June 10, 2009

Maternal death:Caging the terror of Nigerian women

By Sola Ogundipe & Chioma Obinna

It took the death of some soldiers during an encounter with  Niger Delta militants to provoke the military authorities into declaring an all out offensive to flush out and punish the killers. Why? Because a life in service of the nation is considered precious enough to be treasured. But everyday several Nigerian women go into the battle of giving birth to children and not many come out of it alive to tell the happy story. In fact, statistics from relevant sources have it that maternal mortality in Nigeria is not only alarmingly high but one of the highest in the world. It is even more disturbing because government in spite of its posturing in addressing the problem has only succeeded so far in paying lip service to it. Sola Ogundipe and Chioma Obinna report.

A COMMON cliche in Nigeria in recent times is that the quickest way for a woman to “find death” is simply to become pregnant.

“About every 10 minutes, a Nigerian woman dies as a result of complications of pregnancy or childbirth and hundreds of thousands  more are disabled in birth related accidents every year.”

This daunting statement was the gloomy verdict on the nation as the world marked the 2009 Safe Motherhood Day, May 26. By and large, this is the lamentable situation in Nigeria today.

It is indisputable that women in the country are dying before, during or after childbirth. The lamentation of unnecessary loss of lives has been on for so long it is beginning to sound like a broken record.

Somewhere,  it is either  lamentation of one woman dying of a pregnancy-related complication or illness, or a tale of woe of another woman surviving the onslaught of a pregnancy-related complication, only to be permanently condemned to a life of strife. The bottom line is that all over the land there is lamentation about the wastage of human life in the guise of maternal mortality.

From all indications, high maternal mortality and morbidity rates in Nigeria have remained a pattern and the rates have remained particularly worrisome.

How many women have access to quality drugs during pregnancy?

How many women have access to quality drugs during pregnancy?

According to the World Health Organisation (WHO) and UNICEF, a woman in Nigeria has a 1-in-18 risk of dying in childbirth or from pregnancy-related causes during her lifetime, which is higher than the overall 1-in-22 risk for women throughout sub-Saharan Africa.

The risks of maternal death are even greater for Nigerian women, in the northern region of the country, rural women, and low income women without formal education. Essentially, from Lagos to Maiduguri, from Calabar to Sokoto, the story is the same. High maternal mortality in Nigeria is one problem that has simply refused to go away.

The statistics are indeed frightening and the numerous numbers of death are numbing. It is on record that every year an estimated 59,000 Nigerian women die due to pregnancy-related complications, second only to India in the world ranking of countries with high maternal mortality deaths. There is no running away from the fact that Nigeria has an epidemic of maternal mortality.

This distressing and disturbing fact is extrapolated from findings which show that the country has one of the highest maternal mortality rates in the world contributing an approximate 10 per cent of the total world estimate of maternal deaths.

For every woman that dies, 15 – 20 other women suffer short or long-term disabilities including obstetric fistulae, ruptured uterus and paralysis and complications such as Vesico Vaginal Fistulae (VVF).

Maternal death, according to the  World Health Organisation is the “death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”

Pregnancy-related death is “death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death”.

The majority of these maternal deaths, are not just preventable, but outright unnecessary. A  report from Women Advocates Research andDocumentation Centre (WARDC) and the Center for Reproductive Rights (CRR) which focuses specifically on the Nigerian government’s responsibility for the dire state of maternal health in the country puts the issue in perspective.

Entitled “Broken Promise: Human Rights, Accountability & Maternal Deaths in Nigeria”, the report provides an analysis of some of the key factors that contribute to Nigeria’s high maternal mortality rate and their human rights and legal implications.

It looks at failures in government leadership, including issues involving health-care financing and corruption, and  discusses how the nation’s lack of contraceptive access and funding contributes to its high maternal death rate amongst others.

While the Nigerian government has repeatedly identified maternal mortality and morbidity as a pressing problem and developed laws and policies in response, the report notes that “these actions have not translated into a significant improvement in maternal health throughout the country.

A number of factors inhibit the provision and availability of maternal health care in the country, including: the inadequacy or lack of implementation of laws and policies, the prevalence of systemic corruption, weak infrastructure, ineffective health services, and the lack of access to skilled health-care providers worsened by separation of responsibilities for the provision of health care among the country’s three tiers of government.

But the absence of a constitutional or other legal prescription of health-care responsibilities is largely seen as the cause of a dysfunctional health-care system in which all three tiers of government have failed to prioritise their health-care duties, having  deleterious effects for women seeking maternal care. Issues around resource allocation for health care also abound.

According to the WARDC report, “most of these deaths can be prevented  Preventable maternal death and disability are increasingly recognized as pressing human rights issues, encompassing questions of resource allocation and political commitment, for which governments must be held accountable.”

The situation in Nigeria illustrates the importance of government accountability in effectively reducing maternal death, the report stressed.

