Christopher Isiguzo
23 September 2008
Lagos — In her determined efforts to ensure that the increasing rate of maternal and child mortality is drastically reduced in Ebonyi State, the state's first lady is consulting people to actualise the dream. One such interface was recently held in the state as Christopher Isiguzo writes
Maternal mortality, also known as obstetrical death is the death of a woman during pregnancy or shortly after childbirth. According to the World Health Organisation (WHO), a maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
In 2000, the United Nations estimated global maternal mortality at 529,000, of which less than 1 per cent occurred in the developed world. However, most of these deaths have been medically preventable for decades, because treatments to avoid such deaths have been well known since the 1950s. The situation is also not different in Nigeria, as the rate of maternal and child mortality records, is unacceptably high. The scourge has indeed become a huge problem in many developing countries and unfortunately, Nigeria is not an exception. If maternal mortality is about 800-1100/100000 live births, like it is in Nigeria, a country that has a population of more than 140 million, it means about 54,000 deaths occur yearly. The figure shows that the country unfortunately prides itself as having about 10 per cent of all the maternal mortality cases per year the world over. One of the sad statistics is poor reproductive health care. Only about 60 per cent of women have access to pre-natal healthcare in Nigeria and even fewer have access to family planning.
Generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or their management, and an indirect maternal death that is a pregnancy-related death in a patient with a pre-existing or newly developed health problem. Other fatalities during but unrelated to a pregnancy are termed accidental, incidental or non-obstetrical maternal deaths.
It is against this backdrop that the First Lady of Ebonyi state and founder of the Mother and Child Care Initiative, (MCCI), Mrs. Josephine Elechi in collaboration with the United Nations Population Fund (UNFPA), recently organised a three-day stakeholders' workshop with the sole objective of fashioning out ways of tackling the scourge at least in the state.
The stakeholders' workshop which was held in August, at the main bowl of the Women Development Centre, Abakaliki, had over 700 participants representing the broad range of stakeholders with critical roles to play in achieving maternal mortality in the state. Some of the participants included the First Lady, the wife of the Deputy Governor, Mrs. Cathrine Ogbu, members of the State Executive Council and their spouses, members of the State House of Assembly, permanent secretaries, general managers, council chairmen and their wives, development centre coordinators and other top officials of the local governments, traditional rulers, women leaders, religious leaders, traditional birth attendants, NGOs, and other women groups.
The workshop with the theme: 'Reduction of Maternal Mortality, Vesico Vaginal Fistula, Breast and Cervical Cancer Detection' which attracted the UNFPA Country Representative, Dr. Sidiki Coulibaly, resource persons, Governor Martin Elechi, among others, witnessed several presentations including a documentary on maternal mortality, presentation on safe motherhood, findings from UNFPA 5th Country programme, thematic evaluation in maternal care, and MCCI interventions in safe motherhood, documentary on obstetric fistula, documentary on cancer-screening among others. There were also series of robust discussions of the topics during plenary and group work sessions, where stakeholder groups reviewed the presentations and made suggestions into a plan of action to facilitate the desired changes.
Addressing participants at the workshop, the initiator of the MCCI, Mrs. Elechi, declared that the nation's quest for safe motherhood, improved maternal care and Millennium Development Goals (MDGS), would be actualized, if government at all levels, prioritize issues of maternal health in its policy thrust and implementations.
According to the Ebonyi State first lady, in the light of the need to accelerate the development of the state, the workshop is anchored towards reduction of the unacceptable maternal mortality ratio, reduction of maternal morbidities like obstetric fistula, early detection of breast and cervical cancer/highlighting the issue of gender-based violence, and also effecting positive inputs.
Mrs. Elechi said that her office sponsored the maternal mortality monitoring bill; already passed into law by the House of Assembly, stressing that the bill, aims at making the death of any woman during pregnancy an investigative matter, with a view to ensuring that pregnant mothers receive a minimum standard of care and encourage early referral of patients. She said that the mother and child care initiative (MCCI), had been tackling issues, relating to the reduction of maternal death, cancer prevention and control.
On his part, the United Nations Fund for Population Activities, (UNFPA) Country Representative in Nigeria, Coulibaly, said that the workshop marks another milestone in the demonstrable commitment of the Ebonyi State government, in the enhancement of the overall well being of the people of the state, in general and the improvement of maternal health in particular.
The UNFPA country representative, expressed worry, over the maternal mortality ratio in Nigeria, describing it as unacceptably high, and bearing 10 per cent of the global burden of maternal mortality and 40 per cent of the global burden of obstetric fistula.
He said that the UNFPA is committed to zero tolerance to maternal mortality, and would therefore continue to provide support to government at all levels in the implementation of practical broad based multi-sectoral interventions, within the mandate Area.
In a communiqué issued at the end of the workshop, it was noted that maternal mortality is high in Nigeria and Ebonyi state in particular, and progress towards its reduction still remained slow. The workshop further noted that the major causes of the high maternal mortality rates in the state, apart from those noted internationally which include bacterial infection, variants of gestational hypertension including pre-eclampsia and HELLP syndrome, obstetrical hemorrhage, ectopic pregnancy, puerperal sepsis, amniotic fluid embolism, and complications of abortions and the lesser known causes which are renal failure, cardiac failure, and hyper emesis gravid arum, are, poor utilization of services due mainly to low level of literacy among women, socio-economic, religious, cultural beliefs and norms which restrict women from seeking health care; gender inequality, teenage pregnancy, poor perception of the risks of pregnancy by pregnant women and the families.
Others are the inadequate skilled attendance at birth and after birth, low availability of emergency obstetrics care services to take care of the main direct causes of maternal mortality, poor referral services, poverty leading to financial barriers to accessing quality care, poor attitude of health worker, distance of health facilities to where people live and work and poor road network and inadequate transportation to health care centers in times of emergencies.
Other challenges also identified are inadequate facilities for cancer screening in Ebonyi State, an unacceptable level of obstetrics fistula prevalence and the conspiracy of silence that shrouds issues of gender based violence at the state level.
Participants therefore resolved that in view of the many challenges facing the effective tackling of the scourge, all resources (technical, human and financial) should be mobilized to reverse the high maternal and morbidity rate in the state. "Therefore, all efforts to improve the infrastructure, address human resource issues; engender a conducive policy environment and collectively tackle cultural challenges should be supported and advanced".
It also recommended that the institutional capacity of the existing health facilities at the state level should be improved to provide quality maternal health services integrating cancer screening and obstetrics fistula management services appropriately. It added that the level of funding for health care delivery system be increased and that the leadership of council areas be encouraged to commit between 1-5 per cent of their resources to health issues especially maternal health.
Other recommendations included: that adequate funds be committed to the operations of the South East Regional Centre on Fistula, the traditional birth attendants be supported with an effective transportation system to facilitate prompt referral of maternal cases to the appropriate level of care.
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