To make childbearing safe and healthy
With an estimated 512 deaths per 100,000 live births, Nigeria’s maternal mortality rate is still among the highest in the world, and this should be worrisome to all health authorities in the country, particularly in this age of marked improvement in maternal health care delivery globally, and given the resources and potential of Nigeria. Sadly, the country’s record is nowhere near the SDGs target of 70 per 100,000 live births by 2030; and this is the crux of the concern expressed the other day by the Society of Gynaecology and Obstetrics of Nigeria (SOGON).
Warning that the target date is fast approaching, SOGON President, Dr Habi Sadauki had lamented that: “There is still a lack of access to and utilisation of family planning services in Nigeria, with only 22 per cent of women using any method of family planning, including modern methods. Gender-Based Violence is still dominant in Nigeria, with one in three women reporting one form of physical, sexual abuse, among others.”
A more recent Report, Trends in maternal mortality, shows that every two minutes, a woman dies during pregnancy or childbirth. This is unfortunate because the miracle of childbirth should not be marred by the tragedy of maternal deaths; and with modern development in the medical world, no woman should die giving birth to a child. According to the Report, which tracked maternal deaths nationally, regionally and globally from 2000 to 2020, an estimated 287 000 maternal deaths occurred worldwide in 2020.
The Report also stated that maternal deaths continue to be largely concentrated in the poorest parts of the world and in countries affected by conflict; and about 70 per cent of all maternal deaths were in sub-Saharan Africa, where Nigeria is located. Specifically, in nine countries facing severe humanitarian crises, maternal mortality rates were more than double the world average with 551 maternal deaths per 100 000 live births, compared to 223 globally. This suggests that so many women continue to die needlessly in pregnancy and childbirth; and at variance with SDG Target 3.1 which is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
So, what is responsible for this situation? Roughly a third of women do not have even four of a recommended eight antenatal checks or receive essential postnatal care, while some lack access to modern family planning methods. In addition, severe bleeding after birth also called postpartum haemorrhage is one of the most common causes of death and can kill a healthy woman within hours if she is unattended to.
Other leading causes of maternal deaths are high blood pressure, pregnancy-related infections, complications from unsafe abortion, underlying conditions such as HIV/AIDS and malaria that can be aggravated by pregnancy, early and child marriages, early pregnancies, high fertility rates and inadequate family planning services, the low rates of contraceptive usage leading to unwanted and unplanned pregnancies; some deliveries are attended to by unskilled birth attendants, lateness in taking a decision to go to a health facility, poor logistics to a health facility, and waiting time in a health facility.
In the words of UNICEF Executive Director, Catherine Russell, “No mother should have to fear for her life while bringing a baby into the world, especially when the knowledge and tools to treat common complications exist.”
All said, issues resulting in maternal deaths are all largely preventable and treatable with access to high-quality and respectful healthcare. Nigeria can save maternal lives, improve their health and well-being, and advance their reproductive rights through access to high quality care in pregnancy, and during and after childbirth.
There is therefore urgent need to double down on national commitment to women and adolescent health; through more investments in primary health care and stronger, more resilient health systems. It is the responsibility of duty bearers to ensure that every Nigerian mother survives childbirth. Nigeria should give priority to interventions targeted at reducing the high maternal mortality rate in the country; ensure basic improvements in reproductive health services, including family planning. Timely management and treatment can make the difference between life and death for the mother as well as for the newborn, because maternal health and newborn health are closely linked.
Government at all levels should be more responsive to maternal health care. It should allocate adequate resources, track and fight corruption to ensure that money budgeted for health is actually used for health – hospitals are equipped with state-of-the-art medical equipment; enough trained medical personnel employed (getting the right people into the public health sector); and medics trained and retrained to be abreast of global best practice in the field and render client-friendly services, especially in public health facilities.
Preventing unwanted pregnancies is also critical to avoiding maternal deaths. As such, women of child bearing age (WCBA) should have access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care. Exercising control over their reproductive health, particularly decisions about if and when to have children is critical to ensure that WCBA plan and space childbearing and protect their health.
Since information about sexual and reproductive health helps improve knowledge and understanding of maternal health issues, not discounting access to affordable contraceptive methods for men and women, and helps them in making informed decisions on the spacing and number of children desired; the relevant ministries, departments and agencies (Federal Ministries of Health, Women Affairs, and Information, plus the National Orientation Agency); and media organisations should embark on intensive media campaign and community mobilisation to educate women and men, on the importance of accessing maternal health care. Educating men is critical because arguably, most men undermine the severity of maternal mortality, thus do not give their wives the necessary support needed to attend ante-natal clinic.
Non-governmental organisations (NGOs) should also join hands in the provision of reproductive health information, because achieving individual behavioural change for the reduction of maternal mortality requires sensitisation on prevention and response to emergency obstetric services.