(Update) COVID-19: Eight testing laboratories now available in Nigeria – NCDC

The Nigeria Centre for Disease Control, NCDC, said there are total of eight testing centres in the country for Coronavirus.

The centre added that it now has capacity to test up to one thousand five hundred persons per day.

#COVID-19 #Coronavirus #NCDC #Laboratories #Virus #Video

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Job Creation Is Not The Solution In Nigeria, But Entrepreneurial Explosion – Dr. Charles Omole

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Your View, May 11, 2020

“A lot of our workforce are not geared for the economy of the future. Covid has helped to make it more obvious that there is a need for a complete retraining and refocus of our education and the capacity of our workforce to deal with the economy of the future.” Speaking on the impact of the COVID-19 outbreak on the Nation’s economy, Resource person, legal and economic strategist, Dr. Charles Omole pointed out feasible solutions to Nigeria’s major challenges, with reference to the Great Depression (Economic depression) in the United States during the 1930s.

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Five new laws that could affect your rights at work in 2020 – Somerset Live

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The year 2020 is set to see a range of new laws come into effect.

Here are five key employment law changes that could affect you at work, as explained by Abigail Hubert of Birketts LLP to The Gazette.

From how holiday pay is calculated – to the leave you can expect when you are grieving – these are worth knowing.

Improved rights for agency workers

‘Swedish Derogation,’ also known as ‘pay between assignments’ contracts would previously see agency workers agree a contract that would remove their rights to equal pay with permanent counterparts after 12 weeks working on the same assignment.

From April 6, these will no longer be permissible and agency workers who have been in their employment for 12 weeks will be entitled to the same pay as those on permanent contracts.

Agency workers will have more rights

As well as this, all agency workers will be entitled to a key information document that more clearly sets out their employment relationships and terms and conditions with their agency.

Agency workers who are considered to be employees will be protected from unfair dismissal or suffering a detriment if the reasons are related to asserting rights associated with The Agency Worker Regulations.

Holiday pay calculations changing

From April 6, the reference period to calculate a ‘week’s pay’ for holiday pay purposes will be extended from the previous 12 weeks of work to the previous 52 weeks.

This could affect employees who work variable hours seasonally.

New parental bereavement leave

In September 2018, a new workplace right for paid leave to be given to bereaved parents was officially enshrined in law.

The first of its kind in the UK, the Parental Bereavement Leave and Pay Act 2018 is expected to come into force in April 2020 and will give employed parents the right to two weeks leave if they lost a child under the age of 18 or suffer a stillbirth from 24 weeks of pregnancy.

Employed parents will also be able to claim pay for this period, subject to meeting eligibility criteria.

New right to a written statement of terms

Currently, employees who have been continuously employed for more than one month must be provided with a written statement of terms within two months of employment commencing.

From April 6, all new employees and workers will have the right to a statement of written particulars from their first day of employment. Additional information will have to be included as part of the extended right.

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Accountability for tax shifting

At present, the IR35 rules apply where an individual personally performs services for a client through an intermediary. If the services were provided under a direct contract, the worker would be regarded for tax purposes as being employed by the client.

Currently, it is the intermediary’s responsibility to determine whether IR35 applies.

From April 6, changes to IR35 rules will be implemented for medium and large businesses in the private sector and will largely mirror changes that took effect in the public sector in 2017.

Under the new regime, for all contracts entered into, or payments made on or after April 6, the onus will shift from the intermediary to the end user client to make a status determination.

Responsibility for accounting for tax and national insurance will shift to the party who pays for the individual’s services, known as the ‘fee-payer.’

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When Universal Credit and benefits will change in 2020 and how you’ll be affected – Kent Live

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The General Election result meant a lot of things but it also ensured the continuation of Universal Credit.

Campaigners had been hoping for an end to the controversial scheme, with  Labour promising to scrap Universal Credit  altogether.

However, there will still be a number of changes to the benefits system this year – some of which will be good news for claimants, reports BirminghamLive .

Here’s the timetable of what will be happening – see how it will affect you.

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1. April 2020 – End of benefit freeze

The end to the benefit freeze would mean Universal Credit and other working age benefits rising by 1.7 per cent from April 2020.

The freeze was brought in by the Tories and came into effect from April 2016. It has meant that most benefits and tax credits have not gone up in line with inflation for four years.

Other benefits that have been frozen but are now set to rise are Employment and Support Allowance (ESA), income support, housing benefit, child tax credits, working tax credits and child benefit.

Adam Corlett

The increase means someone on £1,000 a month in benefits will get an extra £17, equivalent to £204 over a year. Those receiving £500 a month get an extra £8.50.

But according to think-tank the Resolution Foundation, families will still be hundreds of pounds a year worse off due to the past five years of bills rising while benefits have remained at the same level.

The Resolution Foundation’s Adam Corlett said: “While the benefit freeze is over, its impact is here to stay with a lower income couple with kids £580 a year worse off as a result.”

2. April 2020 – Pension changes

The Government also said the state pension – which has not been frozen – will increase by 3.9 per cent.

This is expected to be announced in the Budget.

It means retired Brits are in line for £5.05 a week extra on the ‘old’ basic state pension and £6.60 a week on the ‘new’ state pension.

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The bad news is that the  adult dependency payment is being stopped  in April, which could mean thousands of pensions cut by £70 a week.

In addition, the qualifying age for men and women will rise to 66 in October 2020.

It means anyone born after October 5, 1954, will have a state pension age of at least 66.

And there will be further rises too. The Conservatives have set out plans to increase the state pension age to 67 by 2028 and 68 by 2039.

3. April 2020 – Disability benefit changes

The Scottish Government is taking on responsibility for disability benefits from April 1 and will implement changes after that.

In summer 2020, Social Security Scotland will open to claims for the brand new Disability Assistance for Children and Young People, which is Scotland’s replacement for Child Disability Living Allowance.

By the end of 2020, Social Security Scotland will also open to claims for the new Disability Assistance for Older People. This is the Scottish replacement for Attendance Allowance and is for people over the state pension age who need someone to help look after them because of a disability or long-term illness.

Also by the end of 2020, children who receive the highest care component of Disability Assistance will be entitled to Winter Heating Assistance.

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Further changes will come in 2021, including PIP being replaced by Disability Assistance for Working Age People and Carer’s Allowance being replaced by Carer’s Assistance.

Social Security Secretary Shirley-Anne Somerville says the system will have a redesigned application process and significantly fewer face to face assessments.

There will be rolling awards with no set end points and those with fluctuating health conditions will not face additional reviews due to changes in their needs.

She said: ““Since the Social Security Act was passed by the Scottish Parliament in June [2018], progress has been swift.

““Our next priority is delivering payments for disabled people, as this is where we can make the most meaningful difference for the largest number of people.

“We have a duty to quickly reform the parts of the current system which cause stress, anxiety and pain. And I have been moved by the personal stories I have heard, many of which criticise the penalising assessment process.”

Around half a million cases – the equivalent of around 10 per cent of people in Scotland – will transfer from DWP to Social Security Scotland in 2020.

Ms Somerville added: “This is not simply a case of turning off one switch and turning on another. For the first time in its history, our agency will be making regular payments, direct to people’s bank accounts and our systems need to work seamlessly with those of the DWP.

“It is therefore essential we have a system that is fully operational for those making new claims and ensure we protect everyone and their payments as their cases are transferred – that is what those who rely on social security support have told us they want. We must work to a timetable that reflects the importance of moving quickly but not putting people’s payments at risk.”

During the transfer no-one will have to reapply for benefits, no claims will be reassessed and payments will be protected.

She added: “The timetable I have set out is ambitious but realistic and at all points protects people and their payments. I have seen the mess the DWP has made when transferring people to PIP and introducing Universal Credit, and we will not make the same mistakes.    

“There is much hard work to be done but the prize is great – a social security system with dignity, fairness and respect at its heart and which works for the people of Scotland.”

4. June 2020 – TV licence changes

Free TV Licences, funded by the Government, for all those aged 75 and over will come to an end in June. So you can get a free licence up to May 31, 2020.

From June 1, a new scheme means you can only carry on getting a free licence if you – or your partner – are receiving Pension Credit.

If not, you’ll have to fork out the cost of a TV licence – which is £154.50 per year for a colour TV, and £52 for black and white. You can choose to pay monthly (£12.87 a month), quarterly (£39.87 every three months) or yearly.

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So it’s worth checking if you can get Pension Credit to avoid the licence fee.

Pension Credit is a top-up benefit payment available if you or your partner have reached state pension age, or if one of you is getting housing benefit for people over pension age. You get more if you’re responsible for a child or young person who lives with you and is under the age of 20.

There are two elements to Pension Credit. Guarantee Credit tops up your weekly income if it’s below £167.25 (for single people) or £255.25 (for couples), while Savings Credit is an extra payment for people who saved some money towards their retirement and is up to £13.73 for single people and up to £15.35 for couples.

The Pension Service helpline is available on 0800 731 0469. Call Monday to Friday, 8am to 8pm. Calls to 0800 numbers are free.

5.  July 2020 – Universal Credit transition protection extended

From July 22, claimants are to get an additional two weeks of income-related Jobseekers Allowance, income-related Employment and Support Allowance, or Income Support if they receive one of these benefits when moving across to Universal Credit.

Universal Credit is intended to replace six existing benefits in total.

People are transferred on to UC if their circumstances change – such as moving home or having a child. This is called natural migration.

Everyone else on the six old benefits will have to move across in a managed migration scheme by the DWP that is set to be completed by December 2023 and is currently being tried out in Harrogate from July 2019 to July 2020.

Normally, existing benefits are terminated when a Universal Credit claim begins but the Government has amended the rules to allows a “two-week run-on” of the three benefits named above.

6. September 2020 – Universal Credit change for self employed

The DWP works out Universal Credit for self-employed people using what’s called a Minimum Income Floor (MIF).

This is roughly equivalent to the national minimum wage for each hour the claimant is expected to work.

It can mean Universal Credit is calculated on a higher level of earnings than you were actually paid.

However, this Minimum Income Floor is not applied to those who started a business within the past 12 months .

And from September 2020, this 12-month exclusion period will also not apply to “those who are naturally migrated in self-employment and all those existing UC claimants who become new gainfully self-employed.”

‘Naturally migrated’ means switched across to Universal Credit because of a change in circumstances.

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KentLive: We have Kent covered

Do you want to stay up to date with everything that’s happening across the county with KentLive?

