Mortality rate: any hope for “every woman every child”?

No doubt, maternal and child morbidity contribute significantly to the low life expectancy in Nigeria. With the visit of the United Nations Secretary General Ban Ki-Moon to Nigeria, Alexander Chiejina writes that addressing this health challenge requires concerted efforts from government and stakeholders.

The statistics are damning and thought provoking, especially when one considers the over used cliché “Nigeria is the giant of Africa”. Whereas, events have shown that perhaps we may not merit that tag. The latest United Nations inter-agency estimates place the 2005 average national maternal mortality ratio at 1,100 deaths per 100,000 live births, and the lifetime risk of maternal death at 1 in 18. 

When viewed in global terms, the burden of maternal death is brought into stark reality: Approximately 1 in every 9 maternal deaths occurs in Nigeria alone. The women who survive pregnancy and childbirth may face compromised health even as studies suggest that between 100,000 and 1 million Nigerian women may be suffering from obstetric fistula.

Experts have argued that disparities in poverty and health among Nigeria’s numerous ethno-linguistic groups and states are marked. Poverty rates in rural areas estimated at 64 per cent in 2004 are roughly 1.5 times higher than the urban-area rate of 43 per cent.

While low levels of education especially among women, discriminatory cultural attitudes and practices have been identified as barriers to reducing high maternal mortality rates, it has been observed that high rates of adolescent births are commonplace across Nigeria, exposing girls and women of reproductive age to numerous health risks.

Only recently, the United Nations Children's Fund (UNICEF) revealed that despite significant reductions in child mortality globally, children still die of diseases like diarrhoea, pneumonia, malaria, malnutrition, neonatal causes and HIV/AIDS.

In a chat with BusinessDay, Sara Beysolow-Nyanti, assistant country representative and chief, UNICEF Lagos Office, disclosed that more than half of these deaths occur in sub-Saharan Africa. While lamenting the rate of infant mortality across the globe, Beysolow-Nyanti noted that 9.2 million children under the age of five still die every year. 

According to her, “UNICEF has developed the concept of Accelerated Child Survival and Development Packages in order to achieve the component of the Millennium Development Goals (MDGs). The programme was initiated to ensure that the services needed by a woman from conception to delivery are created even as the agency has been working with government, community and civil society to build their capacity and achieve the goals of the organisation.”

With this health challenge, it is no surprise therefore that the United Nations, Multilateral organizations, the Nigerian government and Non-Governmental Organizations have synergised mainly to fundamentally address this health problem. This played out when Friends of The Global Fund Africa (Friends Africa) led other organizations including the United Nations Foundation to host the United Nations Secretary General Ban Ki-Moon tagged "Implementing the Global Strategy for Women's and Children's Health in Nigeria: Opportunities for Private Sector and Civil Society Engagement".

Akudo Anyanwu-Ikemba, CEO/Founder of Friends Africa opined that “the every woman, every child” project needs the collective effort is needed towards ensuring that a huge difference in the lives of the voiceless vulnerable multitude is made through support of country-led health plans, integrated delivery of health service, stronger health systems; innovative approaches to financing and efficient delivery of health services especially in less privileged regions and improved monitoring and evaluation to ensure accountability.”

For Akudo Anyanwu-Ikemba, CEO/Founder of Friends Africa, “Friends Africa (an NGO that works primarily to create and sustain visibility and mobilize strategic political and financial support for AIDS, TB and Malaria), is grateful for the opportunity to be part of a process that constantly galvanizes African private sector especially, to take responsibility and achieve results, while getting people to commit to women and children’s health all over the world.”

On his part, Ban Ki-Moon state that success will come when there is focus of attention and resources on people, not their illnesses; on health, not disease. “With the right policies, adequate and fairly distributed funding, and a relentless resolve to deliver to those who need it most – we can and will make a life-changing difference for every woman and every child,” Ban Ki-Moon stated.

In the mean time, recent research suggests that for every woman who dies from childbirth in Nigeria, another 30 women suffer long term chronic ill-health. The UNFPA estimates that 2 million women suffer vesico-vaginal fistula globally, 40 percent of these (800,000 women) are in Nigeria.

Friday Okonofua, consultant obstetrician and gynaecologist, revealed that factors contributing to maternal mortality rate have to do with lack of antenatal care, low proportion of women attended to by skilled birth attendants, delays in the treatment of complications of pregnancy, poverty, harmful traditional practices, and low status of women.

Okonofua, who is former Adviser to the President on Health, noted that all these are characterized by Nigeria’s health systems which are weak and inefficient, under-capitalized, as well as poor motivated health units that are costly and inaccessible. He noted that moving forward therefore, and in order to achieve the goals of “every woman, every child” especially as it concerns Nigeria, the government must demonstrate the Political leadership that is needed.

“The Presidency should personally commit to addressing the problem of the high rate of maternal and infant mortality in Nigeria, just like President Goodluck Jonathan did for HIV/AIDS, as evident in his speech at the United Nations during his recent visit to the United States of America. With the new administration in place now, following the conclusion of the last general election in May, there is the need for a multi-sectorial approach to be adopted whereby all sectors (Legislative Assemblies, Information, Education, Women Affairs etc) should include Mother and Child Health programming in their portfolios,” Okonofua added.

It will be recalled that the strategy for Women's and Children's Health otherwise known as “Every Woman, Every Child” which was launched at the Millennium Development Goals Summit of World Leaders in April 2010, seeks to mobilise resources and catalyse public-private partnerships to prevent the deaths of millions of women and children through enhanced engagement with the business, philanthropic and civil society communities.  Since the launch, stakeholders in the health sector have pledged to commit more funds for women and children's health around the world.

Medical causes of maternal mortality in Nigeria

Hemorrhage                -       23%

Infection                      -       17%

Malaria                        -       11%

Anaemia                     -       11%

Abortion                     -       11%

Eclampsia                   -       11%

Narrow Pelvis            -       11%

Others                          -       11%