Nigeria’s high maternal, child deaths spark calls to action

As Nigeria joins the rest of the world to mark this year’s World Health Day, women and their families as well as medical experts and advocates have called for increased efforts towards ending the country’s high maternal and child mortality rates. Nigeria still has one of the highest Maternal Mortality Rates (MMR) in the world, […]

As Nigeria joins the rest of the world to mark this year’s World Health Day, women and their families as well as medical experts and advocates have called for increased efforts towards ending the country’s high maternal and child mortality rates.

Nigeria still has one of the highest Maternal Mortality Rates (MMR) in the world, with over 1,000 maternal deaths per 100,000 live births.

Experts said this is far from the United Nations Sustainable Development Goal of reducing global MMR to below 70 deaths per 100,000 live births by 2030.

Some of them who spoke to the Daily Trust said the reduction rate of the death rate in the country over the years had been slow, as many of the contributory factors remained unaddressed.

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They also said this further underscored the need for interventions to support healthy pregnancies and births to ensure every woman and baby survived and thrived.

Daily Trust gathered that the causes of maternal mortality are haemorrhage (bleeding after childbirth), infection, eclampsia (seizures that occur in pregnant women with hypertensive disorders), unsafe abortion, obstructed labour, malaria and anaemia.

Other factors associated with maternal mortality include low health-seeking behaviour, poor emergency obstetric services, harmful traditional practices, high out-of-pocket expenditure on health care and poor transportation.

This year’s World Health Day kicked off a year-long campaign on maternal and new-born health. The campaign, titled ‘Healthy Beginnings, Hopeful Futures’, urges governments and the health community to ramp up efforts to end preventable maternal and new-born deaths, and to prioritise women’s longer-term health and well-being.

 

Women, families share experiences

Hassan Musa (not real names), 35, lost his 28-year-old pregnant wife last year in Abuja. He described it as the worst experience of his life.

“She was eight months pregnant and we were both looking forward to the birth of our first child. After sometime, she complained of headache and fever. We went to a health facility near our home.

“She was admitted and treated for three days, and discharged. Then suddenly, two days later, she began to pant for breath, as at the time we got to the hospital she was convulsing. There were only nurses around to attend to her for a while before the doctor finally came, and she died shortly after that,” he narrated.

He said he felt whatever was wrong with his wife was not properly diagnosed and treated in addition to the delay in attending to her during the emergency.

Like any other state in the country, Borno also records high maternal, new-born and child death rates.

Women and health workers interviewed by our reporters in some hospitals in Borno and Yobe states said overstretched manpower and hospital facilities were responsible for the high rates.

Amina Sheriff, said, “It’s not that the services are not there but they are overstretched. I have a pregnant sister who missed her step in the toilet and started bleeding, she was in her second trimester when she had the complication, but the hospital officials neglected her until she became unconscious.

“We met other women in such conditions but only those that have connections with top officials received the needed attention,” she said.

Malam Yunusa, a husband, who lost his wife at one of the hospitals in Damaturu, said he brought her to the facility on time, but couldn’t get a bed space for her to be admitted.

“I tried all I could, pleading with the hospital staff to help me get a space or even treat her in the car but they turned a deaf ear. We went there around 4:30pm and she gave up around 6:45pm.

“I watched her helplessly until she bled to death. It’s the most brutal moment I will never forget in my life,” he narrated.

Another husband, who doesn’t want to be mentioned, revealed that the doctors stitched his wife and forgot cotton wool in her body

“The doctors performed Caesarean Section (CS) on her. After some days, she started complaining of stomach ache with pus around the stitches.

“On reaching the hospital, the doctors discovered that cotton wool was left inside during the CS operation. We nearly lost her but not for the timely intervention of some consultants at the hospital,” he said.

In Kano, Rukayya Kurawa, a resident, had a caesarean section during her first delivery at a private clinic where she spent days receiving medical attention.

“My husband has spent quite a lot when I had the procedure and the thing that came to my mind was what if we could not afford it? What other people with similar conditions go through and what if they had no money and so on? What it means is that if you do not have the resources, nobody outside your immediate family would take care of you and that should not be the case. But looking back now I will say Alhamdu lillah,” Kurawa said.

However, the Kano State government’s strategy in dealing with the significant challenge of maternal mortality rate in the state is to render free prenatal and delivery services in all government-owned hospitals.

For instance, Nuhu Bamalli maternity clinic located at Kofar Nasarawa in the ancient city has been rendering free delivery services to pregnant women for a while. The hospital has recently been renovated and provided with state-of-the-art facilities.

Salama Umar, a housewife and resident of Yakasai Quarters, said she was delivered of her three babies at the Nuhu Bamalli maternity clinic without paying a kobo.

In Lagos State, where some of the best hospitals in the country are located, many women in low-income areas still face challenges.

