Last month the medical professionals at Malumfashi General Hospital, Katsina State, helped Gaje Zubairu bring the blessing of quadruplets into the world. The initial widespread jubilation at such wonderful news soon, however, gave way to sorrow. One of the babies passed away and was tragically followed four days later by Gaje herself.
This case has attracted such widespread attention not only because of its inherent tragedy but also because of the fundamental issues which led to the loss of the mother and baby. Doctors who attended to Gaje stated that she did not survive because she was malnourished and had not attended antenatal care (ANC). Gaje's husband reportedly explained that his wives have never attended ANC because the classes are given too far away. This is a story that is all too familiar in Nigeria, where limited access to – and knowledge of – ANC, limited health spending and a widespread failure to deal with postpartum hemorrhage (PPH) makes pregnancy a fatal journey for so many women and their babies. Nigeria now has the second highest rate of maternal mortality in the world. As we address these specific issues we must also look at how best the provision of maternal healthcare and healthcare delivery in general can be transformed in Nigeria.
My organization is committed to improving the health services for expectant and new mothers and it has been a life- long mission of mine to ensure that all mothers give birth in a safe environment. That is why, as Founder-President of the Wellbeing Foundation Africa (WBFA), I launched the Mamacare clinics over two years ago. Mamacare classes are led by qualified midwives, with partners and family members welcome to attend. Practical information, advice and support is given to pregnant women to ensure that they are prepared to give birth safely and care for their newborn child. Our midwives are trained to a global standard and expectant mothers are encouraged to discuss any issues relating to their pregnancy. No subject is off-limits in the pursuit of health babies and healthy mothers.
A woman's chance of dying from pregnancy and childbirth in Nigeria over her lifetime is 1 in 23. A staggering figure. Yet over 200,000 women have taken part in our Mamacare classes, and we have not lost a single mother to death in childbirth. It is my hope that one day Mamacare classes will be available for all mothers in Nigeria, so that all expectant mothers - mothers like Gaje - have the chance to access the education and care that they should be entitled to.
This case also highlighted the issue of postpartum hemorrhage (PPH)- a complication resulting from childbirth which can have dire consequences. The Chief Medical Director of Malumfashi General Hospital, Dr. Abdulhamid Abdullahi, highlighted that in addition to not having attended ANC, Gaje's multiple pregnancies put her at risk of PPH. The impact of PPH is devastating: every year about 100,000 women around the world die of blood loss soon after a baby is born, making it the biggest cause of maternal death worldwide.
In April of this year, an extensive trial conducted by the London School of Tropical Medicine and Hygiene revealed that tranexamic acid, when administered to women experiencing PPH, can reduce maternal deaths by 30%. This drug, which costs just $3 per injection, should be a health focus for those of us passionate about reducing maternal mortality – particularly in Sub-Saharan Africa, which accounts for a shocking 99% of deaths which occur due to PPH. The distribution of this drug in Africa would have a significant impact on the lives of many mothers and we must consider how we can increase the accessibility of such interventions both in Nigeria and across Africa.
Whilst both education about the importance of ANC and increasing access to life-saving drugs is crucial, we must also reflect on the realities of healthcare in Nigeria. With an estimated population of 191 million, less than 5% of the Nigerian population is covered by the National Health Insurance Scheme (NHIS). S ome progress has been made - the National Assembly of Nigeria has wisely vowed to carry out a pro-health legislative agenda and, in July, Nigeria's Senate President launched the Legislative Network for Universal Health Coverage to address "the issue of financing in healthcare in a sustainable manner to reach all Nigerians." I trust that this network will pave the way for Universal Health Coverage and a health system which will provide the life-saving medicine and care which is taken for granted elsewhere in the world.
Women, children and communities in Nigeria deserve the best global standards in care. That will require a change in public policy, in attitudes and through better education, and improved accessibility of quality ANC. It will also necessitate the best in modern medicine being made universally available, so that our mothers are not left to bleed to death. In the meantime, let us pray that Gaje Zubairu and her child rest in peace – and may we all dedicate ourselves to ensuring that their legacy is healthy mothers and children in Nigeria and across the world.
Toyin Saraki is the Founder-President of the Wellbeing Foundation Africa