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BBC – Future – why do women reduce this operation?

When Alice Just recently revealed the details of her caesarean section to a group of women, it was not a common "birth story" commonly shared among friends: she did something that many would consider risky. It was because she was talking about an operation that some women would refuse to go through, never to talk about, even though they knew it could save their lives.

"When I walked by myself [into the operating theatre] I saw everything they were going to use on me, and I cried," Apparent told the others. She said she was afraid she would be injured irreparably. Then a plate was placed over her stomach. "The next thing I heard was that my baby was crying," she recalled ̵

1; as congratulating applause from the women surrounding her.

Outside the farm in Lagos, Nigeria, Ogbara may not be able to share his story so willingly. Concerned about the safety of the operation, combined with religious and social factors, means that C sections are stigmatized in Nigeria. This causes many women to resist the operation – or hide it when they go through it. Also, her C section also kept secret from the members of her family. "If you tell us Nigerians that you are going through the Caesarean section, they will tell you," God forbids, "says God."

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The meeting she attended was led by a Nigerian non-profit called Mamalette, who supports pregnant women and tries Lowering the Mortality of the Mother over Lagos Part of that effort is to address the stigma of birth defining women's access to life-saving care.

In Nigeria, 58,000 women are killed each year, giving the country the world's fourth highest mortality rate for children. of the problem is the country's low caesarean section: only 2%, the global interest rate is 21%, while there is only one doctor for every 6,000 people in the country.

Mamale tte aims to provide women with the most often unaccompanied minors: supportive health education and a sympathetic ear for their concerns. Their grassroots orientation shows early success in improving the health outcomes of pregnant women. But the small organization faces big challenges.

Global disparity

In the global context where C-sector interest rates are rising rapidly, Nigeria's numbers are distinguished. Between 2000 and 2015, the C sector's prices almost doubled worldwide . In countries like the Dominican Republic, women now undergo surgery in more than 50% of cases. In North America, it is 32.6%; in the United Kingdom, 26.2%.

In West Africa, on average, only 4.1% of birth causes a C section, and Nigeria's interest rate is half.

To effectively prevent maternal mortality, a country's caesarean section should not be less than 5%, says the World Health Organization. This is because medical C-sections are important for preventing obstructed work in cases where the woman's pelvis is too small, the child is in the breast position or is too large to leave the birth canal. Without intervention, a cramped baby may break the uterus or cause tears as catastrophic bleeding.

"I think it is the indicator of health with the greatest possible difference in overuse and under-use," says Carine Ronsmans, an epidemiologist at the London School of Hygiene and Tropical Medicine and a writer on recent reports on the global empire search.

A very large number of C sections may be due to the fact that Caesareans may increase the risk of conditions such as placenta previa, which can cause serious bleeding. At the same time, "so many women still die from not having access," says Ronsmans. "We really can't afford to forget these women."

In Nigeria, the barriers to access are particularly high in rural areas, of which approximately 58% of deliveries are made by undamaged laborers.

In the city center with more hospitals, cost and stigma, the primary obstacles are. Stigma is driven by thoughts that vaginal birth is tailored to femininity, while C-sections are not a common idea in countries such as the United Kingdom as well.

It is enhanced by religion in Nigeria: Christian women usually hear that birth vaginally as a "Hebrew woman" is a sign of strength and competence. This stems from a passage in the Bible that tells the story of "powerful" Hebrew women born stoically unattended by midwives.

The mythical ability to feed the vagina – and unguarded – has been maintained as a symbol of mother's virtue in Nigeria. "Nigeria is a deeply religious country, and everything is very spiritualized," said Adepeju Jaiyeoba, founder of the Nigerian Brown Button Foundation, working to reduce maternal deaths.

Hospitals routinely meet women who – scared to shame their families – simply refuse the operation. Often women have limited control over their own births: A case study by a Nigerian hospital showed that in 90 percent of cases, women thought men should sign the consent form so that they could undergo the C section – make the decision in male hands.

In other countries like the United Kingdom and the United States, the situation cannot be so extreme. But women still face stigma to have Caesarean section.

And high-quality obstetric care does not necessarily have to be translated into perfect conditions for pregnant women. In 2018, Mother's Rights Charity Birthrights found that nearly three-quarters of UK public hospitals do not have a clear policy that allows women to request planned caesarean sections that violate national clinical guidelines. Birthrights believe it has a stigmatizing effect – especially when women have particular reasons to avoid vaginal birth, such as a history of sexual abuse or mental health problems, says Amy Gibbs, Birthrights CEO.

"Women should be the primary decision-maker at birth. The right to choose what will happen to your body is so fundamental."

That principle is what Mamalette fights for in Nigeria.

Health Promoter

Just outside a chaotic street where three-wheeled keke taxis and motorcycles weave through gridlocked traffic, Anike Lawal sits inside Mamalette's quiet, cool office in the tech hub that is Lagos Yaba neighborhood.

A thoughtful, soft-spoken woman she says that she launched Mamalette as an online society where mothers can support each other. "I didn't decide to try to save someone's life," Lawal says. But tapping into the widespread female society showed her how much risk even city mothers met at birth. "When people talk about mother's loss, you never think of women living in cities, women who have smartphones and Facebook," she says.

In 2017, Lawal began recruiting mothers to help local women in their communities safely through pregnancy. It was developed into today's 20-member strong team that Lawal calls "Mamalette Champions".

