Lagos — Concerned stakeholders and experts drawn from all over Nigeria have stressed the need for community participation through self help and village development communities in reduction of maternal mortality.

Above call was made at a two-day training workshop on the reduction of maternal mortality in Akwa Ibom State in particular, and the whole of Nigeria in general, where more than a hundred stakeholders gathered to deliberate on the issue.

Participants at the intensive forum included medical doctors, representative of relevant state Ministries and department, Chief Executives of Non-Governmental Organisations, Traditional Birth Attendants (TBAs), traditional rulers, medical personnel in reproductive health service areas, media practitioners and other invited guests were present.

Facilitated by Mrs. Uduak Akpan, the Gender desk officer of the State Ministry of Gender Affairs, participants were led through a self introductory exercise aimed at enhancing interaction among them to reduce communication barriers and stimulate learning.

Speaking Ibibio dialect, Akpan sought to know from participants their knowledge of maternal mortality and their roles in line with the issue of maternal mortality.

The facilitator aligned the objectives of the workshop to the issues raised by participants to include to raise participants awareness to the high rate of maternal mortality in Nigeria; and to mobilise stakeholders to advocate for changes in value system so as to reduce maternal mortality.

The two-day workshop began with arrival of the representative of the Minister of Women Affairs and Social Development, Hajiya Saudatu Bungudu, Akwa Ibom State Commissioner of Gender Affairs, Mrs. Eunice Thomas, and a consultant, Mrs. Nsikan- George Emana. Saudatu, said the issue of maternal mortality has emerged as a development challenge in Nigeria, due to the high rate of maternal mortality and under-five deaths, with successive Governments joining the League of Nations to take maternal mortality to the international arena and calling for the improvement of health-care services.

She commended the Federal Ministry of Women Affairs and Social Development, as a national vehicle for promoting women's rights and concerns; where several initiatives have been conceptualised and implemented, and many others adopted as best practices to address maternal mortality and enhance the reproductive rights of women in Nigeria.

Some of them include the safe Motherhood Initiative, training and re-training of nurses and midwives in the service area of reproductive health-care and the National Programme on Immunisation (NPI), a notable effort by the government of Nigeria to rescuing children from killer diseases. The commissioner appealed to the State Governor, Chief Godswill Akpabio to pay more attention to women's issues and concerns especially as it had to do with their reproductive health. She further emphasised the need for women at individual level, to take advantage of available amenities, facilities and information provided by the government to improve their health status and minimise risks.

George-Emana, while acknowledging the maiden implementation of the programme on the reduction of maternal mortality in Akwa Ibom State, noted the impressive outcome of the workshop but decried that current health indicators did not reflect any significant progress in the effort to reducing maternal mortality in Akwa Ibom State.

Welcoming participants to a second round of maternal mortality training, she said maternal mortality is a development concern in Nigeria in 1992 due to the high rate of deaths in pregnant women and under-five children, maternal mortality has become part of the health discourse at local, regional and international spheres with ample declarations and pledges to reducing it.

These pledges, she said had however dovetailed into concrete actions leading to significant reduction and a near-zero death in developed countries but significant progress was not seen in Nigeria with the likelihood of the situation to worsen if immediate actions are not taken. According to her, statistics from the World Health Organisation, WHO and reports from medical experts revealed a grim picture of maternal and under-five deaths in Africa and its regions. Reports also estimate that about 870 deaths per 100,000 live births occur in Africa and Nigeria accounts for over 10% of the world's maternal deaths. The country, experts say, ranks second globally to India in the number of maternal deaths.

The consultant said women were primary guardians of the health, education, nutrition and social well-being of their children and in many cases the breadwinners of the family, which makes the impact of maternal mortality in affected families, traumatic. This, she said underpinned the importance of galvanising efforts at all levels, strengthening public institutions and perhaps re-aligning our policy statements and goals to realising Millennium Development Goals (MDGs) 4 and 5.

She urged participants to begin to see the need to re-examine the politics of priority- wealth or health so as to define a road map to improving health care services in Akwa Ibom state and build consensus around maternal mortality issues as a prominent national issue. George-Emana urged the government of Akwa Ibom State to entreat synergic relationships between relevant Ministries and line departments, recreate the political will to reduce maternal deaths to avoid losing the nation's cream of decent and law-abiding citizens of the State's origin.

At the end of the two-day advocacy training workshop, participants acquired skills in value clarification and re-orientation. Stakeholders were able to identify their role in the fight for the reduction of maternal mortality. Based on knowledge gained, participants were able to develop strategies to address challenges to the reduction of maternal death. They also demonstrated learning skills on the various interventions required at various levels to check incidence of maternal death.

A communiqué was issued at the end of workshop to map the way forward for reduction of maternal mortality in Akwa Ibom State, with six advocacy groups mandated to replicate the process in their various constituencies. Participants interest was galvanised and collective action engendered.

Many Traditional Birth Attendants (TBAs) drew lessons from the workshop with commitment to refrain from handling complicated ante-natal and delivery cases. All traditional rulers present at the workshop and other representing heads also sought improvement in government's and other stakeholders' interests in reducing maternal mortality to save the lives of women in the state.

Participants called on the State Government to evolve a method for the training and re-training of TBAs, as well as ensure they are supervised by trained midwives; with a call for the need to collate data of trained and untrained TBAs from the ward to local levels in the state.

Calling for the establishment of a monitoring mechanism to check the activities of TBAs at every tier of government in the state, participants expressed the need to establish legislation to regulate the activities of TBAs in the state; with a call that unethical work attitudes of health personnel in line with Servicom dimensions should be addressed. The need to review the private practice policy for doctors and to enhance the remuneration for them was stressed; village heads /traditional rulers were enjoined to ensure that movement of pregnant women should not be obstructed; with a call for provision of more hospitals, health centres, health post and maternity homes to bring health care closer to the people.

Government was urged to mandate village heads to discourage traditional beliefs, that enforce the incidence of maternal mortality within their domain; while the need to ensure communication network between TBAs and qualified health personnel in order to enhance their operation was emphasised.

Local Government Areas were called upon to provide ambulances and medical boats in riverine areas to convey critical and emergency cases; while government was also urged to provide free antenatal care for pregnant women and children less than five years of age in the State.