A combination of harmful cultural practices like force-feeding, female circumcision and irregular attendance of antenatal clinics by pregnant women threatens the health and well-being of children across Africa
By BUNMI OYERINDE
Gloria Dwomoh, a United Kingdom-based mother, will spend the next three years in prison. A British court has just sentenced Dwomoh to a prison term for the manslaughter of Diamond, her daughter. Ten-month-old Diamond died in March 2010 as a result of food accumulation in her lungs, causing her to suffer pneumonia. What led to this, prosecutors say, was Dwomoh’s habit of force-feeding Diamond.
Force-feeding, in this context, is the act of feeding a child against his or her will. This is exactly what Dwomoh was accused of. She defended her actions, saying she would never have done anything to harm her child wilfully. She feared her baby might die from starvation, and that she had seen nothing wrong with the mode of feeding, given that she and her siblings were fed the same way by their mother back home in Ghana. One thing she had not realised was that as she forced a reluctant Diamond to eat from a jug, the food went the wrong way.
Describing what happened to Diamond, Salisu Mohammed, a paediatrician at Lagos State University Teaching Hospital, Ikeja, said, “The throat has two parts. The anterior part of the throat is where the breathing pipes that connect the nose to the lungs are. Behind that pipe is the oesophagus via which food passes down to the stomach. When you force-feed a child, that child can neither talk nor breathe even if he or she makes an attempt to cry. The gate leading to the lungs then opens, causing the food to go the wrong way – into the lungs.”
Researchers have found out that this practice, though harmful, is still prevalent in many African countries like Nigeria, Ghana, Sierra Leone and Kenya, and that mothers often blame their actions on the fear of ailment, the refusal of babies to eat and fear of breast feeding. Mamie Kadah, a Sierra Leonean grandmother, declared that she had fed all her seven children with her hand through force-feeding because she saw the use of feeding bottles as a waste of time. The elderly woman added that she had never encountered any complications, as she had the ‘experience and know-how’.
Olubunmi Coker, a paediatrician in Sierra Leone, criticised the severity at which Sierra Leonean mothers force-feed their babies, bringing about the death of children mostly below the age of two. He highlighted the fact that force-fed children “are normally choked or may suffocate and then eventually cease breathing.” Additionally, such children look black because they have been deprived of oxygen, some get choked and lose consciousness, and their only chance of survival is if air could get into the lungs again. Other negative effects are that they may suffer growth problems as they develop and may likely suffer breathing difficultly.
Such children become traumatised by force-feeding and the reluctant child becomes more difficult to feed due to the discomfort he or she now associates with meal times. As a result of force-feeding, the small fold of tissue that secures or restricts motion of the tongue or upper lip may be torn while the palate and fauces, the posterior part of the mouth, which leads into the pharynx, get injured. While struggling with the captor, the child may be bruised. Again, owing to so much food stuffed into the child’s throat, the child could suffer ‘impacted bowels’ also referred to as constipation which is much more painful in children than in adults. Nevertheless, medical experts encouraged spoon-feeding in place of forcefully feeding a child. Each time a child displays disinterest for food, it could be that the child is ill or filled up, therefore it is advised that the parent should seek medical attention.
Gladys Raphael, an expectant mother, is not into force-feeding. Her own area of challenge is of a different type. Though grateful that her first delivery brought forth a healthy baby, she has learnt her lessons the hard way. While pregnant with her first child, Raphael stuck to herbal concoctions in taking care of herself. She never visited the hospital for antenatal care all through the period. When the time came for her to give birth, she was taken to the herbal home where she was in labour for days. After many days of severe labour, she was transferred to a health centre. At the end of the day, she had to undergo a Caesarian section. Pregnant with her second child, Raphael is currently registered and has started antenatal classes, a case of once bitten twice shy.
