“I feel pity for these women,” the nurse in the dark mud brick clinic said. “They are dying because they can’t afford to give birth in hospital.”

I met Soliu at the checking point between FCT and Nassarawa state. Mararaba was its chaotic self, with people loping across the road in between speeding danfo busses, taking drops to work or hanging about selling wares on the street. Managing, I heard someone call it.
Armed with some statistics from the United Nations Human Development Report published this month, we turned off the main road into an area of the sprawl called Sharp Corner, in search of a maternity clinic.
Nigeria, despite having all this oil wealth, has a poor record on ante and post natal maternity care. Out of every 1000 live births 100 babies die before the age of one, and 200 die before the age of five. That’s about 20 per cent of children dying before they can reach the end of infancy. Problems in heath care start before birth. Few women go to clinics during the pregnancy, and according to the UNDP, 80 per cent of the poorest Nigerians will have no trained health professional present when they go into labour. One of the most startling facts contained in the report is there are only 28 doctors for every 100,000 people.
Although we were in the capital city, and not in the “interior”, as Soliu called it, we believed we could find evidence of this poverty here.
Mararaba is 5 kms outside of Abuja. As little as a year ago, Isa told me it was not a very big place, a few shops on the main road to Keffi and a small slum. Now, swelled by demolitions in the Federal Capital Territory, it is part of the giant sprawl of the Abuja satellite towns. Housing is basic and unregulated, water comes from standpipes, and security is non existent. These areas are almost untouched by government, and yet a great deal of the people who live here are civil servants.

We met the director of the Blessed Trinity Maternity Clinic, Dr Chuks Asogwa. His clinic has seen a drop in the number of women coming to give birth there. At Blessed Trinity delivery costs N5000. They used to see two or three every week, but now the number has gone down to about three or four every month. This in part because the Nyanya specialist hospital and the general hospital in Asokoro have started charging only N1000 (just over £3) to deliver a baby.
Dr Chuks said: “Cost is the number one factor affecting where women go to deliver their baby. Some women are going to the general hospitals. We here have to work out deals with our patients where they can pay back the cost of their treatment over time. Other women are going to churches to deliver. You see them one day and they’re pregnant and the next their not. You ask them where they went and they say the church.”
Doctors, he says, are leaving university and joining a waiting list for houseman placements that can last up to a year. “There just aren’t enough hospitals,” he says, “Is it any wonder doctors are moving abroad in such numbers?”
Some women, such as 22 year old Mary-Anne, have come back to the Blessed Trinity clinic. Sitting in a bare room, she holds a newly born girl in her arms, wrapped in a pink fluffy blanket.
Marry-Anne, who works at a video shop in Mararaba, said she came back to the Blessed Trinity because at the state-run specialist hospital she didn’t feel the service was good enough. “They don’t teach me anything,” she said, “they just leave you there, and unless they know you have money they won’t look at you.”
She hasn’t named her baby yet, and in the slightly dirty room, with the marks remaining on the wall from the ripped-out tiles, she looks very weak and tired. But now she will have to work out a payment schedule to cover her medical bills.
We walked a few hundred yards through Sharp Corner to an Apostolic Church. Soliu said: “I doubt anyone would know if a woman died in childbirth in a church. They would never admit it. They could get rid of the evidence and no one would aver know.”
The Mountain of Joy Apostolic, known locally as the Yoruba church, is obviously fairly well off. A large compound holds a hall with mirrored windows to reflect the heat during the day. Junior Pastor Joshua Ajosanni lives in a small bungalow next door.
He said: “We have a Faith Home where we take care of women up to their delivery. If there are any problems we take them straight away to Adoni or Asokoro hospitals. We make sure that they come for prayers three times in a week before we go into prayer and the delivery.”
As we talk, the church’s midwife, Victoria Oladele, walks in. She has some startling information. Of the Church’s 500-strong congregation, 59 have given birth at the church’s ‘Faith Home’ in the last year, that’s over 10 per cent of the congregation. She has two years training as a midwife and ten years experience of delivering in churches. She has been working in Mararaba for three years. She claims she has never lost a mother or a baby, But they won’t show us the records without the permission from the head pastor.
Victoria shows us the faith home clinic. It is two beds and a cupboard, with some plastic bowls and cups on a tray.
“We pray for water!” Victoria says. “There are no drugs or anything. The only thing you can have is faith.”
In just one area of one part of the satellite town we can see a picture; People turning away from costly private clinics for either impersonal care in the state-run specialist hospitals, or opting to give birth in the place that sustains the rest of their struggling lives, the church. Although we have seen is only one example, Soliu and I agree it is probably replicated over and over again across all the satellite towns.
We decide to go further out of Abuja to see what the situation is there. On the road to Karshi, 45kms out of town, it seems that every third building is a church.
We stop at one clinic, but the Doctor is not in. He is working at a private hospital in town. We are led to another clinic, a mud hut with a concrete flood and blue curtains. We find a nurse, 22-year-old Rahila Danjuma, in a dark, cool room. We sit, and through the curtain I can see a woman patient lying on a bed. She had a waxy look on her face.
Rahila is initially uneasy to talk to us. But she starts to speak when we ask her what happens to people who give birth in their own homes.
She said: “Women die because they lose too much blood. They may have to cut the umbilical cord themselves. They do it badly and get an infection, or they have a case of where their placenta can’t be delivered.”
“I pity these women because they are dying because they can’t afford to give birth in a hospital.” She can’t say how many die in this way, and neither can she give figures on how many come to the clinic. “Not many,” is all she can say.
Other people in town tell a different story. We want to talk to some villagers about the subject, but this presents some difficulties.
Soliu says: “You don’t just go up to people and start talking, especially when it concerns women and such things.”
Alhaji Said Makama is a village elder in Karshi. He sits with one of his wives in a room that doubles as a classroom and mosque. Tablets with Qur’anic surahs inscribed on them are stacked up in the corner. We sit on an old mat while one of the Alhaji’s sons translates. “My Hausa is not strong enough,” says Soliu. The room is full of children excited to see strangers. They crowd around us, giggling. As we ask questions Alh. Makama’s wife looks at me intently, but says nothing.
Through his son, Alh. Makama says: “We are well provided for in terms of health here. We have clinics and a hospital, there are no problems here.” But ask him how many children he has and something slightly different emerges. His four wives have had 30 children between them. He leans over to Soliu and says: “Eight of them died.” That’s significantly over the Nigerian average for infant mortality rates.
As we leave Soliu shrugs: “He couldn’t say anything else because he is responsible for his people, and admitting things were bad would be admitting he has failed.”
As we approach the area’s general hospital, outside is a sign that says “Karshi hospital is baby friendly”. By the sign sit four children, selling sachets of ‘pure water’. One boy of about five has a baby strapped to his back.
Inside the hospital we are warmly received, but our questions don’t get far. Giving birth here costs only N500 (£2). The medical director says that poor people do sometimes give birth in their homes, but they provide a good service at the hospital. But they can’t go into any specific detail about numbers as that would mean going into patient files.
The secretary of the hospital’s board inadvertently reveals more than perhaps he should have: “We cannot say anything without clearance from the ministry because it might embarrass the authorities.”
This is a village not more than 30 minutes drive from the capital, and we have heard from a nurse that there are women trying to give birth without assistance from any sort of health professional and dying. A village elder who has lost more children than the Nigerian infant mortality rate finds it difficult to say there is anything wrong with his villages’ health care provision, and the local hospital can’t go into specifics “for fear of embarrassment.”
“Just imagine what it’s like in the interior,” Soliu says.