How to reduce maternal and child mortality rate in Nigeria

At a recent gathering of pen professionals and press briefing by a collective of health-oriented Non-Governmental Organisations, under the aegis of Mothers and Beyond International with the support of the UK Department For International Development (DFID), fearful details about the status of the health care delivery system of Nigeria were revealed, though expressed shock but showing on how to ensuring the reduction of these unwarranted morbidity and mortality rate in the country.

According to Bolaji Adepegba, the Founder/Representative of Mothers and Beyond International emphasised that critical and bold step need to be taken in reducing Maternal, Newborn, and Child Mortality Health (MNCH) in Nigeria, as the state of health of women, babies and children in the country is really below acceptable global standards.

She added that statistics are abysmal and the realities are worse, but efforts of authorities do not seem to have yielded significant and positive results over the years. The society at large appears to be at a crossway about what to do, and the major factor in all of this is the dearth of knowledge in the existing systems.

Though, in her submission, she pointed out that the role of the media in promoting Maternal, Newborn, and Child Health (MNCH) in Nigeria is clearly imperative and major as the people are highly depend on the media for information. The media has left the level of information dissemination only to become community rally points.

Between 80 and 85 percent of health related issues in Nigeria affect women and children. Nigeria was declared 189th worst nation on some basic health indices. About 200 of every 1,000 Nigerian children die from malaria, pneumonia, and diarrhoea before their fifth birthday. Only five die in America.

Results of Goals 4, to reduce child mortality; 5, to improve maternal health; and 6, to combat HIV/AIDS, malaria and other diseases, of the recently rested Millennium Development Goals (MDGs) programme were just short of dismal for Nigeria. For example, by 2008, only 5.5 percent of children slept under insecticide-treated mosquito net.

The Goals 5, to improve maternal health in the country, but do we really working towards achieving this goals? Maternal mortality refers to deaths due to complications from pregnancy or childbirth. From 1990 to 2015, the global maternal mortality ratio declined by 44 percent, and everyday, approximately 830 women die from preventable causes related to pregnancy and childbirth; 99 percent of all maternal deaths occur in developing countries.

Maternal mortality is higher in women living in rural areas and among poorer communities, the maternal mortality ratio in developing countries in 2015 is 239 per 100,000 live births versus 12 per 100,000 live births in developed countries. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.

A woman’s lifetime risk of maternal death- the probability that a 15 year old woman will eventually die from a maternal cause- is 1 in 4900 in developed countries and 1 in 180 in developing countries, but in countries designated as fragile states, the risk is 1 in 54; showing the consequences from breakdowns in health systems.

Women die as a result of complications during and following pregnancy and childbirth, the major complications that account for nearly 75 percent of all maternal deaths are; severe bleeding (mostly bleeding after childbirth), in fictions (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortion.

Five women die of childbirth every hour in both rural and poor urban centres in Nigeria. This is because most pregnant women have little access to health facilities; are too young, especially in Northern Nigeria; do not space their pregnancies; or do not feed well. With fewer children, the food goes round, and the ravage of breastfeeding on malnourished mothers are reduced.

Family planning facilities and delivery that can reduce maternal death are inadequate. Again, the Nigerian state fails to provide counterpart funding to complement the foreign donors. And sometimes, donated family consumables are abandoned by callous state agents. Most Nigerian women now seek alternative herbal medicine, not out of choice, but because the private hospitals are far too expensive, relative to government hospitals that lack requisite drugs, and keep them all day on the Out Patient Department benches.

Because section 33(1) of the Nigerian constitution guarantees right of life to all. It is a constitutional responsibility for the Nigerian state to ensure that feeding and health care, both basic requirements for life, are available to all Nigerians without discrimination, always. One rule of thumb to achieve this is to concentrate on the health issues that concern reproduction (or pregnancy), mothers, newborn babies, and the adolescents children. In the long terms, this strategy reduces general mortality rate, it also guarantees a healthy and productive citizenry.

There are many pregnant women in distance villages with no access to health care or facilities for delivery, these women either give birth in their homes unattended to or are hurried off to the nearest town, which maybe several miles away in searching of maternity clinics or hospitals, and that is, provided they have the right means of transportation, good roads are also scarce in some of these places.

Women education, which must include enlightenment programmes on immunization, adequate feeding, family planning, spacing of children, and general health information, must be intensified. Somebody said if you educate a woman, you educate a nation.

A systematic review from 1990 to 2014 on Maternal Mortality, Newborn and Child Health (MNCH) intervention in Nigeria by Mothers and Beyond International in conjunction with UK Department For International Development (DFID) indicated that over thirty (30) policies have been developed in Nigeria since 1990 this date and development of integrated maternal, newborn and child health strategy was in 2007.

One of the recent most effective policies was on the use of magnesium sulphate for management of pre-eclampsia (2010) and national Maternal Mortality Rate (MMR) has consistently reduced during the period (1990-2014) With a marked/sharped decrease in the last decade. But, in spite of the progress the number of women who die in pregnancy or from complications associated with childbirth remains significantly higher in Nigeria.

It is advocated that the concentration and integration of maternal health interventions targeting high risk and vulnerable points during maternity care minimises morbidity and mortality, the downward trend in the under five mortality also corresponds with the implementation of MNCH intervention and the study has shown that 38 (67.3%) MNCH interventions were implemented for less than two years.

The menfolk, religious leaders, and traditional leaders should be recruited into the vanguard to save the Nigerian women and child. A constructive engagement of the menfolk, who have immense authority, as husbands and policymakers, in Nigeria’s male-oriented environment is critical to health care delivery.

Meanwhile, the federal budgetary allocation to health is tapering year after year. Most of the paltry 4.13 percent allocated to health in the 2016 budget went to recurrent expenditure. We don’t even want to know the figure in Naira. Yet, less financially endowed African countries allocate way above 15 percent of their budgets to health care; Burkina Faso, 15.8 percent; Zambia, 16.4; Malawi, 17.1; Botswana, 17.8; and Rwanda, 18.

The provision of the Nigerian Health Act of 2014 that at least one percent of the Federal Government’s portion of the Consolidated Revenue or Federation Account Allocation be directed to health care is observed in the breach.

The dilapidated health facilities in most government hospitals compel higher budgetary allocation to capital projects than recurrent expenditures like travelling allowances, meetings, workshops, and retreats. Government policies must create an enabling environment for increased local production of drugs, equipment, and other medical consumables.

Section 17(3)(d) of Nigeria’s constitution provides that “the state shall direct its policy towards ensuring that there are adequate medical and health facilities for all persons.” State actors, who as humans are also susceptible to illnesses, must address this provision with the passion it deserves. An appreciation of the nexus between health and economy better persuades the unwilling to make adequate budgetary allocation to the health sector.

***Orunbon, a public affairs analyst, wrote in from Federal Housing Estate Olomore, Abeokuta