Here’s the link to our main Facebook page where we share our latest stories, including anything from breaking news to features, court coverage and much, much more.

For What’s On content such as the latest openings, events, and shopping news see here.

And we have a specialist Facebook group covering traffic and travel across the south east, where we provide the latest updates from any incidents on the roads or trains.

You can also follow KentLive on Twitter here, as well as on our Instagram page where we share great pictures of Kent.

For a round-up of the day’s top stories direct to your inbox, subscribe to our newsletter here.

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EBB 117 – The Evidence on Inducing for Due Dates – Evidence Based Birth®

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Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing labor for going past your due date.

Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Hi, everyone. On today’s podcast, we’re going to talk about the evidence on inducing versus waiting for labor when you’re going past your due date. I’m going to be joined by Anna Bertone, MPH, our Research Editor at Evidence Based Birth to talk about this topic.

Before we get started, I have a quick announcement, and that is next week we are hosting free webinars for the public all about the Evidence Based Birth Childbirth Class. On Monday, March 2, we’ll host a special webinar just for parents. We’ll give you a peek behind the scenes at what it’s like to take our Evidence Based Birth Childbirth Class. Then on Tuesday, March 3, we’ll have a special webinar just for birth professionals to give you a tour of the Evidence Based Birth Childbirth Class so that you can decide if it’s something you’d like to recommend to your clients or not. You can register for these free webinars at evidencebasedbirth.com/childbirthclasswebinar. That’s all one word /childbirthclasswebinar.

All right, now back to the topic at hand, inducing labor for going past your due dates. Now before we begin, I do want to give a brief trigger warning. In our discussion about the research evidence on this topic, we will be talking about stillbirth and newborn death. So there has been a ton of new research on the evidence on induction versus waiting for labor when you go past your due date. So much research, in fact, that we have decided to separate our Signature Article on due dates into two separate articles.

So we still have the original article, The Evidence on Due Dates, which you can find at ebbirth.com/duedates. And although we updated that article a little bit, it’s remained very similar to previous additions. It talks about the length of a normal pregnancy, factors that can make you more or less likely to have a long pregnancy, et cetera. But then we separated out the research on induction into a new article that you can find at ebbirth.com/inducingduedates. This is a peer-reviewed article that covers all of the research on induction versus something called “expectant management” for going past your due date. And in today’s podcast, we’re going to update you on the latest info that we found for that article.

Just a heads up, we will not be covering the research evidence on inducing at 39 weeks. We already covered the ARRIVE study, a randomized trial that looked at induction versus expectant management for 39 weeks of pregnancy in episode 10 of the Evidence Based Birth podcasts. And just a tip, if you’re having trouble finding any of our earlier episodes of this podcast, iTunes has stopped showing the earliest podcasts, but they’re still out there and you can find them on Spotify and any other podcasting app. You can also find info about the ARRIVE study at ebbirth.com/arrive.

So we’re not going to talk about induction at 39 weeks. Instead, we’re going to be focusing on the evidence on induction versus waiting for labor once you reach 41 weeks. And to do so, we’re going to talk with our Research Editor, Anna. So welcome, Anna, to the Evidence Based Birth podcasts.

Anna Bertone:   Thank you! I’m glad to be on the podcast again.

So I want to start by explaining to our audience a little bit kind of about the background of why this topic is important. Inductions for non-medical reasons have been on the rise in the United States and all around the world for the past 30 years. And increasingly, more people who are pregnant are being induced for reaching their estimated due date. So we really want to cover the benefits and risks of elective induction for going past your estimated due date. And we’ll also talk about whether or not your goals and preferences for your birth matter, which of course they do, but that kind of plays a role as well.

So how often are people induced for going past their due date? Well, we don’t know for sure because this hasn’t been measured recently. But according to the 2013 Listening to Mothers III survey, which was now published about seven years ago, more than 4 out of 10 mothers in the U.S. said that their care provider tried to induce labor. Inducing labor for going past your due date was one of the most common reasons for an induction. Out of everyone who had an induction in this study, 44% said they were induced because their baby was full term and it was close to the due date. Another 18% said that they were induced because the healthcare provider was concerned that the mother was overdue.

The Centers for Disease Control in the U.S. also reported in 2018 that about 27% of people had their labor induced, but we think that number is probably low and that the percentage of people who have labor induced is under-reported in the Vital Statistics Program in the United States. So Anna, can you talk a little bit about why there’s so much controversy over this concept of electively inducing labor once you go past your due date?

Anna Bertone:   So why is there so much controversy about elective induction? Elective inductions by definition are labor inductions that do not have a clear medical reason for taking place. They occur for social reasons, like the provider wanting the mother to give birth before the provider goes out of town or for other non-medical reasons like the pregnancy getting uncomfortable and for the mother’s convenience. But there’s also a gray zone about what constitutes an elective induction. Many providers only consider an induction to be “elective” when the mother is healthy, pregnant with a single baby, and less than 41 weeks pregnant. The gray zone is that sometimes when the pregnancy goes past 41 weeks, some providers consider that to be a medically indicated induction rather than an elective induction. But in general, inductions are considered medically indicated when there are accepted medical problems or complications with the pregnancy that make it less safe to continue the pregnancy.

For many years, and I remember when I first entered the birth world in 2012, a lot of people talked about the fact that if you have an induction it doubles your chance of cesarean. And then all of a sudden there were people saying that wasn’t true. So can you talk a little bit about that controversy?

Anna Bertone:   So for many years, the common belief was that elective induction doubles the cesarean rate, especially in first-time mothers. But researchers nowadays consider those earlier studies to be flawed. In the earlier studies, what they would do is they would compare people assigned to elective induction to people who went into spontaneous labor. Nowadays, they don’t compare those two groups anymore. They compare people assigned to elective induction to the people assigned to what’s called expectant management, or in other words waiting for labor. And in that group, the person could either go into spontaneous labor or they could require an induction for medical reasons (so that would be a medically indicated induction), or they could choose elective induction further along in the pregnancy.

So that’s a subtle difference but an important one because in the earlier studies they compared elective induction to spontaneous labor. But you don’t have the choice to go into spontaneous labor today. Your choice is to be induced today or to wait for labor to start. And sometimes during that waiting period you might develop complications that require an induction, or you might change your mind and decide to have an elective induction, or you might go into spontaneous labor.

Anna Bertone:   Right. So nowadays, we compare a group assigned to elective induction to a group assigned to expectant management. One example of this was the ARRIVE trial.

The ARRIVE trial was a study comparing elective induction at 39 weeks versus expectant management. We’re not going to go into that trial in detail because we already covered it in detail in episode 10 of the Evidence Based Birth podcasts. But they actually found a lower risk of cesarean in the elective induction group. Researchers think that had to do with the fact that of the people in the expectant management group, more of them developed problems with blood pressure that required medical inductions and increased risk for complications. So again, that just kind of goes to show you that it does make a difference when you compare elective induction to expectant management.

Although, one thing you have to keep in mind with the ARRIVE study is that they had a very low cesarean rate in both groups compared to some settings. The cesarean rate was 19% in the elective induction group versus 22% in the expectant management group. So those research results cannot probably be generalized to settings with extremely high cesarean rates or high cesarean rates with inductions. We have some, for example, some professional members at Evidence Based Birth who talked to us about where they’re practicing and how high the cesarean rates are with the elective inductions there. So I think you have to be careful how you generalize or apply that data from the ARRIVE study, and we talk more about that in episode 10 of the podcast.

Which leads me to another point, and that is some cautions about the evidence. When I say generalize, that means taking research from a research study, and seeing if you can apply that to where people are giving birth in your community. So it’s important to understand that there are some major drawbacks to some of the research that we’re going to be talking about. Many of the studies are carried out in countries or time periods where there are low cesarean rates. So when that happens, when a study is carried out in a setting where culturally there’s low C-section rates, that might not apply to a hospital with high cesarean rates. If your hospital has high rates of “failed inductions” and strict time limits on the length of labor, then the evidence in these studies may not apply to you because induction might be more risky in your community hospital.

Also, another disclaimer about the evidence, in these trials, people are randomly assigned to induction or expectant management. And it’s important to remember that the people assigned to expectant management do not always go into labor spontaneously. There’s a mix of people in that group. Some of them do have a spontaneous labor. Others have an elective induction later on, and others have a medical induction for complications.

Also, you have to look at what they’re doing for fetal testing in the studies. In some studies there’s lots of fetal testing going on in the expectant management group. However, we’re going to talk about one of the studies where they were not doing any standard fetal monitoring during expected management. So those results might not apply to your community if your community does the fetal monitoring, and the study did not have fetal monitoring.

Finally, another disclaimer about the research evidence is that the induction protocols vary from study to study, and even within studies themselves. So knowing what the protocol was for induction in that study can be very helpful to decide if this is going to apply to your unique situation in your local community or not.

So with all of those disclaimers being said, there’s been quite a lot of new research in the past year about induction at 41 weeks. So Anna, can you talk about one of the most recent studies? Let’s talk about the INDEX trial from the Netherlands. There were two trials that came out in 2019, two large randomized control trials. Let’s talk about the INDEX one first.

Anna Bertone:   Sure. So the INDEX trial was from the Netherlands. INDEX stands for induction at 41 weeks, expectant management until 42 weeks. This was a large multicenter trial. It was conducted at 123 midwifery practices and 45 hospitals. Most of these pregnancies were managed by midwives.

…So this was the midwifery-led model of care-

Anna Bertone:   Exactly.

… which is very different than in the United States which is typically an obstetrician-led care model.

Anna Bertone:   The researchers randomly assigned a total of 1,801 pregnant people to either induction at 41 weeks and zero to one days or to wait for labor until 42 weeks and zero days, which is called expectant management. The reason they were able to conduct this study in the Netherlands and got ethical approval for it is because it was standard practice for them to not induce labor before 42 weeks with an uncomplicated pregnancy.

