By Francesca Hangeior

Gynaecologists have expressed concern that the recent hike in fuel prices could significantly reduce antenatal attendance among pregnant women across the country.

The maternal health experts have warned that low antenatal attendance could lead to poor pregnancy outcomes due to a lack of supervision and specialist care.

The physicians further expressed worry that the hike in fuel prices could exacerbate Nigeria’s already troubling maternal health indices, highlighting that effective antenatal, intrapartum, and postpartum care were crucial in averting maternal mortality.

The hardship, which started after the removal of fuel subsidy and devaluation of the naira, was exacerbated on Wednesday when the pump price of fuel jumped from around N800 to N1,150 per litre.

This has led to increased transport fares nationwide and worsening the hardships faced by Nigerians.

The gynaecologists disclosed that the new fuel pump price would certainly impact antenatal attendance, stating that pregnant women with low income would not be regular with their appointments due to high transport fares.

The World Health Organisation’s new guidelines recommend at least eight antenatal visits during pregnancy, emphasising that care should begin within the first trimester.

According to the 2018 National Demographic and Health Survey, Nigeria has a worrisome maternal mortality ratio of 512 deaths per 100,000 live births.

Speaking exclusively with PUNCH Healthwise in different interviews, the gynaecologists expressed concern that reduced antenatal attendance would prevent many expectant mothers from receiving necessary interventions.

Dr Chukwuneme Okpala
A Consultant Obstetrician and Gynaecologist at Nnamdi Azikiwe University Teaching Hospital in Nnewi, Anambra State, Dr Chukwuneme Okpala, warned that the recent fuel price hike would lead to decreased antenatal attendance.

He explained that the initial increase in fuel prices had already raised transportation costs, and the latest hike had further worsened the situation, making it difficult for many pregnant women to keep to their appointments.

Okpala stated, “Hospitals will see a decline in antenatal care attendance in Nigeria due to the rising fuel cost. High transportation costs will have a ripple effect on people’s living standards, reducing the purchasing power of pregnant women.

“Many will struggle to afford basic needs, which will inevitably affect their ability to attend appointments. When finances are tight, families will have to prioritise essentials like food over healthcare, leading to fewer women attending routine antenatal services.

“Many women will not visit the hospital regularly for antenatal care due to financial constraints, regardless of their proximity to healthcare facilities.”

Okpala stressed that irregular attendance at antenatal clinics could lead to poor quality care, significantly impacting pregnancy outcomes.

“Without regular visits, those who need interventions may not receive them. Attending antenatal clinics frequently increases the chances of detecting and managing potential complications.

“Only through hospital visits can healthcare providers assess and identify any issues, whether maternal or foetal. When women do not present or arrive late, it often results in more severe problems that could have been addressed earlier”, he said.

Okpala lamented that decreased antenatal attendance will exacerbate Nigeria’s maternal health indices.

“If the current hardships persist, our maternal health statistics will suffer. In 2023, the WHO reported that Nigeria has the second highest rates of maternal, stillbirth, and neonatal deaths in the world, following India,” he said.

The expert explained that maternal mortality serves as an indirect measure of a country’s Gross Domestic Product, adding, “If our GDP declines, healthcare will be adversely affected. Preventing maternal mortality relies on proper antenatal, intrapartum, and postpartum care.

“If women begin to seek alternative care due to high transportation costs, our maternal mortality rates will undoubtedly rise. While the effects may not be immediately visible, they will become apparent if the current trend continues without intervention.”

Offering recommendations, Okpala stated that the government was aware of the necessary actions to take, as many professionals have provided potential solutions.

He said, “The government has two options: either reinstate the fuel subsidy and tackle corruption or refine our fuel and sell it reasonably. Alternatively, they could establish an affordable public transport system for antenatal mothers, enabling them to attend their appointments.”

He emphasised that such measures could lead to positive pregnancy outcomes, asserting, “The responsibility lies with the government, not individuals. If they implement these changes, it would help, but I remain sceptical about their willingness to do so.

“Our government travels abroad and observes how things work there. If we can enhance purchasing power, we will access quality care; if purchasing power decreases, the outcomes will suffer.”

He said, “If a person earns N100,000 and that amount remains unchanged over time, their quality of care, as well as the quality of food they can afford, will decline.

“Consequently, the amount they can allocate for healthcare will also decrease. The government knows what needs to be done, but corruption often hinders these efforts.”

Corroborating Okpala’s statement, a Consultant Obstetrician and Gynaecologist at the Niger Delta University Teaching Hospital in Bayelsa State, Dr Judiet Ugbechie, emphasised that reduced antenatal attendance increases the risk of pregnancy complications.

She noted that higher numbers of antenatal visits are crucial for decreasing the likelihood of stillbirths and improving pregnancy outcomes.

Ugbechie said, “Having eight or more contacts for antenatal care can significantly reduce perinatal deaths compared to having only four visits or none at all.

“A woman’s visit to her antenatal care provider should encompass more than just a routine check-up; it should involve comprehensive care and support throughout the pregnancy.”

She highlighted that more frequent and higher-quality visits between women and their healthcare providers facilitate the uptake of preventive measures, timely detection of risks, and address health inequalities.

“Antenatal care is particularly vital for first-time mothers, as it sets the foundation for how they will engage with antenatal care in future pregnancies,” she said.

She recommended that pregnant women schedule their first antenatal visit within the first 12 weeks of gestation, followed by subsequent visits at 20, 26, 30, 34, 36, 38, and 40 weeks.