Lagos — The statistics are quite revealing. Nigeria has the second highest number of maternal deaths in the world with 59,000 deaths a year. Grim as this figure may appear, experts contend that a majority of these deaths are preventable. Amid this zig-saw, there is an attempt to link these deaths to the fundamental human rights of women to life in a conscious effort to mend the broken promises. Godwin Haruna writes

Mrs. Carol Dike-Okorafor is both a mother and a practicing legal practitioner with her chambers located in Abuja and Enugu. Last week in Lagos, she recounted her ordeal that reduced her to a mother of just one child. Dike-Okorafor told a rapt audience at the launch of a new report entitled: Broken Promises: Human Rights, Accountability and Maternal Deaths in Nigeria, that she suffered complications during childbirth as a result of delays and lack of equipment to make her access caesarean section. In her case, she was lucky to be alive, thousands of others as revealed by maternal statistics in Nigeria are not so lucky.

The report was launched by Centre for Reproductive Rights (CRR) based in New York, United States and the Nigerian-based Women Advocates Research and Documentation Centre (WARDC). Presenting the report in Lagos last week, Ms Ximena Andion Ibanez, international advocacy director for CRR, said Nigeria is an oil-rich country that has failed to implement and enforce its own policies on maternal health. Mrs. Abiola Akiyode-Afolabi, executive director, WARDC was on hand to present the report alongside Ximena.

Ibanez disclosed that based on the findings of the report, in July this year, the United Nations Committee that monitors states' compliance with the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW), expressed great concern at the precarious situation of the health system and "at the very high maternal mortality rate, the second highest in the world and regrets that there has been no progress in reducing the maternal mortality rate since the consideration of the state party's combined fourth and fifth periodic report in 2004". The Committee, she added, urged Nigeria to "address, as a matter of priority, the high maternal mortality rate, including the allocation of adequate resources to increase women's access to affordable health services."

The report states that while there are multiple and complex causes of maternal mortality focus, is often placed on cultural, religious and medical factors, overlooking the socio-political and economic factors that contribute to this ongoing loss of women's lives. It focuses specifically on the government's role in the dire state of maternal health in the country in order to identify best practices for the future. It provides an analysis of some of the key factors that contribute to the high incidence of maternal death and their human rights and legal implications. Although the report highlights these issues in the context of maternal health, many of the problems discussed have repercussions for the health system in general.

She said the field research involved two fact-finding trips to Nigeria by CRR in collaboration with WARDC and continuous fact finding by WARDC. Over 60 people were interviewed, including federal, state, and local government officials, non-governmental organisations, health-care providers, traditional birth attendants, as well as pregnant women and women, who had been affected directly or indirectly by the poor state of maternal health care.

The facts contained in the report are grim enough. According to the report, although Nigeria makes up 2 per cent of the world's population, it accounts for 10 per cent of its maternal deaths; a woman in Nigeria has a 1-in-18 risk of dying in childbirth or from pregnancy-related causes during her lifetime, which is even higher than the overall 1-in-22 risk for women in sub-Saharan Africa. Conversely, a woman in Sweden has a 1-in-17,400 risk of dying in childbirth or from pregnancy-related causes during her lifetime, while a woman in sub-Saharan Africa as a 1-in-22 risk of dying from the same causes.

The report notes that the risks of maternal deaths are even greater for certain Nigerian women, such as those in the northern region of the country, rural women and low income women without formal education. The MMR in the northern part is consistently over 1,000 per 100,000 live births, compared to the MMR in the southern part, which is frequently below 300 per 100,000 live births. For every maternal death, 20 other women suffer serious and often permanent pregnancy-related health complications and injuries.

According to Ibanez, the key findings of the report show that; although the Nigerian government has repeatedly identified maternal mortality and morbidity as a pressing problem and developed laws and policies in response, these actions have not translated into a significant improvement in maternal health throughout the country; One key structural problem in this area is related to the separation of responsibility for health care in Nigeria's three-tier federal system (federal, state and local), which has increased bureaucratization and diminished accountability. The absence of a constitutional or other legal prescription of health-care responsibilities has resulted in a dysfunctional healthcare system in which all three tiers of government have failed to prioritise their healthcare duties, and have faced no political or legal repercussions for doing so. The problem is particularly visible at the primary healthcare level, which constitutes the first point of contact with the healthcare system and has particularly deleterious effects for women seeking maternal care.

The report also shows the lack of political will evident in the lack of health policies implementation. A striking evidence of the lack of policy implementation is found in the Reproductive Health Policy of 2001. Its stated goal for 2001-2006 "to reduce maternal morbidity and mortality due to pregnancy and childbirth by 50 per cent", is far from being attained.

Akiyode-Afolabi said one of the main financial barriers is the user fees. According to her out of pocket payment for health care services are high, ranging from 70 per cent to 85 per cent in many cases. Usually, women have to pay other costs apart from the formal fees, such as out of pocket list of supplies (antiseptics, plaster) and in some hospitals there is a compulsory spousal blood donation and many women do not seek healthcare services as a result.

The report also highlights how lack of how lack of access to family planning methods and contraceptives and the shocking number of deaths due to high numbers of unsafe abortion, contribute to maternal deaths in the country. Nigeria has one of the lowest rates of contraceptive prevalence in the world, between 8 per cent and 12 per cent. The high incidence of unsafe abortions is one of the major causes of maternal deaths in Nigeria.

According to the duo, the vast scale of maternal death in Nigeria and the lack of necessary government commitment to effectively address the problem have more than just public health implications, they also constitute serious violations of human rights that are protected under national, regional and international law. Fundamental human rights that the government of Nigeria is obligated to guarantee include the rights to life and health, the right to non-discrimination, the right to dignity and the right to information. The dismal state of maternal health in the country also implicates key issues involving good governance, accountability and transparency in resource allocation, among several other findings by the report.

It's recommendations: "WARDC and CRR urge the Nigerian government to back its stated commitment to reducing maternal deaths with the necessary actions, including strengthening Nigeria's human rights framework, establishing effective accountability mechanisms to ensure that when appropriate, public officials are subject to investigation and liability for corruption; improving access to information within the healthcare system; improving access to family planning services including a full range of contraceptive methods, removing financial barriers that result in the denial of or delays in receiving necessary healthcare services; developing a comprehensive strategy to address infrastructural problems, including equipment and supply shortages; and reducing incidents of unsafe abortion; which is one of the primary causes of maternal mortality for women.

In a review of the report, which he titled: "Mending the Broken Promises", Mr. Lanre Arogundade, coordinator, International Press Centre (IPC0, Lagos, noted that both in terms of her natural endowments and human resources, it is an inverse relationship that persists in the realm of maternal health. Arogundade said with 2 per cent of the world's population and ranking as the world's sixth largest oil producer, Nigeria accounts for 10 per cent of global maternal deaths.

"2015 is only 7 seven years away and it should be clear that if the present trend continues the task of attaining the MDGs' goal of vastly improved maternal health would seem near impossible," he said.

To avoid the monumental set back that this will constitute, the report concludes with 25 major and 31 sub recommendations on the way forward direct at the government, the public communities, international and regional human rights bodies and civil society organisations.

Mr. Adekunle Ojo, former chairman, Ikeja branch of the Nigerian Bar Association, represented the NBA President, Mr. Rotimi Akeredolu as chair of the launch ceremony. He said the new NBA Exco has convictions that the country should be better run and the rights of every Nigerian would be protected.