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Childbirth: Grim statistics of a journey of no return

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BY SOLA OGUNDIPE
SENTENCED to death by pregnancy” has been a common cliché in Nigeria for decades. Nigeria has had a very poor record regarding maternal and child health outcomes. An estimated 53,000 women and 250,000 newborn die annually mostly as a result of preventable causes.

Every 10 minutes, a Nigerian woman dies as a result of complications of pregnancy or childbirth. Countless others are disabled in birth related accidents every year. The statistics are scary, the numbers of deaths numbing. For every woman that dies, 15 – 20 other women suffer short or long-term disabilities including obstetric fistulae, ruptured uterus and paralysis and complications.

It is an undisputed truth that too many women in the country are dying before, during or after childbirth. High maternal mortality and morbidity rates in Nigeria have remained a worrisome pattern.

High Risk: Statistics from the World Health Organisation (WHO) and UNICEF, reveal that 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.

Although the risks of maternal death are greater for women, in the northern region, the rural areas, and low income women without formal education, essentially, from east to west, north to south, the story that women are dying while giving life is sad. High maternal mortality in Nigeria is one problem that has simply refused to go away.

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.

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.”

Expectedly, preventable maternal death and disability are increasingly recognised as pressing human rights issues, encompassing questions of resource allocation and political commitment, for which governments must be held accountable.

While government has repeatedly identified maternal mortality and morbidity as a pressing problem and developed laws and policies in response, the big question is just how much have these actions  translated into a significant improvement in maternal health throughout the country?

Midwives Services Scheme

Nigeria has always had a very poor record regarding maternal and child health outcomes, hence it must have been a big relief when the Midwives Service Scheme (MSS), was established by the National Primary Health Care Development Agency (NPHCDA), under the 2009 Appropriation Act. The MSS is a public sector initiative and a collaborative effort between the three tiers of government in Nigeria.

Mothers and their babies: Many women die trying to attain motherhood

A memorandum of understanding between the Federal, State and Local governments sets out clearly defined shared roles and responsibilities, which are supported by the strategic partners of the MSS.

Mobilising midwives

This MoU has been signed by all 36 states of Nigeria and is designed to mobilise midwives, including newly qualified, unemployed and retired midwives, for deployment to selected primary health care facilities in rural communities. The aim is to facilitate an increase in the coverage of Skilled Birth Attendance (SBA) to reduce maternal, newborn and child mortality.

However, even this may not be enough, as experts point to a major challenge of ensuring that skilled personnel are present at all deliveries with access to emergency care where necessary is the most effective means of saving the lives of mothers.

A consultant gynaecologist and Managing Director, Optimal Specialist Hospital, Surulere, Lagos, Dr. Ugochukwu Chukwuneye noted: “The MSS will definitely make some contributions down the line. It is a relatively new scheme but the improvement observed in our maternal mortality status, cannot just be attributed to MSS and to extension workers alone.

Many of the patients that die in pregnancy and childbirth, midwifery cannot help them. The only thing midwifery can do is that if they see such patient on time they can encourage a referral to where they can be helped but they cannot help them.”

Referral System

Chukwuneye, who challenged government to look beyond the widely acclaimed MSS as a means to curtaining the menace of maternal and infant deaths in the country, admits the scheme does provide skilled birth attendants and community health workers in villages and remote settings to help reduce maternal mortality in the country, but attributed its major limitations to the poor referral system in the country.

On addressing infant death at childbirth, he said it was up to the government at every level to provide adequate services in their facilities. “Government should provide enough operating teams or operating theatre or get into a kind of arrangement with good private hospitals who can be contacted and they can immediately take such a patient to that facility for the operation to save the life of mother and baby.”

“There is definitely a problem with the referral system in the country. The other problem is education. A lot of people don’t know for instance when they are already in trouble and that they should be asking to be moved to better facilities.

Some factors that 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.

MDG 5

But there indications in several circles that the pace of progress towards reaching the Millennium Development Goal, MDG, on maternal health, which calls for a 75 per cent reduction in the maternal mortality ratio between 1990 and 2015, has been too slow in Nigeria and throughout the developing world in general.

The MDG on maternal health has as target reduction of maternal mortality ratio by three quarter by 2015, but is Nigeria realistically approaching this target?

Are there things such as better health care particularly during pregnancy, delivery and in the post-partum period with  interventions that improve maternal health such as antenatal care, provider-initiated HIV testing and counseling, skilled attendance at birth, emergency obstetric care, post-partum care and family planning?

Expectations today are that the pace towards the MDGs must be accelerated if the intended 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 and 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.”

Read Dr. Ugochukwu Chukwuneye, an experienced Consultant obstetrician and gynaecologist on how to reduce death at child birth

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