Improved midwifery can reduce maternal mortality – Toyin Saraki

What inspired your interest in maternal health?My interest in maternal health stems from my personal experience of childbirth in Nigeria and loss of a child over 20 years ago. After losing one of my twins, and coming close to death myself, I had to fight to save my life and the life of the surviving […]

What inspired your interest in maternal health?
My interest in maternal health stems from my personal experience of childbirth in Nigeria and loss of a child over 20 years ago. After losing one of my twins, and coming close to death myself, I had to fight to save my life and the life of the surviving twin. My child and I are very lucky to be here today but knowing that this is an all too common experience for mothers and infants around the world is heartbreaking.
Now, I am fighting for every mother and every child around the world through my foundation. Luckily, I am not alone in this fight to improve maternal and child health. We have a number of skilled and dedicated partners who are working tirelessly to improve maternal health and implement respectful maternity care as a global standard. Amongst these partners are midwives, and I’m very pleased to say that I am the inaugural Global Goodwill Ambassador for the International Confederation of Midwives (ICM).
Midwives help to ensure that women of childbearing health are healthy, happy, and able to contribute to their community and economy. They empower women to make life-saving choices for their children at birth, early infanthood and throughout childbirth so that when these babies survive, they grow into healthy children and adults. The empowerment of women at a time when their health is at its most vulnerable is crucial for their future and the future of their children. After all, we know that an empowered woman is a health-seeking woman for herself, her family and her community.
Urban poor women are still quite neglected when it comes to provision of maternal health facilities. What’s your take on this?
In Nigeria, we are facing serious challenges regarding the provision of maternal health services and facilities in both urban and rural areas. Financial barriers, scarcity of skilled birth attendants, and lack of awareness about the services that are available to them, have created a situation where 13% of Nigerian women give birth without anyone present – not even a family member.
Much is made of the scarcity of doctors across the African continent but equally worrying is the lack of midwives and their skewed distribution within countries. Low remuneration and poor work conditions have contributed to an exodus of health workers from Nigeria to other countries. Yet, if we were to increase access to midwifery care in urban and rural areas by only 25%, we could reduce maternal mortality rates by 50%. So that must be our primary goal over the coming years.
Access to primary healthcare for urban poor women must also be a priority. Often, women are unable to pay health insurance premiums, which means they are forced to rely on expensive emergency care services.
Out-of-pocket financing at the point of service in hospitals can cripple families financially for years, resulting in further economic vulnerability and limited access to regular primary healthcare, setting off a cycle of poverty and poor health for generations. Affordable health insurance is key to avoiding this situation. It will prepare families for the cost of healthcare, allow families to access regular primary healthcare physicians at a low cost, and encourage healthy home habits. This is why the WBFA initiated the Alaafia Universal Health Coverage Scheme (AUHCS), which will pay the insurance premiums for 4800 people each year.
Further to this, WBFA has developed Safe Delivery Kits, which we affectionately call ‘Mama Kits’, to help provide women with maternal health commodities. Mama Kits contain all the necessary health commodities to achieve a safe delivery and can transform any incidental delivery location to the likeness of an equipped health facility. WBFA believes that access to Mama Kits will help save the lives of women in urban areas who are unable to access maternal health facilities due to financial barriers.
MDGs expire this year. How would you say Nigeria has fared in terms of maternal and child health care issues?
Despite Nigeria’s outstanding economic growth since 2000, we still lag far behind the rest of the world in the MDGs. Nigeria accounts for 13% of all global deaths of children aged under 5 and ranks in the bottom ten of all countries in terms of maternal health. Yet, I know that we can achieve progress in maternal and child health. We have the resources and skills but we must channel them in a more coherent, more sustainable way. This will include access to innovative financing for health insurance through initiatives like WBFA’s AUHCS, better access to midwives in rural areas, and an emphasis on respectful maternity care within our services. As we move into the Sustainable Development Goals era, I am positive that with the right leadership asking the right questions about how to save the lives of Nigerian women and children, we can accelerate progress on our maternal, newborn and child health indices.
Which of the various experiences you have had has affected you the most?
In 2010, I received a phone call very late at night about a set of sextuplets born in a hospital in Ogun State that was ill-equipped to deal with premature multiple births. Their mother was a trader and their father was an auto-mechanic, but they did not have access to a clean, safe, and equipped hospital that was able to look after a multiple birth. WBFA was notified that the mother had died shortly after childbirth, and the smallest three – weighing under a kilogram each – required additional equipment and expertise to survive. We immediately sent an ambulance to transfer the smallest three babies to a specialist facility outside Ogun State.
Tragically, the three healthy babies that remained at the original hospital died shortly after. The three smallest babies are now thriving at an SOS Village just outside of Lagos State, which warms my heart, and I regularly check in with them and their family. But the tragedy of losing the three babies was devastating, and it became very clear to me that decisive action at the hospital and regular antenatal care during pregnancy could have kept them alive.
If the hospital had the skills, experience, and equipment to provide adequate and respectful maternity care, the lives of the mother and her babies could have been saved. If the mother had access to prenatal care that was covered by affordable health insurance throughout her pregnancy, both she and the hospital would have prepared for the difficult birth, and her life, and the lives of her babies could have been saved.