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HEALTH-NIGERIA: Little Progress on Maternal Mortality

Ibrahim Abdul'Aziz

YOLA, Jul 30 2008 (IPS) - Over half a million women die in childbirth annually around the world, according to the World Health Organisation. Nigeria alone accounts for 10 percent of these deaths.

Jummai Ya'u is a mother of four children, and a resident of the village of Lafia-Lamurde in northeastern Nigeria. She has been to a hospital exactly once in her life, when she registered for pre-natal care during her first pregnancy. She never made it to those appointments because she couldn't afford the fees. Her eldest child was born in a corner of her home.

She didn't even bother to register for her subsequent pregnancies. Instead, she took herbs given to her by the traditional birth attendant who practices in Lafia-Lamurde. Ya'u is the healthy mother of four children now, but for many other women in Nigeria, childbirth is a tremendous risk.

Health professionals in the north of the country say there are many reasons why pregnant women do not have assistance from trained medical personnel. These include the absence of health facilities in rural communities, and bad roads preventing easy access to facilities in nearby centres.

Abare Galadima is the regional manager of the Abuja-based Society for Family Health (SFH), which works closely with local public health offices to improve the quality of health care and treatment. According to him, "it is not that the region does not have health professionals. It does, but the trouble is that they tend to be clustered in state capitals and other major towns."

Galadima says another factor increasing the rate of maternal mortality is the young age at which many women in the north have their first pregnancy. "A woman should not start having children too early in life because if a woman's body is not ready to receive pregnancy, the likelihood that they should start having children at about the age of 18 or older. Also, many women in the north will not allow a male doctor to attend to them during delivery."

According to the most recent estimates from the World Health Organisation, published in 2007, Nigeria's maternal mortality rate is the second highest in the world, after India: 1,100 maternal deaths per 100,000 live births. The country is home to two percent of the global population, but 10 percent of all maternal deaths take place here.

Dr Arabi Tukur, a gynecologist based in Yola, capital of the northeastern state of Adamawa says almost half of maternal deaths can be attributed to haemmorhage immediately after childbirth.

"Post-partum is the most dangerous period. The treatment should be taken immediately when the bleeding starts. Even small cottage hospitals, I believe, have such medication available – drugs, intravenous estrogen, and intravenous fluid curettage and other tools. But the treatment must begin within two hours to be effective," Tukur told IPS.

But family members in rural areas often do not take immediate action to get women to hospital. The low status of a daughter in-law in northern culture, or a simple lack of money to pay for treatment or transport may lead to the delay.

"She will be rushed to the hospital at the last minute, and by that time, it is too late to save her;" says Arabi.

Providing an overview of the situation in northern Nigeria at a roundtable organized for women politicians in the region's largest city, Kano, Dr Hadiza Galadanchi agrees that delays in seeking treatment that often prove fatal; in addition to the social position of women, she says delays are due to inadequate knowledge of danger signals during pregnancy and labour and simple inaccessibility of health care sites.

Galadanchi, a gynecologist at the Aminu Kano Teaching Hospital, told women politicians at a roundtable organised by the Development Research and Project Center,a research centre that the Northwest has the second highest rate of maternal mortality in Nigeria. She asserted that the "estimates of maternal deaths are under-reported by as much as 50 percent because maternal deaths are more often than not counted at all."

Nigeria slow to improve

"What we need most is to raise awareness in the rural areas to practice safe motherhood. This is possible even in a dicey situation like ours," Ustazu Mu'azu Gombe, coordinator of Ahlul Bayt Muslim community, told IPS. The group works to bring behavioral changes in the society and is collaborating with government agencies and other NGOs to achieve desired results.

Ustaz Gombe says success in promoting family planning and the importance of trained medical assistance for child birth depends on how NGOs deal with the specific cultural and religious practices of people in the north.

He says his group is making headway: "(As for) the issue of religion, what we have started doing is to work with other faith-based organizations to help us in propagating this information, we are also working very closely with some traditional organizations and community based agencies which are also helping us to make information widely available to different groups of people" he said.

The Islamic scholar adds that Muslim faith-based groups accept that family planning, contraception as well as male doctors examining women are consistent with Islamic teachings.

His group and others are working with the Nigerian government and several international organizations to help Nigeria meet the U.N.'s Millennium Development Goals to cut maternal and infant death rates by three quarters by the year 2015.

Two forums were convened by northern state governors in November 2007 – on health – and march 2008 – on education -have outlined policy changes that could accelerate progress towards this goals. The governors committed to providing free pre- and post-natal care; free services for children under five and free compulsory education for girls up to the senior secondary school level.

"Certainly financially resources are not a constraint," Usman Garba Santuraki, a social commentator based in the northeastern town of Jimeta told IPS. "The total federation account allocated to the 19 northern states from 1999 to 2007 is 2.4 trillion naira (100 million dollars). What is lacking is the political will and public commitment. If the governors muster the political will, there is hope that the world will witness appreciable progress on the attainment of the MDGs."

But he emphasised that achieving this target cannot be left to government alone. "The government does not have to bear all the financial and logistic responsibilities. The community can equally help. This is perhaps our only hope and the most practical solution."

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