Nigeria’s food crisis is taking its toll on vulnerable pregnant women, as they share how difficult it is for them to eat daily and meet the dietary requirements expected of persons in their state to avert poor pregnancy outcomes. JANET OGUNDEPO reports

At 1 pm, a three-month-old pregnant mother, who wants to be identified as Mummy Ifeoluwa, was just cooking her first meal of the day.

Bent over three-stoned firewood with an aluminum pot set up in a corner of her shop, the mother of one, stood up wearily to speak with our correspondent.

“This is my first meal for the day. I am just cooking now because there has been no money to get food. My next meal is until night time and I have to pray to make sales or that my husband comes home with some money so we can eat,” she said resignedly.

Although Mummy Ifeoluwa’s husband works as a mechanic, the irregularity of work makes it hard to feed his growing family.

Consequently, the 25-year-old pregnant mother said that she eats only twice a day and bears the hunger pangs until the next meal is available.

“I eat fruits sometimes once a week and no more,” she said.

Mummy Ifeoluwa, who is in her first trimester, has lost count of when she had to approach her friends for food.

“Sometimes, when all hope of getting money for food has been exhausted, I have no choice but to beg for money from my friends so I can get food,” she said, worried lines dotting her forehead.

Biting economy

With the skyrocketing prices of food, transportation and goods and services, the artisan said she has discarded thoughts of buying her baby clothes as her daily concern was to get food on her table.

Nigeria’s economy has been heading towards a downward slope since the decision by the Central Bank of Nigeria to allow a free float of the naira to other currencies.

Consequently, Nigeria, which is an importing and dollar-dependent economy, as said by an economist, Prof Ken Ife, began to witness inflation and a weak currency.

The fuel subsidy removal in May 2023 further deepened Nigeria’s economic woes.

PUNCH Healthwise reports that the fuel subsidy removal, further depreciation of the naira, increase in electricity tariff, and the introduction of Value Added Tax on diesel, amid an already battered economy, have further worsened the cost of living, pushing many Nigerians into untold hardship.

As a result, a litre of fuel that once sold for N185 per litre before May 29, 2023, rose to over N500 per litre, N700 per litre and now N1,030 in some states.

PUNCH Healthwise also reports that the Association of Nigerian Private Medical Practitioners noted that there has been a rise in high blood pressure cases in the hospitals.

Pregnant women and children, who are Nigeria’s most vulnerable group, are grossly affected as experts and the United Nations Children’s Fund warned of rising malnutrition in the country.

Handicapped by economic situation

Before the rising prices of food and services, a 30-year-old pregnant mother, Mrs Ayomide Oladapo, could boast of eating three to four times a day.

In her previous pregnancies, she recounted to our correspondent, she ensured she satisfied her cravings and ate to her fill whenever hungry.

But Oladapo, who is in her first trimester, now struggles to eat three times a day.

Her sales of foodstuff are no longer booming as the prices have limited the purchasing power of the populace to buy as much as they did.

Oladapo hoped the prices of foodstuff would reduce so she could have enough to eat and stop the constant weakness caused by hunger pangs.

Begging to eat

Another pregnant woman in her second trimester, identified as Mrs Igbinedion, could go on and on about the rise in food prices.

The 26-year-old seamstress told our correspondent that the food prices had affected her ability to eat the required quantity of food she desired.

Sometimes, to silence the hunger pangs, the six-month pregnant mother would munch on anything she could, whether it was nutritious or not.

“The prices of food are so high. Fruits are now gold and there is no money to buy it. I go countless times to request food or money to buy food if I don’t make sales. I do this to cover my secret and so I can eat.

“If there is no money, I drink water and go to bed hungry. This has sometimes made me think about my life and the situation but again, I stop it so I don’t develop a high blood pressure,” Igbinedion said.

The cloth and bag maker is not alone in this situation.

Our correspondent spoke to another six-month pregnant woman, Mrs Chioma Igwe, who now rations her meals.

The businesswoman said whenever she was pregnant she couldn’t eat the food she cooked and had to visit local restaurants for her meals.

But the plate of food she bought for N500, three years ago when she was pregnant with her second child, could no longer fill her now.

“I can’t eat my food so I eat from one buka to another until I give birth. Now, if I manage to spend N1,000 for one meal, I will still be hungry. Now, I only eat twice a day. I love fruits but can no longer eat them as much as I should. I am tired of the situation,” Igwe said.

The 36-year-old, whose husband is a hotelier, shared that there were times she went to bed without food or survived on a few biscuits to ease her hunger pangs.

Increased risk of anaemia

However,  nutritionists, gynaecologists and paediatricians who spoke to PUNCH Healthwise mentioned that these pregnant women were at risk of anaemia and giving birth to babies with low birth weight.

They noted that being malnourished came with dire consequences for both the mother, the child and the future of the child.

They fear an increased risk in Nigeria’s 39 deaths per 1,000 live births of neonatal deaths and 67 deaths per 1,000 live births of infant mortality.

The experts, in exclusive interviews with PUNCH Healthwise, were wary of an increased maternal mortality rate currently at 512 per 100,000 live births.

