By Chioma Obinna

Mrs. Eberechi Ugo is grief-stricken. Her world seems to have crashed. The reason is obvious! She has had three pregnancies in five years without at least one  baby delivered there from surviving. Although, Eberechi, in Igbo, means ‘mercy of God’, sadly, the five-letter-word is far from her. The most painful aspect of it is that people in her neighbourhood have labelled her a witch. It all began when Eberechi, 30, became pregnant few months after marriage. She and her husband, Ibe, were so happy. They immediately set about preparing for the arrival of their first child but little did they know what fate had in stock for them.

“As a  woman, once you are married, you are expected to be pregnant and that happened in  my case. Unfortunately, I lost the pregnancy through miscarriage after about four months,” she stated.

“I took in the second time, and, after an uneventful gestation period, I gave birth at a private hospital in Lagos. Unfortunately, the baby took ill almost immediately and died few days after”.

To make up for the loss, her husband decided they should have another baby quickly. Two months later, their prayers were answered. Eberechi became pregnant again.

Pregnant woman

The couple daily offered prayers to God for the survival of the baby they were expecting. Sadly, history repeated itself. The baby died shortly after birth. It became clear that something was amiss.

Tongues began to wag. Some neighbours and family members concluded superstitiously that Eberechi’s children were born to die.

Just like the phenomenon  of  Abiku  in Yoruba and Ogbanje in Igbo, many people believed Eberechi’s babies were the same child that had continued to reincarnate.

“Each time I was pregnant and I went to register in hospital, they will ask me what did I want to register, was it the one that will die or survive?

“I went to many hospitals and met the best of gynaecologists but there was no solution”.

Husband’s disposition

Eberechi’s husband became frustrated and could no longer hide his feelings. He started keeping late nights and travelling more often.

“My husband threatened to get another wife. He called me one early morning to say he was going to get another wife. I told him that if that will make him happy, so be it, that he should go ahead but inside of me I was dying,” she narrated.

“When he finally brought the woman, I asked the lady if my husband told him he was married. She said to me that she knew, that my husband said I could never have a life baby. That he (my husband) was so angry that after spending so much money on each pregnancy, all he got in return were dead babies.”

Her situation made her an object of mockery in the neighbourhood. Her story was on everyone’s lips.

“Sometimes, when I fought with somebody in the compound, people will say I was the only one that was giving birth to dead babies. If you go to the street, they will tell you to ask for that aunty that goes to the hospital with pregnancy but comes home with dead babies. It was that bad.”

After much suffering, a doctor guessed her problem could be her blood type. Investigation soon revealed the cause. Through the help of a friend, Eberechi met another doctor who explained to her what the problem was. Unfortunately, it was too late. Series of tests carried out showed incompatibility between Eberechi and her deceased children’s blood groups.

According to medical experts, they were Rhesus incompatible, a condition that occurs during pregnancy if a woman has Rhesus (Rh) negative blood and her baby has Rh-positive blood. Rhesus is an antigen, a proteinous substance found on the surface of the red blood cells. Individuals with Rh positive have the antigens and people who are termed Rh negative do not have the antigen.

Further investigation showed Eberechi and Ibe never carried out the necessary blood grouping medical tests before they were married.

“I never heard about this before. My mum never buried any child. We didn’t know anything about that,” Eberechi said.

Inherited blood cells

Eberechi and her dead babies were just incompatibility in simple terms. The mother and children had different Rhesus factor. It means that the mother is Rhesus factor negative while the unborn child is Rhesus factor positive.    Rhesus factor is a protein that is found in our red blood cells. It is inherited from our parents just like we inherit our complexion, our eyes, height, etc.

Eberechi’s predicament is typical of the situation many other Nigerian women often find themselves in.

According to a professor of haematologist, Aba Omotunde Sagoe,Rhesus incompatibility is a common but serious situation and has nothing to do with  Abiku  or  Ogbanje but pure medical problem.

She stated that an Rh negative woman, who gives birth to a Rhesus positive baby, would have problems.

Meanwhile, in this part of the world, when a woman consistently loses children after delivery, such kids are superstitiously called  Ogbanje  or  Abiku  and this belief has made it difficult for many victims to find solution to their problems.

Sagoe said medical evidence has shown that Rhesus incompatibility occurs between an unborn baby and his mother as a result of the generation of antibodies by the mother’s immune system against the baby’s red blood cells. Normally, pregnant women do not display any symptoms of this reaction, but babies born with this condition often have anaemia and jaundice.  “The symptoms  in newborn babies include jaundice and anaemia (a lack of red blood cells). Babies with the condition will usually need to be admitted to a neonatal unit. Treatment includes phototherapy (treatment with light) and, possibly, blood transfusion. If left untreated, the effects of the jaundice in the newborn baby can lead to learning difficulties, deafness and blindness. Severe cases can lead to stillbirths.”

This condition, also called Rh  disease, or haemolytic disease of the newborn, can only happen if the mother has Rhesus negative blood (Rh negative), the baby has Rhesus positive blood (Rh positive), or if   the mother has previously been sensitised to RhD positive blood.

Statistics available show that about 34 million Nigerian women are Rhesus incompatibility while Rhesus disease contributes to the incidence of 144 Nigerian women who die daily from pregnancy and childbirth complications.

Rh incompatibility has also been found to be another major cause of the country’s high infant maternal mortality rate.

Sagoe also noted that women who might have had a history of elective abortion could have been exposed to the condition.

Although research has shown there are measures to ensure that Rhesus negative women are able to deliver life babies, most Nigerian women like Eberechi are ignorant of their Rhesus status.

Treatment

According to a consultant haematologist, Dr Modupe Olaiya, an injection of anti-D immunoglobulin injection, known as Rhogam, introduced in 1977 to prevent sensitisation, has reduced the number of cases of Rhesus disease tremendously.

She explained that knowing one’s Rhesus status and including it in routine screening for all pregnant women would reduce deaths in infants and mothers.

Olaiya, however, explained that the disease can be prevented by treating the mother during pregnancy or within 72 hours after childbirth.

“The mother would receive an intramuscular injection of anti-Rh antibodies (Rho (D) immune globulin) so that the fetal Rhesus positive erythrocytes are destroyed before her immune system can discover them. This is passive immunity and the effect of the immunity will wear off after about 4 to 6 weeks or longer depending on injected dose as the anti-Rh antibodies gradually decline to zero in the maternal blood”, the consultant said.

Also, it is part of modern antenatal care to give all Rhesus D negative pregnant women an anti-RhD IgG immunoglobulin injection at about 28 weeks gestation (with or without a booster at 34 weeks gestation). This reduces the effect of the vast majority of sensitizing events which mostly occur after 28 weeks gestation.

However, despite the importance of this injectable, many of these women may not be able to access this treatment in Nigeria as the cost of the drug has skyrocketed following the current economic challenges.

President/Initiator, Rhesus Solution Initiative, Mrs Olufunmilayo Banire, said there are millions of women who are suffering due to ignorance and who cannot afford regular meals not to speak of affording, treatment injection of N25, 000.

She said research conducted by RSI puts prevalence of Rhesus negative women who may be at risk of complications from Rhesus incomparability at about 6.01 percent of the sample population.

Banire said previous research put the prevalence to be between 5 and 9.5 percent which may seem small but not negligible compared to the size of the population.

“As an organisation, we believe that every life counts and, in this regard, we have been able to donate over 1500 anti-D immunoglobulin (Rhogam) across general and private hospitals. We have been able to reach over 3,000 Rhesus negative women.”