10 May 2018

Nigeria: Addressing Maternal and Child Deaths

Every day, Nigeria loses 2,300 children below the age of five and 145 women of childbearing age, making the country the second worst place on earth to conceive, give birth or raise a child. Martins Ifijeh writes that underneath the statistics lies the pain of thousands of families.

In the expanded room sits the head of the home with his three young children, who are probably within the ages of two and seven. His mien depicts hollow and emptiness. He hasn't gone to farm in two weeks, not because he is contented with the plenty tubers of yam already in his barn or has harvested all his produce from the farm, but he is sad and disheartened and does not have the strength to carry on. The love of his life has left him to cater for their little children all byhimself at a youthful age of 31.

Azeez Ayae is one of the newest widowers in Iyegbe community, a small village in Ifeku Island in Edo State. The wife had died during labour after undergoing an excruciating pain for several hours without succour coming her way.

She could not get the needed healthcare to enable her deliver her baby. She was denied of one of her foremost fundamental human rights - right to life and right to healthcare, which are embedded in chapter two and four of Nigeria's constitution. She died from the mystery of not understanding why she has to suffer from something that is 100 per cent preventable.

"I didn't realise she would go into labour that day, so I went to farm as usual, but few hours later, a small boy in this community was sent to call me, that my wife has been in pain. I rushed back and I met her wailing uncontrollably. That was the third hour since she had been in labour. I sorted to get a nurse from the village that sometimes assist people with health emergencies like this, but I learnt she went to town and may not be coming back anytime soon.

"We had to put my wife in a wheelbarrow and started transporting her to the closest health facility which is two villages from here. She couldn't wait much longer as we were almost an hour into the journey. She died on the way," Ayae said.

The case of Philip, who married his wife three months ago, is not any different. She was seven months pregnant when they legalised their union in Abeokuta, Ogun State, but that union was cut short because she was trying to bring forth a new life.

"I watched life leaving my wife just few hours after she had delivered our son. In one minute she was discussing with everyone, the next minute she started bleeding profusely. The doctors started running helter scepter, but within two hours, my wife was gone.

"I couldn't understand why they didn't realise my wife was going to bleed, or why they couldn't stop the bleeding," said a tearful Philip, whose narration obviously brought back the pain he was going through haven to live in his two bedroom apartment in Egbeda, Lagos, without his wife.

Holding his one month old son in his arms, one could see grief and sorrow written all over him. The cottons and other designs in Philip's cozy small sitting room were chosen by his wife. She had eyes for colours. She was a make-up artist with a flair for interior decoration. "There are so many things I will miss about my wife. I wake up every day feeling a deep hole in my life. I am empty," he added.

They were going to have three kids, two boys and a girl, if their family planning discussions were to go by. But the plans of a forever-after-life is gone; no thanks to Nigeria's healthcare system where it is never a guarantee that a pregnant woman will come out of a labour room alive, or whether she was going to end up leaving the hospital with a living child.

For other families, they either lose the newborn, or lose both the mother and the child.

When Funke and her husband, Segun welcomed their third child at a Lagos hospital, they looked forward to the big day when he will be named in an elaborate ceremony, as it is often done in the Southwestern part of Nigeria. But little did they know that the expectation will be cut short.

Segun had kept to his chest four different names which he intends to announce on the big day, as names for the child. But on the sixth day, the little baby began to run temperature, and his breathing was belaboured. By the time they rushed him to the hospital, he was dead.

His little boy died of pneumonia and jaundice, which are 100 per cent preventable diseases. This threw the family into mourning. It took the couples several months before they could shrug of the pain that came with it.

The disheartened experience by these three families is what several hundreds of Nigerian families go through every day.

According to a 2015 report from the World Health Organisation (WHO), approximately 830 women die from preventable causes related to pregnancy and childbirth every day and a high percentage of all maternal deaths occur in developing countries, including Nigeria. And even more specific representation is provided by the United Nations Children's Emergency Fund (UNICEF), which reports that "Every single day, Nigeria loses about 2,300 children under five and 145 women of childbearing age. This makes the country the second largest contributor to the under-five and maternal mortality rate in the world."

However, due to the fundamental role a mother plays in the life of a child, Nigeria's current statistics of very high deaths per year during childbirth is indicative of inherent lapses in the critical aspects of the healthcare delivery system of the country.

A recent UNICEF's report states that for every 10 minutes, one woman dies on account of pregnancy or childbirth in Nigeria, while every hour, at least 95 children of under five years lose their lives in Nigeria from preventable health issues.

These worrying statistics reveal the extent of damage that is being done and dims any hope of a possible solution if urgent steps are not taken. It also shows that financial and geographical access to care and good quality healthcare delivery service is becoming scarcer by the day.

No wonder a representative of the United Nations Population Trust Fund (UNFPA), Ms RatiNdhlovu, once likened the deaths experienced daily from pregnancy-related complications to Boeing 747 plane crash every day, adding that because the women were poor and disadvantaged, their deaths were often ignored.

"Yet, these numbers of deaths don't just happen once in a while like plane crashes. They happen every blessed day, which ordinarily should make the country scale up interventions to achieving the targets of reducing maternal and child mortality rates," she explained.

According to a public health physician, Dr. Samuel Orji these deaths can be curbed if deliberate priorities from the government at all levels and other stakeholders are given to making sure women and children in both rural and urban areas have access to skilled healthcare.

He said the emphasis the government is placing on secondary and tertiary institutions in the country would most likely not translate into saving the millions of lives of Nigerian women and children who ordinarily should need the basic primary healthcare for them to live healthy with increased lifespan.

"If our government really wants to curb this issue which unfortunately is very common among rural dwellers, there should be functioning primary healthcare centres close to the people with skilled healthcare providers so that one of the major barriers -which is lack of access to healthcare, will be broken.

"Every pregnant woman should be duly registered for ante natal and close observation should be made to monitor their health all through the process, even till after child birth. Until all these are done, not just in cities, but in every village, community, hard-to-reach areas in the country," he said.

Also for a Gynaecologist, Dr. Kester Osazuwa, despite government's insistence that the healthcare system has improved drastically, these questions are difficult to answer in the affirmative especially for people not living in privileged areas like the cities or towns.

"Honestly, in many villages in the country, healthcare facilities are luxuries. Only TBAs and quacks, or maybe persons who feel there is need to take up the job the government fails to provide, and then decided to start doing deliveries for women who need them.

"So, for government to tackle this, healthcare must be taken to the people. People must be able to access treatment anywhere they are, be it the remotest village in the country or in big cities," he added.

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