A professor of Obstetrics and Gynaecology at the Usmanu Danfodiyo University, Sokoto State, Abubakar Panti, said that poor nutrition during pregnancy had serious consequences for both the mother and the baby.

The physician noted that such pregnant mothers were at an increased risk of anaemia.

“It could also lead to preeclampsia, which is high blood pressure during pregnancy. It could also lead to gestational diabetes, because poor dietary habits, particularly excessive intake of processed foods and sugars can lead to gestational diabetes, which can lead to increased complications during pregnancy. It could also lead to osteoporosis, which is due to insufficient intake of calcium and vitamin D, which is less mineral content of the bone, which can lead to fracture. Then you can also have other postpartum complications,” Panti said.

The don further noted that pregnant mothers who had poor nutrition had slow recovery after childbirth and were at high risk of infections, prolonged recovery time and of course postpartum depression.

He said, “You could also have difficulty in breastfeeding because of poor nutrition during pregnancy, which can affect milk production and the quality of breast milk, which can potentially impact the baby’s early nutrition.”

The gynaecologist further noted that such babies suffered restricted growth, which is called intrauterine growth restriction and developmental delays later in life.

The doctor asserted that such women were at risk of preterm labour and giving birth to babies with neural deformities.

Poor baby development

“Deficiency of certain nutrients, such as folic acid, can lead to neural tube defects or spinal bifida, which means the brain and the spinal cord cannot develop properly. You can also have premature births because of poor nutrition.

“The mother can go into labour before her time because once the baby senses danger in utero, it will want to come out. This can also be linked to preterm birth, which can also result in complications like respiratory problems. Of course, you have low birth weight, because of inadequate maternal nutrition and the mother may deliver a baby less than 2.5 kg, which can also have an increased risk of health issues and cognitive and behavioural issues later in life.

“Because of this poor nutrition, the baby’s brain did not develop properly, so it could lead to cognitive delays, learning difficulties, and behavioural problems. That is why in developed countries, they pay a lot of emphasis to mother and child because the future of the country lies in the children,” Panti said.

The fertility expert also stated that the babies had a higher risk of conditions such as heart disease, diabetes and obesity later in life.

The maternal expert further noted that the economic hardship was likely to increase Nigeria’s maternal mortality rate.

He added that it could also limit access to health care, cause poor nutrition, and lack of social support, significantly impacting maternal health and contributing to higher mortality rates.

“So, with the current hardship, I’m very sure we will expect a rise in maternal mortality. For example, if we have limited access to quality health care due to hardship, there could be inadequate prenatal care, because women may not be able to afford regular prenatal visits or specialised medical services. And lack of consistent care increases the risk of complications during pregnancy and childbirth. You know, a lot of things can go undetected or untreated, which may lead to death.

“Then you also have poor access to skilled birth attendants. Women giving birth without skilled birth attendants, like doctors, nurses, and midwives have an increased risk of complications, such as postpartum haemorrhage, eclampsia, and sepsis, which are the leading causes of maternal mortality,” the don said.

He added that the lack of funds would increase the delay in decision-making to access medical care, noting that persons in economically disadvantaged areas had transportation problems and inability to afford emergency services.

“Inadequate nutrition, due to economic hardship, often leads to food insecurity, which can result in malnutrition during pregnancy. So, poor nutrition, especially deficiencies in iron, folic acid, and minerals like calcium, increases conditions like anaemia, and preeclampsia, which are contributors to maternal mortality.”

“Poor economic conditions often coincide with limited access to preventive care and early treatment for chronic diseases like hypertension and diabetes, which are dangerous during pregnancy if not properly managed. Also, there would be an increased risk of infections. Due to unhygienic living conditions, economic hardship is also associated with poor living conditions, including lack of clean water, inadequate sanitation, and overcrowding, which increases the risk of infections like malaria, and HIV, which are indirect causes of maternal mortality, especially in low-resource settings,” the don said.

Promote maternal feeding

Panti called on the government to strengthen the healthcare system by ensuring affordable accessible and quality maternity care.

“They also have to promote maternal nutrition through food assistance programs. In countries where they know what they are doing, they don’t joke with mothers and children.

“Expanding the family planning services and access to contraceptives will also help in the face of hardship. If people can access things that can prevent pregnancy, of course, they could face themselves and the few children they can.

“Also, we can improve social safety nets for vulnerable populations to ensure that women can access healthcare regardless of the economic situation,” he said.

Prone to infections

Also, a Consultant Obstetrician and Gynaecologist at the University of Ilorin Teaching Hospital, Kwara State, Prof Adegboyega Fawole, asserted that poor nutrition during pregnancy could cause anaemia, low birth weight, stillbirths, haemorrhage, pre-eclampsia and death in mothers.

He added that malnourished pregnant women were predisposed to poor weight gain, molar pregnancy (carotene deficiency), preterm labour, and infectious diseases.

The don noted that unborn babies of malnourished pregnant women would be affected.

The gynaecologist further hinted at the likely rise in maternal mortality due to economic hardship.

