Reducing maternal mortality through family planning

Aisha Tanko, a 45-year-old woman in Pasu village, had eight children. After her last delivery, the doctor asked to see her alongside her husband. Aisha’s husband could not understand why the doctor wanted to see him since his wife had a safe delivery. But after much persuasion by his wife, he followed her to the […]

Aisha Tanko, a 45-year-old woman in Pasu village, had eight children. After her last delivery, the doctor asked to see her alongside her husband. Aisha’s husband could not understand why the doctor wanted to see him since his wife had a safe delivery. But after much persuasion by his wife, he followed her to the hospital. The doctor explained to them that Aisha was hypertensive, and after having eight children, child bearing had become very risky and could take her life. He advised the couple on the various family planning methods and why it had become  necessary for Aisha.
Aisha’s illiterate husband found this unimaginable as he saw his mother deliver children until she reached menopause. He wondered why his wife, who looks younger than his mother, should stop having children. In any case, he thanked the doctor and promised they would think about it. After a year, Aisha became pregnant again. During delivery, Aisha had pre-eclampsie and the doctors tried to save her life, but she could not make it. Aisha died.
The 2006 census estimated that there were about 68 million females in Nigeria. Out of this, 30 million become pregnant each year, with five million resulting to childbirths, while 576 women out of every 100,000 live births die as a result of these pregnancies and childbirths. This figure translates to 111 women and young girls dying daily, or five women every hour in Nigeria.
Up to 33 per cent of these deaths can be prevented by increasing access to and uptake of contraceptive, Chinwe Onumonu, national coordinator, Association for the Advancement of Family Planning (AAFP) said.
“We now have evidence that family planning can reduce maternal mortality by 33 per cent, so the government set By Victoria Onehi
 