…Whereas in the U.S. it’s rare to see someone go to 42 weeks, in the Netherlands, they typically won’t induce you unless there’s medical reasons until you get to 42 weeks – 

Anna Bertone:   Exactly. So the mothers were enrolled in the study between 2012 and 2016. Everyone had to be healthy, and pregnant with single, head-down babies. The gestational ages were estimated with ultrasound before 16 weeks of pregnancy. They excluded people with a prior cesarean, with high blood pressure disorders, with expected problems with the baby’s growth, abnormal fetal heart rate, or known fetal malformations (congenital anomalies). In both groups, cervical ripening and induction methods depended on local protocol. It’s like what Rebecca was talking about earlier. There wasn’t a standard protocol to apply to both groups in this study when it came to cervical ripening and induction. It was based on local protocol. And this is an important weakness of the study because the providers might’ve managed labor inductions differently based on whether someone was being electively induced or was assigned to the expectant management group. It also limits the study’s generalizability, which means our ability to apply the results of this study to the population at large because providers don’t have an induction protocol that they can replicate.

…So we can learn from what happened in this study, but it’s difficult for us to apply it to across the board because there’s no specific induction protocol that could be followed – 

Anna Bertone:   Yeah. What happened was in the elective induction group, 29% of the participants went into labor before their induction and 71% were induced. Then in the expectant management group, 74% of the participants went into labor spontaneously before their planned induction and 26% were induced.

…And before we talk about how long the pregnancies were, I think it’s important for people to understand that when you have a randomized controlled trial like this the researchers do something called intent to treat analysis. So it doesn’t matter what type of birth they had, whether it was a spontaneous labor or a medical induction, the data were analyzed depending on which group you were originally assigned to. So if you were assigned to an elective induction but you happen to just quick go into labor on your own before the induction, you were still grouped with everyone in the elective induction group and vice versa. So that’s just an important distinction for people to understand. – 

Anna Bertone:   Yes. What happened with these results is that the median pregnancy was only two days shorter in the elective induction group compared to the expectant management group. This is interesting because they still found a difference between these two groups, but-

…And this is important because a lot of people ask us like, “Well, I only want to wait one more day, or two more days, or three or four more days,” but they’re saying by decreasing the length of the pregnancy by two days they found significant results. So what did they find in the INDEX trial? – 

Anna Bertone:   So for mothers, they found that there was no difference in the cesarean rates. This was taking place in a country with low cesarean rates. It was a midwifery model of care and the rates were very low in both groups (11%). 

They only had an 11% cesarean rate then?

Anna Bertone:   Yeah. They also had an outcome called a composite outcome, which is a combined outcome for mothers, and there was no difference in that measure either. They were looking for things like excessive bleeding after birth, manual removal of the placenta, severe tears, intensive care admission, and maternal death, and they didn’t find a difference in those things. There were no maternal deaths in either group. So as far as the bad outcomes for the mothers, there were about 11% to 14% in both groups, but not different.

…And what about for the babies then? – 

Anna Bertone:   And then for the babies, the babies in the elective induction group had a lower composite outcome rate. And in this composite outcome, what they were looking at was perinatal death, Apgar score less than seven at five minutes, low pH, meconium aspiration syndrome, nerve injury, brain bleeds, or admission to a NICU. And here they found a lower composite adverse outcome rate with the babies in the elective induction group (1.7% versus 3.1%). 

And why do they think that outcome was better with the elective induction group?

Anna Bertone:   They think that it was mostly due to the lower rate of Apgar scores less than seven at five minutes, and that probably contributed the most to having a lower adverse outcome rate with the babies in the elective induction group. The author’s note that there was no difference in rates of Apgar score less than four at five minutes, but they found that the combined outcome was still lower in the elective induction group if they used an Apgar score of less than four at five minutes and excluded fetal malformations. So basically, the babies in the elective induction group had better Apgar scores overall.

…And what about stillbirths? Because that’s like the main reason they’re doing these kinds of elective inductions, is to lower the risk of stillbirth. – 

Anna Bertone:   Yep. And they did not find a difference in stillbirth in this study. There was one stillbirth that occurred in the elective induction group. It was at 40 weeks and six days, before the mother was induced. Then, there were two stillbirths that occurred in the expectant management group while the mothers were waiting for labor.

Anna Bertone:   I looked for a few more details about those stillbirths because I was interested in that. Of the two stillbirths that occurred in the expectant management group, one was a small for gestational age baby at 41 weeks and three days to a first-time mother. The other one was to a mother with a prior birth, and that was at 41 weeks and four days. The mother’s placenta showed signs of infection (infection of the membranes). Then, the one stillbirth that occurred at in the elective induction group at 41 weeks was to an experienced mother (someone who had already had given birth before), and that was at 40 weeks and six days, and there was no explanation for that one. But with two versus one, they didn’t find a significant differences in stillbirths between those groups.

And what was the protocol for fetal monitoring in that study?

Anna Bertone:   There was no protocol for fetal monitoring. It depended on local guidelines, just like the induction and cervical ripening protocol. But the study authors say that fetal monitoring and assessment of amniotic fluid levels was typically done between 41 and 42 weeks. 

So how would you sum up the results of this INDEX study then?

Anna Bertone:   They found that elective induction at 41 weeks resulted in similar cesarean rates and less overall bad outcomes for babies compared to waiting for labor until 42 weeks. However, they say that the absolute risk of a bad outcome happening was low in both groups. It was 1.7% in the elective induction group versus 3.1% in the expectant management group (the group that waited until 42 weeks).

All right. Well, the next study we wanted to talk about was the SWEPIS trial from Sweden, also published in 2019, also coming out of Europe. It’s S-W-E-P-I-S, and it stands for the Swedish post-term induction study, or SWEPIS. It got a lot of media attention with headlines like … There was one that said, “Post-term pregnancy research canceled after six babies died.” And it is true that this study was ended early after deaths in the study. The researchers intended to enroll 10,000 mothers from multiple centers across Sweden, but they ended up stopping the study with about 1,380 people in each group after their data safety and monitoring board found a significant difference in perinatal death between the groups.

Data safety and monitoring boards are basically a board that keeps track of what’s going on in the study. They get interim reports. And if they see any concerning safety issues, they have the power to stop the studies. That’s a standard part of a lot of randomized controlled trials is to have one of these safety boards.

Similar to the INDEX trial in the Netherlands, in Sweden, labor is typically not induced before 42 weeks if you have an uncomplicated pregnancy. Also similar to the Netherlands, in Sweden, midwives manage most of the pregnancies and births. It’s a midwifery-led model of care.

The purpose of the SWEPIS study was to compare elective induction at 41 weeks and zero to two days versus expectant management and induction at 42 weeks and zero to one day if the mother hadn’t gone into labor by that point. The study was carried out in the years 2015 to 2018. The researchers enrolled healthy mothers with single babies in head-first position. They had accurate gestational ages. They excluded people with a prior cesarean, diabetes, and other complications such as high blood pressure, small for gestational age, or known fetal malformations.

There is a pretty low stillbirth rate in Sweden, so they thought they would need about 10,000 people to see a difference between groups, but they ended up not needing nearly that many people to find a difference in stillbirth rates. One of the big strengths of the SWEPIS trial is that in contrast to the INDEX trial, in the SWEPIS trial they defined an induction protocol and they used that same protocol with everyone in the elective induction group and everyone in the expected management group who had an induction. The protocol was basically if the mother’s cervix was already ripe, they simply broke her water and gave her oxytocin as needed by IV. If the mother’s cervix was not ripe or the baby’s head was not engaged, they used mechanical methods or Misoprostol, or prostaglandins, or oxytocin, but they did cervical ripening first.

In the elective induction group, most of the people were induced. 86% had their labor induced. 14% went into labor spontaneously before the induction. In the expectant management group, 67% of them went into labor spontaneously and 33% ended up with an induction. Similar to the INDEX trial, there was a really tiny difference in the length of pregnancy between groups. Pregnancy in the elective induction group was in general only three days shorter than pregnancy in the expectant management group, but yet they did go on to find significant differences.

So what the SWEPIS trial found was that for babies – this is why this study was stopped early – there were five stillbirths and one early newborn deaths in the expectant management group out of 1,379 participants for a death rate of 4.4 deaths per 1,000 women. There were zero deaths in the elective induction group out of 1,381 participants. All five stillbirths in the expectant management group happened between 41 weeks, two days and 41 weeks, six days. Three of the stillbirths had no known explanation. One was for a baby that was small for gestational age. The other was with a baby who had a heart defect. There was one newborn death that occurred four days after birth due to multiple organ failure in a baby that was large for gestational age.

The authors mentioned that when complications are present at the end of pregnancy, such as problems of the placenta, or the umbilical cord, or fetal growth, these problems may become increasingly important as each day of pregnancy progresses, which they believe is why they found a higher death rate with expectant management past 41 weeks.

Another key finding of the study was that all of these deaths occurred to first-time mothers, which suggests that 41-week induction may be especially beneficial for babies of first-time mothers. They found that it only took 230 inductions at 41 weeks to prevent one death for a baby, and this was a much lower number than previously thought. If you remember, though, as Anna was saying, the INDEX trial did not find a significant difference in death between the induction group and the expectant management group. We think the reason the SWEPIS study found a difference was because it was a larger study, it was better able to detect differences in rare outcomes like death. Also, with the SWEPIS study, there might not have been as good fetal monitoring. So it’s possible that the better fetal monitoring of participants between 41 weeks and 42 weeks in the INDEX trial might’ve been protective, leading to fewer perinatal deaths. We can’t be certain though because there were no fetal monitoring protocols in either trial.

Another thing to note is that participants in the SWEPIS expectant management group tended to give a birth a little later than the participants in the INDEX expectant management group. That might help explain the higher perinatal death rate in the expectant management group in SWEPIS. They did not find a difference in what they call the composite adverse perinatal outcome, which included death, low Apgar scores, low pH, brain bleeds, brain injury, seizures, and several other major complications, but there was that significant difference in perinatal death (either having a stillbirth or newborn death).

Also, the elective induction babies were less likely to have an admission to intensive care, 4% versus 5.9%. They had fewer cases of jaundice, 1.2% versus 2.3%, and fewer of them were big babies, 4.9% versus 8.3%.

For mothers, the outcomes were overall pretty good. There were no differences in cesarean rates similar to the other trial. The cesarean rate in this study in both groups was about 10% to 11%. More mothers in the elective induction group had an inflammation of the inner lining of the uterus called endometritis, 1.3% versus 0.4%. And on the other hand, more mothers in the expected management group developed high blood pressure, 3% versus 1.4%. They also interviewed the women in both groups and they found that the mothers in the expectant management group really struggled with negative thoughts. They described feeling in limbo while they waited to go into labor. So Anna, can you talk a little bit about the fetal monitoring in this study and how it may have differed from the other study?

