Ebele’s story is just one of many untold tales of pregnant women in the hands of TBAs who continue to endanger lives in Anambra State.
By Chidalu Glory
That rainy day, Ebele Onwudinjo, a middle-aged pregnant woman in Ojoto, dressed up and left her house for Madam Gloria’s, where she had registered to give birth. This would be her third child, and she was a familiar face at the local Traditional Birth Attendant (TBA) centre. She gave birth to Ogechukwu, her first child, there in 2018, and Joshua, her second, in 2021. Despite people’s concerns over her continued patronage of the TBA centre, she preferred it. The sense of community she felt there kept her coming back.
This time, she packed a few delivery items and set out, ready for labour.
Months earlier, she had fallen ill and was taken to a nearby hospital. There, she was diagnosed with high blood pressure, and the doctors pointed out that her baby was in a breech position. They advised her to register for antenatal care and return for a full body scan. But Ebele, not convinced, went to her trusted Madam Gloria, who told her not to panic. The woman encouraged her to take her medication but insisted she didn’t need to return to the hospital. She promised to help correct the baby’s position herself. Ebele, the faithful client, followed her instructions and believed all was well.
But as she left her house that fateful day in 2024, she didn’t know she wouldn’t return with her baby. Midway through delivery, Madam Gloria realized the baby was still in a breech position. She tried all she could but couldn’t help. Ebele lost a lot of blood and strength and was rushed to a hospital where she underwent an emergency operation. Sadly, the baby didn’t survive.
“I wish I had followed the doctor’s instructions. Maybe my baby would be here with me,” she said with a sorrowful heart, reflecting on her painful labour experience.
Ebele’s story is just one of many untold tales of pregnant women in the hands of TBAs who continue to endanger lives in Anambra State.
According to Global Data Lab, Anambra State records a maternal mortality rate of 32.2 per 1,000 live births and an under-five mortality rate of 43.3 per 1,000 live births.
Two years ago, the Anambra State government launched an ambitious initiative to provide free healthcare services to vulnerable populations across all Primary Health Centres (PHCs). The aim was to reduce high maternal and infant mortality rates by making healthcare more accessible to pregnant women, nursing mothers, and children under five. The introduction of free medical care through the Anambra State Health Insurance Agency (ASHIA) was expected to change the healthcare narrative in the state. But reality paints a different picture.
Akanator Primary Healthcare Centre.
In Akanator, a rural community in Ayemelum, a mother named Ifeoma Obiakor shares her experience with a sceptical smile. “I’ve been using a traditional birth attendant for all my children,” she says. “I feel more at home with her. She’s from my village and knows how to care for me. I don’t trust the health centres, no matter what they promise.”
Ifeoma’s story is common across Anambra. Despite government efforts, many pregnant women still prefer TBAs. This is often due to a deep lack of trust in PHCs and their staff. TBAs are familiar, accessible, and from the same community. That trust is stronger than the promises of free services. Nzuka Ede, for instance, despite having access to a PHC, prefers to trek long distances to Amukor to see her trusted TBA.
“It’s not that I hate the PHC. It’s just personal preference. At Nurse Ify’s place (the TBA), I trust that she knows what she’s doing. We grew up together, and she has helped deliver three of my children,” she said. “The midwives at the PHC are strangers. I don’t feel comfortable with them.”
When you visit the PHC in Akanator, the contrast is striking. The building is modern, clean, and well-maintained, with posters promoting free antenatal care, immunizations, and child health programmes. Yet the waiting room is nearly empty. When asked why Mrs Nkechi Obi, a nurse, responded sadly:
“The villagers don’t trust us. We just arrived, and most of them prefer their own people,” she said. “I tried reaching out to them, but I had to stop before it looked like I was attacking someone’s business. Many would rather go to TBAs or chemists, even if they cost more.”
For many, healthcare decisions are shaped by culture and trust. TBAs are known faces and are often more accessible, friendly, and relatable. “I trust the traditional birth attendant because she’s from my village,” says Chinyere Arinze, a 30-year-old woman from Umuoji. “She treats me like family. I feel more comfortable with her than with any nurse or doctor.”
This trust is further fueled by a belief that traditional healers understand local health challenges better. Meanwhile, healthcare workers at PHCs are often seen as outsiders who may not understand the community’s customs and needs. This disconnect is a major barrier.
Popular opinion within the community also plays a role. “Almost everyone I know uses a TBA. My mother used one, and so did my grandmother and their friends. Nothing happened to them. It’s hard to go against what works,” said Blessing Ofor, a mother of four.
Despite the government’s promise of free care, many PHCs are underfunded and under-equipped. A survey of five PHCs in the state revealed that many lacked basic amenities like water, electricity, and medical supplies. They also face severe staffing shortages. Most have no assigned doctors, and those that do rarely see them.
“Sometimes I come to work and find I’m the only nurse available to attend to everyone,” says Ugochi, a nurse at Igbariam Old PHC. “It’s hard to provide proper care when you’re overwhelmed and alone. Honestly, I understand the villagers. If I walked into a clinic and met just one unfamiliar face, I wouldn’t be comfortable either.”
Abigail Nwodo also shared her experience. She ended up in a private hospital after being turned away due to the absence of doctors. “The PHCs you’re encouraging pregnant women to visit don’t even have doctors. Sometimes I wonder how they’re different from chemists or TBAs. If not for my husband insisting on a private hospital, I don’t see any difference,” she said.
Some patients also complain about the attitudes of PHC staff. “When I went for my first pregnancy check-up, the nurse barely spoke to me and got irritated when I asked questions,” said Promise Aku, a young mother from Nnewi. “I’d rather go to someone who treats me with care and respect.”
Another problem is hidden costs. While services are advertised as free, patients are often charged for drugs, equipment, and other items. “They say it’s free, but when you get there, they ask you to pay for medications or supplies,” said Kosiso Udegwu. “The excuse is always that the government hasn’t supplied anything, so you end up paying.”
Accessibility is also an issue. Many PHCs are far from residential areas, especially in rural communities. Bad roads and poor transportation make matters worse. “It’s hard to reach the PHC during rainy seasons. When it’s an emergency, I’d rather visit the nearby TBA,” said Amara Egwuatu. Dr Chijioke Ngwu, a public health expert in Awka, says there’s a need for systemic change. “We need to rebuild trust in the healthcare system. That means improving service quality and how patients are treated,” he said. “We also need to ensure that services are truly free and offer cultural sensitivity training for healthcare workers.”
This story was produced for the Frontline Investigative Programme and supported by the Africa Data Hub and Orodata Science.