These mentors, who receive training from midwives, nurses and doctors, are currently working in 20 urban poor communities across Lagos and one in the city of Ibadan, serving more than 300 people through one-to-one home visits. They ensure that women participate in their childbirth classes and register in hospitals to feed instead of using traditional birth attendants. They often go to hospital with women when they go to work. "In a country when we don't have enough hospitals or doctors, preventive care is very important. That's what we do," Lawal says.

Uniquely, Mamalette also creates a secure space where women can talk about taboo issues around birth, such as Caesareans. Often they are in the communities they serve the first port of call for women who want to discuss these concerns – ranging from stigmas to the quality of surgical care, which may be low in some premises.

"Mamalette is like an intermediary between the healthcare system and the people," says Blessing Kolade, a former mentor who is now working on the program store at Mamalette. "Health care is so overwhelmed that even healthcare professionals do not have time to break down the information. Women cannot open themselves; they cannot ask any questions," she says.

This means that misconceptions go through and stigmas go uncomfortable. Many women who need a C-section think about it for the first time when they are already working. At that time, they are less likely to accept the operation, because they resort to anchored beliefs that they should give their families shame. "Because of that stigmatization, you will see someone who is at the point of death and still denies a Caesarean, because she does not want to go through all that," mentor Oluchi Anumni says.

Mamalette tries to solve these problems before coming to this fateful Mentors, specially trained to abuse C-section misconceptions, clearly outline the reasons why women may need a C-section, such as having a small pelvis or medical condition such as preeclampsia. Women Mentors Give Them Ammunition Against Those They Can Get.

Some mentors finally end up defending their mentees' decisions in hospitals. "We've had masters who have advocated for pregnant women with their families if they needed medical procedures," Lawal.

The women have noted that their group members are much more receptive to Caesarean section. says she calls on women who have had C-sections to come and show their mentees to dispel the myths about which C-sections really do. "Their view was that C-sections were a no-go. They are now informed that [it’s] is not a death order," says Lasisi-Opaleye. The data collected by Mamalette also show that the majority of women during their care are in the health care according to

"I can proudly say that so many women have escaped death through the things they have learned," Anumni

Complex solutions

But when it comes to maternal health, it is not enough to address cultural and social barriers to C-sections

New research showed that C-sections in sub-Saharan Africa are up to 50 times more lethal than in high-income countries, mainly due to untreated bleeding and botched anesthesia, Salome says. Maswime, obstetrician, gynecologist and lecturer at the University of the Witwatersrand, who was involved in the research.

"As a doctor, I really feel admission is the place to start. But I'm nervous to just say access on my own, says Maswime. "We must pay attention to the quality of the surgical care that women have."

She believes that if healthcare improves, it would also reduce stigmas associated with the operation: "I don't think it's as easy as consulting with women," says Maswime. "It's a complicated problem that requires complex solutions."

The cost of healthcare is also a deterrent to getting surgery in Nigeria. Some countries have tried to improve availability by releasing C sections. In Mali and Benin, removal of user fees has been shown to increase hospital birth and to lead to better health outcomes for women and their children. In Nigeria, similar changes are evolving: Lagos state government, for example, recently announced the launch of a new health insurance system that makes Caesareans free.

In some hospitals, some hospitals now also refer to women who refuse C sections to social workers to discuss their problems, says Aduragbemi Banke-Thomas, a health political researcher based at the London School of Economics and Lagos State University. He believes that lending women a sympathetic ear is a powerful approach. "What we really need to do is try to bring the women together as a partner," he says.

In the UK, a similar "partnership" contributes to hospitals increasing women's access to planned C-sections. Instead of banning planned C-sections directly – as existing birthplaces were discovered, were strikingly common, occurring in 15% of hospitals – some plants now say that if women have been presented with the information they need to make an informed choice, their a decision to have a planned C section will be respected.

It has calmed the relationships between patients who have previously been able to feel stigmatized or anxious about the lack of control over their birth and doctors who felt compelled to consider women's concerns, says Nina Johns, an obstetrician at Birmingham Women's Hospital. has adopted this new approach. "It gives it the opportunity to work together, rather than antagonistically."

If it is Nigeria or the UK, the basic problem and solution is the same, says Birthrights Amy Gibb. "Often the woman's right to choose what happens to her gets lost," she says. "The way to get this is to place women in the middle of the choice of their care."

An inheritance of change

Mamalette recognizes the task they face is too big for a small organization working in just one sprinkling of societies. But they believe that empowering women with information also creates a long-lasting kind of change.

"Something that Mamalette does what we have not seen is giving the woman's identity," says former Mamalette mentor Olamide Ekpenyong. "We are trying to let women know that you must stand and be bold. Don't let society define you."

Encouraging women to assert their rights of life-saving care crystallizes that goal. "With that knowledge, the others train," says another mentor, Christiana Ogunbowale. "Some of them have girl children, so Mamalette is already preparing the future for women's coming."

Alice Ogbara says her own prospects have changed. Now her daughter is a year old, and Ogbara is no longer so careful about telling the people how she gave birth.

"I tell you about me, I share my own experience with them," she says. She is cautious – urges women that if they need a C section they should only go to reliable hospitals, for example. But she is also encouraging. "A C section is not a bad thing," she tells people. "It's just another way to deliver."

Reporting for this article was made with funding from European Journalism Center s Innovation in Development ] [19659000] Instagram .

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