allAfrica.com: Nigeria: Maternal Mortality - Saving Rural Women (Page 1 of 3)

Recent United Nations data shows that Nigeria has the second highest maternal mortality rate in the world. The country's 59,000 maternal deaths annually rank second to India's 117,000. Locally, available statistics also show that the North West zone of the country has the second highest rate in Nigeria after the North-East. Understandably, Kano State accounts for much of this prevalence in the zone. Interestingly, the state represents a model on how to reduce maternal deaths which not only other states, but the federation should emulate. Roland Ogbonnaya writes with additional report by Taiwo Olawale

Hajiya Hassana Rabiu is a mother of five children; the youngest being three months old. The family leaves in one of the rural areas in Rano Local Government area of Kano State. Until her last baby, she was delivered of the first four children by a local birth attendant in the community. She told THISDAY that not many of the women that used the services of the local birth attendant at the time survived.

Hassana was able to deliver her four babies with the help of local birth attendant and alive to tell her story because of "providence." She said that she never bothered to go to a hospital, which any way was not close to their community, because they could afford the cost of antenatal and delivery in any public or private hospital.

Fortunately, she had to attend the antenatal and delivery of her last baby at the Murtala Mohammed Specialist Hospital, Kano because it was free. Sounding very excited, she told THISDAY that during the antenatal and delivery of her baby, her husband did not spend a kobo as fees. No wonder the hospital and other similar ones in the state are besieged daily, stretching their facilities even as several lives that would have been wasted are saved.

Ironically, while the Kano State Government recognised that offering pregnant women free medical services will reduce the rate of maternal death in the state and Nigeria as whole, scores of other women continue to die in other states of the country because of their inability to access medical services because they can not pay for it as a result of poverty and ignorance.

Recent United Nations figures show that Nigeria has the second highest maternal mortality rate in the world. The country's 59,000 maternal deaths rank second to India's 117,000. Available statistics show that the North West zone of the country has the second highest rate in Nigeria. Understandably, Kano State accounts for much of this prevalence in the North West. What are the reasons for this prevalence and what is being done to stem the tide?

The maternal mortality rate (MMR) in Nigeria surely calls for urgent action. Though recent United Nations figures place Nigeria second to India on the MMR table; a closer look at the statistics shows that Nigeria has the worst figures in the world. In the first place, if the figures are placed in the context of the general population, Nigeria is definitely worse off. Nigeria's population of 140 million people is only about 10 per cent of India's nearly one billion people. So, 117,000 deaths out of one billion are surely lower than 59,000 out of 140 million.

Secondly, India actually improved between 2000 and 2005. In 2000, India's maternal deaths were 136,000. It was this figure that dropped to 117,000 in 2005. On the other hand, Nigeria's 37,000 deaths in 2000 rose to 59,000 in 2005! So, placed within the right context, Nigeria's MMR is perhaps the most dangerously high in the world.

Providing an overview of the epidemic in Northern Nigeria at a roundtable organised for women politicians by the Development Research and Project Centre (DPRC) in Kano last year, Dr. Hadiza Galadanchi, consultant gynaecologist, AKTH, told an overwhelmed audience that the North West has the second highest ratio in Nigeria. According to her, the zone has an average death rate of 1025 per 100,000 live births. She noted that the "estimates of maternal deaths are under reported by as much as 50 per cent because most maternal deaths are more often than not counted at all."

And, Kano accounts for a significant part of the dire figures from the North West. It has the highest MMR of about 1,700/100,000 births according to latest statistics (SEEDS, NDHS 2003). In fact, some statistics claim Kano has an average ratio which is as high as 2420/100,000 live births, according to European Journal of O&G and Reproductive Biology, 2003.

With such a high ratio, it is obvious that the government and people of Kano have a big problem on their hands. Scholars and stakeholders in the state give several reasons for the high MMR in the state. The causes are divided broadly into direct and indirect causes. At the same time, they can be seen in the context of medical and health management, socio-economic and cultural factors.

According Galandachi, the direct medical causes of MM are haemorrhage (23 per cent), infection (17 per cent), malaria (11 per cent), anemia (11 per cent), obstructed labour (11 per cent), toxemia/eclampsia (11 per cent) and unsafe abortion (11 per cent). She said only five per cent of deaths are caused by other factors. She further categorised the factors into delays which she said are, most often than not, responsible for these complications, giving three levels of delays which aide the MMR.

She said the first delay "accounts for 30 to 40 per cent of MM" and identified aspects of the first delay as lack of information and inadequate knowledge about signs of complications of pregnancy and danger signals during labour; cultural practices that restrict women from seeking health care; accessibility and quality of care.

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