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Approaches to tackling maternal, child mortality

MATERNAL MORTALITY

PHOTO: Doctorswithoutborders.org

Halima Sasetu, is 25 years old and a mother of two. She lives in Bwari, a major sub-urban settlement in Abuja. When she was pregnant with her second child, she decided, as with the first one, to do home delivery. Hajara Abubakar, was buoyed by an assurance from a traditional birth attendant in her neighbourhood, who said that giving birth at home was as good as going to the clinic.

Her first daughter had stunted growth. This, doctors say, is because Halima did not attend antenatal services. She did not take routine drugs like folic acid, which enhances the health of mother and child.

Halima’s second baby, a girl, soon came. She bled profusely and the traditional birth attendant tried her best, but the bleeding continued. When it was obvious that the bleeding won’t stop, the birth attendant, Hajara, cried for help.  A tricycle rider soon arrived, and Halima was rushed to the General Hospital where doctors managed to stop the bleeding, gave her much needed blood and saved her life. Halima and her daughter survived the ordeal.

But many other women are not always this luck. If she has attended antenatal services, her first daughter would have grown as healthy as her peers.  The risks to Halima’s health would have been reduced.
Maternal health has been identified as an important issue that determines global and national wellbeing.

This, according to the United Nations Population Fund (UNFPA), is because every individual, family and community is at some point intimately involved in pregnancy and the success of child birth.

Statistics have it that nearly 20 women die every hour in Africa from pregnancy-related causes.

Nigeria, which represents only two per cent of the world population, according to the  2013 Nigeria Demographic and Health Survey (2013 NDHS),has a maternal mortality ratio of 576 per 100,000 live births, accounting for over 14 per cent of the world’s maternal deaths.

Indeed, maternal mortality in the North West and North East is six times and nine times higher than the rate of 165/100,000 live births recorded in the South West Zone. The main causes of maternal mortality in Nigeria, according to UNFPA, are: haemorrhage (23%), infections (17%), unsafe abortion (11%), eclampsia (11%), malaria (11%), anaemia (11%), and others (including HIV/AIDS) contribute about (5%) of maternal death.  At least thirty women suffer short to long term disability such as Vesico-vaginal fistula (VVF).

Experts say preventing maternal deaths is possible even in resource constrained settings because 75% of these deaths can be averted if women had access to commodities. If women had access to interventions for preventing or treating pregnancy and birth related complications.
Some international and development partners say they are working  towards helping African leaders deliver a future where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.

“UNFPA over the years has been supporting the government of Nigeria in strengthening the supply of commodities for maternal mortality reduction through the procurement and distribution of maternal health life-saving commodities,” says UNFPA Representative to Nigeria, Mrs. Ratidzai Ndhlovu.
Ndhlovu told The Guardian: “To its credit, the Nigerian government has continued to work in collaboration with partners to support maternal and child heath at all levels to achieve its goals and to advance efforts to achieve MDGS 4, 5 and 6. But if we are to really deliver for women and girls, we need effective policies, innovative financial mechanisms, enhanced accountability, aligned and transparent budgets, and systems and programmes. We also need dedicated people who will work towards clear and measurable targets and improve maternal health, and our efforts must be coordinated for maximum efficiency.
CHILD mortality rate
“UNFPA is committed to continue to providing support to Nigerian people to facilitate equitable and universal access to MNCH commodities and medicines with the intention of reducing maternal and child mortality. In this vein, UNFPA is committed to support the establishment of an integrated supply chain management system and we do hope that state governments will show their commitment to this.”

She stated further: “If we consider where we are now and if we are to reduce it by 30 per cent. Don’t forget that family planning is a low hanging fruit. The result comes within a year, two or three. I think we need to take that into account. If you factor in the role of family planning in reducing maternal mortality, you will see that we are dealing with avoiding risky pregnancies and risky births because there are some pregnancies that you could easily say whether it will lead to risk delivery. We can avoid them.”

She acknowledged what government has done so far, but noted the challenge of taking the family commodities and contraceptives to those who need them.

She said: “Government commit a lot of money into procurement of contraceptives, but the issue is what we are doing to ensure that what we have procured gets to the users in the remotest parts of the country.

“We bought all these and then they expire. It does not make sense. We need to balance procurement, storage and distribution and then service to the person who is supposed to get it. If we leave any one of them, we will fall into trouble. We need to focus on the whole supply chain management and then also focus on education of the men and women to appreciate the value of planning family.  Getting a family size that you can manage, a size that you can take to school, children that you can feed and feed well and those that you can educate to whatever level you are capable is important.

“The level of education of a girl child affects the extent to which they are going to use these services we are talking about. We need to emphasis education. If we put a lot of efforts in the areas I am talking about, by the next Demographic Health Survey (DHS), we will surely see a gigantic change in the indicators of the country.”

On how to promote access to antenatal services for pregnant to young ladies, she said there was marked improvement.

“You can never predict what will happen during delivery. The main thing is that we should not have pregnancy before the girl-child is mature. No matter how many times she goes for antenatal services, the moment she comes to deliver and if the size of her pelvic region is not strong, biologically it is not ready for such a vigorous process of delivery, it will be difficult. My advice will be let us advice our children as they grow up to, depending on the age. Education is paramount. We need go to give our children, especially, the girl child, appropriate education.” She said

A gender specialist, Nkiru Bokwe, noted how the inability of development partners and national actors in Nigeria to mobilize women to take advantage of the services and supplies in the hospitals, especially in relation to pregnancy and delivery, pose a major factor that contributes to the maternal mortality ratio in Nigeria.

She told The Guardian: “If we look at the factors that contribute to some women’s inability to attend antenatal clinics in Nigeria, its boils down to the fact we live in a very patriarchal society where decision making is to the advantage of the male headed household.
“We all know that men control resources. By this I mean political and economic power. As long as the society is tilted towards one half of the people, it becomes very disadvantageous to the people that are considered to be less subordinates.”

She stressed how women in certain parts of the country would require permission to access antenatal services.

She noted: “There are also other factors that arise. The financial status of a person most times correlates with the way the person is able to access these commodities that are being paid for.

“We have other factors such as the fear of sexual and gender based violence, especially where the man is the head. The woman may be afraid to go without permission. There is also the factor of time poverty. We have facilities at the local government health facilities but the women may not have the time to go there. The services in the hospitals may not be in line with the timing of the social services women rendered at home. The only way we can change that is the sharing of roles in the family, a transformation of gender and social relations at the family level.”

How the situation could be changed for good, she explained: “You know that one of the strategic approaches is to locate the hospitals near the women, near where they live. We need to approach this from different angles. For example, what do you to the decision making power in the house? As long as men and women remain unequal, even if we take the medicines to their houses, as long as the man will not approve for them to be taken, it becomes useless.”

She called on Nigeria to take drastic legislative and policy measures, especially in the area of girl child education.

Bokwe noted: “We have the Child Right Act. How have we implemented it and what are the enforcement mechanisms? It requires a lot of advocacy and interpersonal communication with the men. I believe that our conversation with the men should not be confrontational. It should be based on the issue of complementality and appeal to the humane side of the man.”

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