Ms. Ratidzai Ndhlovu is the United Nations Population Fund (UNFPA) Country Representative to Nigeria. She oversees the Country Programme support to the Government of Nigeria in its aim to improve the lives of the citizens. Ndhlovu has a Bachelor of Science degree with Honours in Psychology and a Master of Science in Educational Psychology from the University of Zimbabwe, Harare. In this interview with EMEKA ANUFORO in Abuja, she speaks on the health sector in Nigeria, stressing why all stakeholders should work to ensure that no woman dies giving birth in the country, among other issues. Excerpts:

WHAT progress can you say development partners have made in reducing maternal mortality in Nigeria?
A lot of work has been done and for that reason I always want to be very optimistic. The fact that we have made some progress, we should really acknowledge that and congratulate the government of Nigeria for having done what it has done so far.

Even though we have been reducing the maternal mortality slowly, we could be reducing it faster. One reason that I think should be taken into consideration for faster reduction of maternal mortality should be taking into account the role that family planning plays in reducing maternal mortality. This is because research has shown that if you have a very good family planning programme, you will reduce maternal mortality by 30 per cent.

If we consider where we are now and if we are to reduce it by 30 per cent, we would have done a great deal. We consider family planning as a low hanging fruit. The result comes within a year, two or three. I think we need to take that into account. If you factor in the role of family planning in reducing maternal mortality, you will see that we are dealing with avoiding risky pregnancies and risky births. There are some pregnancies that you could easily say whether they will lead to risk delivery. We can avoid them. I want to acknowledge what the government has done so far.

If family planning could reduce maternal mortality by 30 per cent, are we acting too late?
I think the challenge we are having on the part of family planning is a lot of issues. One is the distribution and accessibility of the service. We have more than 20 per cent unmet needs. This means we have so many women who will like to use it but cannot get it. If we can target that group of people and be able to make the services available to them, we would have done a lot.

The question is if we are really getting the services to those who really need it. One challenge we have is distribution. Are we taking the family commodities and contraceptives to those who need them? Government commits a lot of money into the procurement of contraceptives, but the issue if we are doing what we should to ensure that what we procure gets to the users in the remotest parts of the country.

We buy all these and then they expire. It does not make sense. We need to balance procurement, storage and distribution and then service the persons who are supposed to get it. If we leave any one of them, we will fall into trouble. We need to focus on the whole supply chain management and then also focus on education of the men, women to appreciate the value of planning family. Getting a family size that you can manage, a size that you can take to school, children that you can feed and feed well and those that you can educate to whatever level is important.

If you have a family you can provide quality health care for and a family you can cloth very well, it means there will be good quality of life in your family. In this case, maternal mortality will definitely reduce. This is because the level of education of a girl child affects the extent to which they are going to use these services we are talking about. They value why it is important to have a manageable family and they value why you need to go and deliver in a good health institution. We need to emphasis on education. If we put a lot of efforts in the areas I am talking about, we will certainly see a gigantic change in the indicators of the country by the next Demographic Health Survey (DHS),

Nigeria is not the only country that is contending with the issue of teenage pregnancy, but it appears it is in Nigeria that it has become a huge problem?
Do not forget that the size of Nigeria is so large. When you take 36 per cent in Nigeria and compare with 36 per cent from another country, in terms of numbers for Nigeria, these are millions of people. That alone gives Nigeria an edge against any other country. We are many and that means that we have to put strategies to address the magnitude and complexity of this country.

Talking of teenage pregnancy in Nigeria, I find that it is closely related to child marriage, especially in the North. This is so in the sense that they are teenagers but they are married. They are not being mischievous. They went through a process with the family and they got married. They are part of a family process. They did not run away from home to get married to a young boy like it usually happens in other cases. Once they are married, they are expected to have children.

To address this problem of teenage pregnancy, which so closely related to child marriage, which is accepted or endorsed by the community, religious leaders, community leaders, the custodians of our culture, it will take a long time. We cannot do it the way we do it in other countries where teenagers are too promiscuous. We need to have a sustained partnership of dialogue where we talk and work with religious leaders. Give them evidence and enter into generational dialogue with young people. That will help but it will take long.

How can we address the issue of teenage pregnancy by giving them access to antenatal care?
Fortunately the statistics for antenatal services are good in this country. Women do go for antenatal care. You can never predict what will happen during delivery. The main thing is that we should not have pregnancy before the girl-child is mature. No matter how many times she goes for antenatal services, the moment she comes to deliver, and because the size of her pelvic region is not strong, biologically it is not ready for such a vigorous process of delivery. It will be difficult.

Education is paramount. We need give our children, especially the girl child appropriate education.

You were recently accredited, what will be your agenda for the UNFPA going forward?
Having come to Nigeria and now being accredited, by the time I leave this country there should be something to talk about that has changed. You know we have a lot of players and we are working as partners in maternal health and neonatal health programmes, but it depends on what you contributed as an organization.

For instance, if the next DHS comes in the next four years and we see great improvement, I want to rejoice and say yes, UNFPA contributed in this and this way to make that happen.

My vision is to contribute to the national indicators of Nigeria. We are in Nigeria and so many donors are putting money into Nigeria, but no drastic change considering there is so much money that is coming in. It is that change that I am fighting to see. UNFPA cannot do alone.

We need to partner with others to make sure that our colleagues complement whatever contribution we do and we complement what they do so that together we can improve the national indicators come next four years.