The statistics on pregnancy is very depressing in Nigeria. An estimated one in eighteen women reportedly die giving birth in-country! Now that is appalling and is clearly one of the world’s highest maternal mortality rates MMR. When people hear the above, they typically and erroneously attribute incidents of MMR to the rural poor. Alarming as it sounds there are more than socio-economic factors contributing to MMR in our country. As a matter of fact statistics show that there are a good number of educated, urban, middle income families that have been touched by the sorry experience of MMR or left with a woman (mother or daughter) rendered chronically ill by a pregnancy experience.

Amazingly though, much of the causes of this depressing statistics can be addressed in simple ways like for example, awareness and education.

ISSUES

The issues relating to maternal mortality in Nigeria are greatly rooted in poverty and culture. Healthcare in Nigeria is given little or no attention. There is constant competition between cultural practices and medical practices such that outrageous practices like female genital mutilation (FGM) which is an indirect cause of MMR are still being carried out in some villages despite aggressive sensitization and awareness campaigns. A good number of Nigerians are not properly educated and so ignorance enjoys a wide presence in Nigeria. This ignorance influences decision making and enforces believe in culture and tradition.

The low status of women does not help matters; in some cases women need to take permission from their husbands to attend anti-natal treatments. Health care providers are not willing to work in public facilities because compensations are not satisfactory or at least motivating.

On the economic front, it appears that the Nigerian government is yet to realize that maternal mortality is a limitation to national development. There are no strong policies to improve women’s health by allocating more funds to the public health sector .And when such fund is allocated, if it does get to its designated area of need; it takes a very long time. Hence, the incessant strikes orchestrated by medical staffs because they have not been compensated for months.

Causes

The causes of MMR could be specifically of a medical nature or a general one.

Medical causes of MMR in Nigeria are:

Hemorrhage                 -        23%

Sepsis                            -        15%

Malaria                         -        7%

Obstructed labor          -        9%

Abortion                       -        17%

Eclampsia                     -        9%

Toxaemia                      -        9%

Others                           -        10

 Other general factors contributing to MMR in Nigeria are;

·       Lack of antenatal care.

·       Low proportion of women attended to by skilled birth attendants.

·       Delays in treatment of complications of pregnancy.

·       Poverty.

·       Harmful traditional practices.

·       Low status of women.

·       Delays in transportation.

 Causes – The Delay factors

The delay factors standout as one of the major causes of maternal mortality in Nigeria.

   They are three types.

1. Type 1 delay- when a woman with a pregnancy  complication fails to get to a hospital in time.
2.  Type 2 delay- when the delay is due to difficulty in transportation.
3. Type 3 delay- When there is a delay in treatment after the patient has reached the hospital. This delay contributes 40% of maternal mortality deaths in Nigeria.

Causes of type 3 delay.

·       Non- affordability of antenatal cost, delivery cost and post natal cost.

·       Delays in seeking staffs in health facilities.

·       Incessant strikes and lockouts.

·       Delays due to poor supplies and consumables.

·       Delay in referral of patients.

·       Basic essential obstetric care is not available in most facilities.

·       Systematic problems: doctors and mid wives refusing rural postings.

·       External brain drain.

True Life Vignette of type 3 Delay.

…a typical example.

Today, Mary the lady who helps in the house came late to work. I told her off and asked her why. One of her town’s women died at childbirth. This was her 5^th pregnancy.

She had not gone late to the hospital, but on time. By the time they found a vehicle to go to the hospital, by the time they struggled to get her to an admission ward, by the time she was admitted, by the time her file was made up, by the time the midwife was called, by the time the midwife had finished eating, by the time the mid wife came, by the time the midwife examined the woman, by the time the bleeding started, by the time the doctor was called, by the time the doctor could be found, by the time the ambulance went to find the doctor, by the time the doctor came, by the time the husband went to buy the drugs, I.V. set, Drip, by the time the husband went to look for blood all over town, by the time the husband found some, by the time the husband begged the pharmacist to reduce the prices since he had already spent  all his money on swabs, dressing, drugs and fluids, by the time the hematologist took blood from the poor exhausted husband, by the time the afternoon and night nurses exchanges notes and duty, by the time the midwife came again, by the time the doctor was called , by the time the doctor could be found, by the time the doctor came, by the time the T’s had been properly crossed and all the I’s dotted, and the husband signed the consent form, THE WOMAN DIED!

Today, the husband wanted to sell the drugs and all the things they never used to be able to carry the body of his wife back to their village, but the corpse could not be traced to the hospital. As he stood biting his lips, tears pouring down his face, trying to ‘be a man’, nodding to the echoes of consolation around him, another rickety vehicle drives in, bringing in yet another pregnant woman, on time. BUT, BY THE TIME…….

(Contributed by Dr Brown). 

Our Response

OIP seeks to minimize and possibly eliminate these delays that threaten safe delivery. Our response is to actively use the media including print, audio , visual and other electronic formats and platforms in both formal and colloquial styles right down to grass-roots so as to procure accurate understanding of this issue across social strata and provoke action in audience to address subject of information to set up a system for data capture of the vital statistics unfolding silently and unseen around us so as to procure a meaningful base for planning, research, deeper analysis, policy formulation and resource deployment by stakeholders, policy makers, care-givers, donors and other interested parties.