Recession not an excuse to neglect maternal mortality

CHRICED Intensifies Campaign Against Maternal Deaths

As Nigeria reels from the effects of a full scale economic recession, civil society activists are worried that key deliverables in the quest for good governance could suffer if citizens do not begin to make strident demands. The thinking is that even when the country was awash with excess cash at a time the price of oil was yet to dwindle, governance failed to rise up to the expectations of the people. In such critical areas as health, education and infrastructure, very little was on ground to show the quantum of monies that accrued to the country.

With the current crunch biting so hard therefore, the resolve among civic agencies is to galvanise citizens to make demands of those in control of the levers of state power and resources. Part of the push is to ensure those in control of state finances do not use the prevailing crunch as an excuse to dodge their responsibilities to the people. Achieving this task of holding government to account, for many activists, would only be possible if there are signature issues around which the people can be mobilised.

For the Resource Centre for Human Rights and Civic Education (CHRICED), a platform of active citizens, the poster issue of maternal health is being used to raise the banner in the clarion call for good governance. At intense four day series of events in Kano recently, the focus was on how best to propel citizen action towards demanding good governance, using the issue of maternal mortality. The event was graced with the presence of influential voices from the Kano Emirates Council. Magajin Rafin Kano and Haikimi Ramin Gado, Alhaji Shehu Mohammed, Haikimi (District Head) of Doguwa, Alhaji Aliyu Harazimi, and the Haikimi of Gwale, Alhaji Inuwa Abass, were all on hand to lend support to the cause of addressing the challenge of high maternal deaths in Kano.

The discussion also drew the presence of community women and men, traditional birth attendants, orthodox maternal healthcare providers, the media and government agencies in the health sector. There was however the realisation that in advocacy in the area must be based on the facts, not on conjectures. The first day of the event was thus devoted to the launch of the report of a study commissioned by CHRICED into the maternal health practices in Gwale and Kumbotso Local Government Areas.

The maternal health study aimed to provide research-based knowledge on the state of maternal healthcare in the area. The report threw up some facts about the question of maternal health; activists are moving quickly to use the knowledge from the research in the campaigns to tackle the challenge of maternal health. The research which was led by CHRICED Principal Consultant, Comrade Lanre Osaze Nosaze, found for instance that three key areas impact on maternal health. They are the level of education, employment, and age at first child birth. The survey found that 18 percent of female respondents had their first child when they were yet below 16 years of age. Similarly, the survey also reported that 55 percent of women had their first child between ages 16 and 20 years, while 21 percent of respondents had their first child between ages 21 and 25. On the number of children, the data showed that 60 percent of the women respondents had more than three children; 16 percent had five children and 2 percent more than ten. The findings are generally consistent in the patterns of their data with those of the 2013 Nigeria Demography and Health Survey (NDHS). It was observed that both surveys reveal the same patterns of gender inequality in three key areas that impact directly or indirectly on maternal health; education, employment, age at first childbirth.

The research therefore concluded that “the problem of maternal healthcare in the communities surveyed is not simply a technical one of providing the required resources in greater quantity and better quality. It involves the power relations between men and women, and requires concerted, consistent, and persistent effort to tackle gender inequality.” It was on the basis of these findings that the point was made about the need for a strategic impact evaluation of the maternal health system in Kano State to measure its results in terms of maternal health outcomes rather than in terms of the mere expenditure of resources. CHRICED has also called for a comprehensive re-strategising for the maternal healthcare goals of the state to establish a rational relationship between those goals, the methods to achieve them, and the resources to implement those methods.

“At the heart of any such future strategy needs to be a systematic, sustained, comprehensive and well-funded programme to eliminate gender imbalances in the distribution of social resources, especially education, literacy, employment, income, and wealth.”

The deliberation on the report was immediately followed by a consultative meeting on the justification for a legislation to combat maternal deaths. Professor AB Ahmed of the Faculty of Law, Bayero University, Kano in his presentation highlighted some of the key issues to be captured in the legislation. He said they include the medical and non-medical circumstances of women’s death that occur during or around the time of pregnancy, as well as gaps in maternal health services and systems that should be improved to prevent future deaths.

He said: “Most maternal deaths in Kano State are due to health complications, like obstetric complications, which could be as a result of; post-partum hemorrhage; infections, as well as prolonged or obstructed labour.” He observed that these complication can be largely prevented or treated through quality prenatal health care.

“By improving access to, and the quality of prenatal and post-natal care, the number of maternal deaths in Kano State will reduce significantly. This requires serious increase in the availability of basic health care to pregnant women in Kano State.”

Although Kano State has already made an executive pronouncement declaring free maternal healthcare for expectant mothers, activists stressed the need for legislative backing for maternal health interventions, such that the governance of the maternal health system would have the force of law. The conversation therefore gave vent to a robust mix of ideas from women groups, traditional institutions, health workers, and the media on how such a legislation should be, and the strategies to bring it about.

Consequently, in locating the nexus between a complex health topic such as maternal mortality, and civil society advocacy for good governance, Executive Director of CHRICED, Comrade Dr. Ibrahim M. Zikirullahi dispelled the notion that as a civic agency, it was venturing into an unknown terrain.

He said: “CHRICED mission is to deepen the accountability components of the Nigerian democratic experience, using maternal health as one of the issues around which citizens should demand action from government. Our organisation is a platform for active citizens who thrive on the conviction that democracy must work to deliver benefits to the ordinary people of this country.”

He was emphatic that the challenge of maternal mortality, which denies citizens the right to life, as enshrined in the nation’s constitution and other international legal instruments, must receive robust attention of both the government and the governed.

“Maternal deaths in the course of child birth show the severe limitations of our healthcare system, as well the failure of governance. The high rate of maternal mortality paints a very ironic scenario in which a mother that is on the verge of bringing another human to life, loses her own life in the process. The bigger tragedy however is that the Nigeria’s maternal health problem is largely fuelled by the grand scale corruption perpetrated by the political elite. A fraction of the amounts which leaves the system as a result of corruption, if well spent on the health system would have gone a long way in saving the lives of thousands of women who die daily while giving birth.”

This reality, he admonished should prick the conscience of any active, patriotic or well-meaning citizen, especially with the realisation that corruption denies citizens the right to health. In the case of maternal health, Comrade Ibrahim made it clear that corruption leaves behind terrible health facilities, manned by poorly equipped and remunerated health workers. He however commended the Kano State government for taking a bold step towards addressing the challenge by declaring free maternal health services in the state. But beyond that milestone, he said more needed to be done.

“It is also critical to make new gains with respect to addressing other realities, which are outside the usual challenges in the health sector. In this regard, religious and cultural practices, which serve as alibi for denying women access to maternal health must be critically examined and captured in the legislative framework. In Kano therefore, the trail blazing initiative of declaring free maternal services must be followed up with other equally important reforms in the overall process of governance,” he said.