Anna Bertone:   Sure. Fetal monitoring in this study was done per local guidelines. So there was no study protocol for fetal monitoring during the 41st week of pregnancy. However, the mothers recruited from one region of Sweden, called the Stockholm region, which made up about half the people in the study, had ultrasound measurements of their amniotic fluid volume and abdominal diameter at 41 weeks, whereas the people that came from the other areas of Sweden in the study did not receive these assessments regularly. None of the six deaths that occurred in this study occurred in the Stockholm region of Sweden where they received this type of fetal monitoring, which leaves us with the question of how important was this fetal monitoring. Could it have made the difference between the Stockholm region participants not experiencing fetal deaths whereas participants from other regions did?

Anna Bertone:   So that’s just an important thing to keep in mind with this study is that the fetal monitoring may have made a difference as far as the perinatal outcomes. It also means that the results of the SWEPIS study might not apply equally to mothers who receive fetal monitoring at the end of pregnancy, specifically during that 41st week of pregnancy which seems to be the really critical time period. Another thing, all of the perinatal deaths in this study occurred to first-time mothers, which tells us that the results might not apply equally to mothers who have already given birth before.

…So in the SWEPIS study, out of the mothers in the study who had already given birth before and were having a subsequent baby, none of them experienced this stillbirth or newborn death, correct?

Anna Bertone:   Correct. Yes.

Okay. So all of the perinatal deaths occurred to first-time mothers.

Anna Bertone:   And the first-time mothers, by the way, they only made up about half of the participants in the sample, so it was about a 50/50 split.

So all of the fetal and newborn deaths from this study came from first-time mothers who lived in the areas of Sweden that did not do any prescribed fetal monitoring during that 41st week of pregnancy.

Anna Bertone:   That’s my understanding. Correct.

Okay. So those are the two big randomized trials that came out in 2019. Before they were published, there was a 2018 Cochrane meta-analysis. Anna, I was wondering if you could talk a little bit about that. This study did not include the SWEPIS and the INDEX trials, but we still wanted to talk about it in our article. So can you explain to our listeners a little bit about this Cochrane review?

Anna Bertone:   Sure. There was a 2018 Cochrane review and meta-analysis by Middleton. Unlike these randomized control trials that we were just talking about, they didn’t focus specifically on the 41st week of pregnancy versus the 42nd week of pregnancy. It was much more broad than that. What they did was they looked at people who were electively induced at some point, and compared them to people who waited for labor to start on its own until some point. So there was a much more broad range of gestational ages there. But they included 30 randomized control trials with over 12,000 mothers, and they compared a policy of induction at or beyond term versus expectant management. All of the trials took place in Norway, China, Thailand, the U.S., Austria, Turkey, Canada, the UK, India, Tunisia, Finland, Spain, Sweden, and the Netherlands.

So it’s quite a global sample.

Anna Bertone:   Yes. But one study in this meta-analysis really dominated and accounted for about 75% of the data, and that was the Hannah post-term trial that I think Rebecca is going to be talking about soon. Because that one trial dominated this meta-analysis so much, most of the data was on giving birth at 41 weeks or later.

And they did not include the ARRIVE trial in this meta-analysis.

Anna Bertone:   Right. They didn’t include the ARRIVE, INDEX, or SWEPIS trials. So in its next update, it’s going to be updated with those three randomized control trials. But they did include 30 other randomized control trials. What they found was that a policy of induction at term or beyond term was linked to 67% fewer perinatal deaths compared to expectant management. So that was two deaths with induction at or beyond term versus 16 deaths in the people assigned to expected management.

Anna Bertone:   The Hannah post-term trial excluded deaths due to fetal malformations, but some of the smaller trials that were included in the Cochrane meta-analysis did not. So if we exclude the three deaths from severe fetal malformations, then the final count is one death in the induction group and 14 in the expectant management group. So it doesn’t change the results too much overall to exclude fetal malformations. Overall, they found that the number needed to treat was 426 people with induction at or beyond term to prevent one perinatal death. Specifically, there were fewer stillbirths with a policy of induction at or beyond term.

Which was a different number needed to treat than the SWEPIS trial, which found only took 230 inductions at 41 weeks to prevent one perinatal death.

Anna Bertone:   Yeah. I think part of the reason the SWEPIS trial was so groundbreaking and got so much media attention is because it did find a lower number needed to treat than had been found previously. So the absolute risk of perinatal death was 3.2 per 1,000 births with the policy of expected management versus 0.4 deaths per 1,000 births with the policy of induction at or beyond term. They found that a policy of induction was linked to slightly fewer cesareans compared to expectant management, 16.3% versus 18.4%.

Anna Bertone:   Fewer babies assigned to induction had Apgar scores less than seven at five minutes compared to those assigned to expectant management. They didn’t find any differences between the groups with the rate of forceps or vacuum assistance at birth, perinatal trauma, excessive bleeding after birth, total length of hospital stay for the mother, newborn intensive care admissions, or newborn trauma. The authors concluded that individualized counseling might help pregnant people choose between elective induction at or beyond term or continuing to wait for labor. They stress that providers should honor the values and preferences of the mothers.

We need more research to know who would or would not benefit from elective induction. And the optimal time for induction is still not clear from the research, which is what they said in 2018. I think Rebecca’s going to talk about the famous Hannah post-term study that accounted for 75% of the data in that meta-analysis.

Yeah, so we’re kind of working backwards through time. We started with the 2019 randomized trials, then the 2018 meta-analysis where they said the optimal time for induction is not clear, but they stated that before the two new randomized trials came out. Then even before then going back in time is the 1992 Hannah post-term study, which is one of the most important studies on inducing for going past your due date and it was the largest randomized trial ever done on this topic, larger even than INDEX or SWEPIS. And it controls most of the findings in that Cochrane meta-analysis that Anna just described.

So let’s look at what happened in this study because it plays so much of a role in the meta-analysis. It was carried out between the years 1985 and 1990 when a group of researchers enrolled 3,407 low-risk pregnant people from six different hospitals in Canada into the study. Women could be included if they were pregnant with a live single fetus, and they were excluded if they were already dilating, if they had a prior cesarean, pre-labor rupture membranes, or a medical reason for induction.

This study had a much different expectant management protocol than INDEX or SWEPIS because unlike those studies where the longest you would go was 42 weeks and zero to one or two days, in the Hannah post-term study, the people assigned expectant management were monitored for as long as 44 weeks pregnancy before they were induced, so up to a month past your due date, which is almost unheard of today. At around 41 weeks, people who agreed to be in the study were either randomly assigned to have an induction of labor or fetal monitoring with expectant management.

In the induction group, labor was induced within four days of entering the study, usually about 41 weeks and four days. If the cervix was not ripe and if the fetal heart rate was normal, they were given a prostaglandin E2 gel to ripen the cervix. They used a maximum of three doses of gel every six hours. If this did not induce labor or if they did not need the gel, people were given IV oxytocin, had their waters broken, or both. And they could not receive oxytocin until at least 12 hours after the last prostaglandin dose.

So one strength of this study is that it had a defined induction protocol that providers could replicate. But the big weakness of this study is that the expectant management group did not have that same induction protocol. In the monitored or expected management group, people were taught how to do kick counts every day and they had a non-stress tests three times per week. They also had their amniotic fluid levels checked by ultrasound two to three times per week. And labor was induced if there were concerning results in the non-stress test, or if there was low amniotic fluid, or if the mother developed complications, or if the person did not go into labor on their own by 44 weeks. And if doctors decided the baby needed to be born, mothers in expectant management group did not receive any cervical ripening. Instead, they either had their water broken and/or IV oxytocin, or they just went straight to a cesarean without labor. So Anna, do you want to talk a little bit about what the researchers found in the study?

Anna Bertone:   What the researchers found in the Hannah post-term study is that in the induction group, 66% of the people were induced and 34% went into labor on their own before induction. And in the expectant management group, 33% were induced and 67% went into labor on their own. There were two stillbirths in the group assigned to wait for labor and zero in the group assigned to induction. This difference was not considered to be statistically significant, which means we don’t know if it happened by chance or if it was a true difference between the groups. The more interesting outcome to look at with the Hannah post-term trial are the findings on cesarean rates because they differ depending on what numbers you look at. You can either look at the outcomes for the two original groups, which were the people randomly assigned to induction and then those assigned to expectant management, or you can look at the breakdown of what actually happened to the people in the two groups, in other words what happened to the people who were actually induced or who actually went into spontaneous labor.

Anna Bertone:   So what happened in the original randomly assigned groups? If you look at the two original groups, the overall cesarean rate was lower in the induction group. It was 21.2% versus 24.5%. That was even after taking into account factors like the mother’s age, whether or not it was her first baby, and cervical dilation at the time of study entry. Or you could look at what happened with the people who were actually induced or who actually went into labor on their own. And if you look at that, you see two very interesting things. You see that people who went into spontaneous labor, regardless of which group they were assigned to, they had a cesarean rate of only 25.7%. But if people in the monitoring group had an induction, their cesarean rate was much higher than all the other groups. It was 42%. The same was true for both first-time mothers and for mothers who had given birth before.

Anna Bertone:   So what does this mean? It means that only the people who were expectantly managed but then had an induction had a really high cesarean rate. The people who were expectantly managed and then went into labor spontaneously did not have a higher cesarean rate. One possible reason for this, for the highest cesarean rate seen in the people who were assigned to expectant management but then ended up getting an induction, is that the people in this group might’ve been higher risk to begin with since a medical complication could have led to their induction. The people that were assigned to expectant management and never developed a complication requiring an induction, those were the lower risk people, which means they were the ones less likely to end up giving birth by cesarean.

Anna Bertone:   Then, another important factor that I know Rebecca has discussed previously is that doctors might’ve been quicker to call for a cesarean when assisting the labors of people with medical inductions if their pregnancies were beyond 42 weeks. They may have been less patient waiting for labor.

…Or more easily worried about the course of the labor, big baby, etc. – 

Anna Bertone:   Yes. More worried.

So basically, it seems like from the Hannah post-term trial, one of the benefits of considering expectant management is that if you do have spontaneous labor, your chance of cesarean is pretty low. But the risk is that you’ll develop medical complications and need an induction, in which case an induction at 42 weeks is going to be riskier than an induction at 41 weeks. So what do you think? We have all this research from all over the world, from the Hannah post-term trial, to the 2018 meta-analysis, to two trials out in 2019. Do you still feel like routine induction at 41 weeks is still going to be controversial or not?

