An expert’s perspective to a practical prevention of maternal mortality in Nigeria.
A maternal death is the death of a woman during pregnancy or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.
Death of a woman during and after delivery remain a very common even in Nigeria and other developing countries while it is very rare in developed countries like Britain and Sweden.
The statistics of maternal mortality in Nigeria is worrisome
A joint report by the WHO, UNICEF, World Bank and United Nations Population Fund estimates that Nigeria has approximately 58,000 maternal deaths, accounting for 19% worldwide. In Nigeria, at least 800 women die per every 100,000 live births. Northeastern Nigeria has the highest maternal mortality rate, compared to other regions, with 1,549 deaths per 100,000 live births.
While inaugurating a 34-member Task force in year 2017 to accelerate the reduction/prevention of maternal mortality in Nigeria, the Minister of Health, Prof Isaac Adewole said…
” Maternal mortality remains unacceptably high in Nigeria, ranking among the highest in the world and the rate of reducing these deaths have been slow as many of the contributory factors remain unaddressed.”
Below are the 8 practical steps of reducing/preventing Maternal deaths in Nigeria..
1. Universal formal education
For the girl child, this will increase the age of at which she will have her baby since she is likely to avoid pregnancy during the period of schooling. It will also increase her awareness and utilization of maternity services. With increased social and economic status which education might bring to her, she is more likely to have improved nutrition and afford medical care. The male child that is exposed to formal education is more likely to support his spouse later in life. More importantly is the ability to free oneself from some of the cultural or traditional practices that are incompatible with good health.
2. Provision of social services
Maternal health is intricately linked with availability of basic social amenities. Good roads, improved transportation system, and communication services will improve the utilization of obstetric services. The woman can easily reach health facilities at the time of need.
3. Development of maternal services
There has been a belated recognition that the public health approach that has been successful in lowering the infant mortality rate in developing countries (immunization, growth monitoring, nutritional supplementation etc) is inappropriate for tackling the high rates of maternal mortality. There is need to have well equipped health facilities where life-saving obstetric procedures like caesarean section for obstructed labour and removal retained placenta can be performed.
4. Manpower provision
Health facilities should be manned by adequate and well-trained practitioners. The staff should be equally well remunerated. There is also inequality in the distribution of health workers in Nigeria. The imbalance is such that the rural areas where their are needed most have little or none while the urban centres are relatively overloaded. There should be extra-packages or incentives for those that work in the rural areas, if we must reverse the trend.
5. Review of abortion is key in the prevention of maternal mortality in Nigeria
We have a choice to either confront the realities of our situation by reforming the laws so that patients may have access to safe abortion by trained personnel or deny the truth and keep quacks in business. Where the latter is chosen, we should be prepared to provide good quality services to treat the complications.
6. Family planning services
Family planning services which will encourage spacing of children and reduce high parity should be integrated into maternal and child health programmes. These services must be affordable and easily available.
7. Blood Transfusion Services
Major maternity centres should have facilities for safe blood transfusion. In some centres in Nigeria, it is mandatory for spouses to donate blood at the time their wives register for antenatal care. We must however guard against policies that might discourage the use of health facilities by those that need them most.
8. Strong political will
No matter how much is written, suggested or recommended to reduce maternal mortality in Nigeria and other developing countries, there must first be a strong political will. The will is the political commitment to re-allocate resources to implement the available strategies to that can reduce or prevent maternal mortality. The will must be present, the will must be at all tiers of government and the will must be sustained until we get the desired results otherwise the developing countries will continue to account for 90% of all maternal deaths in the world.
Contribution: Trends In Maternal Mortality