14 years after MDGs: Fight against maternal mortality continues

Charity Odoemelam reportedly died a day after she delivered a baby boy in the first week of December, leaving the newborn to her grief-stricken husband to cater for.This is not the first time that maternal mortality would deprive newborns of the love of their mothers as a similar scenario played out recently in Abeokuta resulting […]

Charity Odoemelam reportedly died a day after she delivered a baby boy in the first week of December, leaving the newborn to her grief-stricken husband to cater for.
This is not the first time that maternal mortality would deprive newborns of the love of their mothers as a similar scenario played out recently in Abeokuta resulting in the death of a popular musician, Feyitayo Oyetade, just a week after childbirth.  
 Shockingly, thousands of women have died in Nigeria over the years from childbirth complications.
Findings indicate Nigeria  ranks second in the world behind India maternal deaths and in terms of the Maternal Mortality Ratio (MMR), Nigeria is ranked eighth in Sub-Saharan Africa behind Angola, Chad, Liberia, Niger, Rwanda, Sierra Leone and Somalia.
The United Nations Children’s Fund (UNICEF) has revealed that based on 2005 data, the average lifetime risk of a woman in least developed country dying from complications related to pregnancy or childbirth is more than 300 times greater than for a woman living in an industrialised country.
Regrettably, the Centre for Democracy and Development (CDD) revealed in its publication on the progress, prospects and policy implications of the MDGs in Nigeria that the risk of a woman dying is one in 29 relative to industrialised nations.
According to the CDD, 543,000 maternal mortalities were recorded in Nigeria in 1990 a year with a reduction to 287,000 in 2010 a year.
The global concern to reduce maternal mortality was among the key goals agreed by world leaders in 2000 and this eventually was coded as the Millennium Development Goal (MDG) five.
The MDGs target is to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio (MMR) and to achieve by 2015, universal access to reproductive health.
MMR is the indicator used in measuring the number of women who die during pregnancy and after child birth per 100,000 and the data are estimated with a regression model using information on fertility, birth attendants, and HIV prevalence.
In Nigeria, estimates on trends in MMR developed by World Health Organisation (WHO) in conjunction with other international organisations, indicated that in 1990, Nigeria’s MMR was 1,100, slowly decreasing to 1000 by 1995.
This further plunged in 2000 to 970 with additional dive in 2005 and 2010 to 820 and 630 respectively.
Recent data released by the National Bureau of Statistics (NBS) indicated that in 2014, Nigeria’s MMR plummeted to 243 (per 100,000 live births) as compared to 350 recorded in 2012.
Ahead of 2015 deadline for the MDGs, Nigeria has reduced MMR by three quarters, judging from the 1,100 recorded in 1990 and 243 recorded 2014.
Unfortunately, there is no available data from the NBS on Nigeria’s MMR as at 1990 to draw a nexus with the current statistics as WHO’s estimate of 1,100 contradicts that of Institute for Metrics and Evaluation Estimates which reported 473.
Going by the Institute for Metrics and Evaluation Estimates of 473 in 1990, Nigeria has to reduce MMR to 118 in 2015 to meet the goal of reducing the trend by three quarters.
Meanwhile, the recent NBS data also indicated that skilled attendance at delivery rose to 9.3 percent in 2014 relative to the figure in 2012 and contraceptive prevalence rate increased by 6.9 percent to 18.5 percent in 2014 as compared to the 2012 figure, which could indicate that women have increased their dependence on contraceptives as a method of family planning.
In addition, adolescent fertility rate (15-19) stood at 74 (per 1000 live births) in 2014 which was a decrease from 79 (per 1000 live births) recorded in 2012.
The data showed that about 68.8 percent of ante natal visits at least once by skilled personnel were recorded, indicating an increase when compared to the 2012 figure.
Ante natal coverage at least four times by any provider also increased to 60.6 percent from 57.40 percent in 2012 and this shows that the number of women being attended to by skilled personnel or by any provider while on an ante natal visit increased which positively influenced the decline recorded from maternal mortality rate.
The WHO notes that in 2014, the major direct causes of maternal deaths globally are severe bleeding/hemorrhage (27 percent), infections (11 percent), unsafe abortions (8 percent), high blood pressure during pregnancy (pre-eclampsia and eclampsia) (14 percent), obstructed labour (9 percent), blood clots/embolism (3 percent) and pre-existing conditions (28 percent).
Despite these gains, Nigeria is not yet free from this scourge and efforts must be intensified to stamp it out.
Post-2015 development agenda must now centre on zero percent maternal mortality but this may never be achieved if the root causes are not addressed, especially in developing countries like Nigeria where most rural women deliver their babies at home due to ineffective primary healthcare system.
Most of these women are indigent and do not have the financial strength to access quality healthcare services at hospitals.  
“In most cases, even when governments’ aim is to encourage women to have access to health facilities by declaring free services, it is usually a political rhetoric or campaign gimmick,” the CDD stated.
With the recent signing into law by the President, the National Health Bill, which focuses on improved primary healthcare system in Nigeria, it is hoped that the political will exhibited will translate to more access to free healthcare services by rural women and children.
Areas where maternal mortality is high, such as some parts of Northern Nigeria where over 90 percent of women deliver at home, should be prioritised and massive interventions delivered to such areas.
Many non-medical interventions such as improvement in women education, income, improved communication through access to mobile phones and good tarred roads can help in further curbing the problem.