To further avoid the malnutrition caused by the economic hardship, Fawole advised pregnant women to “engage in small scale businesses, by encouraging the partner to engage in farming.”

Reduce growth, malnourished babies

Not only are the pregnant mothers affected, but the unborn babies are at risk of low birth weight, malnourished at birth, prone to infections and at risk of infant deaths.

A paediatrician, Dr Peter Ubane, confirmed that poor nutrition in pregnancy had an intergenerational impact on the unborn child.

He noted that deficiency in macronutrients affected the growth of the baby, such that the overall growth potentials of the baby and organs within the womb are hindered, leading to low birth weight and increased risk of diabetes and hypertension in the future.

The child expert added, “When we look at the other aspects of maternal nutrition, a mother may be taking adequate quantities of food, but quality is not adequate. Eating enough, maybe even carbohydrates and fats and proteins, but if they are deficient in certain minerals or vitamins, which we call micronutrients, that itself is also a form of malnutrition and it would affect the baby. A major example of that is what we call folic acid deficiency, which is associated with what we call neural tube defects.

“These are congenital abnormalities of the central nervous system, the spinal cord and the brain so that there’s no complete formation. So, that’s one way the nutrition of the mother can affect the baby. And when a baby is born with such a problem, it’s a lifelong thing. Yes, we need surgery to correct the defects and all that but it tends to lead to some form of disability, lifelong disability.”

Ubane further noted that vitamin and calcium deficiency were other micronutrient deficiencies that could affect a baby in the womb.

The paediatrician stated that the mother, family, society, and the government were responsible for ensuring adequate nutrition for pregnant women and unborn children.

The physician asserted that babies born to malnourished and nutrient-deficient mothers had their health compromised and were at risk of dying shortly after birth, further increasing the infant mortality rate.

He also noted that such babies would be malnourished after birth and have weaker immune systems, making them at risk of newborn infection, called neonatal sepsis.

Cleveland Clinic explains neonatal sepsis as a serious medical condition that occurs when a baby younger than 28 days old has a life-threatening response to an infection.

Continuing, Ubane said that malnourished babies at birth who were still deprived of adequate nutrition could be shorter than their genetic potential.

“For a girl, what it means is that the girl is going to be shorter. She has a critical period within which she needs to grow, in height, width, bone length and all that.

“If this malnutrition persists and she doesn’t catch up adequately, what it means for that girl is that she is likely to remain shorter than her genetic potential. It also means that that girl, her pelvis is going to be narrower than it should be and when she becomes a lady and begins to get pregnant, she is more likely to have a narrow pelvis that is more likely to be obstructed during labour. So the risk of her having to depend on an operation to give birth is high,” the doctor explained.

He emphasised that nutrition and immunity were strongly linked and the lack of improved nutrition for malnourished children would result in a high risk of having bacterial infections, viral infections, infections like pneumonia, diarrhoea and deaths.

The paediatrician asserted the nutrition of an unborn child was an inalienable right, adding that “to deprive an unborn child of adequate nutrition is to kill that child while the child is living. It’s to burn the child with a sort of half-life.”

He emphasised the need for the economic protection of the vulnerable population in society.

The child expert also advocated adequate education on nutrition for women of reproductive age and pregnant women.

“A balanced diet that contains adequate and appropriate amounts of the different classes of foods, including nutrients, adequate nutrients, and then supplementation with vitamin, vitamin tablets and all that, as recommended by nutritionists or by healthcare professionals is recommended,” Ubane said.

Undernourished, at risk of fainting

Pregnant women deprived of adequate diets due to the unavailability of food or the purchasing power to buy them are at risk of fainting.

A Chief Dietitian-Nutritionist, Olufunmilola Ogunmiluyi, stated that pregnant women incapable of adequate diet and essential minerals and vitamins were at risk of fainting.

She, however, noted that the main causes of dizziness and fainting during pregnancy were hormonal changes due to a drop in blood pressure which allows less blood to get to the brain.

She further explained that undernutrition in pregnancy was a maternal nutritional state in which nutrient storage and macronutrient and micronutrient intake are less than that needed to achieve optimal maternal, foetal and newborn outcomes.

“During pregnancy, poor diets lacking in key nutrients – like iodine, iron, folate, calcium and zinc – can cause anaemia, pre-eclampsia, haemorrhage and death in mothers. They can also lead to stillbirth, low birth weight, wasting and developmental delays for children.

“Malnutrition affects every system in the body and results in increased vulnerability to illness, increased complications and in extreme cases even death,” the nutritionist said.

She further noted that babies with low birth weight had a risk of developing several diseases later in life.

Ogunmiluyi also said that babies born to malnourished pregnant women could have infant micronutrient deficiencies, short-term health risks such as hearing/visual impairment or delays in neurological development among other diseases.

The dietitian warned that malnourished pregnant women in the first few weeks of pregnancy suffered deficiency in certain nutrients, minerals and vitamins, which would affect the child’s immune system and increase the likelihood of viral and bacterial infections.

She urged expectant mothers to ensure their diets contained key nutrients such as iodine, iron, folate, calcium and zinc and refrain from consuming lots of calories.