By Rasak Musbau
Statistics from the World Health Organisation (WHO) and UNICEF reveal that a woman in Nigeria has a 1-in-18 risks of dying in child-birth or from pregnancy related causes during her lifetime, which is higher than the overall 1-in-22 risk for women throughout sub-Saharan Africa. Nigeria?s maternal mortality rate means that 144 women die each day and one woman every 10 minutes from conditions associated with child-birth.
Women who are dying consist mostly of mothers giving birth before the age of 15, women from poor family, women with the most serious form of genital cutting and those who lack capacity to exercise reproductive choice. Maternal mortality rates are higher in rural areas, where the rate is estimated to be around 828 per 100,000 live births. In urban Nigeria, the average is 351.
In Lagos state, for instance, out of every 40 pregnant women, one dies during gestation, child-birth or during six weeks after the end of pregnancy or delivery, according to a recent study commissioned by the Lagos State Ministry of Health. The study found the lifetime risk of maternal death in the state to be 0.025 or one in 40, which translates to a Maternal Mortality Ratio (MMR) of 555 per 100,000 live births.
The study, which was a collaborative effort with the United Nations Population Fund (UNFPA), World Health Organisations (WHO), United Nations Children?s Fund (UNICEF) and Ipas identified abortion, anaemia and hypertension as the most commonly mentioned causes of death during pregnancy; while anaemia, prolonged labour and obstructed labour were common causes during child birth; and HIV/AIDS, infection and malaria were the common causes during the six weeks after end of pregnancy/childbirth.
It is worrisome that many mothers still die from child-birth in this millennium when it is known that most of the deaths are avoidable, if preventive measures are taken and adequate care is available.
Nigeria spends relatively little on health. It currently spends 6.5% of the budget, well below the 15% threshold that Nigeria pledge to spend when it signed the African Union?s Abuja 2001 Declaration. The implication of this is that larger percentage of total health care costs are borne by individual house-holds. This mostly contributes to poor or delayed access to adequate obstetric care. It is, therefore, not surprising that maternal mortality rates are highest amongst the poorest.
Last year, on 18 October 2011 at a Conference of Speakers from African Parliaments, Nigeria pledged again to increase the budget allocation on health to 15% by 2015. 2001 to 2011, we have same people in government and same pledge and as usual citizens have no input into government budgeting and performance. But those who know have obligation to tell the government that what is budget for health and gender spending is a core issue in looking at maternal death holistically.
It is incontestable that early attendance of antenatal clinics has the benefit of proper monitoring of fetus development, detection of problems, complications and possibility of early referral. On the part of the people, ignorance is a major cause of maternal death. A lot of people still don?t know when they are already in trouble and when they should move quickly to health facilities or when they should be asking to be moved to better facilities away from the one that could not solve their problem.
There is also the case of those who out of religious belief dilly-dally in going for ante-natal care because they believe that men should not see or attend to them. This is prevalent in zones where women lack capacity to exercise reproductive choice the most.
Another cause is the contentious issue of family planning. Improvements in maternal health are often associated with declines in fertility because women are exposed less often to risks of child-bearing. Fewer births should also imply that more resources are available to provide adequate care to those who need it.
The antidote to this is proper education and enlightenment.? Governments at all levels, civil society, the media, religious bodies and women groups all have the responsibility of this enlightenment until inaccessible illiterate rural dwellers are mobilized to reduce maternal death.
The problem of women dying in child-birth in Nigeria may also be considered from absence of data for effective planning and lack of political will for strategic policy. Till now, the National Health Insurance Scheme that was established under Act 35 of 1999 caters for only 20 percent of the entire population. This represents about 30 million out of over 150 million Nigerians who are entitled to health care services under the scheme. It is unfortunate that a vital service like antenatal is not available in most of the health centres that subscribed to the scheme.
It is cheering that Lagos State? has conducted an Investment case on reducing health disparities. The state has the data and road map to reduce the maternal mortality by 33% and reduce the disparities in health between the rich and the poor by 2020. A case is now being made for a purposeful, multi-disciplinary and multi-sectorial approach for addressing the problem.
Lagos State is also taking a critical look at unpleasant conditions in most hospitals that encourage some women to seek assistance outside the services of skilled midwives and other health professionals. The unpleasant factors include overcrowding of health facilities and unfriendly or hostile attitude of health workers.
Sadly, most? private hospitals that most women rush to for succour don?t fair better either. Aside some notable ones, which are exclusively meant for the rich, most private hospitals in Nigeria, are mere commercial centres .
Governments at all levels need to step up action on maternal health care with particular attention given to antenatal care. In realization of the importance of primary health care as the bedrock of any health care system, local governments, in particular, should be empowered to build facilities to treat people at the grassroots. In line with federal government guidelines on health, the state governments should equally establish Primary Health Care Board to work hand in hand with local government councils to build uniformed primary health care facilities. It is imperative that all the local governments have health centres whose aim is to decongest the secondary and tertiary health centres to cater for the child and maternal Health care needs of the public.
One expects that Budget Appropriation Committee and Senate Committee on Health will use their wisdom to ensure that government allocate substantial portion to health and take gender budgeting into cognizance as well when appropriating. It is, however, very important that health workers change their attitude towards pregnant women if the latter are to be encouraged to embrace antenatal care. But then, it is not only the governments that need to improve its performances to enhance the practice of antenatal care among women, everyone in the society equally has a role to play. For instance, the clergy, who are responsible for solemnizing of couples and naming of new born, will do better in giving sermon on the importance of ANC attendance. The media can do better in editorial writing to constantly put the policy makers on line. Communication experts will, equally, do better in doubling effort until collectively we get to where we will all be proud of.
The security of the nation hinges on poverty reduction, but there can be no poverty reduction without improvements in health. In other word, sustainable development is impossible without a healthy population and health of our women is the most important if we are set to thread the path of progress.
?Musbau is of the Features Unit, Ministry of Information and Strategy, Alausa, Ikeja.
Posted by pmnews 4 hours, 5 minutes ago on October 17, 2012, 2:32 pm. Filed under Opinions. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.Source: http://pmnewsnigeria.com/2012/10/17/tackling-maternal-mortality/
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