These were the parting words of Dr S. Kailani of IPAS Nigeria in a paper captioned: “Should we let them die”, which he delivered at a grassroots mobilisation campaign held at Bodinga local government area of Sokoto State.
Maternal mortality has been a source of concern to many in Nigeria. Statistics indicate that more than half a million women die during pregnancy and childbirth every year worldwide, with 99 per cent of the death occurring in developing countries. Nigeria is said to be among nations with the highest maternal mortality rate in the world.
It was in view of the alarming rate of maternal mortality recorded in the country that the International Federation of Women Lawyers (FIDA) organised the enlightenment workshop in Bodinga council area.
Dr Kailani in his paper defined maternal mortality as the “death of a woman while pregnant or within 42 days of a 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 cause.”
He disclosed that the maternal mortality rate in Nigeria is 800 to 1,500 per 100,000 births with one-third of the incidents occurring due to deaths from unsafe abortions while two-thirds of the victims are young persons less than 20 years of age.
On maternal morbidity, he stated that for every woman who lost her life, approximately 20 more would suffer short and long term disabilities such as chronic anaemia, maternal exhaustion, vesico-vaginal or recto-vaginal fistulae, ectopic pregnancy, infertility and chronic pelvic pain among others.
Kailani who lamented that the factors that lead to maternal mortality are largely preventable, identified medical, socio-cultural, health service and reproductive factors as being responsible for the high maternal mortality rate in Nigeria.
He said the direct causes of maternal mortality include haemorrhage, unsafe abortion, infection and obstructed labour, adding that women and children die under what he termed: “The Three Delays.”
The first delay, he said is in the home and community where there is lack of information or inadequate knowledge about pregnancy and labour complication signals. The second delay, according to him, is the inability to access a health facility due to the location of health facilities, poor roads and communications network, and poor community support. Lastly, he said, the third delay is between the time of arrival and accessing services at a health facility.
Dr.Kailani expressed concern that maternal deaths were all the more tragic because it affected young women who were healthy but die during what should be a normal process and that the deaths could be prevented in simple, and cost effective ways.
“The trend is decreasing in the developed countries such as in Scandinavian countries and the USA while improving in some developing countries like Cuba, Egypt, Tanzania and Bolivia; and is worsening in Nigeria and many other developing countries”.
Kailani stressed that what is needed is the political will to tackle the problem, maintaining that strategies to reduce maternal mortality rate include proper management of pregnancy and its complications, addressing the socio-cultural and political barriers to maternal health.
Dr Kailani also called for the improvement in infrastructure in the country, overhauling of hospital equipment, improvement of health providers’ remuneration and incentives to rural health practitioners.
“To halt this major cause of premature death and high disability of our women, all hands must be on deck,” he added.
Also speaking, Dr Tunau Karima of the department of obstetrics and gynaecology, Usumanu Danfodiyo University Teaching Hospital, Sokoto, named abortion as one of the commonest gynaecological emergencies, as according to her, unsafe abortion ranks as the fifth cause of maternal death in Nigeria.
She stated that about 13-50 per cent of all maternal deaths are due to complications arising from unsafe abortions.
“Unsafe abortion is a leading cause of death in women world wide. It is estimated that about 500,000 women die annually as a result of complications of pregnancy or childbirth. That is to say one woman dies every minute. The WHO has estimated that Nigeria is second only to India as the world’s largest contributor of maternal deaths. “Nigeria is only 2 per cent of the world’s population but accounts for 10 per cent of the global maternal deaths. This is indeed alarming,” she said and asserted that it is unacceptable to allow women die of circumstances relating to pregnancy and childbirth in the present age of enlightenment, and considering available human, and material resources.
“When a woman dies as a result of complications of pregnancy and childbirth, her right to life and right to health care and protection have all been violated. When a child dies of malnutrition, his right to life and right to health care and protection are all violated and we can go on and on”, she stated.
She pointed out that unsafe abortion did not only occur in adolescents or single women. Studies, she disclosed, have shown that a significant proportion of cases of unsafe abortions occur in married women in mutually faithful relationships who have had unplanned pregnancies that they were not yet ready for.
Dr Karima further gave the Islamic perspective of abortion, saying that “while Islam permits preventing pregnancy for a valid reason, it does not allow terminating it once it has already occurred. An abortion may only be permissible under certain conditions like the life of the mother is threatened by a medical condition and there are severe congenital abnormalities incompatible with life”.
The FIDA/IPAS grassroots enlightenment campaign also focused on the issue of domestic violence in Nigeria. In a paper titled: “Domestic violence in Nigeria: Legal and Islamic law perspective”, Dr Mansur Ibrahim Sa’id described domestic violence as “the infliction of direct or indirect harm, threats or violence on one individual by the other, in most cases the male on female”.
The practice, he observed is “abhorable and did not meet the basic tenets of civilisation, fairness and humanity.” Speaking on the legal framework, he said the starting point is the 1999 constitution.
“The constitution emphatically guarantees the safety and protection of citizens in the broadest sense. This includes both genders. Fundamentally, the rights of citizens have been guaranteed under the constitution. It is therefore clear that the constitution will not in any way condone domestic violence in whatever form it may be perpetrated,” he added.
He cited section 32 of the constitution which states that “every individual is entitled to the respect of his dignity.” Dr Sa’id observed that a subtler form of domestic violence may be disguised under the framework of discriminatory practices.
“This is the indirect form of domestic violence .while perpetrators may not directly inflict pain on the victims, the form of abuse may assume a number of discriminatory practices directed against the spouse or partner,” the expert stated.
He said silence as espoused by culture and tradition is one of the most important factors militating against the complete elimination of domestic violence.
“Cultural norms prescribe silence by the female partner who may have suffered abuse or violence against her person or children. This is an especially retrogressive culture which is not sanctioned by any Islamic tenets; it is also not sanctioned by our laws,” he maintained.
He also identified ignorance on the part of the victims, pointing out “victims of domestic violence have no inkling that the practice is not one that is to be condoned by society. This is somehow tied to their level of education.
“It is apparent that no serious attention is given to complainants of domestic violence. Very often police who should be the first refuge of victims treat them with disdain and even mock such victims by telling them that it is family affairs and they cannot intervene. In reality their intervention is necessary to safeguard the victims and by extension the society.”
The way forward according to him is through proactive pubic enlightenment campaigns, education of spouses, and the establishment of special law enforcement units for investigation and prosecution.
Dr Sa’id stressed the need to purge domestic violence from the society as it “demeans the institution of marriage, breaks homes and inflicts untold pains and sufferings on the victims and by extension, society.”