Against the backdrop of increased maternal deaths in Nigeria and, indeed, Africa, recent research findings have identified basic interventions necessary to improve maternal health and reduce the number of women who die from pregnancy-related complications.

These interventions include proper ante-natal care, adequate emergency obstetric care, trained attendants at child births and more family planning programmes. If these are adopted and implemented judiciously, maternal deaths, especially among disadvantaged populations, can be drastically reduced.

At a recently concluded international conference on family planning held in Kampala, Uganda, organized and sponsored by the Bill and Melinda Gates Foundation for Population and Reproductive Health, the Johns Hopkins Bloomberg School of Public Health, and Makerere University, family planning was, however, identified as the best documented practice for reduction of maternal deaths, prevention of unintended pregnancies and unsafe abortions, as well as the reduction of the rate of transmission of HIV.

Speaking at the opening ceremony of the conference, Mrs. Janet Museveni, wife of the President of Uganda, who gave the keynote address, attributed high maternal deaths to inadequate healthcare facilities, saying the situation in Africa was a major cause of concern.

She lamented that in sub-Saharan Africa, a woman's risk of dying from treatable or preventable complications of pregnancy and child birth was high compared to her counterparts in developed countries.

She agreed that one of the most effective, low-cost technologies for prevention of maternal mortality is family planning.

This is not the first time that family planning is being canvassed as a major factor for checking maternal deaths. At the 1987 Safe Motherhood International Conference in Nairobi, Kenya, the Conference on Population and Development (ICPD) in Cairo, Egypt, in 1994 and the Women's Summit in 1995 in Beijing, China, issues of reproductive health, family planning as well as gender were brought to the attention of governments. The consensus at these meetings was that individuals have the right to determine freely the number and timing of their children. But 15 years after, despite increase in the use of contraceptives, the need for family planning services is still not being met, leading to high maternal deaths.

Nigeria has one of the highest maternal mortality ratios in the world and the highest in Africa. The World Health Organization (WHO) estimate for Nigeria, for instance, is 1,100 per 100,000 live births. This is because proper pre-natal care is still a dream in Nigeria. More than 40 per cent of women giving birth do not receive pre-natal care from trained health care providers, while more than 60 per cent of maternal deaths take place in the period following delivery, with more than half occurring within a day of childbirth.

This is disturbing as pregnancy is identified as the major cause of deaths among women and girls of childbearing age. While pregnancy is a thing of joy in other countries of the world, it has become a death sentence for many women in Nigeria. This is unacceptable. Very sadly, the causes of these deaths are treatable and preventable, but still occur in spite of existing, cost-effective technologies that have been developed to protect women. Equally worrisome is the culture of silence that fuels the unfortunate situation, and if something drastic is not done, the mortality rate is expected to rise. This has far- reaching consequences for the economy.

The Nigerian government has adopted several policies aimed at reducing maternal mortality by 75 per cent by 2015, but these policies are not effectively being implemented, largely because of the very low level of government spending on health care. Another issue of critical concern is that programmes on safe motherhood are being initiated by non-governmental organizations, while governments watch from the sidelines instead of collaborating to achieve a higher level of success.

Maternal mortality rates are major indicators of the state of the health systems of nations. Poor ratios reflect inadequate health care infrastructure, improper planning and lack of sustainable programmes. Governments must become more committed to upgrading the healthcare delivery system, providing adequate resources, training providers, and supplying up-to-date equipment.

We also urge health authorities in the country to popularise the African Union's "no woman should die while giving life," campaign, while NGOs and civil rights groups should double their efforts in the area of public enlightenment to create awareness, especially in rural communities and urban slums where there is lack of basic knowledge of family planning.

Education of the girl child is equally a key empowerment tool that would help the girl child and eventually all women to take informed decisions about themselves and their families. Governments must eradicate illiteracy through universal formal education and provide free ante-natal care services as well as deploy trained skilled birth attendants. If these are done, many Nigerian women who, otherwise, would have died while trying to give life can live and enjoy good health like their counterparts in other countries.