Exposed: see how our Nigerian hospitals are making money from forced C section

For days, Franka Eleki refused to be consoled.

Like a woman who had just been widowed, she
cried her heart out. Eyes, cheeks and skin – all
testified to the grief she had been soaked in.
Since a doctor delivered a most frightening
news to the young mother, only few things
made sense as far as she was concerned.
A bulging stomach, Eleki was due to deliver her
second child in the first week of November
2015 according to results from a scan in late
October. Everything was set as she eagerly
anticipated the arrival of the baby which scans
had revealed was a boy.
But as the date drew closer...
anticipation and excitement soon gave way to
anxiety after the baby failed to come in the first
week of November as predicted. Even the extra
weeks given after the due delivery date elapsed
without any sign of labour or the child coming.
It was a terrible period for the family.
Worried at the development, 28-year-old Eleki in
company with her husband, Edward, a software
engineer, visited the doctor of the hospital
where she had registered and had been
attending weekly ante-natal checks in the Agric
area of Ikorodu, a Lagos suburb. After
expressing their concern to the doctor on her
situation, he directed that they go for another
scan immediately and let him have the result. In
less than 40 minutes, the couple returned with
the result which predicted that the child would
come in the second week of December 2015.
The doctor checked the woman to see if the
child was in the right position and ready to be
born. But after his examination, he told Eleki
and her husband that the head of the child was
yet to enter the cervix which means that the
labour process could not be triggered. He said
even if they were to induce her into labour, it
wasn’t going to be possible at that point since
the baby’s head was yet to ‘engage’.
The doctor explained to the curious and
emotionally-depleted couple that the only
reasons why the head of the child was yet to
‘engage’ could be perhaps because the cervix
was too small for it to go in or that there was
no pressure in the woman’s womb to push the
baby’s head into it. He prescribed Castor Oil – a
therapy used to trigger labour in pregnant
women – for Eleki and advised her to check
back at the hospital the following day.
Throughout that night, the young mother
couldn’t sleep as pains similar to labour signs
engulfed her. By morning, she was back at the
hospital to see the doctor on the way forward.
That was where everything changed.
“After explaining my experience throughout the
previous night to him, he immediately
proceeded to check me to see if the baby was
ready to come out,” Eleki said. “Even though I
was feeling the baby’s head and force around
my waist more than at previous times, the
doctor simply told me that the head was yet to
‘engage’ and that the situation had become a
bit critical. He said he needed to speak with my
husband urgently,” the Anambra State-born
lady said.
That afternoon, the doctor and Edward who was
at work at the time, spoke. Hard and
demoralising, his words destabilised the young
father for the rest of the day. It was not the
type of news Edward wanted to hear.
“The doctor during our conversation on the
phone that afternoon told me that my wife’s
situation had become very critical,” the 33-year-
old software engineer told our correspondent.
“He told me that from all indications, the child
was too big to pass through the cervix and that
if something was not done fast, it could lead to
tragedy. I asked him what options were
available to us and how long we had left. I was
shocked with what he told me.
“With all certainty and authoritativeness, the
doctor told me that the placenta of the foetus
was only a few days from dying and that if that
happened, it would not survive and the mother’s
life would be at grave risk as well. He said the
only option was for my wife to undergo surgery.
The most painful part was that the doctor
boasted that even if we took her to London,
Germany or anywhere in the world to meet the
best gynaecologists, my wife could not be
delivered of the baby normally except through
surgery.
“The news rattled and affected my mood at
work throughout that day. The doctor sounded
very convinced and emphatic about what he
was saying but something within me still felt
the baby could come out without operation.
That was when we finally decided to contact
the doctor that delivered her of our first child.
The man is a gynaecologist.
“The next day, my wife had to take the pains to
go look for him at his hospital in another part
of Ikorodu even though the roads in that area
were so terrible. She called me later that day to
tell me that the doctor had checked her and
said that her condition was perfect for the baby
to come out normally. He told her that the
child’s head had been in the cervix all along.
Two days later, my wife gave birth at that
hospital through normal delivery and in fact
without a single tear. The same woman the first
doctor said could never give birth normally even
if we took her to meet the best gynaecologists
in the world. It is a big shame on them because
God rescued us from their evil plans,” he said.
