24 March 2008
Lagos — It is estimated that about 50,000 Nigerian women die annually due to maternal mortality. The deaths are even higher in the northern part of the country for its backwardness in healthcare and education. The rural areas where 70 per cent of the people reside are worse hit. Reuben Buhari writes on the grim situation and efforts to combat the menace
"It has even become a problem for a woman to be pregnant in Nigeria. What is supposed to be a source of joy has turned into a source of fear. With pregnancy comes the fear that you could be the next one that could be included in the country's statistics on maternal mortality," says Mrs. Martha Danfulani, a 32 year-old primary school teacher who is presently carrying a five-month old pregnancy. She ruefully made these observations when THISDAY spoke to her on the issue of maternal morality.
Maternal mortality in Nigeria has continued to be a lingering problem for Nigerians. The statistics are frightening: one woman dies every minute as a result of complication in pregnancy and childbirth. It is also on record that every year an estimated 50,000 Nigerian women die due to pregnancy-related complications, second only to India in the world ranking of countries with high maternal mortality deaths. This clearly point to the distressing fact that Nigeria has an epidemic of maternal mortality. With over 60 million women in the country, Nigeria has one of the highest maternal mortality in the world contributing an approximate 10 percent of the total world estimate of maternal deaths. An estimated 40 per cent of pregnant women in Nigeria, according to a report by a Consultative Forum which collaborated with some development partners a year ago, experienced pregnancy-related problems, and that for every woman that dies, 15 - 20 other women suffer short or long-term disabilities including obstetrics fistulae, rupture uterus and paralysis. Prominent among these complications are Vesico Virginal Fistulae (VVF).
The World Health Organisation's maternal mortality ratio in the country put it at 800 per 100,000 live births. However, the story becomes bleaker in the northern part of the country, legendary for its backwardness in key areas like health delivery and education. The northern region statistics is as high as 1,500 - 2,000 per 100,000 live births. In fact, a report by the Society of Obstetricians and Gynecologists of Nigeria (SOGON) put the deaths at 3,000 per 100,000 live births. This in essence means that the north contributes the bulk of women in the country that die before, during or after child birth due to pregnancy-related complications.
But even these deaths, according to Ruth, a nurse with one of the government health centers in Kubau local government in Kaduna State, is not a true reflection of the situation on ground. She confidently said that the figures are much higher in the rural areas. "There are so many unreported deaths that happen at both the hospital in Kubau and in surrounding homes. Some of the women prefer to give birth at home rather than come to the hospital. When they die, which happens often, they are quickly buried by their relatives according to Islamic rites. What happens in this local government is the same thing that is happening all around the north," she said.
Socio-cultural practices, religion, ignorance and poverty have been singled out as responsible for the high deaths in the north. A recent observation by a coalition of health-related Non Governmental Organisation (NGO) noted that "many socio-cultural practices in Nigeria as in other African countries are associated with women's low status. From childhood, the girl child is brought up to accept an inferior status in all aspects of existence, even in situations that threaten her life and wellbeing. The low status of women in the north is also a major contributor to their poor survival rates in pregnancy and childbirth and also that of their offspring.
"In most cases, decisions are made for them about childbearing, as to the numbers of children and timing, and access to health care and services. Women who mostly suffer from these deaths and disabilities from maternal mortality are usually young, illiterate, poor rural girls who have often times been given out in marriage at very young ages and become pregnant soon after. They lack the information and knowledge to make informed decision about child bearing and use of available services. As a result they have no benefit of antenatal care."
Another issue that is also notching up the number of deaths in Nigeria, especially in the north is a peculiar practice where some women go out of their way to ensure that they give birth to their children at home without the help of any medical personnel. It is assumed that a woman who gives birth at home is strong. Such women are most often seen proudly telling whoever cares to listen about the number of their children that were born at home. The need for other women to be labeled as strong consequently influenced them also to shun medical help and attempt birth at home, which in some cases have fatal results.
