Hauwa’u Sulaiman had twice in the past given birth to a set of triplets, a set of twins at two different times and then three babies at different times. Last Friday, the 34-year-old Nigerian mother of 13 was blessed with four more children after giving birth to quadruplets at the Gambo Sawaba General Hospital, Zaria, Nigeria.
Sulaiman and the babies were transferred to the Ahmadu Bello University Teaching Hospital (ABUTH) for better care, reports the News Agency of Nigeria (NAN).
Sadly, the only male among the quadruplets died before they arrived at ABUTH and the remaining three have so far been placed under observation at the pediatrics care unit, Sulaiman told the news agency. This is her eighth delivery, she said, adding that she is also receiving care at the maternity ward of the hospital.
“I am very healthy and strong but the medical experts advised that I need to be monitored very well before they can discharge me,’’ she said. Her husband, Sulaiman Mohammed, who couldn’t hide his joy, said his brother has been helping him to take care of his large family.
In Nigeria, having large families is not entirely new considering some societies define a woman’s worth largely in terms of her ability to bear children. Despite having one of the highest maternal mortality rates in the world, data cited by The Economist show that the fertility rate is estimated to be 5.4, implying that the average woman can expect to have that many children during her life.
In northern Nigeria, which is far less developed than the south, studies show that women are having more children than they say they want to – they have an average of more than seven babies.
And even though having large numbers of children tend to be a struggle for many families, the arrival of twins and higher order multiple births as is the case of Sulaiman, is often received with so much joy and regarded as a blessing.
Once a rarity, these deliveries are now more frequent in Nigeria due to the advent of fertility treatments and advanced maternal age at conception. Studies have revealed that higher order multiple births are associated with Assisted Reproductive Technologies (ARTs) used primarily to address infertility.
“In Nigeria like other developing countries, ART is beginning to gain ground after a previous delay in availability of adequate facilities, high-cost implications of treatment, and some cultural beliefs in certain regions that multiple births are not normal and should not be accepted,” a study published in the Nigerian Journal of Clinical Practice says, adding that the spontaneous occurrence of higher order multiple births is rare.
“The natural incidence of triplets and quadruplets in Nigeria is 0.13%. Triplet births occur in 0.2% of live births in Hausa women in Nigeria, whereas the Yorubas in the South-West are notable for the highest twinning rate in the world with four times as many twins and 16 times as many triplets as women from the US and Europe,” the study says.
In Yorubaland, one town, in particular, appears to take the prize for the highest number of multiple births in the world. Igbo Ora, an agrarian town 80 kilometers from Lagos, is easily the twin capital of the world: unconfirmed estimates from the town say it boasts a mind-blowing 158 sets of twins for every 1,000 live births. This tends to prove accounts that African women have a higher chance of giving birth to twins in comparison to others.
Although one’s diet may play a role in having twins, the most common form of multiple births, generally, twins run in families, implying that the chance of having them is partly determined by one’s genes. In the case of Sulaiman, her mother-in-law, Saudatu Haruna, said she also gave birth to a set of twins on three different occasions. She said her father was a twin while her mother was a triplet.
Higher order multiple births do come with risks and complications with higher morbidity and mortality rates than singletons and twins, according to the study published in the Nigerian Journal of Clinical Practice.
It explains that such babies are usually born preterm and often of low birth weight which raises the risk for increased morbidity and mortality. “They are more prone to congenital malformations such as conjoined twins and cardiac defects in addition to problems of prematurity,” it adds.
Health experts say that to successfully manage multiple pregnancies, there should be an early diagnosis, adequate antepartum fetal surveillance, prompt management of pregnancy complications as well as the timing and mode of delivery, among other factors.