Lydia Trupe
Maternal Health in Nigeria
From: Secretary of Health, Nigeria
To: Minister of Finance, Nigeria
Introduction:
Maternal mortality is one of Nigeria’s most significant concerns. Our maternal mortality ratio is the second highest in the world, and an estimated 54,000 women die each year from pregnancy related complications. Maternal mortality is highest among adolescents and those who are poor, uneducated, or live in rural areas. These populations lack access to and knowledge about modern contraceptives and have generally high fertility rates. These at-risk populations also lack access to quality antenatal, obstetric, and postpartum care. The loss of productivity caused by our high rates of maternal mortality and childbirth-related disability drives many families into poverty and adversely affects our nation’s economic growth.Interventions are needed that educate at risk populations on appropriate contraception use and birthing practices. Access to care must also be improved, especially for those who lack both the physical and monetary means to receive care. Additionally, the quality of our obstetric care must be improved through the training of midwives and other skilled birth attendants.
Nature and Magnitude of the Problem:
The health of women in Nigeria is extremely poor, and the rates of maternal mortality in our nation are among the highest in the world. Our maternal mortality ratio is 840 per 100,000 live births, which is the second highest maternal mortality ratio in the world[i]. The lifetime risk of dying during childbirth in our country is approximately 1 in 23[ii]. We must take steps that other nations have taken to address these issues. While maternal mortality ratios are continuing to decline globally, they are increasing in Nigeria. In addition to the estimated 54,000 women who die each year from pregnancy related complications, another 1,080,000 to 1,620,000 women suffer disabilities related to pregnancy and childbirth that leave them unable to live healthy, productive lives[iii].
Affected Populations:
High maternal mortality primarily occurs among populations who have little access to or knowledge about family planning and obstetric care, namely those who are poor, uneducated, or living in rural areas. Nigeria’s poorest women receive approximately 6.5 times less access to skilled care during childbirth than their richest counterparts[iv]. Many poor women are denied access to care because they cannot pay the user fees imposed by hospitals or cannot pay for the blood that is required for transfusions in the case of hemorrhage. Access to necessary care is especially limited in rural areas, particularly in northern Nigeria. Women in rural areas have a maternal mortality ratio that is 2.4 times higher than that of women in urban areasiii and are 2.7 times less likely to use modern contraceptives. Thus, nearly 70 percent of our births take place in areas where access to care is limitediii. Uneducated women, as well, are far less likely than their educated counterparts to receive antenatal care.
Risk Factors:
The primary risk factors for poor maternal health include poverty, rural living, lack of access to family planning and contraception, high fertility rate, lack of access to obstetric care, and poor quality of care. The total fertility rate in Nigeria is high at 5.7 children per family, and it does not appear to be decliningvi. Many women do not have access to or cannot afford modern contraception. Contraceptive prevalence in our nation is a stunningly low 15 percenti. Major barriers to contraceptive use include both affordability and awareness. In rural areas, only 43.8 percent of women consider condoms to be affordable.iii. Contraceptive awareness is also a key problem, as 1/3 of women incorrectly believe that family planning can lead to infertilityiii. The adolescent fertility rate is particularly high, at 124 per 1000 women. Reducing high fertility rates in our country is crucial, because each pregnancy a woman has multiplies her chance of dying from pregnancy or childbirth related complications.
The major causes of maternal mortality, including hemorrhage, unsafe abortion, and obstructed labor—can all be treated effectively in well-staffed, fully equipped health centers[v]. However, women in Nigeria experience three major delays in accessing necessary obstetric care: delays in the decision to seek care, delays in reaching appropriate care, and delays in receiving treatment. The first two delays are related to access to care. Many women choose not to seek obstetric, prenatal, or postpartum care because they are unaware of its importance or they are unable to afford it. Even women who desire to seek care are often physically unable to reach health centers due to a lack of transportation. In rural areas, only 27 percent of births are assisted by a midwife or other skilled birthing attendantiii. The final delay relates to the poor quality of care in health centers, which includes a lack of skilled birthing attendants and a deficit of necessary equipment.
Social and Economic Consequences:
The extremely high rates of maternal mortality and pregnancy related disabilities in our country have lasting social and economic consequences on both individual families and our nation as a whole. Children who are left without their mothers are more likely to suffer from illness or malnutrition and are at an increased risk for early deathv. Even women who survive severe complications from pregnancy and childbirth often face long recovery times, and their ill health and loss of productivity may have social and economic consequences within their families and society. Long term health problems such as obstetric fistula, anemia, and uterine prolapse can limit a woman’s mobility and her ability to contribute to the household. Often times these problems drive families into poverty, put children at risk of malnutrition and illness, and cause marital problems.
Priority Action Steps:
To combat maternal mortality in our nation, we must immediately implement programs that target the lack of access to contraception and obstetric care, concentrating particularly on rural areas in the North with high populations of poor or uneducated women. In order to decrease our high fertility rate, we must implement contraception education programs that target high-risk areas and make modern contraceptives more affordable. Countries such as Malaysia and Tunisia have seen their maternal mortality rates significantly decline as women have gained access to family planningvii.
The three delays in receiving obstetric care must also be addressed. Delays in the decision to receive care must primarily be addressed through birthing practice education programs. Eliminating “user fees” from health centers would also encourage women to seek medical care rather than attempt in-home delivery or unsafe abortions. In order to address delays in receiving care, some organizations in Nigeria have begun partnering with local communities to improve their emergency transport systems to hospitals[vi]. These programs should be expanded and should target high-risk communities in the North. Finally, delays in receiving treatment must be addressed. Many countries in the region have had tremendous success in improving obstetric capabilities through the training of midwives in their midwifery schoolsvii. Our nation should implement these training programs, so that our health centers may be better equipped to handle life-threatening complications that arise during childbirth and pregnancy. It is necessary to improve both access to and quality of care simultaneously, so that women both receive the help they need and benefit from the services provided by our health centers.
1
[i] UNICEF. At a Glance: Nigeria. Accessed on April 8, 2011.
[ii]World Health Organization. Broken Promises: Human Righs, Accountability, and Maternal Death in Nigeria. Accessed on April 9, 2011.
[iii] USAID. Maternal and Child Health: Nigeria. http://www.usaid.gov/our_work/global_health/mch/mh/countries/nigeria.html. Accessed on April 11, 2011.
[iv] World Health Organization. Nigeria Country Profile. Accessed on April 8, 2011.
[v] UNFPA. Maternal Morbidity. Accessed on April 11, 2011.
[vi] Pathfinder International. Nigeria:Projects. Accessed on April 11, 2011.