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BBC – Future – Why do women refuse this operation?

<img src = "http://ichef.bbci.co.uk/images/ic/raw/p067ssc1.jpg" border = "0" alt = "" When Alice Ogbara recently revealed the details of a cesarean section of a group women, this was not a simple "birth story" shared by friends: she was doing something that many consider risky, because it speaks of an operation that some women would refuse without even thinking about they knew they could save their lives

"When I was walking alone [into the operating theatre] I saw everything I was going to use and I would cry," said Ogbarra to the others, and said she was afraid she would be damaged "The next thing I heard was my baby's weeping," she recalled, greecing applause from the women who surrounded her

Beyond this yard in Lagos, Nigeria, Ogbarra could not delight in his story. Concerns about the safety of the operation, combined with religious and social factors, mean that C-sections are stigmatized in Nigeria. This causes many women to resist the operation ̵

1; or to hide it when it passes through it. Ogara even kept his secret section from his family members. "If you tell us that the Nigerians will pass through the Caesar section, they will say," Give God, "Ogbara says.

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The meeting at which she was attended was run by a Nigerian harassment called Mamalette that supports pregnant women and tries to reduce maternity deaths in Lagos, part of these efforts include overcoming the stigma around birth,

In Nigeria, 58,000 women die at birth each year, giving the country the fourth highest mortality rate in the world, with a low share of cesarean sections in the country – In the meantime, there is only one doctor in every 6,000 people in the country.

Mamalette aims to provide women with what they often can not get underprivileged health workers: supporting health education and sympathy for their fears. Their basic approach shows early success in improving health outcomes for pregnant women. But the small organization faces significant challenges

Global inequality

In the global context in which the percentage of the C-section is growing rapidly, the numbers in Nigeria stand out. Between 2000 and 2015, the C-section rate almost doubled worldwide . In countries like the Dominican Republic, women are currently undergoing surgery in more than 50% of cases. In North America, this is 32.6%; In the United Kingdom – 26.2%.

In West Africa on average only 4.1% of births include C-section, and Nigeria is half.

To effectively prevent maternal mortality, a cesarean section in the country is less than 5%, says the World Health Organization. Since medical C-sections are essential to prevent difficult work in cases where the pelvis of the woman is too small, the baby is in a sitting position or too big to get out of the canal. Without interference, a shrunken baby can break the uterus or cause tears that can be catastrophically bleeding.

"I think this is a health indicator with the greatest possible inconsistency of overuse and use," says Karin Ronsmans, an epidemiologist at the London School of Hygiene and Tropical Medicine, and author of the latest reports describing the global cesarean section.

A very large number of C-sections may be relevant because cesarean sections may increase the risk of conditions such as placenta, which can cause severe bleeding. At the same time, "so many women still die from lack of access," says Ronsmans. "We really can not afford to forget these women."

In Nigeria, barriers to access are particularly high in rural areas, where around 58% of supplies are made with unskilled workers.

In urban centers with more hospitals, costs and stigma are the main barriers. The stigma is dictated by the idea that vaginal birth is consistent with femininity, while C-sections are not a common idea in countries like the UK.

This is fortified with religion in Nigeria: Christian women Hear that birth vaginal as a "Jewish woman" is a sign of strength and competence. This stems from a passage in the Bible that tells the story of the "energetic" Jewish women who stoically give birth without midwifery to midwives.

This mythical ability to give birth vaginally – and without supervision – has been maintained as a symbol of maternal virtue. in Nigeria. "Nigeria is a deeply religious country and everything is very spirited," said Adepej Jieeoba, founder of the Brown Batton Foundation in Nigeria, which works to reduce maternal deaths. operation. Often women have limited control over their own births: a Nigerian hospital study reveals that in 90% of cases women think that men must sign the consent form by allowing them to move to the C-section – making the decision

In other countries like the United Kingdom and the United States, the situation may not be so extreme. But women still face a cessation of cesarean section.

High-quality midwifery care does not necessarily have to become the perfect setting for pregnant women. In 2018, Mother's Rights charity found that nearly three-quarters of UK public hospitals lack a clear policy allowing women to want planned cesarean sections, which is contrary to national clinical guidelines. Birth rights believe it has a stigmatizing effect – especially when women have specific reasons for avoiding vaginal birth, such as a history of sexual abuse or mental health problems, says Amy Gibbs, Chief Executive Officer of Bridal Law.

"Women must be a primary decision – birth-giving workers. That right to choose what will happen to your body is so fundamental. "

This principle is what Mammilet is fighting in Nigeria.

Right from a chaotic street where tricycles and motorcycles interweave through clogged traffic, Anike Lohal sits in the quiet and cool office of Mamalet at the technology center that is the Jaba district in Lagos .

A conceived, quietly spoken woman, she says she has released the Mamalette community in which mothers can support each other. "I did not try to save anyone's life," Lowell says. But the eavesdropping of the widespread community of women showed her how risky even birth mothers were at risk. "When people talk about losing a mother, you never think of women who live in cities, women who have smartphones and Facebook," she says.

In 2017, Lawal began to recruit mothers to help local women in their communities safely through pregnancy. This has become today's 20-strong strong team, which Loval calls the "champions of Mamalle".