Anna Bertone:   I think it’s definitely still controversial, and I think everybody’s still processing the results from the INDEX trial and the SWEPIS trial. Rebecca and I reached out to Dr. Wennerholm who conducted the SWEPIS trial in Sweden, and she said she’s currently working on secondary analysis of the data. They’re talking about the economic implications of the findings in Sweden and what it means for Swedish national policy. So I think it’s still controversial. People are still talking about what to make of these findings.

Anna Bertone:   There was another systematic review from 2019 by Riedel. This one came out too early to include the SWEPIS and the INDEX trials, but it’s still interesting to look at. Because unlike the Middleton Cochrane review, these authors were specifically interested in induction during the 41st week of pregnancy versus during the 42nd week of pregnancy. So in their analysis, they restricted the studies only to people having a routine induction at 41 weeks and zero to six days versus routine induction at 42 weeks and zero to six days. If you remember, the Cochrane review was much broader than that. They also only looked at studies published within the last 20 years. They only looked at studies with low-risk participants, and they ended up with three observational studies, two randomized controlled trials, and two studies that they called “quasi experimental studies”, which they grouped with the randomized controlled trials even though these studies weren’t truly randomized.

Anna Bertone:   What they found was one perinatal death in the 41 week induction group and six deaths in the 42 week induction group. That was a rate of 0.4 versus 2.4 per 1,000. This finding was not statistically significant. In other words, we don’t have strong enough evidence that this couldn’t have happened by chance. These same studies, those two randomized controlled trials and the two quasi experimental studies, they showed no difference in cesarean rates between groups also. But the authors did report that one observational study found an increase in the cesarean rate with the 41 week induction group. So basically, they’re saying if you look much more narrowly at the evidence of induction during the 41st week versus the 42nd week, then there might not be a significant difference in the death rate.

But that Riedel study from 2019 is already outdated because that was before the two big randomized trials came out.

Anna Bertone:   Yes. We need to see a systematic review and meta-analysis that includes those two randomized controlled trials and see if that changes. These authors also expressed concerns about the cesarean rate possibly rising with 41-week induction because both the SWEPIS trial and the INDEX trial took place in countries with very low cesarean rates. So we just don’t really know at this point whether there would be a difference in cesarean rates if they took place in countries with higher rates of cesarean, such as the U.S.

Anna Bertone:   So I think it is still controversial. There’s also countries that are changing their policies about induction and going back and looking at whether that policy change led to any difference in outcomes. One such country is Denmark. They just published a study where they compared birth outcomes from 2000 to 2010 versus 2012 to 2016. And in that time period there was a change in policy from recommending induction at 42 weeks and zero days to 41 weeks and three to five days. They included over 150,000 births in the dataset. And when they looked back, they didn’t see any difference in stillbirths, or perinatal deaths, or low Apgar scores when they compared the period before versus after the policy change. The perinatal death rate was already declining before the policy change in 2011, and it just continued going down without any additional impact from the 2011 policy change. There was also no impact on the rate of Cesareans with the policy to switch from 42 weeks to 41 weeks.

Anna Bertone:   That’s just an example of how this is still controversial. Countries are implementing new policies, and Sweden and the Netherlands may implement new policies based on the INDEX and the SWEPIS studies. Then they’ll probably conduct a study the same way that Denmark did to see if that policy change had any real impact on the population.

I think it’s important to mention, though, that with the Denmark national policy, they switched from 42 weeks and zero days to 41 weeks and three to five days, and that might not have been early enough to make an impact on the stillbirth rate because the studies that we were looking at from 2019, SWEPIS and INDEX, were looking at inductions happening at 41 weeks and zero to one or two days and it was that couple of days difference that made the difference between low stillbirth rate and a higher stillbirth rate.

Anna Bertone:   Right. Exactly. I think that future researchers shouldn’t group 41 weeks and zero to six days together in one grouping because there seems to be differences between the earlier part of the 41st week and the later part of the 41st week because, like you said, SWEPIS and INDEX found that waiting even just two or three days make a difference in outcomes during that week.

So let’s just sum up the pros and cons of induction at 41 weeks versus continuing to wait for labor since that’s what we have the bulk of the evidence on now. I would say that the research shows that the pros of inducing labor at 41 weeks include a lower risk of stillbirth, especially among those with risk factors for stillbirths such as being pregnant with your first baby. In our article, we have a table of the pros and cons. The absolute risk of stillbirth is 4 out of 10,000 pregnancies at 39 weeks, 7 out of 10,000 pregnancies at 40 weeks, 17 out of 10,000 pregnancies at 41 weeks, and 32 stillbirths out of 10,000 pregnancies at 42 weeks. Research also shows a lower risk of the baby receiving intensive care with an elective induction at 41 weeks, lower risk of the baby having jaundice, lower risk of the baby being large for gestational age, and lower risk of needing a cesarean, although that finding may depend on your practice setting. There is a lower risk of mother developing a high blood pressure disorder. at the end of pregnancy. And for some people, they may find an elective induction at 41 weeks convenient and it could help them end an uncomfortable pregnancy.

Also, in our article, we reference one study that found some cognitive benefits for babies. It suggests that the cognitive benefits for the baby from the mom remaining pregnant appear to increase until about 40 to 41 weeks after which there’s no cognitive benefits to the baby’s brain development for continuing to remain pregnant. So Anna, can you share the cons of elective induction at 41 weeks?

Anna Bertone:   Yeah. One of the cons of being induced at 41 weeks instead of continuing to wait and see if you go into labor is the potential for medicalization of birth. One example of this is continuous fetal monitoring may occur if you have the induction, whereas you might not get continuous fetal monitoring if you go into labor on your own spontaneously during that 41st week. 

Anna Bertone:   Another con would be a potential for failed induction leading to a cesarean. That also depends a lot on your practice setting. Another con is the potential for uterine tachysystole, which is defined as more than five contractions in 10 minutes averaged over 30-minute window. There’s a potential increase in the risk of uterine rupture with medical induction. That is especially important among people with a previous cesarean having a VBAC.

Anna Bertone:   Another con is missing the hormonal benefits of spontaneous labor. Another con is increased risk of mother getting inflammation of the inner lining of the uterus, endometritis. One study found that as a possible risk of induction 41 weeks. Then, lastly, medically-induced contractions might increase pain and make epidural use more likely.

We also have a section in the article where we talk about whether there are any benefits to going past your due date. That table we just took you through was comparing the benefits and risks of elective induction. In terms of benefits of going past your due date, one of the major benefits of awaiting for spontaneous labor are the hormonal benefits, which Anna briefly mentioned. In our article, we link to the book Hormonal Physiology of Childbearing by Dr. Sarah Buckley, which talks about the physiologic understandings and the physiology of spontaneous labor. So that is something to keep in mind, and that’s one reason why some people prefer to wait for spontaneous labor. So Anna, if someone wants to wait for labor to begin on its own and they’re talking with their care provider about expectant management, what’s kind of the bottom line about that?

Anna Bertone:   I think the bottom line about that is it all needs to be very individualized. When someone goes past their estimated due date, they could talk to their care provider about the benefits and the risks of elective induction versus continuing to wait for labor and how those benefits and risks apply to them personally. Most research articles and guidelines say that because there are benefits and risks to both options, the pregnant person’s values, goals, and preferences should play a part in the decision-making process.

Anna Bertone:   It’s important for expectant families to be aware of the growing research evidence showing that there could be worse health outcomes for those who wait for labor after 41 weeks of pregnancy instead of being induced at 41 weeks, especially among first-time mothers and those with additional risk factors for stillbirth. But ultimately, after receiving accurate evidence-based information and having conversations with their care providers, pregnant people have the right to decide whether they prefer to induce labor or wait for spontaneous labor with appropriate fetal monitoring.

I want to also let people know about a couple more resources that are in this article at evidencebasedbirth.com/inducingduedates. We have a section all about how people and their care providers can talk about the risk of stillbirth with some sample scripts that healthcare providers can use when they’re talking about risks of stillbirth. We also have links to different guidelines from different organizations about induction at 41 weeks. Then we also have our section called The Bottom Line. So what would you say are some of the bottom lines, Anna, about elective induction at 41 weeks and zero to two days?

Anna Bertone:   I think the bottom line is that elective induction at 41 weeks and zero to two days could help to reduce stillbirths and poor health outcomes for babies without increasing harm, like the risk of Cesarean for mothers. We’re getting that from those two large randomized controlled trials published in 2019 that both found benefits to elective induction at 41 weeks instead of continuing to wait for labor until 42 weeks. One of those studies, as we mentioned, found less perinatal death with 41 week induction and the other found fewer poor health outcomes for babies like intensive care unit admission and low Apgar scores with 41 week induction. Neither of those trials found an increase in the risk of Cesarean during birth with 41 induction compared to continuing to wait for labor until 42 weeks. However, both of those trials took place in countries that follow the midwifery model of care and the overall Cesarean rates were very low. So I think it remains to be seen how that will translate into countries like the U.S. that have higher Cesarean rates. 

So I hope you all found this podcast helpful in looking at the recent research on induction at 41 weeks versus expectant management. Make sure you check out the blog article that goes along with this podcast episode for all of the resources, links, research references. We also have a free one-page handout you can download that summarizes the results of this research. Just go to evidencebasedbirth.com/inducingduedates to download that new article. Thank you so much, Anna, for joining us to help our listeners understand the evidence.

Anna Bertone:   Happy to do it, Rebecca. Thank you.

Today’s podcast was brought to you by the PDF library inside the Evidence Based Birth Professional Membership. The free articles that we provide to the public at evidencebasedbirth.com and this free podcast as well as other resources are supported by our Professional Membership program. Everyone who joins our professional membership gets access to a library with all our printer-friendly PDFs. Each signature article that we publish online has been turned into a professionally-designed, easy-to-print PDF so that our members can print and share evidence-based info with their clients, other parents, or other professionals. To learn how you can become a member today, visit ebbirth.com/membership.

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Death, Diarrhea and Late Night Sackings: The Inside Story of an Unfolding Staff Nightmare at UBA and Dangote

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Last November, thousands of Lagosians including hundreds of UBA Bank employees attended what was billed as the ‘party of the year’ at the Lekki Special Events Centre on Admiralty Way.

The UBA RedTV Rave had everyone from Wizkid to Olamide to Jidenna to Burna Boy thrilling the festive crowd as UBA chairman Tony Elumelu and CEO Kennedy Uzoka mingled with the artists and guests.

