Chukwudi Obi
13 September 2007
Lagos — CHUKWUDI OBI, with Agency reports, explores the vast terrain of maternal mortality as well as the way forward.
Hadiza, 25, has lost hope of ever being a mother. Her childhood fantasy of raising children of her own is now a pipe-dream.
The unfortunate situation results from the negligence and ignorance of a Traditional Birth Attendant (TBA).
At 15, Hadiza, from the northern part of the country, was given out in marriage some years ago to a man old enough to be her father.
The husband had other wives and many children before the marriage.
Immediately she joined her husband, the young woman got pregnant, but the birth attendant killed her joy when it was time to deliver her of the baby.
In trying to cut the placenta, the womb was chopped off. The baby also died.
The truth is that the young lady can no longer be a mother. Her dream died in that unfortunate incident.
Dr Esther Obinya, Programme Specialist on maternal and child health, narrated the heart-breaking story recently in Calabar to senior journalists at a dialogue organised by UNICEF and the Nigerian Guild of Editors.
She says it took the intervention of medical experts to save the life of the young woman.
"The consolation in the entire ugly incident is that the woman is still in the husband's house because the man is a gentleman.
"So many Nigerian men under that situation would have thrown her out of the house for no fault of hers," Obinya says.
For Hadiza, that was her first childbirth and unfortunately her last. She is one of thousands of pregnant women who face such ordeal because of poverty, ignorance and lack of good medical facilities.
The 2006 census put the country's population at 140 million, with women of child bearing age totalling 30 million.
However, 145 women die in the process of child delivery daily, putting the number of women who die annually due to pregnancy-related cases at more than 52,900.
From all indications, Hadiza should be considered lucky to be alive today to tell her story.
The experience could have claimed her life if medical experts had not been called to intervene.
A survey by UNICEF shows that the major killer of pregnant women in Nigeria is haemorrhage which claims 23 per cent of the victims while infection rate is put at 17 per cent. Anaemia, malaria, obstructed labour, unsafe abortion and eclampsia each contributes 11 per cent of the deaths, while other causes account for five per cent.
A disturbing trend, according to the survey, is that about 58 per cent of pregnant women in Nigeria deliver at home in the hands of quacks and only 37 per cent have access to health facilities.
In those health facilities, 54 per cent have no midwives while 46 per cent have only one midwife.
The survey further shows that the majority of women in the country are poor and illiterate, and above all cannot take decisions on their own without the approval of their husbands or other male relations.
Obinya says the situation calls for a new approach, which has resulted in the adoption of the Integrated Maternal Newborn and Child Health strategy.
As part of the Millennium Development Goals (MDGs), world leaders in 2002 in New York pledged to reduce child mortality and improve maternal health by the year 2015.
Obinya, however, observes that Nigeria and many other countries are not doing enough to attain those targets.
She says the focus on health care should entail linkages from home to community, to health facility, health policies and programmes.
According to her, interventions in the fields of maternal, newborn and child health should be approached together and incorporated into programmes.
Also, there should be a radical way of mobilising resources, coordinating and putting into action effective interventions which will aid the attainment of MDG 4 (reduced child mortality and MDG 5 (improved maternal health).
Obinya says, "it is insanity to expect to do what we have always done in the same way we have always done it and expect to achieve dramatically improved results."
In a presentation, Mr Geoffrey Njoku, UNICEF's Communication Specialist (Media and External Relations), notes that the media have not been mother and child friendly.
According to him, the media pay more attention to political and economic issues, including entertainment, to the neglect of maternal health.
A UNICEF survey on media coverage of women and child-related stories for the period January-June 2007 shows that most of the newspapers paid scanty attention to maternal and child health.
To the chagrin of the participants, some newspapers gave less than five per cent of their editorial space to those issues.
Njoku, however, says that the survey covered only the print media, although the electronic media did not perform better in that regard.
He stresses the need for greater enlightenment on maternal and child health by the media.
The participants all agreed, but listed ownership structure (which determines
editorial policies), the lack of funds, inadequate knowledge of health issues and dominance of male practitioners as media managers as constraints.
They, however, called for greater media attention to safe motherhood issues, particularly by the electronic media because of their versatility in the use of different languages to reach the people.
The participants say high risk fertility behaviours such as underage marriage, birth interval, getting pregnant at 40 years and above and having too many children by one woman should be discouraged.
But the source of greatest worry to them is the absence of a law compelling state governments and local councils to devote a certain percentage of their revenue to health.
For Obinya, the situation at the council level is pathetic.
"Some of the council chairmen see you as a nuisance and will do everything to avoid you since they have nothing to show for all the money they receive from the federation account.
"At a particular council I had to lay an ambush for the chairman. When we started to work together on those issues we became friends and everybody was happy for it," she recalls.
Every Nigerian is a stakeholder on issues that border on health and the time to unite for save motherhood is now. It is a daunting challenge.
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