• NMA, doctors warn that UNICEF’s 22,000 annual mortality figure is no fluke
By Cosmas Omegoh
Recently, in Lagos State, a young man, Tony (not his real name) was inconsolable and rightly so. Life meant nothing to him anymore. His world had almost come to a screeching halt or so it seemed. Reason: he lost his wife in her first childbirth.
That fateful morning, Tony also lost the twin babies – a boy and a girl – his wife was in labour to deliver before her passage. He was simply out of his mind. The air around him smelt death and distress. He couldn’t make out how he arrived at such crossroads. As he starred into space, relatives and friends helmed in on him as the tragedy that befell him continued to break like dawn. His wife for 18 months was gone.
The United Nations Children’s Fund (UNICEF) recently startled Nigerians who are still sensitive to shocks with a staggering figure of women who die every day and year in the course of childbirth.
The global body at one of its recent sessions disclosed that 82,000 Nigerian women annually die from pregnancy and childbirth-related complications.
According to UNICEF’s Nigeria Chief of Health, Eduardo Celades, a new global maternal mortality report indicates that on the average, Nigeria’s daily maternal mortality figure stands at 225. And probably, Tony’s wife was a part of that ugly figure.
Ordinarily, this is a revelation that will trigger a big shock wave in any health sector. But probably not in Nigeria!
NMA’s reaction
Shockingly, the Nigerian Medical Association (NMA) declared UNICEF’s pronouncement as no news. It went on to make more startling revelations about mortality rates in the country.
NMA’s President, Dr Uche Oginmah warned that the UNICEF mortality figure could be much higher as long as the Nigerian government continued to pay lip service to the health sector needs.
Listen to him: “We have been talking about this incident for a long time. I’m surprised that many people were not getting it until now.
“Truth be told, we have one of the highest maternal mortality rates, infant mortality rates and under five mortality rates in the whole world.
“As it stands, we are competing with war-torn countries in mortality rates.
“The fundamental thing is that it is pitiable that in Nigeria of today, women are still dying during pregnancy or immediately after delivery. It is a very sad development.”
Then he added: “Of course, that cannot change until Nigeria begins to pay attention to the health sector.
“We had said this over and over again. You cannot earmark a paltry two per cent of your annual budget for the health sector. That cannot work especially in an underdeveloped country that has no structures as it pertains to equipment and facilities, not to talk about taking care of people working in the health sector.”
He expressed sadness that the Nigerian government and other countries sometime ago met in Abuja and agreed to set agenda for themselves to improve their health systems.
“No one forced them to set aside 15 per cent of their annual budget for the health sector improvement. “But the Nigerian government has refused to focus on that area.”
It was the NMA boss’ view that the health sector would continue to depreciate because quality manpower was being lost every day.
“What is happening now is bound to happen. Nigerian doctors and nurses are leaving the country in droves because they are not well paid. The security of the healthcare professionals is very bad. Doctors are being killed. Doctors are being attacked by patients and their relatives for challenges that are not the doctors’ fault. Yet no body is doing anything about that. Remuneration is poor; the equipment are not there.
“Sadly, those who would have rescued the situation are gone. And now, the doctor-patient ratio is quick shocking. Rather than having 1-50, we now have 1-5,000.”
He, therefore, appealed: “We implore everyone to help us tell the Nigerian government that women and children are dying. The NMA is not happy about this at all because our job is to protect the interest of the doctors, patients and the citizens. We are getting tired of repeating ourselves.”
Causes of maternal mortality among women
A medical missionary, Rev. Sister (Dr) Luciana Agba expressed sadness that Africa and Nigeria in particular has continued to experience rising death figures during and after pregnancies despite regular improvement in medicine.
“This is a sad commentary for Nigeria and Africa,” she said, adding that “we hope that the relevant authorities will rise up and do the needful and help doctors to save lives.”
She noted that several factors could cause a woman to die either before, during or after she had given birth, maintaining that some of the complications that might arise could be managed with good care.
According WHO, “most of the complications developed during pregnancy are preventable or treatable. Other complications may exist before pregnancy, but are worsened during pregnancy, especially if not managed as part of the woman’s care.”
The body noted that “major complications that account for nearly 75 per cent of all maternal deaths are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery; and unsafe abortion.”
How women’s lives can be saved
WHO warned that to avoid maternal deaths, it is vital to prevent unintended pregnancies.
