow anyone to deny them their natural entitlement in the name of family planning. The fact that rural areas are agrarian economies doesn’t help the women, as the man sees a larger family as one that can farm larger farmlands and make him prosperous.

Women face many problems when they try to exercise their reproductive rights; these range from beating, refusal by the man to provide her and the children their needs, to marrying another wife –  and in some cases, sending the woman away from the home.

The Brown Button Foundation often goes through traditional rulers and influential people in the society, who Adepeju says make their advocacy job easier. Failure to do so would cause massive problems, with these same rulers and influential people acting as obstacles to the Foundation's short term aims and long term goals.

The Effects of Improper Healthcare

Can you share with us some case studies/stories where the lack of basic necessities has led to life-long illnesses and disabilities in the mother or in the child? Is anyone held responsible for such preventable complications?

Instances abound where women have lost their lives due to the inability to travel miles to reach medical facilities for delivery or even to purchase drugs to sustain live.

There was a particular case where the lack of electricity and oxygen caused the death of a woman whose labour was prolonged.

In most cases, no one is blamed for the death but destiny.

How do mothers react to losing a child whether through childbirth or as infants? How do you try to tackle this faith they have that death is a decision of the gods and not as a result of improper healthcare?

BBF Borehole-in-OgunThe mothers feel very bad losing a child. Their individual reactions depend on their circumstances. A mother is affected more if she’s still searching for a first child or looking for a particular gender.

We tackle their fate issue on child death by counseling them in such circumstances. BBF, on its part, tries to provide facilities that make the stay of the mothers in hospitals less stressful.

We provided a water borehole to a local community hospital in Ogun state.

Now the patients and their sick ones do not need to come to the health facility with water they have fetched from the stream.

'Refer and Reward' System Brings Massive Improvement

The foundation’s 'Refer and Reward' system has seen massive improvement, bringing Adepeju closer to realising the goals for her foundation. Currently, BFF expects the Nigerian government to become involved and spread the system beyond Ogun state (in the South-West of Nigeria). Under the 'Refer and Reward' system, TBAs are “encouraged to refer, in a timely manner, women who seek medical attention from them”. Those TBAs who refer patients promptly, get a reward of seven dollars.

However, this improvement comes at a costly price because in cases where hospitals or trained TBAs are not able to save a child or mother, relapses are common among local women who then re-visit untrained TBAs. To prevent relapses of this kind,  BFF strives to provide the basic facilities in their healthcare centres in order to reduce maternal and child death.

Traditional Birth Attendants and Trained Medics are Essential

In a country where corruption is rife, do you feel that the TBAs exploit rural women for profit?

There have been cases of such exploitation by the TBAs, but on the whole, the insufficient healthcare facilities and trained practitioners have shown that TBAs are a very essential part of the community as it presently stands. This realization is what makes us embark on training them to refer and recognize cases they should accept or reject.

Are there volunteer medics working with the BBF? What is their role in your organisation?

Yes we have volunteer medics working for BBF. Their role is mainly in being resource people on the ground during our outreach programmes, providing counseling for women and attending training of TBAs in workshops organized by the BBF.

Outreach Programmes

Have there been women, families and communities who have specifically benefited from the BBF? In what ways?

BBF-Clean-WaterPresently, we have completed a water project for Community Hospital in Ilisan-Remo, Ogun State. The taps are running and the community is happy.

The staff at the hospital are also happy. We have also done many outreach programmes in many rural communities in Ogun state.

Does BBF have any plans to extend their outreach programmes to other parts of Nigeria (especially in the Northern parts where it seems maternal infant and mortality is rife with a poverty rate of about 70%compared with a range of 25% of in the South)? 

Yes we do. The violence in the north is a barrier and we hope the challenges faced by the government will be tackled soon; hopefully, we will also require more funding to help in spreading the message.

Sources:


 

Lola-Johnson-4Lola Johnson is a second year Film and Media Studies student at the University of Leicester.

"I was born in Lagos, Nigeria; a city of living chaos...

Every woman in Africa is born weak. Life teaches her strength...

Zora Neale Hurston wrote that, “De nigger woman is de mule uh de world.”

Yet, the more I read and live, the more I see that all women are mules of the world. For me, it is not about strengthening or empowering women, as we already have both qualities. For me, it is about breaking free from the cage that man, society, culture and tradition have built around us."