Not many women are as lucky as Raphael and their unborn children have had to bear the brunt of their negligence. Sade Oba, not her real name, got pregnant by her lover who failed to accept responsibility, stopped attending antenatal classes not so long after she began due to the shame she thought she had to face for a while, ignorant of the health implications to her and the unborn child. There was incompatibility between Oba’s blood and that of her unborn baby, leading to the destruction of the baby’s blood cells. As a result she gave birth to an anaemic baby. Amidst tears, Oba regrets her inaction. “When I got pregnant I was too ashamed to be moving around not to talk of completing my antenatal classes. Now my baby has to suffer for it,” she said.
Mohammed also spoke on this. He emphasised on the importance of the attendance of antenatal sessions by pregnant women most especially for the sake of the baby. He explained the gains of antenatal clinic, “Mothers are educated about behaviour that could be harmful to them and their pregnancies. Some problems can surface along the line that would be detected early. For instance, if a baby develops an abnormality at conception, and the mother comes for antenatal; it would be easily discovered and corrected. They could be congenital issues like structural abnormality, infections like diabetes, sickle cell anaemia or hepatitis, being transferred from mother to child. For instance, babies of diabetic mothers are usually big, so during labour it complicates birth, which could lead to death of either mother or child, both or a very bad situation. It is during this period that such will be detected and necessary therapy carried out.”
Ayodele Falade, a gynaecologist at Ladoke Akintola University Teaching Hospital, Ogbomosho, Oyo State, also enumerated the dangers of irregular attendance of antenatal sessions. For instance, he said, “The patient might not have adequate self education about breast feeding, family planning and baby care; she might not have safe delivery or even suffer post-natal haemorrhage; the woman might also have infections that will on the long run affect the baby, and her urethra could as well get damaged.” From the foregoing, both the mother and child suffer afterwards.
Female circumcision, FC, is another practice that is harmful to the female child. According to the World Health Organisation, WHO, FC (also referred to as female genital cutting, FGC, or female genital mutilation, FGM) comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural, religious or non-therapeutic reasons, and does not include medically prescribed surgery or that which is performed for sex change reasons. As outlined in numerous international conventions such as the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination Against Children, FGM is a violation of the fundamental rights of women and children.
Speaking from the medical perspective, Mohammed says FC can be basically divided into three: the mild one is the cutting off of only the clitoris, the moderate one involves the amputation of the clitoris as well as a partial or total removal of the labia minora, and the severe type involves the complete removal of the clitoris and labia minora, and the inner surface of the labia majora. Unlike male circumcision, circumcision of females is not religious; it is however embedded in the tradition and cultural heritage of a people. It is believed that when a female child is circumcised, there is a high tendency of such preserving her virginity till marriage, the vaginal area looks more pleasing and fertility is increased. Female children exposed to this act fall within the age range of four to 14; more than half are usually below a year old. There are however rare cases of girls subjected to this painful experience in their late teens.
Female genital mutilation is risky to the health of the child, not just at the time of the procedure or shortly after it, but for a lifetime. Aside from the severe pain the patient experiences, acute loss of blood and infections could also occur, and then lead to death if not promptly attended to. There is a possibility of the child contracting viral infections such as hepatitis that could degenerate into chronic liver infections and then HIV. The girl may also possibly suffer pelvic infections, difficulty during urination, recurrent pains, painful menstruation and intercourse later in life.
Again, contrary to the belief that the practice enhances fertility in a woman, getting pregnant might be a problem when the time comes. There could also be impediment in labour, leading to life-threatening complications, for mother and child. “Due to scarred tissues resulting from a major circumcision, if a woman is in labour, the vagina can tear and get damaged,” said Mohammed. Besides the physical implication, psychological problems such as depression and trauma is inevitable. Chronic pains bring back bad memories and she is not easily aroused during sexual intercourse, leading to marital problems.
In spite of the many dangers of these practices, many parents still engage in them with the ignorance of the damage they cause, while some are borne out of good intentions, which are most times misguided.