NKECHI was full of life and in high spirits. She was nine months pregnant and was already feeling the contractions of labour at well-spaced intervals. She had no expectation of problems and was hopeful of a normal delivery.
She woke very early on the D-Day, dressed up and packed her bags. The hospital was over 25 kilometres away, so she had to wait for her husband to run around and get enough money to give to her for the trip. That was the first delay.
Finally, she boarded a taxi and departed. But there was heavy traffic. A journey that should have taken about 30 minutes lasted three hours. That was the second delay.
At the hospital, Nkechi waited for patients. She waited almost six hours before she could see a doctor. That was the third delay.
Even on seeing the doctor, Nkechi could not be admitted because there was no bed. The wards were full. Nkechi was told to go home and report back the next day because her contractions were still too far apart. More delays.
Little did anyone know the unexpected would happen. That same night she began to bleed. The bleeding was uncontrollable. She was rushed to a nearby hospital. Alas, it was already too late.Nkechi and her unborn baby died.
Such has been the fate of many Nigerian women. Today, getting pregnant in Nigeria is almost a suicide mission. Statistics from the 2008 National Demographic Health Survey put Nigeria’s maternal mortality ratio, MMR, at 545 per 100,000 live births, ranking second only to India in the global maternal death statistics.
A 2012 World Health Organisation, WHO, publication, “Trends in Maternal Mortality”, puts the MMR in the country at 630 per 100,000 live births.
Maternal death is defined as “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. Nigeria may be one of the worst places in the world to become pregnant, compared to other countries. Why are our women dying?
In the view of Professor of Obstetrics and Gynaecology, Assuit University, Egypt, “Women are not dying because of diseases we cannot treat rather they are dying because societies are yet to make the decision that their lives are worth saving.”
Health watchers say the high maternal death burden is yet to be addressed as a public health concern. Today in Nigeria, many health facilities are still taking delivery with candles or lanterns.
Many health facilities do not have necessary staff and even so-called government hospitals are short of doctors and have a limit of the number of pregnant women they see daily.
A case in point is a February 2013 study measuring the availability and accessibility of facilities, equipment and personnel to support the Maternal & Child Mortality Reduction (MCMR) Programme in 20 Local Government Areas,LGAs, in Lagos State. The survey by the Lagos State Civil Society Partnership, LACSOP; the Lagos State Community Coalition and Innovation Matters Limited, found that the Primary Healthcare Centres, PHCs, were short staffed.
In some centres only a midwife and Chief Nursing Officer was available to attend or take deliveries. Of the 29 Centres inspected, 22 offered laboratory services while seven had no services.
The study which was targeted at in-depth assessment and analysis of the capacity of 20 PHCs to provide maternal health services among others, discovered that some centres are still using lantern to take deliveries and in some of the PHCs, staff contributes their money to enable supply of electricity.
Speaking in Lagos, Mrs, Dede Kadiri of InnovationMatters, noted that equipment and supplies are lacking in most of the PHCs. “In February 2013, 45 percent of the responding PHCs stated that they did not have one form of functional equipment or the other. But by October 2013, only 13 percent stated that they lacked such equipment.
“Ten of the PHCs do not have any supplies to handle emergency conditions at all while the other 19 PHCs have these available in varying degrees. In most of the PHCs doctor to client ratio was 1 to 1,653, nurses, 1 to 999 amongst others,” she added.
In 2006, Nigeria pledged to support the Maputo Plan, which addresses the serious threat to the right to health in Africa with poor sexual and reproductive health as a leading killer. Also, at the Summit for the UN Millennium Development Goals in New York, Nigeria was one of the countries that pledged to save the lives of 60 million women and children by 2015.
In July 2012, the nation was in attendance at a Summit which proposed to “mobilise global policy, financing, commodity, and service delivery commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries. Despite these commitments, Nigerian women have not stopped dying.
An Obstetrician/Gynaecologist at Randle General Hospital, Surulere, Lagos, Dr. Adeleke Adesola Kaka, noted: “Every minute, a woman dies during pregnancy, labour and puerperium. Each year approximately eight million women suffer pregnancy related complications worldwide and over 500,000 maternal deaths yearly worldwide and most of the deaths are avoidable or preventable.
“These women are dying needlessly. Most of these deaths could have been avoided, which suggests important opportunities for prevention.”
Kaka who spoke in Lagos at a media training organised by Devcoms stressed that each death or complication represents an individual tragedy to the woman, her partner, children and family.
Major causes of maternal deaths include delays in seeking care, accessing health care and at the health facility, hence the quality of care to a pregnant woman is a key determinant of maternal outcome.
To reduce the high MMR, there is need for demonstration of the will and courage to pursue compulsory Universal free Basic Education, particularly for girl-children.
Kaka called for conducive working environment for women, extended and flexible maternity leave, increased awareness to encourage hospital delivery, provision of basic and comprehensive Emergency Obstetric Care services in health facilities, increase access to effective methods of contraception amongst others.
However, maternal mortality is a tragedy of immeasurable magnitude. Most deaths are preventable; therefore, reducing maternal deaths requires concerted efforts by all. It is beyond mere statement of intention or the rat race to 2015.”
By CHIOMA OBINNA