About 24 days from now, thousands of medical practitioners, policy makers, development workers and advocates for improved health care delivery for women will converge on Kuala Lumpur, the capital city of Malaysia. Their mission would be the third edition of the Women Deliver Conference, a global conference put together by Women Deliver, an advocacy group comprising a coalition of organisations working towards generating “political commitment and resource investments to reduce maternal mortality and achieve universal access to reproductive health.”
The conference prides itself as a platform which brings together voices from around the world to call for action against maternal death. It builds on commitments, partnerships and networks mobilized during its conferences to achieve Millennium Development Goal 5, which is the reduction of the maternal mortality ratio by three quarters.
As usual, tens of Nigerians will be part of the conference. The Health Minister will travel with a retinue of colleagues from the Federal Ministry of Health and its parastatals. They will join the ministerial forum at the conference, reeling out loads of statistics on efforts being made to arrest the current rate of maternal mortality and morbidity in Nigeria. As representatives of government is showing the world that progress is being made, Nigerian charities represented at the conference would also be pontificating on efforts being made by each of them in their areas of coverage.
I do not begrudge any one of them. They sure have a right to show the world what they are contributing to the movement towards improving maternal health in Nigeria. What bothers me is that things are not seriously changing. In the three days of the jaw-jawing at that conference, for instance, about 426 Nigerian women may have died from childbirth or pregnancy related complications. And that is no exaggeration at all. Statistics from campaigners against maternal mortality insist that a woman dies every 10 minutes from childbirth and pregnancy. Official figures from the National Population Commission claim that there are 52,000 cases of maternal death in Nigeria annually. This would amount to about 142 mortalities daily. The report also hinted that for every dead woman, there are 20 cases of morbidities such as obstetric fistula, infections and disabilities. More recently, the Society of Gynaecology and Obstetrics of Nigeria was quoted as saying that an average of 45 women died from pregnancy complications every day between January and March this year. Any death resulting from pregnancy, childbirth or within 42 days after delivery would be considered as maternal mortality.
I do not think any of these figures is anywhere near correct. Nigeria currently has no standard way of recording or keeping records for anything. The records brandished at various levels are without doubt from those of women who presented themselves at hospitals. And those would be at hospitals where proper records are kept for that matter. I am also of the opinion that the hospitals where these records come from are mostly in the urban areas, in places where women realize the importance of prompt and adequate medical attention during pregnancy. My take is that far many more women die in the rural areas in Nigeria and that no one has any record showing the number of women who lose their lives through pregnancy and child birth.
The reasons for these are not farfetched. The first is that a lot of women in the rural areas do not go to hospitals. That may be because hospitals are not readily available or that families cannot afford them or that these families do not see the point. This speaks to the issue of lack of access and, sometimes, ignorance. I shall return to this shortly.
Another reason why we do not have records of maternal deaths is the tendency for people to very easily resign to fate when they lose lost ones. It is in the nature of the average Nigerian, especially those in the rural areas, to conclude that everything is the act of God and once they reach that conclusion, they close the chapter, raising no questions. Of course, every medical practitioner is happy with this situation. It makes him go away without accounting for the lost life or lives and denying the nation the opportunity to track that mortality and whatever the cause might be. In some way, that worsens the national condition, as it constantly becomes impossible to identify and address the most important demands for the survival of women. It makes planning impossible. That is if we want to plan anyway.
The situation in Nigeria is more depressing because the World Health Organisation and every partnership working in this area have identified that about 80 per cent of the total maternal death recorded in the world (Nigeria records the second most terrible occurrence in the world) are preventable and prevention only takes simple conscientious planning and multi-level collaboration in the case of Nigeria.
By far the most worrisome cause of these mortalities is lack of access to skilled medical care. There are too few primary health care facilities in the rural areas in Nigeria and when they are available, they are sometimes too far away for easy access, especially in emergencies. This brings up the problem of transportation. While the WHO recommends that a woman visits the hospital at least four times within the nine-month period of a pregnancy, hundreds of thousands of women in this country, do not visit a hospital until they fall into labour. Even then, some do not go to hospitals!
When some women then fall into labour or are faced with any of the possible complications of pregnancy like post partum haemorrhaging (bleeding), eclampsia, prolonged labour, obstructed birth, unsafe abortions and malaria infection, which are conditions that could have been discovered during ante-natal clinics, only timely, skilled medical intervention could guarantee any chance of survival. And when that is not available for whatever reason, the life of the woman and sometimes that of the unborn child would be at risk.
From the foregoing therefore, it is obvious that all attempts to address the unacceptable number of maternal deaths in the country must look at the improvement of access to medical health as well as providing skilled personnel in all these facilities
Dealing with the former cannot just be about building and equipping hospitals. It must involve dealing with the problem of ignorance, which is largely fuelled by traditional and culture practices that stop women from attending ante-natal clinics and planning their families. In addressing these issue, government must involve traditional, community and religious leaders, showing them the benefit of these simple medical practices to the survival of women and children. It actually would not be out of place to wield the big stick on any erring party after massive awareness campaigns must have been embarked on. I am aware, for instance, that in 2010, the Kwara State Government introduced a law, which was initiated in the state House of Assembly by Toyin Saraki’s The WellBeing Foundation. Among other things including making medical care free for pregnant women and children under-five all over the state, the law also provides punishments for men who refuse to allow their wives attend hospitals during pregnancy. I am aware that Ondo State is also making serious impact in this area. This is one law that I believe every state in Nigeria must enact, especially in the Northern part of the country where maternal mortality is most alarming.
On the issue of skilled medical personnel, it is important that government at all levels embark on the recruitment of well-trained personnel to man facilities. I recall the Midwives Service Scheme, a programme in which the three tiers of government collaborated to get retired midwives back into service to fill the personnel gap, introduced by the National Primary Health Care Development Agency a few years back but I am not certain that the laudable programme exists again. I hope it still does and would never understand why government would not continue with such programmes.
I am actually of the opinion that the National Health Council should consider a large scale response to the maternal and child mortality challenge as we did with HIV/AIDS. The response to the HIV/AIDS scourge, included the setting up of Action Committees at the Federal, State and Local Government levels, had the desired impact. These committees are made up of people from every possible sector of the Nigerian economy and this has contributed to the successes that have been recorded in stemming the rate of new infections, reducing stigmatization and arresting the loss of lives, which attends the progression of infection into the AIDS stage through the sensitization of Nigerians to early testing.
The rate of maternal, newborn and child mortality in Nigeria is currently at an emergency proportion. We are at a point at which every nation serious about development must move decisively. Even if Nigeria cannot meet the MDGs 4 and 5 in three years time, as is obvious we cannot, we must set new achievable targets for ourselves and work towards it with every seriousness. A nation which allows her women to die in the process of bringing forth lives only exists on borrowed time.
Adedokun, a Lagos-based PR consultant, wrote in via nadedokun@gmail.com.
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