The Need to Make Health Insurance Mandatory for Pregnant Women and Children

Ada found out she was pregnant barely five months after the previous one. She was thrilled and afraid at the same time. Her husband, Obi, was uncomfortable because his business was going through some challenges and he still had to take care of his family, including his five-month-old twins. However, considering that Ada delivered the set of twins vaginally, they hoped this second one would also come without complications. But alas, they were about to be shocked.

Seven months into her pregnancy, Ada began to notice the pregnancy came with challenges she didn’t experience in the first one. She began to experience false labour, especially at night. She complained at the antenatal clinic and was told it happens to many women and she has nothing to worry about. By the eighth month of her pregnancy, the contractions continued even though the cervix wasn’t opening. In addition to this, she began to retain water on her legs. But maybe she didn’t see it as a problem, after all, it happens too. However, the midwives at the clinic began to worry because the foetus was lying in a non-cephalic presentation. She was sent for a scan and it was also discovered the foetal weight was much. That was when Ada was referred to a doctor.

Of course, doctors don’t take chances with pregnant women, especially when there are issues. The doctor told Ada to start preparing for the caesarean section (CS) and nothing more. Ada told her husband, Obi, and they both went to meet the doctor to see what it will take to have CS. Well, your guess is as good as mine. Anyway, Obi didn’t have the amount of money the doctor mentioned as the initial deposit. He began to call for help but many turned deaf to his plea – it’s his responsibility, right? Well, suggestions began to come from left, right, and centre; and the poor man and his wife began to listen to them – do they have a choice. This was how Ada was taken to a woman that is “an expert in repositioning foetus”, and later taken to another hospital for delivery when labour started fully. To cut the whole story short, Ada’s labour lasted longer than normal and they still had to go for CS. But unfortunately, Obi lost Ada and the beautiful daughter that would have been born to him.

This story is real; the only difference is the changes in the names.Many people may relate to this couple’s experience. Some women died as a result of something like that. Many have been incapacitated for life because of such an abysmal experience. It is easy to blame people like this when you have not been in their shoes but, believe me, you may do exactly what that couple did if you find yourself in their position. Today, Obi laments his wife’s death and blames it on lack of funds. According to him, if he had the amount the first doctor demanded, he wouldn’t have sought help or even heard all the suggestions they followed. This is why it is unacceptable that pregnant women should be expected to pay for their delivery through the out-of-pocket method. They should be mandated to obtain health insurance before their due date.

Pregnant women are not the only ones that need compulsory health insurance. Children do too. According to the World Bank, in 2019, the mortality rate of children below the age of five was 117 deaths per every 1000 live births in Nigeria. Of course, this figure was derived from reported cases when deaths happen in hospitals. This does not include children that died at home because their parents could not afford hospital bills. Furthermore, the World Health Organisation (WHO) reported that in Nigeria, the maternal death rate in 2015 was 800 deaths per every 100 000 live births. According to the organisation, 58 000 maternal deaths occurred in the country in that year alone. The problem here is that the rate is increasing because, according to Index Mundi, the maternal mortality rate in Nigeria in 2017 is 917 deaths per 100 000 live births. This is becoming worrisome.

It should be noted that infant and maternal mortalities in Nigeria are not caused by poor medical services. This is far from it. Even to date, we still hear about women going to non-professional midwives for delivery. We still see those taken to “churches” for prayers because their labours are prolonged and, hence, it must be the hand work of the “enemy”. We still see people avoiding antenatal classes because they couldn’t afford them (especially when the Primary Health Centres in their communities are non-functional). In Nigeria today, the major cause of maternal mortality is the lack of access to proper health care. This is the same with infant mortality.

It will be improper to blame the government for these death rates because the government has put things in place to curb them. For instance, antenatal classes in government hospitals are free and so are deliveries. All that the woman had to provide are materials needed for the delivery. However, if CS is needed, delivery is no longer free; this is where many women encounter challenges.

But a woman that is covered by health insurance does not have to worry about money for delivery. As far as I know, a woman that is duly registered under National Health Insurance Scheme (NHIS) does not pay a dime for her delivery, even if it is through CS. Even the child she gave birth to will be covered by her insurance until he/she is three months old. So, why do our people take chances with their lives when there is an easy way out?

Many people, to date, think NHIS is a scam. Some think it is for government employees alone. They are not to be blamed because the level of publicity of NHIS is low. But those that have discovered about it and its benefits do not hesitate to register with them. However, NHIS is still voluntary in the country; something I believe should be changed for pregnant women and children. It is left for the appropriate quarters to insist that pregnant women and children should, compulsorily, be covered by health insurance. How they will go about it is up to them.