Maternal Mortality in Kano State:Civic group, activists drill down to root causes

From the deeply emotional and touching personal stories that were told about the silent tragedies in the form of the many avoidable deaths of expectant women or nursing mothers, it was clear that the debate was about coming to terms with the root causes of the problem in Kano, a frontline state in the maternal health debate. Several fundamental questions agitated the minds of healthcare providers, community activists and other concerned advocates. There was unanimity that there was a serious need for a maternal healthcare system, which would end the sentencing of women in the throes of childbirth to early graves.

The gathering, for instance, sought to understand why in spite of the free maternal healthcare programme of the Kano State Government, there still remained several cases of expectant women preferring home deliveries to hospital care. Another important question raised was the gender and power relations dimensions of the maternal health issue, especially with the fact that in an overwhelming number of cases, it is the men who determine whether their wives are allowed to access healthcare or otherwise.

Added to these important questions, which go to the roots of the grime maternal mortality indices across Nigeria, and specifically in a state like Kano, were critical issues of education of women and the resultant effect it has on their economic fortunes. As expected, it was found that educationally disadvantaged women, who in turn tended to be economically disempowered, were more exposed to the danger of maternal death because they are unable to make important choices that would help preserve their lives.

These and many more conclusions and extrapolations recently came out of the Validation Workshop organised by a frontline civil society organization, the Resource Centre for Human Rights and Civic Education (CHRICED). The discourse was a fallout of a study commissioned in June 2015, to critically examine the health infrastructure, services and practices in seven communities in Gwale and Kumbotso Local Government Areas of Kano State. The study was led by CHRICED Principal Consultant, Comrade Lanre Osaze Nosaze. Its aim was to provide research based knowledge on the state of maternal healthcare in the project area.

The project is supported by Misereor KZE, the German Catholic Bishops organization for development cooperation. Specifically, the study sought to establish the state of access to maternal healthcare in the project communities, identify the public perception of the performance of maternal healthcare facilities and gather a wide range of data on the quality of system performance. The workshop, which held at the Royal Tropicana Hotel was convened to give an array of stakeholders the opportunity to make their inputs in the report. These stakeholders include, community women and men, impacted by the problem of high maternal mortality, Traditional Birth Attendants (TBA), medical personnel like nurses and midwives, officials of the Kano State Hospital Management Board, policy makers in the relevant ministries and departments of the Kano State Government, civil society organisations, as well as the media.

The discourse was designed as a veritable platform for those on the demand, and supply side of the maternal health system to review the report, brainstorm on the key findings and recommendations, assess the findings in relation to their everyday experiences on the ground, in readiness for the publication and release of a final report. The final report would then form the basis of advocacy to the relevant government agencies, enlightenment of the citizenry, as well as the drafting of a bill on maternal health for the action of the Kano State House of Assembly.

Executive Director of CHRICED Comrade Ibrahim M. Zikirullahi, while noting that the task of reversing the dire maternal mortality indices in Kano would be enormous, admonished that citizens could no longer afford to watch in helplessness as the maternal health system continues to claim the lives of women. He said apart from the inhumanity apparent in such a tragic reality, the avoidable deaths of expectant women and nursing mothers, run contrary to the spirit and letters of all national and international human rights instrument, which advocate the right to life, as inalienable.

Comrade Ibrahim went on to observe that the bigger tragedy remains the fact that Nigeria’s maternal health problem is largely fuelled by the grand scale corruption perpetrated by the political elite.

He said: “If we are to calculate all the massive amounts stolen or shared by politicians, it would be realised that Nigeria has no business enduring the pain of so many deaths linked to poor maternal health. A fraction of these amounts well spent on the health system would have gone a long way in saving the lives of thousands of women who die daily while giving birth. This reality should prick the conscience of any active, patriotic or well-meaning citizen. We must never forget that corruption denies us the right to health, and in the case of maternal health, corruption leaves behind terrible health facilities that may at best be described as mere “consulting clinics.”

However, the study on maternal health in Kano found that apart from corruption, there were still norms, cultural dispositions, as well as systemic constraints hampering the realisations of the goals of the Kano State government’s free maternal healthcare programme. For instance, on the survey tracked were issues such as the number of children and desire for more children, which have implications for maternal health. The survey data indicated high fertility rates in the project communities with 60 percent of the women respondents answering that they had more than three children. 16 percent had more than five children, while two percent indicated having more than 10. Similarly, on the desire for more children, the data indicates a desire for a high number of additional children without a definite limit. 34 percent among the women and 60 percent among the men want as many children as God wishes to give them.

These two points on the number of children and the desire for additional children generated an intense and interesting debate at one of the plenary session. A male participant expressed the opinion that the number of children should not be an issue especially as population constitutes an advantage, which is being used to effect by a country like China.

His words: “If you look at the land mass of Northern Nigeria, it is very vast. Secondly, there is abundant land in Northern Nigeria, so having many children is not a problem. And then, the main occupation in Northern Nigeria is farming. So the more children you have, the better your agricultural fortunes. And that has seriously contributed to the development of this country. It is not only here; when you look at the developed societies like the United States of America, they have population.

This position was however, countered by a woman participant who argued that although the number of children is determined by religion because as Muslims, the worldview is that nobody knows what God has destined, she noted that was not an excuse to have too many children that the family would not be able to sustain.

She espoused her view thus: “You cannot have as many wives as possible and say you will not have many children. If you have one wife, she may give birth to as many as you want, but if you have four wives and each has five children, that makes 20. So even though religion says it is all destined, the same God says he will not put a burden on you except what he knows you can control it. If a man has large numbers of children, and he does not have control over them, does not feed and take care of them, then what is the essence? Islam wants children that are of good character and who would be helpful to themselves and others around them in the society, not children that would be problems to the society.”

The participant, a healthcare worker noted that there had to be a manageable population, in order not to overstretch healthcare facilities, which are not even enough. She went on to state that globally, there has been a food crisis, as well as high cost of living.

“At our level, things have to be paid for; school fees have increased; the price of commodities have also increased. Today, a bag of local white rice costs N28,000; so imagine you have four wives and each one has five children, whatever the state of the farm you have, it cannot feed them. Even if you go to schools now, you have to buy text books. That is what we are saying; let’s have a population we can manage.

“We are not saying we are against any religion, but let’s look at what is on the ground. With minimum wage at N18,000, for a man that has four wives and 20 children, how can he educate them? And then we have not talked of shelter, clothes, medicine; everything costs money. Please, we should take the opportunity of this information so that we can have a better life.”

Other issues relating to maternal health raised include the poor attitude of healthcare professionals, which discourages pregnant women from going to health care facilities, as well as access to health centres, which in many cases are too far away from the people who need them.

In the light of these challenges, in its recommendations, CHRICED called for a strategic impact evaluation of the maternal health system in Kano State. The civic group noted that this needs to be conducted to measure results in terms of maternal health outcomes rather than in terms of the mere expenditure of resources.

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