While listing some of the risk factors that could be easily taken care of, it noted that “most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known.
“All women need access to high quality care in pregnancy, and during and after childbirth. Maternal health and newborn health are closely linked.
“It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the women as well as for the newborn.”
It further warned that “severe bleeding after birth can kill a healthy woman within hours if she is unattended.
“Infection after childbirth can be eliminated if good hygiene is practised and if early signs of infection are recognised and treated in a timely manner.”
Most women who die during childbirth
According to Dr Ojinmah, some women die because they live in remote communities where there is poor road networks or even in creeks.
“We need good road networks. We need to improve our water ways so that people can have easy access. In some riverine communities, if a woman goes into labour at night, she needs to be evacuated quickly,” he said.
WHO on its part, is unhappy that “poor women in remote areas are the least likely to receive adequate health care.
“This is especially true for regions with relatively low numbers of skilled health care providers, such as sub-Saharan Africa and Southern Asia.”
According to the body, “the latest available data suggest that in most high income and upper middle income countries, approximately 99 per cent of all births benefit from the presence of a trained midwife, doctor or nurse.”
It noted that the situation is not the same in countries with weak health systems such as Nigeria where “health system failures translate to poor quality of care, including disrespect, mistreatment and abuse, insufficient numbers of and inadequately trained health workers, shortages of essential medical supplies; and the poor accountability of health systems.”
Nigerian govt’s intervention
It was learnt that as part of the Federal Government of Nigeria’s effort at reducing maternal mortality in the country, sometime ago, it launched the Nigeria Reproductive, Maternal, Newborn, Child, Adolescent and Elderly Health Plus Nutrition (RMNCAEH+N) platform.
According to reports, the programme was intended to improve the well-being of women, children, adolescents and elderly in the country.
According to the Minister of Health, Dr Osagie Ehanire, that intervention in the lives of women and children would support the overall socio-economic development of the country.
He admitted that: “Our health indices are unacceptably poor and there are emerging issues around gender, public health emergencies and, most recently, the COVID-19 pandemic.”
Earlier in 2017, the then Minister of Health, Prof Isaac Adewole had set up a task force to handle reduction of childbirth related death in the country.
The task force focused on the states of the country where maternal mortality cases were highest.
However, doubts exist as to the impact such intervention programmes and the fruits they yielded before now.
What to do to remedy the situation
It was Dr Ojinmah’s considered view that the right solution to the Nigerian health sector debacle is “to appropriately focus on the right things.
“A long time ago, we had a good health care system. Under the watch of the late Prof Olukoye Ransome Kuti, we established functional primary healthcare centres.
“Now, unfortunately, those primary healthcare centres are gone. We need to re-establish them. We need to have doctors attached to them. This is very important.
“Now, most of those women who are dying of pregnancy-related incidents are mostly in the rural areas. They need primary healthcare services.
“Besides, we need universal health insurance scheme. Universal health insurance coverage is vital. In a situation where Nigerians spend a high percentage of their income on healthcare is not sustainable.
“Anyone who is not listening to this might not understand what Nigerians go through until they have a relation as a patient or they are down with one ailment or the other – and without an income. Automatically, they go into penury. Therefore, we need a national insurance scheme that is functional. The government needs to make it work.
“Now, the government is talking about petrol subsidy removal, it is our prayer that when that is done, it will channel a part of the proceeds into the health sector to make it optimal and functional.”
Then he urged the government to pay doctors and nurses well so that wave of brain drain would be minimised.
What women should do once pregnant
As a way of minimising maternal mortality across the country, here is Dr Ojinmah’s advice. “For starters, they should know that pregnancy should be planned. You don’t just get up and say ‘oh I’m pregnant.’ That should be planned. Prepare your body to carry the pregnancy and also ensure that there is money to take care of the pregnancy.
“Our women ought to know that once they are pregnant, they must approach a doctor for a guide.
“Some women don’t understand that some pregnancies are risky and how much they need care from the early stage.”
Similarly, Dr Olugbenga Agbajie advised women to visit at least the primary health centre in their locally in their area for medical advice.
“Once a woman is pregnant, she needs special care from a qualified health professional.
“She should not sit back at home and keep taking concoctions. Some of those local mixtures can complicate things in the course of the pregnancy,” he added.