These mentors, who are trained by midwives, nurses and doctors, are currently working in 20 urban poor communities in Lagos and one in the city. of Ibadan, serving more than 300 people through one-on-one home visits. They ensure that women visit their antenatal classes and register in hospitals to give birth instead of using traditional attendants. They often visit the hospital with women when giving birth. "In a country where we do not have enough hospitals or doctors, preventative care is very important. That's what we do, "says Laval.

Unique, Mammale also creates a safe place where women can talk about taboo themes around birth such as caesarean section. Often in the communities they serve, they are the first port for women who want to discuss these issues – from stigmas to the quality of surgical care that may be low in some settings.

A mediator between the health system and the people, "says Blessing Collad, a former mentor who is now working on the Mamalette program team. "The healthcare system is so overwhelmed that even health workers have no time to break the information. Women can not open; they can not ask any questions, "she says.

This means that the delusions sneak in and the stigmas remain undisputed. Many women who need a C-section look at it for the first time when they are already in childbirth. At this point, they are less likely to accept the operation because they are fighting with established beliefs that will lead their families to shame. "Because of this stigma you will see someone who is in the place of death and still refuses to take a cesarean section because she does not want to experience all this," says Ouchi Anumni, a mentor. they reach this crucial stage. Mentors who are specially trained to discard misconceptions about C-sections clearly outline the reasons why women may need a C-section such as the presence of a small pelvis or medical conditions such as preeclampsia. It takes away the shame of the equation and provides women with facts that give them ammunition against the solution they could get.

Some mentors even eventually defend mentees' decisions in a hospital. "We had champions who advocated pregnant women with their families if medical procedures were required," Laval said.

The anecdote, women have noticed that their group members are much more receptive to cesarean section. Adenek Ladyssi-Opaley, co-supervisor, says she invites women who had C-sections to come and show their menstrual abdominal scars to dispel myths about what C-sections really do. "Their notion is that C-sections are not on their way. Now they are informed that [it’s] is not a death sentence, "says Lasci-Opaley. The data that Mammilet collects also shows that the majority of women who care for them now give birth to health care facilities, according to Lawal. "I can proudly say that so many women have escaped from death through the things they have learned"

Complex Solutions

But when it comes to maternal health, just to deal with cultural and social barriers to C-sections is not enough.

Recent studies show that in Sub-Saharan Africa, C-sections are up to 50 times more fatal than in high-income countries. This is mainly due to untreated haemorrhage and failed anesthesia, says Salome Masvime, obstetrician, gynecologist and lecturer at the University of Witwatersrandt, who was involved in the study.

"As a doctor, I really feel that access is the starting point, but I'm nervous to say only that I have access," says Masvim. "We need to pay attention to the quality of the surgical help that women have."

She believes that if the care improves, it would also reduce the stigma associated with the operation: "I do not think it's as simple as counseling for women," says Masvim. "This is a complex problem that requires complex solutions "

The cost of medical care is also a deterrent to the operation in Nigeria, and some countries have tried to improve access by releasing C-sections." In Mali and Benin, it was found that abolition of consumer charges increased births in hospitals and results in better health outcomes for women and their technicians In Nigeria, similar changes are taking place: the government of Lagos, for example, has recently announced the launch of a new health insurance scheme that will relieve Caesareans

Also in Lagos, some hospitals are now directing women who refuse C- sections of social workers to discuss their concerns, says Aduragbey Banke-Thomas, a health policy researcher based at the London School of Economics and the State University of Lagos. He believes that giving women sympathy is a strong approach. "What we really need to do is to strive to bring women together," he says.

In the United Kingdom, such a "partnership" approach helps hospitals to increase women's access to planned C-sections. Instead of banning the planned C-sections altogether – as open births are strikingly common, occurring in 15% of hospitals – some facilities now say that if women were given the information they need to make an informed choice , their decision to have planned C-section will be followed.

This soothes the relationships between patients who may have previously been stigmatized or worried about lack of control over their births, and doctors who feel compelled to overcome women's problems, says Nina Jones, a female obstetrician at the Women's Hospital in Birmingham, which has adopted this new approach. "This allows us to work together, not antagonistically."

Whether it is Nigeria or the United Kingdom, the main problem and solution are the same, says Amy Gib. "Often the woman's right to choose what will happen to her is lost," she says. "The way to get this right is to put women at the center of choice for their care." Mamalette admits that the task they face is too great for a small organization to work with just spraying communities. But they believe that by empowering women with information, they also lead to more lasting changes.

"Something that Matalet does that we have not seen is that it gives women the identity," says former mentor Olamide Ekpenyong. "We are trying to let women know that you have to stay and be brave. Do not let the community define you. "

Encouraging women to uphold their rights to care for life crystallizes this goal. "With this knowledge they train others," says another mentor, Cristiana Ogunboale. "Some of them have girls, so Mamlett is already preparing the future for the upcoming women."

Alice Ogara says her perspective has changed. Now her daughter is a year old, and Ogbaara is no longer so cautious about telling her how she was born.

"I tell people around me, I share my own experience with them," she says. She is careful – advises women that if they have to have a C-section, they only have to go to hospitals with confidence, for example. But she also encourages. "The C-section is not a bad thing," she says to the people. "This is just the second way to achieve results." [19659902] –

Reporting on this article was made possible by funding from the Center for European Journalism Grant Reporting Program.

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