But the pattern may be set to change, given the commitment of the Federal Health Ministry. Maternal survival was prominent on the primary agenda of the Nigerian delegation to the 62nd World Health Assembly held in Geneva Switzerland May 18-22, 2009.

The nation was engaged in series of round table discussions with the best experts in the business of saving women’s lives. According to the Health Minister, Prof Babatunde Osotimehin, “We took on the forum to make a differencefor our women. We described the things we are doing including the midwifery schemes, the anti-shock garment that includes blood transfusion services and the training and re-equipping of primary healthcare centers and the pulling of  more resources as well as increasing physical access.”

Also, to underscore the critical role played by healthcare professionals in the country in ensuring safe motherhood, Osotimehin has consistently advocated for an intensified skilled birth attendance at delivery point.

He stresses that in order to for the process to take place, the attendant must have necessary skills and an enabling environment at various levels of health care system including a supportive policy and regulatory framework, adequate supplies, equipment, infrastructure, efficient system communication and referral.

While blaming factors such as limited coverage of practices like efficient family planning/birth spacing services, poor Newborn Care/postnatal care, hemorrhage, eclampsia, obstructed labour, infection, unsafe abortion, malaria/anaemia etc., the Minister notes: “the high maternal, newborn and child health indices of the country are unacceptable”, he points to the Federal government’s move to embark on the Integrated Maternal, Newborn and Child Health (IMNCH) Strategy which is being rolled out to States of the Federation.

In the view of Dr. Suomi Sakai, UNICEF Representative in Nigeria: “We know how to reduce maternal mortality and illness; it can be done. Basic measures—such as preventing and treating malaria, providing mothers-to-be with adequate nutrition and ante-natal care, training birth attendants, and ensuring that health centers can offer emergency obstetrical care—save the lives of women and their children.”

With the theme “Skilled Birth Delivery, A must for Every Mother” a call for collective effort of all stakeholders to achieve the strategic plan that would facilitate the ultimate reduction of maternal and newborn morbidity and mortality appears firmly set in motion.

But while government at the top could be lauded for its efforts to reduce the rate of maternal mortality here, which is nonetheless still one of the highest in the world, the problem remains. The story of maternal mortality in Nigeria is still a paradox.

Everyone knows that Nigerians know how to reduce maternal mortality and illness; everyone knows it can be done through basic measures—such as preventing and treating malaria, providing mothers-to-be with adequate nutrition and ante-natal care, training birth attendants, and ensuring that health centers can offer emergency obstetrical care.

Nigeria can save the lives of its women and their babies, but it is saddening to note that enough is still not being done to stem the tide of death. More is yet to be done to improve the well being of women. In the face of a struggling healthcare system and services at all levels of government, much remains to be desired. If only Nigerian women could stop dying to give life.

Connecting maternal health with other MDGs
THE Millenuim  Development Goal on Maternal Health  has as target reduction of maternal mortality ratio by three quarter by 2015.
In the developing world, the risk of death from complications relating to pregnancy and childbirth over the course of a woman’s lifetime is one in 76, compared with one in 8,000 in the industrialised world.
Most maternal deaths are avoidable.

A key to avoiding them is better health care – particularly during pregnancy, delivery and in the post-partum period. Interventions that improve maternal health include: Antenatal care, provider-initiated HIV testing and counseling, skilled attendance at birth, emergency obstetric care, post-partum care and family planning in keeping with national policies. When offered across a continuum of care that integrates home, community, outreach and facility-based services, these interventions can have multiple benefits for mothers, children and the communities in which they live.

There have been some promising areas of improvement in maternal health interventions in recent years.

Coverage of antenatal care throughout the developing world has increased by 15 percentage points in the past decade, with 75 percent of expectant mothers now receiving some antenatal care. At the same time, many countries have boosted coverage of skilled delivery attendance.

Ensuring that skilled personnel are present at all deliveries and that these personnel have access to emergency care where necessary is the most effective means of saving the lives of mothers.

However the pace of progress towards reaching the Millennium Development Goal on maternal health, which calls for a 75 per cent reduction in the maternal mortality ration between 1990 and 2015, has been too slow throughout the developing world and must now be accelerated if the goal is to be reached.

To achieve the MDG target, maternal health must be addressed as part of a continuum of care that connects essential maternal, newborn and child health services.

Indeed, levels of maternal mortality often reflect the overall performance of a country’s national health system – particularly during delivery and in the postnatal period, when mothers and newborns are most vulnerable.

To fill this critical gap, services that benefit both mother and child need to be scaled up, as the health of the mother is closely linked to that of her newborn.

“Saving mothers’ lives is not only a moral imperative, but a sound investment that benefits their children, their families, their communities and their countries,” said Tessa Wardlaw, UNICEF’s Chief of Statistics and Monitoring.

“Indeed, there is a clear connection between maternal health and other Millennium Development Goals, such as eradicating extreme poverty, reducing child mortality, and combating HIV and AIDS and other diseases.”