By: Esther Alaribe

Despite efforts targeted at addressing maternal deaths across national and sub-national levels, the maternal mortality ratio has remained high in Nigeria as it contributes 28.5 percent of the global maternal mortality ratio being the second highest maternal, stillbirth, and neonatal deaths in the world followed by India.

Nigeria’s mortality rate

A 2023 UN report on trends in maternal mortality from 2000-2020 reveals that a woman in Nigeria has a 1 in 19 lifetime risk of dying during pregnancy, childbirth, or postpartum, whereas, in the most developed countries, the lifetime risk is 1 in 4900. This is the sad situation Nigerian women are in. The World Health Organisation’s recommendation for a functioning healthcare system is one doctor for every 600 people. In Nigeria however, the ratio is one for every 4,000-5,000 patients.

The Nigerian Healthcare Sector has had major challenges, especially with primary healthcare which is the closest to the people. Primary healthcare unfortunately receives the least attention leading to preventable deaths, especially for pregnant women who can not afford better healthcare treatment from other sources. These women resort to self-help and unprofessional alternatives to guide them through pregnancy and childbirth. The traditional model of hospital-based pregnancy care poses significant challenges for expectant mothers. In a survey carried out by Women Radio 91.7s, 90% of women noted that these challenges include long wait times for appointments, limited accessibility to healthcare facilities and fragmented communication between patients and healthcare providers based on personal bias or offshoot of workload stress on medical practitioners.

An AI-generated image of pregnant women being addressed by medical practitioners

The introduction of telemedicine in Nigeria’s healthcare system began in the early 2000s, with initial projects focusing on tele-education and teleconsultation. Telemedicine gained significant momentum in the 2010s with private sector investment and government support. Today, this approach to medicine is becoming increasingly popular in Nigeria, with various platforms and services available, aiming to improve healthcare access and quality, especially in rural and underserved areas.

30-year-old Sandra Ozoluonye is a first-time mother who lacked the experience needed to carry a child. She lamented the lack of access to necessary information in public hospitals. According to her, she couldn’t access doctors as frequently as she needed their services. She said that public hospitals lack new information that is vital for the mother and unborn child (ren) and are not up to date. “In public hospitals, sometimes you’ll join the queue for hours, you won’t see a doctor until you’re very tired and you go home feeling helpless. Being a first-time mom, I found it difficult to understand the experience I was having and at the hospitals, only old information is being recycled. There’s no new information and you cannot even call the doctor to ask questions anytime you’re confused about something. But on Preggify, once you drop a message for them before you go to your kitchen and come back, they have responded.”

Mercy Emmanuel had lost two babies to premature births, alleging a “lack of enough medical attention”. In her interview with Women Radio 91.7, Mercy lamented the absence of adequate check-ups and follow-ups for expecting mothers. She recounted her “painful experience” with a gynaecologist at a hospital in Abuja, one which could have cost her life. She described the experience as “devastating” and that “it looks like doctors in public hospitals don’t really care about their patients”. “The gynaecologist I met in Abuja told me I will undergo a surgery. He didn’t ask me to do any test or scan, nor did he tell me what the problem was. He only did a physical examination and told me to look for N200,000 for surgery, and another N200,000 for injections. How can a doctor just recommend surgery without adequate examination?”

Graphic illustration of the 2023 UN Report on Trends in Mortality Rate in Nigeria

Born out of a passion….

Founded in 2022 out of passion for women, Preggify is solving some of the problems faced by Nigerian women. Speaking with Women Radio 91.7, the Founder of Preggify, Dr. Ifunanya Igweze said that the motivation behind the establishment of Preggify was her personal and professional experience as a doctor.

A pictorial representation of Preggify’s mobile app

“We provide pregnant women with 24-hour pregnancy support where they can call in or chat with any doctor whether it’s in the morning afternoon or night. This helps them to sort out most of their challenges at home, get a direct home remedy, over-the-counter prescription or prescription medicine delivered to them anywhere they are. We also organise educational classes for them, weekly, to help them stay in the know because most of them are working-class women, they barely have time to spend in the hospital listening to these teachings”. At Preggify, pregnant women are able to connect from anywhere they are in the world. “Since inception in 2022, we provide at-home testing support. Both tests they can do by themselves as well as analysis of their blood pressure, sugar level and vital signs. We guide them on how to take the tests and as soon as they do, they report to their doctor for analysis and counselling. For the ones that require major testing but are not able to go to the hospital or laboratory, the laboratory officials can be sent to their houses to take their samples and get the test done. The labs then report back to Preggify for follow-up.

For Sandra, what she finds most fascinating is the attention given to expecting mothers’ mental health. “Another thing that we enjoy is mental health support. We get mental health screening at least once every month to rate our mental health status and be sure that none of us is going through prenatal depression. And if anybody scores high and gives an idea that their mental health status is not optimal, they send a three-way support system where they advise us on what to do, alert our partners and then Preggify follows up to make sure that we are fine”.