Child delivery done through Caesarean Section
costs between N300,000 and N400,000 in that
hospital as the young couple would later find
out. At the place where she eventually gave
birth, they paid only N25,000 – 16 times
cheaper than they could have coughed out.
While the Elekis remain grateful to the heavens
for rescuing them from a problem that could
have drained their pockets and also put the
lives of two of their own through avoidable risk,
the Adekunles, another young family, have quite
a different story to tell. Doctors at a private
hospital in the Ogudu area of Lagos notorious
for delivering babies through CS, tricked them
into opting for surgery using the weapon of
fear. According to Mr. Damilare Adekunle, an
auto spare parts dealer, the doctors played on
their naivety as potential parents to extort
them.
“My wife got pregnant immediately we moved to
Ogudu after our wedding in 2012,” Adekunle
began his chilling narrative. “She had to quickly
register for ante-natal at a nearby hospital but
we never knew that the doctors there were only
interested in operation and not normal delivery
so that they could make more money. On one
of those days when she visited for weekly
checks, a nurse told her that we should be
preparing N250,000 for operation because her
baby was too big and could not be delivered
normally. She was only six months pregnant at
the time. The nurses even told her that
operation was better because there would be no
labour pain and that it was safer for her and
the baby.
“We were naïve and inexperienced, it did not
occur to us to do extra findings or discuss with
our more experienced relatives and friends, so
we simply believed them. Surprisingly, one
week before her due date, the hospital told her
to bring her things to be delivered of the baby.
Of course she was operated upon that day and
everything went smoothly but it was after that
period that we found out more about that
hospital and how it was known to be only
interested in conducting operations for pregnant
women for their selfish gains.
“My wife has had two other babies after that
time at a different hospital through normal
delivery where we were told her pelvic was big
enough to accommodate the passage of any
baby. We still feel hurt and cheated by that
hospital because we could have lost more than
the money it deceitfully collected from us,” he
said.
Though, Joy Otumagba lost about N150,000 to
a private hospital in the Apapa area of Lagos,
she miraculously escaped going under the knife
for a needless surgery.
As is the practice, doctors at the hospital had
conquered and caged her spirit through fear
about seven months into her pregnancy two
years ago. On one ante-natal visit, she was told
the baby she was carrying was big and could
only be delivered through CS which costs
around N250,000 at the place. To make the
payment flexible, Otumagba was advised to
start depositing N150,000 before her due date
and pay the balance after the surgery. She had
no reason to panic since the hospital was one
of the best in the area. By the end of her eighth
month in pregnancy, she had completed the
N150,000 initial deposit. However, the
intervention of an elder relative who resides in
the Ajegunle part of the metropolis swung the
tide in a different direction.
“I was already looking forward to the operation
when a relative who came visiting one day
opened my eyes. She told me to go to another
hospital and also do a pelvic scan to see if the
‘passage’ was big enough for the child to pass
through or not. She said if everything supported
what I was initially told by the hospital I was
attending, only then should I go for the
operation.
“I heeded that advice and I will forever be
grateful to my uncle’s wife whom God used to
pull me out of that trap. Of course the pelvic
scan revealed that everything was fine, so also
did the doctor at the new hospital I visited.
Three weeks later, I gave birth normally without
any complication. I never knew CS had become
a big business for some hospitals in Nigeria,”
Otumagba said.
Yusuf Abdul-amin, a young doctor learnt a
bitter lesson in 2014. Newly employed at a
private hospital in the Ebutte Meta area of
Lagos, his dream of building a successful
career in the medical profession received the
perfect start any of his colleagues could have
wished for.
One evening, Abdul-amin, 28 at the time,
walked into the hospital to witness a pathetic
scene. A pregnant woman who had been in
labour for a few hours was left wriggling on a
bench after the doctor on duty refused to attend
to her following her husband’s protest to sign a
document for a surgery to be performed on her.
The doctor had insisted that operation was the
only option to save the life of the baby and its
mother as the ‘passage way’ was too narrow
for the child to come out. It was in the middle
of this precarious situation that Abdul-amin
walked in. The sight of the dying woman
gripped him. The newly employed doctor told
his colleague of his intention to personally
deliver the woman of her baby regardless of his
own verdict. Less than 20 minutes after taking
her into the labour room, the shrill cry of a baby
livened the ward. It was a huge relief for the
couple but sadly, bad news for the young
doctor.