Mrs Funmi Adeyemi, a mother of three, says ante-natal services in government hospitals are often overcrowded, with pregnant women waiting for hours before seeing a doctor.

“Many women cannot afford private hospitals, and in government clinics, the situation is frustrating. Some nurses are rude, and sometimes drugs are unavailable,” she lamented.

 

 Nigeria’s high burden of maternal and child death rates

The Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said 172 local government areas in Nigeria account for more than half of the country’s maternal deaths.

Quoting the World Health Organisation (WHO), he said Nigeria has one of the highest maternal mortality rates globally, with 1,047 deaths per 100,000 live births, placing it behind only South Sudan and Chad.

Also, a global maternal mortality report titled ‘Trends in Maternal Mortality 2000 to 2020’ showed that the country records 82,000 maternal deaths every year. This translates to 225 deaths from maternal mortality every day.

Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

Maternal Mortality Rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).

According to the United Nations Children’s Fund (UNICEF) in its situation of women and children in Nigeria report, the country’s women of childbearing age (between 15 and 49) suffer a disproportionally high level of health issues surrounding birth.

Data from the Nigeria Demographic and Health Survey (NDHS 2018) showed that 59 per cent of births are delivered at home, while nearly four in 10 births (39 per cent) are delivered in a health facility, primarily in public sector facilities.

 

Why Nigeria keeps recording high maternal and child mortality rates

Dr Tijani Salami, a specialist in maternal and child health, said there are several reasons for Nigeria’s high maternal and child mortality rates.

He said, “First, the healthcare system in many parts of the country is underfunded and lacks the necessary infrastructure. In rural areas, women often struggle to access care because the nearest health facility could be many kilometres away, and even when they get there, many clinics lack the required staff, drugs and equipment.

“Additionally, poverty, inadequate education and cultural factors also contribute to these challenges. Delays in seeking care and poor prenatal care are other contributing factors.”

Salami, who also consults for the International Center for Research on Women in Washington DC,  USA further explained that at the sub-national level, especially in rural and remote areas, the challenges are immense.

He said many healthcare facilities are poorly equipped, and there are severe shortages of skilled healthcare workers, such as midwives and obstetricians.

He said, “Transportation is a big problem; many women have to travel long distances to reach healthcare facilities, which often lack basic supplies. There’s also the issue of poverty—many families can’t afford to pay for medical care or transportation to health centres. Addressing these gaps requires targeted investments in healthcare infrastructure and the development of local solutions that are specific to each community’s needs.”

Also, the Special Adviser to the President on Health, Dr Salma Anas-Ibrahim, said poorly functional Primary Health Care (PHC) system remains a major contributor to maternal and child deaths in the country.

Dr Anas-Ibrahim said other challenges are low healthcare coverage for life-saving interventions,  ill-equipped and weak service delivery systems, low coverage with community and household-level interventions; gaps in the Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition- RMNCAH+N continuum of care, among others.

The development Research and Projects Centre (dRPC) in its research titled ‘Understanding the Nigeria 2925 Budget: The Healthcare Sector in Focus’, said socioeconomic inequalities further exacerbate disparities in access to maternal, new-born and child health services, particularly in rural and underserved regions.

“Many facilities lack basic equipment and amenities necessary for quality care, and the ongoing emigration of skilled medical personnel continues to weaken the system’s capacity as personnel are either ill-equipped or underpaid,” it said.

Findings by our reporters showed that  while some progress have been recorded from initiatives set up by federal and state governments towards reducing maternal and child care issues,  there is need for them to be expanded to all parts of the country.

Some of the initiatives are bedevilled with challenges of implementation; with out-of-pocket expenditure weighing down on the pregnant women and their families.

 

Experts’ views

Dr Taslim Murtala suggests creating conducive environment to attract doctors to remote rural areas where health professionals are lacking.

Dr Salim, a maternal and child specialist, on his part, said the government and all stakeholders need to focus on strengthening the primary healthcare system, especially in underserved areas.

 

‘FG working to reduce high maternal, infant mortality rate’

The Special Adviser to the President on Health, Dr Salma Anas-Ibrahim, said the President Bola Ahmed Tinubu administration is working hard towards reducing the high maternal and child mortality rate in the country, adding that accelerating reduction in maternal deaths is one key priority area of the president’s Renewed Hope Health Agenda.

She also said the policy direction of the agenda is to reduce the maternal mortality ratio from 512 per 100,000 live births by 35%, reduce Total Fertility Rate from 5.4 by 20% and reduce neonatal mortality rate from 38 per 1,000 live births by 40%.

She said it is also geared towards reducing infant mortality rate from 67 per 1,000 live births by 40% and Under-5 mortality rate from 132 per 1,000 live births by 25%.

The Coordinating Minister of Health and Social Welfare described the government’s Maternal mortality reduction innovation initiative (MAMII) as an ambitious commitment to reducing maternal and new-born mortality across the country.