On the surface, this was the best of times, as a bank that was clearly in rude health celebrated a successful year with thousands of employees, friends and family. The bank had also recently concluded a recruitment exercise that would add nearly 4,000 new employees to its staff strength, so the year ahead looked to be a promising one for most employees present. 

Unknown to them, while senior executives danced with Wizkid in the VIP area, one of the most brutal staff layoffs in Nigerian banking history was just around the corner. They partied well into the night and then showed up for work the following week as usual. A week went by. Two weeks. Four weeks. Then right at the start of the new year – a shocker.

Closed at 5.30PM, Terminated at 10.30PM

Ifunanya (name has been changed) was asked to wait behind at work on Friday January 3. As a 12-year UBA veteran including a long stint in her role as a Branch Operations Manager at a branch in Ojodu, Lagos, this was not an unusual request to receive. She was even used to working weekends so that the ATMs could remain functional and she could troubleshoot other onsite customer-facing issues. This time however, was different. 

Along with other staff members at the branch, she was asked to wait for a board meeting. By 10.30PM, the assembled staff were informed that their services were no longer required. They were then told verbally to write out their resignation letters on the spot and leave voluntarily or be forced out. At this point, her security pass was taken, and along with the other affected staff, her profile was unceremoniously deactivated from the bank’s internal system. She was reminded to drop her work ID on the way out, and thus ended a 12-year association with the bank.

When a relative of hers reached out to tell the story, he was keen to make the point that she was not an agency employee, but a full UBA employee on a monthly salary of N153,000. He could not understand why the bank would treat her that way. I heard similar stories from two other sources who insisted that they were coerced into resigning after being told that their services were no longer required right at the start of the new year.

Shocking and callous as these stories may have sounded, one of the first things you are taught in any professional journalism program is to always balance the story. So I sought an alternate account of what transpired, with the goal of putting the picture together to tell a complete story. There were conflicting accounts of the events of January 3 flying around, with some accounts describing a recruitment and promotion exercise without mentioning any firings, while others reported a purported “restructuring” at UBA, which is a well-known euphemism for “mass sack.”

I managed to establish contact with a current senior employee at UBA who asked to remain anonymous because he is not authorised to speak about such matters. This was his account of what happened at UBA bank at the start of this year:

“Usually when anyone joins UBA with a Bachelor’s degree, they are put on a GT1 level (N80,000). After one year, they are promoted to GT2 (N100,000), then after another year ET1 (N140,000) which is where a lot of people get stuck on. If you are lucky, you get to ET2 (N165,000). So what UBA did was to meld those 4 levels into one (ET) so any one who was on GT1 and GT2 gets automatically promoted to ET2. Those that were on ET1 and ET2 got promoted to SET (Senior Executive Trainee). 

So it was a promotion of sorts, but honestly it was long overdue because compared to other banks, N80,000 for entry level staff is quite low. About the layoffs: I only know 4 people personally who got affected. The people affected were on manager grades and worked at the head office, they all reportedly got 6 months arrears.”

According to this source, he was not personally aware of the fate of any branch staff or what he termed ‘OND staff.’ He did however say that in his opinion, the bank handled the situation poorly and that Nigeria does need stronger labour laws to protect young graduates fresh out of school from exploitation for cheap labor at the hands of corporates like UBA. He also mentioned that he knows current UBA staff have not had a salary increase in ten years – a remarkable situation for workers in a country whose currency has declined 195 percent over the same period.

As it later emerged, more than 2,000 staff were affected by the shocking late-night cull at UBA. It also became increasingly clear that the firings had nothing to do with a harsh operating environment or decreased profitability. The bank which had brought together Nigeria’s most expensive music stars to perform at its end of year shindig was anything but struggling – it actually hired more people than if fired. What the sackings did though, was clear out a number of people in roles that the bank considered obsolete, particularly within branch operations.

It can definitely be argued that such restructuring is inevitable in the face of rapidly changing technology, which is hardly a terrible thing. What is also true however, is that the bank that paid huge sums of money to bring Burna Boy and Jidenna to an annual vanity event that adds nothing to its bottom line could also afford to retrain its redundant staff to fit into new roles –  instead of just sacking them and instantly bringing in thousands of readymade replacements.

Yet again, the actions of a Nigerian corporate made the point that Nigerian labour law, in addition to be being poorly enforced is also woefully inadequate and unfit for purpose. If after 12 years of useful service to a bank, Ifunanya could be dumped out onto the street without even a few hours of notice – and no regulatory action was forthcoming – then clearly, Nigerian employees working for Nigerian companies have a problem on their hands.

As much as the UBA situation made that point, nothing could have prepared me for what I was about to unearth about another Nigerian corporate behemoth.

Diarrhea in India, Death in Ibeju-Lekki: The Unbelievable Story of Dangote Refinery

While senior executives at UBA House were going over the finer points of their plan to log 2,000 employees out of their work systems and force them to resign on the spot, a different level of labour exploitation was entering its fourth year about 73KM east of the Marina. There, at the site of the Dangote Refinery at the Free Trade Zone in Ibeju-Lekki, Lagos, the refinery was taking delivery of the world’s largest crude oil refining tower.

While this was predictably being celebrated across local and foreign media as the start of a glorious new chapter in Nigeria’s industrial history, I was speaking to a whistleblower with close and detailed knowledge of the project. What he had to say about the refinery project, the Indian project managers, the company’s internal culture and its much-publicised trainee program left me absolutely floored. Naturally I reached out to Dangote Group for a comment, but at press time I have received no response or acknowledgment.

My source, whom I shall call “Mukhtar” worked in and around the refinery project between 2016 and 2018, and what I found most distressing amidst everything he said was the revelation that deaths due to onsite accidents are not just known to happen at the refinery site, but are effectively covered up by Dangote. This he said, is because the people who die are mostly site labourers who are hired through staffing agencies instead of directly. When they die, it becomes the staffing company’s problem and the Dangote brand distances itself from it – even though the site owner is legally responsible for all safety-related incidents onsite.

Something else that struck me was that he implied that – contrary to all its public posturing – the company actually has no intention of using Nigerian engineers to run the refinery anytime soon. The trainee program that sent dozens of Engineering graduates for a one-year training program in India? “Strictly PR,” he said.

Accidents
The first batch of Dangote Refinery trainees head off to India in March 2016

For full effect, I have decided to reproduce the full and unredacted transcript of our conversation instead of using quotes and reported speech. Here is the conversation below:

ME: When we started this conversation, you mentioned that Dangote Refinery is exempt from Nigerian labour laws. What were you referencing?

Mukhtar: Because the refinery is in the FTZ, it is not subject to certain laws like local content laws. As such, even mundane jobs are given to non-Nigerian companies. Even the refinery’s fence wall was handled by a Chinese company. This didn’t stop long stretches of the fence from collapsing sometime in 2017. The FTZ affects Labour laws too. The company is not really under any obligation to employ Nigerians. They do so mostly for PR. All key decision makers are Indians (say 98%).

ME: There have been several horror stories about Indian-run businesses in Nigeria. Was this one of them?

Mukhtar: Yes, the Indians are quite racist. Some even demand to be referred to as “master”. To be fair, when this is reported, the HR unit makes a show of cautioning them. But I dont think anyone has ever been dismissed for it or seriously punished. Most of workers who meet their death on site are labourers. So their names might be known to many staff. I’ll see what I can get. It happens. It’s kept under wraps but it happens.

ME: Now you mentioned onsite deaths earlier. I want to know all about this. Why haven’t we heard anything about this?

Mukhtar: The refinery site is not really the best place to work. Mortality rate on site is quite high. People falling from heights or getting crushed by heavy vehicles/machines is quite common. These numbers are not reported because most staff are contract staff (or outsourced) so the company gets to wash its hands off such cases. But safety on site is the ultimate responsibility of the owner of the project. The construction site has a board that is supposed to display the safety statistics but it is never displays the truth. According to that board, there has never been a fatality on site. But in reality, I think 2018 had about 5 fatalities between January and March. If I were to guess, I’d say there have been over 25 fatalities since construction started in 2016/17.

ME: Now you said earlier that the trainee program was a washout and a disappointment. Fill me in on that.

Mukhtar: I was one of the first batch of engineers sent to India for training in 2016. In my opinion, the whole scheme was either poorly thought out or the company was somehow compelled to do it, and did so for PR. Our salaries were being paid into our accounts in Nigeria, so we were using our debit cards to access our Nigerian accounts for expenses over there) Around July 2016 when the naira went from around 160 per dollar to nearly double that number, our spending power was effectively halved.

ME: I also remember that there was a forex shortage crisis in 2016 and Nigerian bank cards stopped working outside the country.

Mukhtar: So when the banks eventually stopped all cards from functioning abroad, we were stranded. The company resorted to selling us dollars or rupees at the black market rate.They deducted the money from our salaries. We had accommodation (two adults per room) and feeding (Indian food which many of us did not like). Some of had to buy intercontinental dishes regularly, because Indian food is really not nice if you’re not into many smelly spices. It was crazy. Meanwhile we were told categorically that we would have Nigerian food and Nigerian cooks. It was a blatant lie by the Indian HR director.

Also, no arrangement was made for our medical care. Those who fell ill had to treat themselves from their pockets. During the currency crisis, those who fell ill had to rely on the rest of us to put together our spare change to pay for their treatment. The company promised to refund medical expenses, but this shouldn’t have been the situation in the first place.

ME: Tell me about the training program. What was the course content and the experience like? Was it what you were expecting?

Mukhtar: The training itself was a mess too. We were supposed to be trained to operate the refinery (at the time, it was said that it will be completed by mid 2017), but we were sent to a design company. These (designing a refinery and operating it) are two very, very different things. The trainers did not want us there in the first place. It was not a part of their initial contract with Dangote. Plus, they didn’t know what to teach us because designers are not operators. They were confused, several times, they asked us what we wanted to learn. But we could not know what we wanted to learn cos we knew nothing about the entire business. In the end, they reluctantly settled for teaching us design (skills we were/are unlikely to use cos the refinery was already 90% designed). 

ME: If you say that the refinery was “already 90% designed,” and you were learning design in India, that sounds like your presence was superfluous. Was the company really serious about sending you to learn skills to run a refinery?

