Ada* didn’t understand why she needed to be hospitalised during her pregnancy. It was her first, and most of the pregnancy had been largely uneventful. But as she approached her due date, Ada learnt that she had developed low blood pressure, which put her baby at risk. With her mother recovering from a stroke in Anambra and the father of her child out of state, Ada was forced to seek care at the Lagos Island Maternity Hospital alone. With sufficient emergency care, Ada’s daughter was delivered without complications.
Ada had only spent six days in the hospital since the birth of her daughter, but she already felt pressure to return to Anambra to care for her ailing mother. But leaving was no longer her choice; she was bonded by a ₦78,850 hospital bill that far exceeded her savings — and unsure of how to pay for low blood pressure medication and investigative tests that she could not afford.
Ada is one of many patients in government and private hospitals across Nigeria who cannot leave the hospital despite receiving treatment for their ailments and making a full recovery. These patients are in limbo; they should be basking in the joys of a growing family, but they cannot because they are burdened with hospital bills they didn’t anticipate.
These situations, where patients must navigate complex financial obligations, are on the rise globally as more people struggle to meet the ever-increasing costs of hospital care. But in Nigeria, one class of the affected really demonstrates how complex the economic burden of medical care can be for patients, hospital staff, and the social workers who serve as go-betweens for both groups.
To mark Mother’s Day and IWD2024’s theme of inspiring inclusion, PiggyVest met with young mothers caring for their newborns at the Lagos Island Maternity Hospital Lagos and UCH Ibadan, as well as hospital staff and social care workers, to understand this complex situation and the most vulnerable group it affects.
A Savings Nightmare
Bilkiss* was unprepared when she discovered she was pregnant, for the third time in her marriage, with twins. She was already mothering two boys and trying to recover from the setback of closing her business selling traditional herbs to construction workers because of bad debt. She was trying to get her life back on track and wasn’t at all prepared for more children.
Bilkiss struggled all through her pregnancy and managed to successfully birth healthy twins. Her problems didn’t start till a week later when the spotting she had experienced graduated into profuse bleeding. Neighbours and her husband convinced her to seek professional medical care at UCH Ibadan, even though she couldn’t afford it. The hospital saved her life, but she couldn’t leave afterwards because of outstanding debt.
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Unlike the other mothers we interviewed who experienced surprise complications, 32-year-old Bibi*, a trader who sells kitchen utensils, was admitted to UCH at the start of her pregnancy. Bibi was diagnosed with a short cervix and cervical incompetence. Due to the condition, Bibi is susceptible to pregnancy complications and has suffered four traumatic miscarriages over the course of her marriage. When she conceived her fifth pregnancy, Bibi was referred to UCH’s obstetrics department for specialised care. She was put on compulsory bed rest and a weekly regimen of medication to improve the odds of her pregnancy. She is expected to stay in hospital for 32 weeks, the duration of her pregnancy, during which she is required to abstain from any kind of work. But Bibi is anxious about paying off her hospital bill because the rising inflation has nearly doubled the cost of the life-saving medication she needs to reduce blood clots and improve her overall health.
Dr Olufemi Omololu, a consultant obstetrician and the Medical Director of the Lagos Island Maternity Hospital, tells us he has seen hundreds of similar cases throughout his career. It is, unfortunately, very common.
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“Not every pregnancy is the same. Issues can arise that can complicate routine pregnancies. With straightforward cases, expecting parents who can register in the hospital for antenatal care have many of their expenses underwritten by government health insurance schemes and intervention programmes.”
Dr Omololu explains that only 69% of births in the Lagos Island Maternity Hospital, where he works, were to mothers who registered for natal care at the hospital and were educated on the cost of antenatal care and birthing. In his experience, when partners decide to have a child, they begin to plan for their pregnancy journey, which includes saving money to offset future costs and researching possible providers for antenatal care. But rising inflation, widespread poverty, and estrangement from family are some of the reasons that mothers find themselves unable to handle their maternity costs and deal with pregnancy complications, even with prior planning.
Dr Omololu says apart from pregnancy complications; many women become entangled in hospital debt because they are already vulnerable before they seek care. This includes women who delay coming to the hospital because they do not have the funds to access healthcare, vulnerable mothers on the run from abusive situations and mothers who struggle with unrelated health issues.
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A Complex Situation
Tare*, who was referred to the Lagos Island Maternity Hospital as a result of a complication due to premature labour, had already exhausted her savings seeking out private hospital care before she got the referral. Even without payment, Tare was admitted for an emergency surgery that saved her life. Despite the hospital’s best efforts, Tare lost one of her twins and the other was born premature and in need of intensive care, which was provided on the understanding that she would pay after the child was healthy enough to go home with her mother. By the time we interviewed her, Tare’s hospital bill (including surgery and neonatal ICU care for her newborn) had risen to ₦432,230.
Tare’s child was saved because public hospitals are obligated to prioritise the health of mothers and their newborns. They cannot turn away any patient, even if they know the patient might struggle to pay hospital bills afterwards. Every mother who has to extend her stay in the hospital is there because they have received care, usually without payment, to ensure a healthy birth. While the worry of future debt can be very emotionally and mentally stressful for new mothers, they are also in a place where they will receive the best care for themselves and their children during this trying time.
Once mothers are healthy enough to care for their newborns independently, hospitals look to offset the debt equitably. Social welfare departments and non-profit organisations work with hospitals to devise solutions for mothers like Tare, Bilkss, and Ada who are caught in this situation. Some mothers are offered plans that stagger the payment of their debts over a period of time. This allows them to be reunited with their families and recover from the strain of birth before having to repay their debts.
These options are all beneficial to affected mothers and families. Still, sometimes, it takes the interventions of private organisations to free these women from the burden of debt and help them reintegrate into society. As a company that has helped millions of Nigerians from all backgrounds overcome debt, build a financial moat of savings and investments, and cross into economic prosperity, PiggyVest resonates with the plight of these women. That is why, as part of our Mother’s Day and IW2024 celebration, we provided ₦1,250,000 in financial aid and maternity supplies to Ada, Bilkiss, Bibi, Tare and a few other women, realigning them on the path to financial freedom — a concept that is especially poignant given their situation.
“We’re truly glad for the opportunity to directly contribute to the well-being and health of both mothers and their children,” Odunayo Eweniyi, PiggyTech COO, said. “Celebrating International Women’s Day and Mother’s Day in a tangible manner is always important to us at Piggytech, and it underscores the importance of recognising and supporting women generally. Whenever we can, and especially now, providing direct support to women in need is critical.”
*Names have been changed to protect the identity of the subjects.
