Why maternal mortality is high –Experts

Adenike Ogungbe
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The death of Adenike Ogungbe, Chief Executive Officer of Ewar Makeovers, a day after giving birth, was a shock to many, bringing to mind the plight of many women in labour, writes MOTUNRAYO JOEL

News about the death of renowned makeup artist and CEO of Ewar Makeovers, Adenike Ogungbe, came as a shock to those who knew her.

Ogunbe, who was known for do-it-yourself makeup tips, died at Lantoro hospital, Abeokuta, a day after giving birth to her child. Reports say she had the baby through a cesarean section, but died from complications.

There are several stories of women who died during childbirth. The situation in Nigeria seems to be more depressing as the World Health Organisation recently identified that about 80 per cent of the total maternal deaths recorded in the world are preventable and prevention only takes simple conscientious planning and multi-level collaboration.

According to UNICEF, everyday, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age which makes the country the second largest contributor to the under–five and maternal mortality rate in the world.  Although many of these deaths are preventable, the coverage and quality of health care services in Nigeria continue to fail women and children. Presently, less than 20 per cent of health facilities offer emergency obstetric care and only 35 per cent of deliveries are attended by skilled birth attendants.

In a report, the Country Manager, Save the Children International, Susan Grant said “Nigeria has one of the highest numbers of maternal and newborn deaths and each year 40,000 women die during pregnancy and childbirth and over 259,000 babies die in their first month of life.”

In July 2012, the Nigerian was one of those in attendance at a summit which proposed to ‘mobilise global policy, financing, commodity, and service delivery commitments to support the rights of an additional 120 million women and girls in the world’s poorest countries.’

The aim of the summit was to revitalise global commitments to family planning and access to contraceptives as a cost-effective and transformational development priority, improve the access and distribution of contraceptive supplies and remove and reduce barriers to family planning.

Health experts, however, say half of Nigeria’s maternal deaths are due to postpartum haemorrhaging, which unskilled health workers lack the know-how or equipment to stop.

A gynaecologist at the Lagos State University, Dr. Adebayo Kayode, said Nigeria’s health care system still lacked facilities for emergency.

He said, “Some of the teaching hospitals and private hospitals are trying in the area of emergency, but a large number of our health care systems don’t have the facilities that deal with emergency. The reason why maternal death in developed countries is low is because they have been able to take care of preventable causes of death.  The unfortunate cases of maternal deaths that happen in these countries are cases they can’t handle.”

Kayode said until Nigeria reaches this level, there will be the issue of maternal deaths. “We need to work towards preventable causes of maternal death during child birth.  For example bleeding during labour is a case that can be dealt with.  We are yet to know the actual cause for Adenike Ogungbe’s death but cases such as this is on the increase,” he added.

Dr. Gbenga Alaba, noted that some factors that contribute to the increase in maternal death include illiteracy and over confidence.

He said, “Many of our women still seek the help of unprofessionals to assist them in the area of labour. You will be surprised to hear that some pregnant women come to ante-natal clinics but they will decide to do it their own way when it is time to give birth. Poverty is another factor. Some do not have the required funds to go to where there are adequate medical services. They prefer to seek assistance of local midwives.

“Also, when a woman is over confident, just because she had given birth to five other children in the past, she may rupture her womb and bleed to death if she decides to have a child on her own. Vaginal delivery after caesarian operation could be another factor. It is always advisable for someone who had undergone caesarian operation to seek the help of the obstetricians if she desires vaginal delivery and the onus is on the doctor to decide whether to allow it or not. But after telling some women that they will undergo caesarian section again, they will abscond to other places where they will want to deliver through the vagina which may lead to rupture and eventually, death of the patient.”

Alaba further identified lack of regular ante-natal visits as a major factor causing an increase in maternal deaths.

“There are some tests that are necessary during gestation period but if there is someone who does not visit clinics regularly, she may miss out on these tests and eventually come down with obstetrics emergency which may lead to her death. The use of untried drugs is a risk factor. It is common in Nigeria for people to experiment with drugs that are not approved or yet to be approved by the regulating bodies,” he said.

Alaba added that both care givers and patients were to blame for the increase in maternal deaths.

“The care giver should know his limit and send the patient to a place where there are adequate experts especially when he realises that he cannot handle the case. And for the patient, she should try to avoid the above factors. If this simple measure is implemented, there should be a decrease in maternal deaths,” he said.

In her opinion, Dr. Tosin Adeyemo urged the government to subsidise health care for pregnant mothers. “The average woman on the street cannot afford three square meals and yet she is required to purchase a myriad of things during the antenatal period and after delivery. Whether it’s at private or government level, there’s no free health care. And when she realises that she has to pay for so many things, she probably would opt for traditional birth attendants or even attempt to deliver at home.

 “The woman has no idea how the delivery will turn out, if she opts for traditional birth attendant or self-delivery. When anything goes wrong, they will attempt to salvage the situation by themselves and most times, this becomes fatal. They are often rushed to a near-by health centre for resuscitation or treatment after the attempt goes wrong. After child delivery, the woman still requires money for so much including her health and that of the baby. If health care for pregnant women is subsidised, it will go a long way in reducing maternal death.”

How to reduce maternal mortality

1. Women must have access to skilled care before, during and after they give birth.

2. Health providers must be trained in emergency obstetric care. Health centers and clinics must have surgical supplies to handle complications.

3. Maternal health-care systems must be strengthened, and communities mobilised and educated to improve deliveries in birth clinics.

4. Skilled community-based birth attendants should be trained and posted to increase maternal coverage in remote areas.

5. Give incentives to health providers to motivate them to do their job effectively.

6. Contract with private organizations to deliver maternal health-care services. This will ensure rural areas are covered and will reduce supply shortages–but attention must also be paid to the quality of service provided.

7. Educate and empower women and girls about maternal health issues. They compose two-thirds of the world’s illiterates and 70 percent of the world’s poorest people. Educated and empowered women can lead healthy lives and can lift their families out of disease. They usually marry later, and have fewer and healthier children who are more likely to attend school.

8. Empower women’s groups so they can deliver political success and tangible health outcomes.

9. Launch professional, well-informed advocacy groups to call for action on maternal health.

10. Implement streamlined and evidence-based maternal health interventions.

Source: msmagazine.com