Mukhtar: Indians will run the refinery. It will take many many many years before that refinery will be populated by just Nigerians. It was strictly PR. Anyways, the training with that design company was suddenly terminated on December 31st. Apparently, Dangote had not paid them a dime for all the months were were being taught design. They didn’t want to send us back to Nigeria so they moved us to the Dangote office in India. The office housed the Indian engineers (around 150 – 200 in number) who were supervising the design work being done by the design company. Now, it is interesting that these guys were working and earning as expatriates within their own country.

But realising that the “training” was a blunder, the company sent back some engineers to train in an actual refinery. So what was supposed to be a 1 year training became 2 years.

ME: Since returning to Nigeria, is there anything else you have noticed about the project that worries or disturbs you?

Mukhtar: Yes. So we have only the refinery at the FTZ, but the company gets to import things meant for other branches of the company duty-free. As a matter of fact, with the Dangote jetty in place and a customs office right there, the company no longer needs to clear stuff at Apapa. Dangote empire effectively has its own customs and port, because we cannot assume that the custom officers stationed at Dangote’s jetty/FTZ are extremely meticulous in checking what comes in and goes out. Personally, I find this disturbing. No non-military entity should be able to import stuff that easily into any country. This is bigger than just skipping custom duty payment.

–Ends–

Between bank staff being fired at 10.30PM and refinery site labourers being killed by workplace accidents without accountability, the sheer grimness of the picture facing Nigerian workers comes into stark relief. It is afterall, an employer’s market, with several thousand qualified people jostling for every job opening, which creates the possibility and incentive to treat staff like battery animals.

Whether the Labour Ministry is willing or able to do anything about such blatant labour exploitation is anybody’s guess. Nigeria’s government is increasingly weak and unable to impose its will on the country even territorially. In the event that the government did take interest, there is a valid fear that it would go to the other extreme and adopt a lazy anti-business Hugo Chavez approach, as it so often does. The real solution if there is to be one, must come from Nigerian labour having a stronger bargaining position through an improved economy. Anything else as it stands, is little more than a sticking plaster.

As Mukhtar mentioned, even inside the ridiculous situation of being financially stranded in a foreign country at the behest of an irresponsible and insincere Nigerian corporate, the vast majority of the group chose to suffer in silence. They did so because spending a year abroad learning useless information, suffering deprivation and experiencing diarrhea after being forced to eat unfamiliar food was still preferable to whatever alternative was at home.

Ultimately, that is the biggest problem facing Nigerian labour. 

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Comedian Bovi narrates his son’s scary birth story as he turns 10

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Ace comedian, Bovi Ugboma has taken to social media to recount on the birth of his son and its extremely hilarious.

The proud father of two who is celebrating his son’s tenth birthday took to the micro blogging platform to tell a never heard tale to his fans, about his son.

Sharing a photo of the celebrant rocking a blue sports attire holding a “Messi” customized football, Bovi wrote;

“Chukwu Onye ebere the hands are together” the nurse screamed in panic as she stared down the vagina. Ten years ago, my sons first day on earth seemed destined to be his last. At a private hospital in Ogba, the nurses operated in panic mode rather than urgency. The doctor on duty, I would later find out, was in his office but refused to come out. He asked the nurses to handle the delivery. @krisasimonye was screaming in pains. The umbilical cord was around the babies neck.

She wanted to push so bad. But the nurses realized that one of the pieces of equipment they were meant to use wasn’t in the tray. A nurse dashed out to go get it. @krisasimonye screamed in anguish “why are you doing this to me”. They had insisted earlier that it was false labor. She was sure it wasn’t. One of them decided to check again and behold it was time. And they weren’t ready. They actually told her to hold on when all she wanted to do was push. Eventually David was born. Swollen all over. Eyes round and shut like a corpse. Still. Lifeless. Numb. Ugly.

They raised him up, turned him upside down and started to slap his butt. Time paused. Silence. Sound. Cry. Breath. Life. He had arrived. I was hurt that the first thing my first fruit had to do was fight to come to life. But I took solace in the fact that he won his first of many battles. Fast forward to hours later and the doctor comes to our room to felicitate with us. He met a blank cold stare from us. And I cannot forget his stupid unprofessional words “I’m so sorry. I got info that one of my good friends died. I just couldn’t gather myself to come. I was just dazed in my office”. The words of a trained doctor. Anyway, here we are today, ten years later. Happy birthday to my son, David Abovi Ugboma jr.’

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Interest rates: Powell tells Congress federal debt is ‘unsustainable’

Powell: U.S. debt is ‘on unsustainable path,’ crimping ability to respond to recession

Federal Reserve Chairman Jerome Powell warned lawmakers Wednesday that the ballooning federal debt could hamper Congress’ ability to support the economy in a downturn, urging them to put the budget “on a sustainable path.”

Powell suggested such fiscal aid could be vital after the Fed has cut its benchmark interest rate three times this year, leaving the central bank less room to lower rates further in case of a recession.

“The federal budget is on an unsustainable path, with high and rising debt,” Powell told the Joint Economic Committee. “Over time, this outlook could restrain fiscal policymakers’ willingness or ability to support economic activity during a downturn.”

Powell also reiterated that the Fed is likely done cutting rates unless the economy heads south.

“The outlook is still a positive one,” he said. “There’s no reason this expansion can’t continue.”

The testimony marks a more aggressive tone for Powell, who generally has steered clear of lecturing lawmakers on the hazards of the federal deficit. But after raising its key rate nine times since late 2015, the Fed has lowered it three times this year to head off the risk of recession posed by President Donald Trump’s trade war with China and a sluggish global economy.

Those developments have hurt manufacturing and business investment while consumer spending remains on solid footing.

The Fed’s benchmark rate is now at a range of 1.5% to 1.75%, above the near-zero level that persisted for years after the Great Recession of 2007-09 but below the 2.25% to 2.5% range early this year.

“Nonetheless, the current low-interest-rate environment may limit the ability of monetary policy to support the economy,” Powell said.

Noting the Fed has lowered its federal funds rate an average 5 percentage points in prior downturns, Powell said, “We don’t have that kind of room.” He added, “Fed policy will also be important, though,” if the nation enters a recession. Fed officials have said they still have ammunition to fight a slump, including lowering rates and resuming bond purchases.

Meanwhile, the federal budget deficit hit $984 billion in fiscal 2019, the highest in seven years, and it’s expected to top $1 trillion in fiscal 2020. The federal tax cuts and spending increases spearheaded by Trump have added to the red ink and are set to add at least $2 trillion to the federal debt over a decade. The national debt recently surpassed $23 trillion.

“The debt is growing faster than the economy and that is unsustainable,” Powell said.

He added that a high and rising federal debt also can “restrain private investment and, thereby, reduce productivity and overall economic growth.” That’s because swollen debt can push interest rates higher.

“Putting the federal budget on a sustainable path would aid in the long-term vigor of the U.S. economy and help ensure that policymakers have the space to use fiscal policy to assist in stabilizing the economy if it weakens,” Powell said.

He added, “How you do that and when you do that is up to you.”

Many economists are forecasting a recession next year, though the risks have eased now that the U.S. and China appear close to a partial settlement of their trade fight and the odds of a Brexit that doesn’t include a trade agreement between Britain and Europe have fallen.

Powell also said the Fed is unlikely to reduce interest rates further unless the economy weakens significantly – a message he delivered after the central bank trimmed its key rate for a third time late last month.

“We see the current stance of monetary policy as likely to remain appropriate” as long as the economy, labor market and inflation remain consistent with the Fed’s outlook, Powell said.

Since last month’s Fed meeting, the government has reported that employers added 128,000 jobs in October – a surprisingly strong showing in light of a General Motors strike and the layoffs of temporary 2020 census workers.

“There’s a lot to like about today’s labor market,” Powell said. He noted the 3.6% unemployment rate, near a 50-year low, is drawing Americans on the sidelines back into the workforce. And while average yearly wage growth has picked up to 3%, it’s lower than anticipated in light of the low jobless rate. Inflation, he said, remains below the Fed’s 2% target.

“Of course, if developments emerge that cause a material reassessment of our outlook, we would respond accordingly,” Powell said.

Sen. Ted Cruz, R-Texas, tried to coax the Fed chief into weighing in on the potential economic impact of “a massive tax increase,” which some analysts say could be required by several Democratic presidential candidates’ proposals for universal health care or free college tuition.

“I’m particularly reluctant to be pulled into the 2020 election,” said Powell, a Republican and Trump appointee who has been repeatedly attacked by the president for not cutting interest rates more sharply.

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Female Victims Of Sex Trafficking Relieve Heart-rending Experiences Of Their Near-death Journey To Get Greener Pastures Overseas – Motherhood In-Style Magazine

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Every year, thousands of women and children become victims of sex trafficking in their own countries and abroad.

Nigeria is a source, transit, and destination country for women and children subjected to trafficking in persons including forced labor and forced prostitution.

Trafficked Nigerian women and children are recruited from rural areas within the country’s borders – women and girls for involuntary domestic servitude and sexual exploitation.

The quest to make it big in life coupled with the harsh living condition in the country forced these women to jump into the prospects of travelling abroad at any single opportunity not minding the consequences.

Many of these distraught and sometimes desperate Nigerians believe that the streets overseas are paved with gold, pounds and dollars that once you step into those countries it will be bye-bye to poverty and hardship.

Unfortunately, as it is said, not all that glitters is gold. To escape the hardship at home, many take great risks to travel abroad only to enter into a more harrowing experience.

Some die in the process while others escape with scars that may haunt them for the rest of their lives. While some were victims of circumstances, having been tricked and deceived into such journey, others take the risk of opting to travel abroad by land and sea routes knowing that they cannot afford the normal process of getting visas and honouring several embassy appointments. Some of the girls deceived into this route end up as sex slaves with so much regret and consequences.

reporter encountered two young women in Anambra, Amarachi Ojene, 23, and Tobechukwu Igboeri, who shared the chilling experiences of their near-death journey to get greener pastures overseas. Years after such ‘journey to hell’, their lives have never been the same again.

Amarachi, from Nibo, Awka South Local Government Area of Anambra State was an SS2 student in 2012 when she encountered a devil in human skin who not only took advantage of her naivety and innocence, but also exploited her poor parental background to trick her into a sex slavery trip abroad.

Having lost her dad when she was seven years, Amarachi relied on her mother who eked out a living by hawking cooked Okpa (a local delicacy) around the Awka metropolis. They also augmented the proceeds by engaging in manual labour in local farms for people at a fee.