Aisha Tanko, a 45-year-old woman in Pasu village, had eight children. After her last delivery, the doctor asked to see her alongside her husband. Aisha’s husband could not understand why the doctor wanted to see him since his wife had a safe delivery. But after much persuasion by his wife, he followed her to the hospital. The doctor explained to them that Aisha was hypertensive, and after having eight children, child bearing had become very risky and could take her life. He advised the couple on the various family planning methods and why it had become  necessary for Aisha.
Aisha’s illiterate husband found this unimaginable as he saw his mother deliver children until she reached menopause. He wondered why his wife, who looks younger than his mother, should stop having children. In any case, he thanked the doctor and promised they would think about it. After a year, Aisha became pregnant again. During delivery, Aisha had pre-eclampsie and the doctors tried to save her life, but she could not make it. Aisha died.
The 2006 census estimated that there were about 68 million females in Nigeria. Out of this, 30 million become pregnant each year, with five million resulting to childbirths, while 576 women out of every 100,000 live births die as a result of these pregnancies and childbirths. This figure translates to 111 women and young girls dying daily, or five women every hour in Nigeria.
Up to 33 per cent of these deaths can be prevented by increasing access to and uptake of contraceptive, Chinwe Onumonu, national coordinator, Association for the Advancement of Family Planning (AAFP) said.
“We now have evidence that family planning can reduce maternal mortality by 33 per cent, so the government set a goal to expand the family planning services in this country so that we can attain the goal of 36 per cent by 2018. Machineries were set in place, studies were done, planned and budgeted for. But government says there is no money yet to start the implementation of this programme which will save the lives of women and children,” Onumonu explained.
Dr. Nathaniel Adewole, consultant gynaecologist and obstetrician at the University of Abuja Teaching Hospital, said family planning allowed people to attain their desired number of children and determine the spacing of pregnancies.
“Leading causes of maternal mortality include haemorrhage, hypertension, unsafe abortion, infection and other medical conditions. If contraceptive prevalence is high, then the incidence of unwanted pregnancy will be low; and subsequently, there will be reduction in unsafe abortion and maternal deaths.
“Again, acceptance of family planning by women with medical condition that can complicate pregnancy will reduce unnecessary deaths from medical complications of pregnancy,” Adewole explained.
In a paper presented by the national coordinator of AAFP in a media roundtable in Abuja recently, Onumonu said evidence indicated that Nigeria had not recorded significant improvement in its family planning uptake for the last 10 years.
“Contraceptive Prevalence Rate (mCPR) has remained at 10 per cent for the past 10 years, with a marked difference between the urban and rural areas, 17 per cent in urban areas, and 6 per cent in rural areas,” she said.
There are also wide regional variations of mCPR across the geo-political zones. “Whereas 25 per cent of married women aged 15-49 years in the South-West currently use modern contraceptive, less than 3 per cent of women in the North-East are current users of modern contraceptive method,”Onumonu further explained.
The low level of contraceptive use, experts say, contributes to Nigeria’s poor maternal and child health status and accounts for the high total fertility rate of almost six children per woman and the high population growth rate of 3.18 per cent.
Unmet need of family planning is 16 per cent. Only one in five (20 per cent) of public health facilities in Nigeria offers family planning services and products. 
Despite the progress made in family planning through supportive policy environment and provision of free contraceptives in public sector facilities, available evidence shows that the budgetary provision for family planning in Nigeria is grossly inadequate to allow individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births.
The government committed to increase its annual family planning procurement budget to about 11.35 million US dollars annually; but this is yet to be completely effected.
Analysis of budget tracking exercise of 2014 family planning budget conducted by the (AAFP) in 2015 to determine the level of family planning funding indicates the absence of a sustained budget line. Whereas the recommended actual per capita cost for family planning is N750.30, only 11.84(1.6 per cent) was provided for in 2014; the rest came from individuals and development partners.
If fund is provided for all currently married women who desire family planning to have their needs met, Nigeria’s contraceptive prevalence rate would have doubled its present value.
“Before now, commodities used for family planning were provided by donor agencies. But Nigeria made a commitment that it would be contributing $10 million per year towards this procurement, and $8.35 million for reproductive health commodities. Part of it was expected to procure drugs and vaccines for family planning, but these monies were not realised. These commitments need to be actualised if we would change the landscape of maternal and child health in this country,” Onumonu said.
If the right actions were taken at the right places, the lives of many rural women, including that of Aisha, may have been saved. a goal to expand the family planning services in this country so that we can attain the goal of 36 per cent by 2018. Machineries were set in place, studies were done, planned and budgeted for. But government says there is no money yet to start the implementation of this programme which will save the lives of women and children,” Onumonu explained.
Dr. Nathaniel Adewole, consultant gynaecologist and obstetrician at the University of Abuja Teaching Hospital, said family planning allowed people to attain their desired number of children and determine the spacing of pregnancies.
“Leading causes of maternal mortality include haemorrhage, hypertension, unsafe abortion, infection and other medical conditions. If contraceptive prevalence is high, then the incidence of unwanted pregnancy will be low; and subsequently, there will be reduction in unsafe abortion and maternal deaths.
“Again, acceptance of family planning by women with medical condition that can complicate pregnancy will reduce unnecessary deaths from medical complications of pregnancy,” Adewole explained.
In a paper presented by the national coordinator of AAFP in a media roundtable in Abuja recently, Onumonu said evidence indicated that Nigeria had not recorded significant improvement in its family planning uptake for the last 10 years.
“Contraceptive Prevalence Rate (mCPR) has remained at 10 per cent for the past 10 years, with a marked difference between the urban and rural areas, 17 per cent in urban areas, and 6 per cent in rural areas,” she said.
There are also wide regional variations of mCPR across the geo-political zones. “Whereas 25 per cent of married women aged 15-49 years in the South-West currently use modern contraceptive, less than 3 per cent of women in the North-East are current users of modern contraceptive method,”Onumonu further explained.
The low level of contraceptive use, experts say, contributes to Nigeria’s poor maternal and child health status and accounts for the high total fertility rate of almost six children per woman and the high population growth rate of 3.18 per cent.
Unmet need of family planning is 16 per cent. Only one in five (20 per cent) of public health facilities in Nigeria offers family planning services and products. 
Despite the progress made in family planning through supportive policy environment and provision of free contraceptives in public sector facilities, available evidence shows that the budgetary provision for family planning in Nigeria is grossly inadequate to allow individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births.
The government committed to increase its annual family planning procurement budget to about 11.35 million US dollars annually; but this is yet to be completely effected.
Analysis of budget tracking exercise of 2014 family planning budget conducted by the (AAFP) in 2015 to determine the level of family planning funding indicates the absence of a sustained budget line. Whereas the recommended actual per capita cost for family planning is N750.30, only 11.84(1.6 per cent) was provided for in 2014; the rest came from individuals and development partners.
If fund is provided for all currently married women who desire family planning to have their needs met, Nigeria’s contraceptive prevalence rate would have doubled its present value.
“Before now, commodities used for family planning were provided by donor agencies. But Nigeria made a commitment that it would be contributing $10 million per year towards this procurement, and $8.35 million for reproductive health commodities. Part of it was expected to procure drugs and vaccines for family planning, but these monies were not realised. These commitments need to be actualised if we would change the landscape of maternal and child health in this country,” Onumonu said.
If the right actions were taken at the right places, the lives of many rural women, including that of Aisha, may have been saved.