“I was sacked by the owner of the hospital that
day, less than two weeks after I was employed
because I allowed the woman to give birth
through normal delivery,” Abdul-amin told our
correspondent on the phone from his base in
the United States where he has since relocated
and has been practising. “The owner of the
hospital, who is a woman, asked me how I
expected them to pay salaries and meet up with
other obligations if staff prevented people from
paying for operations even if they were
unnecessary. The other doctors at the hospital
have become part of the system and that was
why they felt I was crazy when I insisted that
the woman could be delivered of her baby
normally.
“Even though I was shocked at that experience,
I don’t regret losing that job for saving the life
of an innocent woman and her baby. The
hospital could have charged them at least
N230,000 instead of the N35,000 they
eventually paid. Only God knows how many
families that hospital would have ruined
through this criminal and unethical method. It is
a nasty experience I find very hard to forget,” he
said.
According to the United Nations Children
Education Fund, about 5.9 million babies are
born in Nigeria every year with around one
million from that number dying before the age
of five. While many of these babies arrive
through normal deliveries, caesarean births –
the chunk of it needless – have contributed to
an increasing part of that figure. Latest reports
say women in developing countries like Nigeria
are 300 times more likely to die during
childbirth as a result of pregnancy-related
complications than their peers in the developed
world.
Though, Caesarean Section, which is birth
through an incision in the abdominal wall and
uterus rather than through the vagina, has
saved dozens of lives across the country, new
findings by PUNCH reveal that most hospitals
in urban centres are now using it to milk many
families, especially young couples who are
desperate to welcome their first babies.
A lot of these couples in a bid to satisfy the
hospitals’ ‘greed’, sell entire possessions just to
raise funds for needless surgeries that risks the
lives of their loved ones.
The World Health Organisation says that CS
should be done only as a life-saving measure
when there is a risk of foetal or maternal death.
The global organisation believes, “There should
be no justification for any region in the world to
have CS rates higher than 10 to 15 per cent.” In
Nigeria, some states like Kebbi have a CS rate
of 20.3 per cent.
A professor and former WHO consultant, Dr.
Sundari Raveendran, said subjecting women to
CS when not medically necessary is a violation
of women’s rights.
“There are good reasons to be concerned about
the spate of unnecessary C-sections carried out
in a casual manner. Consent has been taken
from women, and doctors are not giving full and
complete information about the possible side
effects of abdominal surgery,” she said.
A surgeon with the Lagos State University
Teaching Hospital, Dr. Olugbenga Saliu Oseni,
explained that CS, as an interventional delivery
process, should only be explored when it is the
only option left to save the lives of mother and
baby.
“The best thing to happen to a woman is to
have a normal delivery but when this is not
available, the preferred option should be CS.
“There are many reasons why a doctor may
prescribe CS and some occur in critical
situations. But it will be crazy for any doctor to
elect to do CS because he wants to make more
money; that means that person is not an
expert,” he said.
While before now CS in most public hospitals
across the country was between N60,000 and
N75,000, the fee has since been jacked up to
around 150,000 and N200,000 in many of the
places today. In private hospitals, it hovers
between N300,000 and N1m.
A gynaecologist, Dr. Samuel Adebayo, fingers
the high cost of medical equipment and other
necessary infrastructure like regular electricity
supply as part of the reasons why some
hospitals charge exorbitant fees for CS. He said
about 90 per cent of the medical supplies
needed for the procedure is imported.
“Most of the supplies we use are not produced
in Nigeria; not even the surgical blade that is
used to severe the umbilical from the mother.
The anaesthetic pack alone goes for N35,000 in
some areas, though it used to be N15,000. Even
ordinary Paracetamol injection is imported.
That is why you see that even teaching
hospitals have to increase their price.
“Again, absence of regular electricity supply is
another challenge because we must sterilise all
the surgical instruments we use and we must
also ensure that we are on generator when
doing the operation because you cannot afford
to experience power failure during a Caesarian
delivery. It is a multi-sector problem which
government must address,” he said.
