“Women are not dying because of diseases we cannot treat; they are dying because societies have yet to make decision that their lives are worth saving” -Prof Mahmoud Fathallah.
This quote by Professor of Obstectrics and Gynaecology and past President of the International Federation of Gynaecology and Obstectrics (FIGO) was made in 2006 during the era of the MDGs. Yet here we are, seventeen years later discussing the same issues.
On the March 21, 2023, the Africa Center of Excellence for Population Health and Research (ACEPHAP) and Center for Infectious Diseases (CIDR), BUK in collaboration with Rand Corporation USA and Marks family Foundation held a Maternal, New-born and Child Health (MNCH) summit in Abuja. This year’s theme was titled ‘Towards an improved MNCH in Nigeria, working together is Key.’
As part of the summit, key presentations as well as panel discussions were held addressing issues of maternal mortality, infant mortality and health challenges of women and children affected by insecurity in the country.
Presently, the world is at a critical point with less than 10 years to SDG 2030. Maternal and newborn health risks getting lost amidst multiple competing health priorities as countries transition through different stages of the COVID pandemic response.
Although, we have made great strides in reducing the indices, in the year 2020, an estimated 287 000 women globally died from a maternal cause (a third lower than 446,000 in 2000). Currently, the global maternal mortality rates are estimated at 223 maternal deaths per 100 000 live births (34.3% reduction in 20-year period). This translates to almost 800 maternal deaths every day, and approximately one every two minutes. In comparison to most developed nations of the world, Nigerian women are 500 times most liable to lose their lives during childbirth. The ripple effect of this dilemma is evident on the socioeconomic development and negates the achievement of the sustainable development goals.
Africa continues to top the chart and suffers from the highest rates of child mortality. Although in retrospect, Africa has reduced maternal deaths and under-five mortality by 41% and 33% respectively. In Sub-Saharan Africa, Nigeria had the highest estimated number of maternal deaths, accounting for over one quarter (28.5%) of all estimated global maternal deaths in 2020. The only countries that come close to these figures are India (8.3%), Democratic Republic of Congo (7.5%) and Ethiopia (3.6%).
These percentages are presented as only figures in our minds until we remember that they are our sisters, mothers, daughters and families that are losing their lives due to something as natural as childbirth. As I listened to Professor Hadiza Galadanci speak passionately about women bleeding to death from conditions that could have been diagnosed during antenatal care visits, I saw a few people in the audience hurriedly wiping away tears.
The most important question she asked was ‘Why?’
Why are we still having these figures? Why, despite knowing the causes of obstetric complications and knowing how to treat them are we still having these preventable deaths? Why are women still dying from post-partum haemorrhage despite life saving drugs and procedures being available since time immemorial?
It was a rhetorical question.
The answer is simply as Professor Mahmoud said years ago, that societies have yet to make the decision that women’s lives are worth saving.
All the English we speak about ensuring quality training of health workforce, setting standards for quality care, adherence to guidelines and protocol, ensuring supervision, monitoring and mentoring of health care workers and guaranteeing our training institutions to have all the necessary manpower and equipment to ensure quality training as well as advocacy for women’s health and rights are all hogwash without political will.
And against this backdrop of high mortality rate is the problem of insecurity as it affects women and children. The Boko Haram humanitarian crisis has led to over 37,500 deaths with 2.4 million internally displaced citizens with severe impacts in Borno, Adamawa, Yobe and Gombe predominantly leading to physical and food insecurity. The venomous effects of conflict on maternal and child health have a broad expanse such as lack of shelter, safe and sanitary facilities, food shortage, dearth of healthcare personnel, reduced access to quality health services and of course, an increase in gender-based violence.
Insecurity, banditry and kidnapping have negative concomitant impact on the Nigerian economy with an overwhelming negative effect on health resources and worsened health indices. Insurgents have left over 788 dilapidated health facilities in the northern region. Taking into consideration Borno state, 48 health workers have been killed with 250 injured, the state has lost over 40% of its facilities with only a third been functional. Within the state, a relative amount of health facilities remains inaccessible and 80% of the state is considered to be “high risk”, seriously compromising the ability of government authorities, UN agencies, and non-governmental organizations (NGOs) to deliver goods and services as well as responsiveness.
At present, as many as 7.1 million people, at least 50% of whom are children, are estimated to be in need of humanitarian assistance. The depleted healthcare workforce stands to be a major limitation in health service delivery as most health workers are unwilling to take up roles or resume appointment. This declination is affiliated with recurring insecurity and volatile nature of work locations.
By this, many women are prone to sickness and the health service which already is in a state of coma hinders access to comprehensive reproductive health care that are set in place to increase chances of women survival during pregnancy, enable them to have healthy children and balanced family.
The whole situation is pathetic and disheartening.
Admittedly, the maternal mortality rate has reduced over the years, but we are nowhere near achieving the target of SDGs in 2030. The stagnation in the decline of our indices should be a source of worry and sleepless nights to our leaders. It is a darn shame that in 2023, women in rural areas and hard to reach areas are dying because of the complications of obstructed labour. Everyday, I hear of women been transported in wheelbarrows, donkeys and makeshift carriages to the nearest PHCs only for them to be denied care because basic amenities are not in place. Or when they are, the drugs available are fake.
Prof Galadanci told a story about administering oxytocin to arrest bleeding in a woman after delivery, but the woman continued pouring until they resorted to other means. Turns out the oxytocin administered was fake and made up of primarily of mixed water.
May the soul of Dr Dora Akunyili rest in peace, amen.
You see, these problems will always be there.
The constitution of the federal republic of Nigeria 1999 (as amended) is the major legislation that provides for the protection of all citizens of Nigeria. This is even as Nigeria is also signatory to many international and regional conventions on this subject matter. There are other existing laws specifically governing the protection of women and children, particularly, the violence against persons (prohibition) act 2015 and the child rights act 2003 (operating at the federal level) and the gender and equal opportunity bill. However, these bills have not been signed into law.
The bitter truth remains that women and children will be better protected if these laws are domesticated and implemented. Nigeria needs to improve awareness on the importance of use of maternity health care services, raise awareness on harmful traditional practices and hold the policy makers as well as the health care practitioners and other stakeholders accountable for the poor maternal and child health services.
Then and only then can we truly tackle the menace that is maternal mortality.
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