Despite global efforts to reduce maternal mortality by 75 percent by the year 2015, it is worrisome that the number of women dying during pregnancy remains high in Nigeria. At the last count by the Nigeria Demographic Health Survey, 545 women die out of every 100,000 live births.
According to the UN report of 2010, about 40 nations, developing countries, have made some appreciable progress along this line, but Nigeria falls within the eight countries that did not make significant progress.
If this current statistics are not reversed, Nigeria might not achieve the global objective that Millennium Development Goal (MDG) 5 was set up for, which was adopted by the federal government in 2007. The need to urgently address the unacceptably high rate of maternal mortality in Nigeria cannot be overemphasized.
To this end, stakeholders in the health sector converged recently in Benin City, Edo State to brainstorm on this important issue. The one-day national workshop with the theme, ‘Advocacy: Key to Improving Maternal and Child Health,’ organized by Women’s Health and Action Research Centre (WHARC), a non-governmental organization, examined the role of evidence-based advocacy on maternal and child health in Nigeria.
To Dr Wilson Imongan, a former commissioner for Health in Edo State, “no woman should die giving birth. No woman should die while doing what she has to do biologically.”
It is pertinent to ask: Why do they die? According to medical experts, causes of death during pregnancy include anaemia, malaria, obstructed labour, unsafe abortion, toxaemia, maternal infections, haemorrhage etc.
They are the same causes of death in Nigeria and elsewhere in the world. But what is responsible for the high rate of maternal death in Nigeria?
“The primary factor is access to health care delivery. If there is a skilled birth attendant during delivery, namely doctors, nurses and mid-wives, they will identify danger signals, if any, during delivery. In this country, the ratio of skilled attendants is barely 50 percent. That means that the women are left at the mercy of complications of pregnancy,” said Dr Imongan.
“There are also other social-economic factors that cause delay in accessing medical care. Many of them are poor, while others are unable to make necessary decision when in labour. Many of the health facilities are few and most times, far from the homes of expectant mothers. There could also be delay in accessing service, occasioned by inadequate manpower, problem of protocols and others.”
Convener of the workshop, Professor Friday Okonofua of the Ford Foundation spoke in the same voice. He identifies poverty as a major factor responsible for the high rate of maternal and infant mortality in Nigeria, just as he also fingered the high rate of women getting pregnant annually, with no provision for taking care of the new mothers and new children.
“Overstretched medical and health facilities, inadequate healthcare providers and a high percentage of health care facilities concentrated in the urban centres, while the rural communities rarely get enough,” are among of the causes Okonofua mentioned.
However, the Nigerian health sector faces an uphill task that makes the realization of MDG 4 and 5 by the year 2015 close to impossible, as successive governments at all levels have always paid lip service to matters affecting the sector over the years. Investigation revealed that one medical doctor attends to the healthcare needs of 10,000 child-bearing women in one of the states in the north.
Take the case of Borno State as an eye opener to the problems confronting the health sector. When asked if the health care delivery system in Nigeria is good enough to make the achievement of the MDG 4 and 5 achievable by 2015 in Nigeria, another resource person at the workshop, Dr Calvin Chama, associate professor, Obstetrics and Gynecology, University of Maiduguri, appeared to be skeptical.
“The system as it is designed is appropriate and good enough, if properly implemented. At various levels, right from the federal down to the local government, most times, governments at various levels fail to do what they are supposed to do,” he observed.
According to him, Borno State is an example of where government pays lip service to the health sector.
“The major problem in the Borno State is that of manpower. The government has built health facilities and equipped a number of them, but there are no trained personnel to make use of these facilities.
“For example, outside Maiduguri, there are only four medical doctors in the civil service. That means that the other general hospitals are dependent on the doctors from the youth corps and community health officers and nurse. Even the nurses, especially mid-wives are not adequate in number. Most of the general hospitals cannot boast of three midwives to cover 24-hour service, whereas you need at least four midwives in a hospital.”
Dr Chama however attributed the reason for the manpower shortage to the poor remuneration for health workers.
“The governor did say of recent that he has employed 50 doctors. To my knowledge, most of them have not resumed duty. I went round the state health facilities recently, I met only four on duty, and these were all old hands, they are not among the new ones employed; it’s a big challenge, we need health workers,” Dr Chama confessed.
The story is not much better in Lagos State either. According to Prof.
Adetokunbo Fabanwo, Consultant Obstetrician and Gynecology, Lagos University Teaching Hospital, Ikeja, Lagos State, observed:
“Lot is being done presumably by the government, but we are not seeing results, because health issues that are pertinent to the attainment of the millennium development goals have not been properly highlighted and dealt with.
“It is said that the level of economic development of a country is measured by the maternal mortality figure. Our figures are one of the highest in the whole world. We together with India contribute so much to maternal mortality all over the world, and we are not doing much about it.”
“It was also discovered that a lot of expectant mothers in Lagos, who should have given birth through caesarean section (CS), can not afford the cost even in public hospitals. We are now advocating that the free health policy in Lagos State should now be upgraded to include all types of deliveries, including CS. It is hoped that when that is done, maternal mortality will be drastically reduced,” he said.
Dr Imongan also expressed worry over the attainment of MDG 5 in Nigeria and the survival of the children of women who die giving birth.
“MDG 5 has to do with reducing maternal mortality by 75 percent by the year 2015, just four years away. As long as we have not been able to reduce maternal mortality by the target 75 percent, we might not be able to breast the tape properly.
“Children of women who died during delivery are also at risk of death. Experts say that for every woman that died during delivery, the chances of survival of the baby delivered within the first birthday is slim, because the woman is needed to give exclusive breast feeding to the child to make immune him against infectious diseases. MDG 5 is a reflection of the poor health indices of the country. If the children are dying at birth or early in life, which means that we are not reproducing the next generation. It reflects on our life expectancy.
It shows that our investment is inappropriate. You cannot talk of economic development when you have no health security. It is an indication of poor health service delivery; it shows that the health profile and programme of the government have failed,” he said.
Way out
To these medical experts, there is only one way out of the logjam: commitment to the health sector by the government.
“Government to decide that no woman should die while giving birth by investing in health care delivery, the National Health Bill should be signed into law. That will open up funding for both primary and secondary health care.
“In view of the chronic and acute shortage of health care personnel, all state governments should engage the services of qualified medical personnel to enhance manpower in the health sector. The private sector also has a role to play by way of investment. The hospitals that our people go to in India are all private hospitals.
“We should put value on human lives and reduce human wastages. If we address the issue of maternal mortality positively, we will sit up to address the issue of accident and other medical conditions. Family planning education also important, just as the national health insurance scheme is very pertinent to proper health care delivery system. It should be made universally available and affordable to all,” Dr Imongan recommended.
Prof. Okonofua also believes that advocacy will help to assist in getting the government and policy makers to appreciate the seriousness of the problem so that we can prioritise the reduction of maternal and infant mortality and the achievement of MDG 4 and 5 and the formation of more policies around these issues, and to make provision of the allocation of enough funding to address the problem.
Okonofua who emphasized the important role of the media in the attainment of the MDG goals by the year 2015, also wants the media to replicate their advocacy role in the electoral reform also in the health sector, just as he commended Mr Akin Jimoh of Development Communications Network for training members of NGOs on the issue of maternal and infant mortality and for also creating the necessary awareness for media practitioners on the need to proper reporting of health matters.
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