According to Dr. Ifunanya Igweze, Pregiffy now has a community of about 2000 women and 250 premium users within Nigeria, Ghana, the UK, US, Canada, and other places. At the moment, the service targets women living in urban areas because the primary clients are working-class women or businesswomen who have access to their smartphones and the internet.

“As a first-time mum, I had little or no knowledge about how to deal with the many complaints that my pregnancy came with. In my first trimester, it was difficult to get the doctor’s attention at the hospital.” Adesanoye Arayemi Precious disclosed. Adesanoye who bemoaned the unavailability of twenty-four-seven medical services to pregnant women, said that visiting a hospital most of the time, even compounded her challenges because “it was time wasting.” She added that Preggify helped her access medical care without having to rush to the hospital at the slightest inconvenience. “I wish I could have enough information at my disposal, so I don’t have to physically be present at the hospital due to slight inconvenience. Getting enough health information and tips on how to be able to access quality healthcare will save pregnant women from unwarranted deaths.” Adesanoye noted that one of the perks of the platform is the opportunity for their partners to learn how to care for them. “On the platform, we have a pregnancy academy where we can learn about pregnancy on the go, everything that happens in pregnancy, even our partners learn how to support us.  Even if I’m asleep, he’ll check me regularly according to how the doctors on Preggify had advised. The men are also learning to discover those things early and report, when necessary,” she said.

A fertility physician, Dr. Collins Aboloje said that the role of telemedical apps and digital platforms is to provide advice. He added that the Nigerian community is still far behind in the embrace of telemedicine.

Doctor to Patient Ratio in Nigeria

“The world in recent times has experienced a huge jump in the practice of telemedicine and also in the number of digital platforms that have sprung up, to take up the task of delivering healthcare services to an extent, especially to the vulnerable population, which is even to women and children in recent times. Lack of access to the internet and as such, absence of standard hospitals will still cause a major setback in combating maternal mortality. Let me reiterate that, of course, apps or platforms like this embracing telemedicine are becoming the order of the day and as such, a lot more people, a lot more countries and a lot more healthcare systems will be integrating telemedicine into their practice. But the question now still lies in “Will everyone be able to access the internet service?”

Running Preggify has not been without challenges. Dr. Igweze highlighted funding and lack of access to collaborations with stakeholders as a challenge faced by Preggify “If you have a good network, like access to resources both material and financial resources, access to networks like the Ministry of Women Affairs, Ministry of Health’s Primary Health Care Board, Maternal Health Service Commission and present this kind of solution to them and it’s adopted, it can spread to general hospitals, primary health centres and even to private hospitals that handle maternal health and they’ll all report to the government. This way, everybody will benefit from it. “Another challenge is funding in the form of grants or equity funding. They don’t come by easily and funding is what you need. To even get enough workforce to push the solution, to talk about the solution, even to market the solution, you still need funding.”

Further addressing the challenges faced by the organisation, Dr Ifunanya Igweze said that the unavailability of data and statistics is another challenge. She noted that Nigeria does not have robust data on maternal health. “There is no uniformity in the data and the data is not so much like you see in the UK or US. Sometimes when you are making references, you tend to reference Western countries instead of Nigeria or somewhere close to Africa. The government needs to fund more research in our institution so that we have robust research that people who want to build solutions can rely on.  Even if the research is not published, it should be accessible to organisations that need them to provide practical and impactful solutions like Preggify”.

A Sexual and Reproductive Health Rights (SRHR) activist, Omolola Pedro said that the nonchalant attitude of the government is why the country is still dealing with high maternal mortality in 2024.  She said, “While the work being done by Preggify is laudable, we need to remind ourselves that no technology or telemedicine can replace the government’s responsibility to the people.” “It is bad enough that the Nigerian healthcare system is in a terrible state, but it is worse that women and children are not even prioritised. The Nigerian healthcare system needs a complete overhaul and we need to have more women-oriented initiatives than ever before. Leveraging technology to improve women’s health is something that the government needs to look into.”

The global outlook on telemedicine is rapidly evolving, and it has the potential to significantly impact maternal mortality rates, particularly in low-resource settings. According to the World Health Organization (WHO), telemedicine can help reduce maternal mortality rates by 30-40% in developing countries, and 10-20% in developed countries. Despite challenges, telemedicine has the potential to revolutionize maternal healthcare, improving outcomes and reducing mortality rates globally. As technology continues to evolve, it’s essential to address the challenges and ensure equitable access to telemedicine services for all.

This story was produced by Women Radio 91.7 in partnership with Nigeria Health Watch through the Solutions Journalism Network.