Poverty is also a factor that has shored up the rate of maternal mortality in the country. The over-flogged phrase that most government hospitals in the country have become mere consulting clinics isn't debatable anymore. This has led to the emergence of private hospitals across the country that come with high charges affordable only to some select few. Even these select few prefer to fly outside the country for their medical needs rather than subject themselves to these private hospitals. Like somebody said, only the poor who can't afford the high charges of the private hospital patronise the government hospitals whose doctors have been known to embark on industrial actions at the drop of a hat and abandon critically ill patients to their fate. Because of this problem, most women who can't afford the high hospital charges prefer to stay at home and explore traditional medical help, sometimes with fatal consequences.
The issue has become so worrisome in the north that the Sultan of Sokoto, Alhaji Sa'ad Abubakar recently cried out against the high rate when a Kano-based Islamic organisaton, Development Research and Project Centre (DRPC) paid him a courtesy call in his palace in Sokoto. He appealed to governors in the region to increase expenditure on maternal health with a view to curbing the trend and attributed the problem to poverty and ignorance in the region.
He specifically highlighted the issue of ignorance in the region when he said that "the high rate of maternal mortality is caused by illiteracy and lukewarm attitude of our people, who preferred their women to give birth at home because of lack of privacy in hospitals and pre-conceived notions about health workers. Men should allow their women to attend anti-natal care and be empowered with health information about basic signs of pregnancy complications because it is not against Islamic tenets," he said.
A coalition of health-related civil organisations during a sensitisation seminar held recently in Kaduna that includes the Society for Family Health (SFH), Pathfinders and some faith-based women groups from both Christian and Muslim religious organizations, came together to find effective ways of reaching out to other women, especially those in the rural areas on the increasing case of maternal mortality.
The Minister of Health, Dr. Adenike Grange, who was represented at the seminar by the Head of Maternal Health at the Federal Ministry of Health, Onuekwesi Nkiru, explained the reasons behind reaching out to faith based organizations thus: "The aim of this seminar is to sensitise women leaders in faith-based organisations to join the fight against maternal and child mortality issue that is really creeping into the Nigeria community. As it is now Nigeria is the second country with the highest maternal mortality in the world, meaning that women are dying. We are big in the world but we shouldn't be big in that sense," she said, adding that the women are expected to go back to their local community and teach the rural women in their local government to also carry the message of curbing infant and maternal mortality.
While making a comparison between the health condition of African and western women, Onuekwesi said, "A woman at the risk of dying as a result of pregnancy-related complications is actually 1 in 13 women in Nigeria. And then you compare it with a woman in the western world, it is 1 in 4000, and when you look at a country like Sweden, it is 1 in 29,000.
So you understand that our women have a higher risk of dying."
Another reason that contributes to the high maternal death, according to her, is that women in the rural village have more confidence in the traditional birth method which includes prayer houses and birth centers, explaining that the women would rather go their when it is time for them to give birth rather than a conventional health centers.
Kaduna State government with a ratio of one nurse to 125 patients as against the standard of 1:20 has started taking some bold step to curb both infant and maternal mortality with the introduction, four months back of free medical care to pregnant women and children less than five years. Governor Namadi Sambo has decided to spend N70m monthly on the provision of the free drugs. He disclosed this during the signing ceremony of the Programme Implementation Agreement (PIA) worth N400 million between the state government and the United Nations International Children Emergency Fund (UNICEF) at his Sir Kashim Ibrahim House office.
Also, the state government has concluded plans to build a 500-bed Hospital and rehabilitate 25 more existing ones. The governor disclosed this when he received in his office a delegation of the Pharmacists Council of Nigeria (PCN) on nationwide advocacy tour of the North-West Zone, where he added that his administration intend to rehabilitate, equip and upgrade all the 25 health facilities in the state, while the general hospitals in Zaria and Barau Dikko Specialist Hospital in Kaduna town would be expanded to provide improved services.
"Pharmacists have important roles to play for us to achieve the objectives of the new administration. But I assure that we will give you all the necessary support you require. We will provide you a piece of land in the new town to build your state secretariat", Sambo said.
Chairman, PCN, Professor Festus Ogunbona said his team has been to all the seven states in the North West zone in order to interact with the health facilities on ways to improve healthcare deliveries and advised the governor by saying: "There is need for improved clinical round by pharmacists, also we were told that there are 25 hospitals in Kaduna State and 51 pharmacists which is grossly inadequate we therefore call on the state government to employ more pharmacists in the state."
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