‘Govt should make antenatal care, family planning free’
What is your assessment of the maternal mortality rate in the country? Maternal and child mortality and morbidity are embarrassingly poor in Nigeria. There are a lot issues that can make these statistics to be much better such as availability of staff that work with obstetricians and gynaecologisst, like nurses, community health extension workers, and […]
What is your assessment of the maternal mortality rate in the country?
Maternal and child mortality and morbidity are embarrassingly poor in Nigeria. There are a lot issues that can make these statistics to be much better such as availability of staff that work with obstetricians and gynaecologisst, like nurses, community health extension workers, and basic equipment and infrastructure. Most of the time the results that is achieved is related to what is available in terms of heath policies, health system structure, funding and motivation of the health workers, and, of course, mobilisation of the community members.
What are the causes of high maternal mortality rate in the country?
There are direct medical causes which directly concerns the medical practitioners, such as obstetric hemorrhage, infections, abortion related issues, hypertension in pregnancy and others. There are also indirect medical causes, for instance, if a woman is diabetic and she gets pregnant, the diabetis is likely to get worse and if not controlled properly, the baby and the mother may be lost. There are new things that are emerging like in the control of hypertensive disorder in pregnancy, and every obstetrician should have the capacity to sort that out, and also train people working with them like the nurse and other health workers.
There are also non medical causes that have to do with culture, social and economic causes which can affect health of the woman. Culturally, there are some women who have to wait for their husband to come back and give her permission to go to the hospital to deliver even if she is in labour. Other issues include finance. Most women are not economically empowered to look after their health when the need arises or during an emergency. There are also issues relating to religion, like the women in purdah, where a woman is not allowed to be seen by another man, other than her husband.
The influence of religion is also seen in the South where people go to prayer houses to deliver. Education is also an issue because when people are educated, they seek for health services. We also have reproductive health causes and this has to do with situations where the woman is either delivering too early, delivering too many, delivering too late in age or delivering too frequently. That is why we agitate that teenagers don’t get pregnant because their pelvis is not yet matured. So the problem of early marriage becomes an issue. Too many means people don’t have strength to know when to stop. From the fifth pregnancy and above, it become more dangerous. Too late is when a woman gets to as old as 35 years, the risk associated with pregnancy, then, becomes increased. Then we have health systems and health services delivery causes.
Health system is a combination of the structures that have been put in place in the country. Our health system is responsible for maternal and child mortality. Because if you don’t have the infrastructures like hospitals, or they are not equipped or made attractive for the people, in the long run, there will be poor results. Health services include the attitude of the health workers which sometimes it can be despicable. There are also delays in seeking help in situations of emergency. Delay can be at the primary, secondary and tertiary levels. At the primary level it could be delay in recognising that there is obstetrics emergency and you can imagine a traditional birth attendant who may not know how to measure blood pressure of the pregnant woman. By the time she recognises, reacting could be an issue, because they maybe waiting for the husband of the woman to give consent to move the woman to the facility where she will get help. The second level delay is delay in reaching to where she will get help and that has to do with the state of the roads transportation means. The third is delay in receiving treatment, having reached that Promised Land. Is the place conducive enough to receive the treatment? Maybe there is no blood and the doctor may not even be on seat. There may be no drugs, and there may be delay in carrying out caesarian section.
From all the causes outlined, you can see that only few of them are within the control of the medical worker. Most of them are within the control of the system, government, policy makers and even the people themselves. Maternal and child mortality in Nigeria has always remained poor. If you look at the 2008 demographic health survey one wonders if all the efforts everybody is putting in is coming to nothing? One of the things that SOGON is doing now is establishing an effective maternal and prenatal death surveillance and response making use of existing mechanisms. So that within the next five years if we get most of our health facilities to key into a uniform way of reporting maternal and child deaths, the cause of the deaths and how to address these issues , we may come up with statistics that may be much better than what we have now.
How can women prevent eclampsia or hypertension in pregnancy?
Pre-eclampsia and eclampsia constitutes about eleven percent of the cause of maternal mortality in the country. Both of them are a consequence of poor antenatal care. If a woman is attending antenatal care at the correct place, they will be able to measure her blood pressure because the sign of pre-eclampsia is a rise in high blood pressure. Pre-eclampsia and eclampsia can be taken care of if a woman subjects herself to good antenatal care in orthodox health facility that have trained doctors and midwives.
Tell us about SOGOM at 50?
SOGON was founded in 1965. We have about 1, 500 members. Obstetrics and gynaecology is a medical specialty that caters for women’s health. Obstetrics has to do with pregnancy and child birth, and gynecology deals with disease conditions that are peculiar to women. Anybody who is qualified in obstetrics and gynaecology should be a member of this professional body. SOGON is an affiliate of the international federation of obstetrics and gynaecology. Our conference will come up in November and we are going to have events to mark our fiftieth anniversary which also corresponds with our 9th international congress. Every three years, we have international congress, and it takes place in Abuja. It is going to be from November 24 to 28. Our main message will be SOGON at 50, how have we fared? And we are going to reveal a lot of issues related to sustainable development goals. We are also going to talk about safety nets in maternal health. We will hold pre-workshops and research proposal writings for academics amongst us.
What is your take on the increasing number of caesarian sections in the country, particularly in private hospitals?
While there are a few cases of people unduly carrying out caesarian section, I will tell you that caesarian section is not bad. It is an answer to the problem of labour that is trying to fail. It is carried out to save the mother and the baby. There are internationally accepted standards of range of caesarian section that can be carried out in any comprehensive obstetrics care facility. CS range should come between five and fifteen percent. If it is below five percent, something is wrong, somebody is not doing well and if it is above 15 percent, then, some people are unwittingly carrying out caesarian section more than is necessary.
What is your advice to Nigerians on their health?
Nigerians should change their health seeking behaviuor to the extent that every pregnant woman should try as much as possible to visit orthodox health facilities to get the necessary things done, so that she will have a safe delivery. One of the other things I want policy makers and government to do is to make ante-natal care delivery and family planning free for our people. I believe we will get there because the national health act was signed into law by the last president and what remains is implementation. There must be the political will to implement it. About 60 percent of women attend antenatal care but less than 40 percent deliver in orthodox health facility, which is very poor for a country like Nigeria.