UMUAHIA, NIGERIA —
Four months after giving birth in Umuahia, the capital of Nigeria's southeastern Abia state, 23-year-old single mother Amarachi Amadi is still in hospital with her baby girl.
While the mother and her daughter are in good health, they are not allowed to leave the public hospital until Amadi settles the 543,000 naira ($1,900) bill for their care.
Amadi, who makes a living selling stones to construction workers for 40 naira ($0.15) per sack, fears she may never be able to clear her debt — leaving her and her baby trapped in the Umuahia Federal Medical Center (FMC) for the foreseeable future.
"I have really suffered ... and they do not allow me to go out," said Amadi, who relies on her mother to bring food into the hospital and to help her care for her baby, Oluebubechi.
New mothers like Amadi are stuck in maternity wards across Nigeria — forbidden from leaving until their debts are settled.
Known as Awaiting Bill Settlement (ABS) patients, these women are responsible for looking after and feeding themselves and their newborns.
Few Nigerians have health insurance, leaving many patients clinging to the hope that their bills will be waived by hospital directors or covered by visiting well-wishers.
Meanwhile, whenever the maternity ward at the hospital is full, many ABS patients are forced to sleep on the floor.
"Sometimes, we place all the babies on one bed while the mothers sleep in chairs," said one nurse, who asked not to be named as she was not authorized by the hospital to speak.
"Some babies have stayed here until they started crawling," the nurse said, adding that some mothers had managed to escape the hospital with their babies when no one was watching.
Hoping for charity
Like Amadi, nine other nursing mothers in the FMC's maternity ward are stuck in limbo, having been discharged by the doctors but trapped within the hospital grounds by their debts.
Janet Moses, 19, said the father of her twin boys had stopped visiting or answering her calls over the past month. She believes he has been scared off by the bill.
No one visits Moses or brings her food, so she depends on other patients to share their meals with her.
Other patients on the ward are slightly more fortunate.
Adaku Mmaduabuchi, a 25-year-old housewife who gave birth to her first child in May, is brought meals daily by her husband.
But they, too, have been struggling to pay off their debt.
"I have been phoning my friends and relatives to see if anyone can lend me the money," said her husband, Ihunze, who has so far only paid a third of the 200,000 naira ($700) they owe.
There are a large number of ABS patients at the FMC due to the hospital's policy of treating every patient who arrives, regardless of whether they can afford to pay upfront for their treatment, said Chuku Abali, the director of the hospital.
Abali said he frequently waives the bills of the hospital's patients, many of whom are nursing mothers, with amounts ranging from 10,000 naira ($35) to 1.5 million naira ($5,300).
"But if we continue to run on charity, we will fold. Things have to be paid for," Abali told the Thomson Reuters Foundation.
Many patients wait in the hope that philanthropists, who sometimes visit during Easter and Christmas holidays, will clear their debts when they next visit, the hospital director said.
"We also conduct investigations to find out if patients have any relatives who can afford to pay, then we write to them."
Call for insurance
Other hospitals, like the University College Hospital (UCH) in the southwestern city of Ibadan, are taking a more novel approach when it comes to dealing with their ABS patients.
The UCH has set up a fund which allows hospital staff to make voluntary monthly contributions from their salaries toward patients' bills. Abandoned teenage mothers are given priority.
Yet these contributions alone are not enough to solve the problem, said Adefemi Afolabi, the UCH's deputy director.
"There is no day I get to my table without seeing letters from people applying for cancellation of bills," Afolabi said.
The health ministry announced plans earlier this year to build 10,000 health clinics across the country, which could provide maternity care at a lower cost, according to Afolabi.
"The government also needs to extend the National Health Insurance Scheme so it goes to the grassroots," he said. "Only government workers and some private workers are entitled to it."
The Nigerian health ministry was not available for comment.
Back at the FMC's maternity ward, the mothers talk about the day when they will finally be free to go home with their babies.
But 25-year-old Blessing Godfrey has no such hope.
The student was rushed to the hospital after she fell unconscious when her baby was born unexpectedly.
Godfrey woke up on the ward to learn that her baby had died.
Two weeks later, the grieving mother is still in the hospital, discharged but unable to settle her 19,000 naira ($67) bill.
Her mother, a widow, makes very little selling vegetables, while her boyfriend, also a student, denies he is the father.
"There is no one to assist me," Godfrey said.