So, she was so excited when she met her friends who told her that their aunt was looking for a house help that would live with her overseas. She reasoned that going abroad with the woman would ease a lot of load for her suffering mother as she would be paid in dollars, which she would send home to alleviate the family sufferings.

Hear Amarachi’s gory story:

“I vividly remember the day that two girls in my town, Chioma and Miracle, met me at the Eke Awka market, where I had gone to buy palm fruits for my mum’s Okpa business. They asked if I would like to travel abroad; they said their relation living in a foreign land was looking for a house-help to take along.

I was excited as I thought that a bright prospect for higher education and escape from poverty had come not knowing that I was walking into a death trap. They told me that the same relation was also taking them with her, so that they could be fixed into money-yielding ventures over there.

When I went home, I didn’t tell my mum immediately because I was afraid of her reaction, but when I eventually told her, she was also excited more so when she heard that the woman taking me abroad is from Awka. One week later, they came back and told me that we would leave in a few days.

They never told me the main thing we were going to do there and it was later that I realized that those girls were her agents who recruit unsuspecting ladies for her in the organized sex pimp business she does.

They took me to the woman called Aunty Ebube and I was surprised when I got there and saw many young girls there too. She asked me probing questions, wanting to know if I was aware of the business I had come to do and said no. We slept that night and the next morning she took us to a shrine at Umubelu Awka to take oath of allegiance and commitment.

The native doctor welcomed us saying that the expected guests had arrived. We were 19 girls in all and I was the youngest and the most immature among them, barely 16 years old then. Everything started happening in a jiffy as the man gave us white cloth to tie on our body.

The native doctor warned Ebube when we got there that I was going to spoil things for her, but I didn’t understand what was going on. I fainted there and they sprinkled water on me, but that didn’t deter them from administering the oath of secrecy.

Ebube said that we were going to pay her N450,000 each when we get to our destination and the native doctor warned us of the dire consequences of reneging in the deal as he told us that the deity of the shrine would strike any defaulter dead.

With a shaking body yet lacking the requisite courage to extricate myself from their grip, we got initiated there. We drank and chewed some substances there and were given a small calabash each. We danced round the shrine to complete the ritual.

The next day, we moved to Onitsha and boarded a luxury bus travelling to the North. She told us to tell any policeman we see on the road that we were going on holidays in the North to see our parents based there.  She told us never to accept that we were together in the journey and that if we implicate ourselves, she would not hesitate to disown us.”

Hijab for all of us

“When we reached the northern part of the country, she told us to change into hijab and pretend that we are northern Muslim girls. A vehicle, which she had pre-arranged, was already waiting for us by the time we arrived. We were squeezed into the vehicle.

She kept picking more people on the road, which showed that a syndicate was involved. We slept in Zendel and by 3:00a.m we left for another route until we got to a place they called Agadez. She told us to stay there for the meantime and find our destiny pending when those who will take us overseas arrive.”

‘Business’ begins

“When she told us that we should stay and test our destiny briefly, I never knew that it was a kick off for the prostitution business until I was handed over to some clients in a hotel. She forced us to wear skimpy dresses and singled me out having seen my demeanour.

She told me that I’m now in a no-man’s land and I should cooperate if I still wanted to remain alive. I was crying knowing that I had walked into a trap that would take divine intervention for me to wriggle out of it. I was deep in thought when she landed me a deafening slap.  She told me to be ready to die if I won’t allow men to sleep with me.

My first time was a man old enough to be my father. The man was given option to make a choice among the bevy of girls quartered there and he picked me knowing that I was a fresh virgin. I told him that it was over my dead body that he would sleep with me. I stubbornly refused to succumb to their threats.

Short time sex there goes for 5,000 CFAs while full time is 10,000 CFA. We kept on arguing and she told me that I should not join issues with her. I was made to know that our batch of girls was the fourth trip for her while the final destination is Libya.  Usually she would just sell the girls at Agadez and return to the Southeast to recruit more for the same purpose.”

How my Igbo dialect saved me

“On that fateful night, two men came to look for female companions. She spoke with them in the local language, which I did not understand. As I was about to be handed over to them, I exclaimed in Igbo language, ‘Ewooh, o kam si jee (Is this how I have ended up)?’  When the supposed sex customers heard my exclamation, they became more interested in taking me to their home at all costs that night. They offered Madam Ebube 15,000CFA and took me.

On our way, they started asking me probing questions and I opened up and told them my predicament and identity. They were shocked and also told me they were from Enugu State. Instead of taking advantage of me that night, they treated me like a sister.

One of the boys, Anayo, told me that perhaps God made them come to the brothel that night for my sake because they had already retired after the day’s business, but on a second thought decided to stroll to a happening joint.

The two boys kept me safe, took pity on me, refused to sleep with me and offered me a mattress where I slept in the sitting room and they retired to the bedroom. They took me back to the hotel the next morning and Madam asked me whether I enjoyed my night with those boys and I said yes.

I told her that I want to go home and she started another round of threats. She told me that I could go if I repay her N450, 000. She sold one girl there and told me that I would be the next; she also reminded us that the oath we took spelt out death or madness on anyone who attempted to leave the place secretly.”

At the crossroads

“At this point, my heart was pounding and I excused her and ran back in the direction to Anayo’s house, but he was not in. I wrote a notice on their gate telling him that if he doesn’t come to rescue me immediately, I would be either dead or sold off into slavery the next day.

As God would have it, I was apprehensive that night knowing that time was ticking away for me when suddenly Anayo showed up and told our madam that he needs me for another night again. Madam thought I treated him well and handed me to him, but he took me to the house of one of the villagers and hid me there.

I was hidden for three days and madam had to suspend her trip and kept searching for me. Anayo gave me a phone and was relating all that was happening to me until the fourth day that he took me to the park. If not that he hid me, I would have died in the desert en route Libya.

Of all the 19 girls, I was the only one who returned home. I have not set eyes again on Ifunanya, who she sold first. (Begins to sob). I don’t know their fate till today. Whether they eventually reached Libya, died of hunger or were devoured by wild beasts.

“Anayo and his brother bought a ticket for me, took me by 3:00 a.m from Zendel and landed in Kano.  I boarded a vehicle to Abuja, but I didn’t know anybody there.”

Ran into kidnapper’s vehicle

“In Abuja, I entered a cab that promised to take me to Kuje where some of our brothers resided, but I never knew I had boarded the wrong vehicle. The man took me on a wrong route and headed towards a thick bush. I raised the alarm, but nobody could answer me.

The man showed me his undies and I saw all manner of weapons, guns, knife and other things he had on him. He told me to say my last prayer because he would kill me and take my body parts. He used the short knife to slash my clothes to pieces and I was stark naked.

He raped me and wanted to take my body parts fresh and I ran and he gave me a hot chase. I saw a vehicle laden with tomatoes and lay flat for the vehicle to crush me. The driver stopped abruptly, picked me naked like that and I passed out. When I regained consciousness, I saw myself in the military barracks, Abuja.”

She never knew I was still alive

Under the custody of the military, Amarachi was taken to the scene where she boarded the evil man’s cab, but the man could not be traced. The army later handed her to NAPTIP who documented her case and made efforts to rehabilitate her and also seek ways of punishing her trafficker.  She was later sent home in Anambra where she reunited with her family. She later saw her trafficker and got her arrested.

“The day I saw her at Eke Awka, she was shocked because she thought I was dead. Because we reported to DSS and NAPTIP when I came home, they gave me a number to call them any day I sight her and that was what I did. When I called the phone line, she was picked up. They raided her home, detained her and the native doctor (he is dead now) and were also charged to court.”

Picking up the pieces of her life

Settling down to a normal life after the harrowing experience for Amarachi has not been easy. Though she managed to go back to school and finally wrote her senior school certificate exams, Amarachi’s problems are far from being over. Her mother suddenly collapsed and died from high blood pressure leaving her and the siblings as orphans.

She also fell in love with a man who is not financially buoyant. The uncle who now acts as her father insisted that all the traditional rites of marriage would be completed before she is pronounced married. Along the line, she got pregnant for the fiancé and had to give birth in her home. Now nursing a 10-month-old baby boy, life has remained tough and harsh for her.

“My uncle refused to allow the man take me home because he couldn’t fulfill the long list of requirements presented to him. My mother died heartbroken for all these shocks and now without both parents, we find it even difficult to feed,” she lamented.

Appeal and words of advice

“I still thank God I’m alive today.  My advice is that people should not allow anybody deceiving them with fairy tale promises about travelling abroad.  I need urgent help presently. Helpless without mum or dad and also nursing a baby, I desire to go back to school and upgrade my life, but now even to feed is a serious problem. Government and public-spirited individuals should help me,” she pleaded.

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Smart Shift to Cloud Based HR Systems

Advance includes turn your entire organization under one platform, and you can quickly handle every element. Hr specialists require to keep a check on overall organizations structure and have to pay correct attention to every staff member requirement. This software application lower pressure on you more than 80% of companies might see a reduction in mistakes with the exemption of double information entry.
may be space and cost savings due to the lessened use of paper, paper clips,
ink, and associated supplies. Empowering employees to collaborate on tasks
from remote locations and communicate with one another immediately can be
advantageous for several types of companies. HR software can promote such
connections while likewise assisting in tracking time spent so that staff members are
being compensated appropriately according to labor laws.

HR software application consists of different kind of modules such as:

These designs are designed to reduce the concern of HR professionals. Moving to an HR based software can alleviate your every stress and make your organization thrive. A company based upon advance technology even appeals to the workers, and they like to operate in an environment which if of less fatigue and optimum unwind setup.

  1. Human Being Resources Information Systems (HRIS)
  2. Human Resources Management Systems (HRMS)
  3. Human Capital Management (HCM)
  4. Applicant Tracking Systems (ATS)
  5. Payroll Software

By making use of HR software application, your company efficiency will get doubled, and you can handle whatever on your hand. A wave of openness in the total company gets prominent. Moving to HR software application is an intelligent decision. Turn your organization’s setup and see how within a couple of months your entire organization gets several and you feel on the top from your competitors.

Hr professionals need to keep a check on general companies structure and have to pay correct attention to every worker requirement. Moving to an HR based software application can alleviate your every tension and make your company flourish. By utilizing HR software, your company efficiency will get doubled, and you can manage everything on your hand. A wave of openness in the general company gets popular. Shifting to HR software is a smart decision.

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