While in many parts of Europe and the United
States of America the cost of CS is largely
covered under the national health insurance, in
Nigeria, women on the verge of delivery and
their families are made to cough out huge sums
from their pockets without largely any form of
support from government. As a result of this,
many nursing mothers are held back in the
hospital for several days after delivering and
sometimes weeks until their husbands or
relations can clear the bogus bills.
President, Nigeria Medical Association, Dr.
Kayode Obembe, said there must be certain
indicators in place for a CS to take place. He
said carrying out such surgeries when these
indicators are absent is not only unethical but
also a violation of the rights of a patient.
“Caesarean Section in the real sense of it is a
life saving measure but there must be some
clear cut indicators for performing such. If there
is any situation now where anybody performs
Caesarean Section and there are no indications
for it, the patients or their relations are quite
free to report to the Medical and Dental Council
of Nigeria and professionals in that field would
be asked to go and reappraise the procedure.
Nobody should be tricked into delivering at any
hospital against their wish,” he said.
Public Relations Officer of the Medical and
Dental Council of Nigeria, Mr. Henry
Okwuokenye, told PUNCH that there is a
tribunal and investigating panel in place that
looks into any such matter and hands down
appropriate sanction if complaints get to them.
He said the MDCN cannot do much on the
matter except victims of such fraudulent
practice take the courage to report their
experiences to the organisation as they cannot
be everywhere at the same time.
“The MDCN is not in hospitals everywhere, so
we may not know some of these things except
people give us information and make reports.
We have an investigating panel and tribunal
that look into matters like this and try erring
doctors. As soon as we get such reports, erring
doctors would be tried and dealt with.
“We need people to come out and make reports
for us to set examples of these doctors. If we
get only one of these fraudulent doctors and
make him or her scapegoat, the others will
behave properly,” he said.
Constitutional lawyer, Mr. Jiti Ogunye, posits
that if truly some doctors now deliberately lure
pregnant women into electing for needless CS
just for pecuniary motives, they have both
violated the patients’ rights and breached a
fundamental part of the law.
“Subjecting a pregnant and expectant mother
on the verge of delivery to a fraudulent and
needless caesarian operation, based on
misleading and fraudulent representation that
she could not self-deliver her baby unless
subjected to an assisted delivery procedure, in
order to compel the woman and her husband to
pay huge sums of money to a medical
practitioner, maternity home, clinic or hospital,
is not only cruel in the extreme but also
unlawful and illegal. It is a gross act of
professional misconduct, a civil wrong and a
criminal act.
“It is against the physician oath because it is a
surgical operation which ought to be embarked
upon only to save the lives of the mother and
child. It is not a cosmetic surgery. Thus, under
Section 16 of the Medical and Dental
Practitioners Act, Cap M8, Vol 8, Laws of the
Federation, 2004, such a medical practitioner,
clinic or hospital is liable to be sanctioned for
infamous conduct or professional misconduct.
“Such act also constitutes a civil wrong. It is
tantamount to a violation of the integrity of the
body of the woman. It is a tort, an act of
battery that is actionable under the law of
negligence, the categories of which, in law, are
never closed,” he said.
A sociologist, Lanre Adewuyi, told PUNCH that
this sad trend of needless extortion and
unethical practice will continue to soar in
Nigeria because of the seeming goldmine
doctors and private hospitals appear to have
found in CS.
According to him, the poor regulation of the
industry and the weak laws guiding the practice
in Nigeria is another dimension to the problem.
“Many of these beautiful hospitals and smartly-
dressed gynaecologists are more interested in
financial gains than saving lives. A caesarean
delivery costs an average of N200,000 in many
of these private hospitals. By the time they add
other related charges, you could be paying as
much as N350,000. This is a lot of money for
the hospitals and that is why they would
continue to trick pregnant women into opting
for CS.
In a country plagued by scores of social
problems top among them infrastructural
shortfalls, many hospitals across Nigeria –
government and private – have had to provide
basic needs like clean portable water, security
and even motorable roads on their own. This is
aside spending huge amounts providing their
own electricity supply and equipping the
facilities to acceptable standards.
Adewuyi explains that until government lives up
to its side of the social contract by providing
basic infrastructure in the country, those who
do so on their own would continue to dictate
the tune to the larger majority – in this case
helpless pregnant women like Mrs. Adekunle
and Otumagba whose hard-earned money is
daily slithered away from their grip.