By Lola Seriki- Idahosa, Kaduna, NorthWest, Nigeria
Over two thousand women Kaduna State die annually from birth related complications , this is according to findings by a non-governmental organisation, Nigerian Urban Reproductive Health Initiative, (NURH) and the state’s ministry of Heath and human services.
The NURHI Project Director, Moji Odeku, said the figure was obtained from a survey carried out on women dying from birth related complications in 2011 and 2012.
She attributed the huge loss of life to early-age and late-age birth, lack of child spacing and access to health care facilities among others.
Consequently, most women who are poor, are very vulnerable to illness, disability and even death owing to lack of access to comprehensive health services, particularly reproductive health services.
These women need good quality reproductive health services, such as medical care, planned family size, safe pregnancy, delivery care and treatment and prevention of sexually transmitted infections like Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).
Sadly, For many women in Kaduna, a state with one of the highest maternal death rates in the country, the prospect of giving birth can be scary.
A pregnant woman
According to the U.N. children’s organization, UNICEF, more than 150 women die every day in pregnancy-related cases in Nigeria, while the same figure is recorded in Kaduna every month.
It’s no wonder many pregnant women worry about coming out of the hospital or clinic alive. One of the causative factors according to findings is lack of adequate facilities, poor remuneration of healthcare personnel in most public hospitals.
Mrs Tina Auta, a mother of three, is one of such women that have issues with child birth, “I almost died of childbirth complications during my first delivery,” she says. “I was afraid during my second delivery. I remembered my first experience and the experience of my friends who died in the process.”
Dispite her fears, Auta count herself lucky because she was in a private clinic where she got all the necessary care and attention.
“The situation is very bad in public hospitals,” she says. “The workers are not motivated and emergency services are almost absent. I don’t know what would have happened to me if I had gone there.”
Even though Kaduna’s maternal mortality statistics are among the worst in Nigeria, stakeholders expressed fear that the situation may be more dire than numbers indicate.
Because the state has no standardized recordkeeping practices in rural communities and settlements — places where women rarely visit a hospital or clinic for pre-natal care or delivery.
But there seems to be a rare of hope as the trend is gradually reversing following a change of leadership in the state two years ago.
In a clear departure from the old, and rather retrogressive, style of administration, the Governor El-Rufai’s healthcare reforms in Kaduna is built on a foundation of solid policies
About less than six months into present administration, the Primary Health Care Under One Roof Bill was signed into law. Essentially, the law permits the state to operate its primary healthcare activities on the same platform. The law also enables the transfer of workers in primary healthcare centres from local councils to the state civil service.
The Kaduna State government has managed to subsidise healthcare in such an efficient manner that patients pay as little as N20,000 for dialysis treatments that cost as high as N200,000. This was achieved by supplying eight dialysis machines to four hospitals.
But despite these achievements, a large number of women still die from child birth complications, which stakeholders say is totally unacceptable.
The primary causes are not farfetched; many women still give birth at home. It is not enough to know the number of people dying but to understand the causes with a view to providing solution.
Why Kaduna Maternal Mortality Is So High?
The major reason why maternal mortality rate in kaduna is still high is as a result of poverty, access to health and not medical errors.
Maternal mortality rate can be reduce if a woman is well educated to know how to go about her pregnancy.
Death can be prevented if care is taken, the question is why are women really dying during pregnancy and the way out?
According to TraceReporter survey shows that the last Person You’d Expect to Die in Childbirth” brought much needed attention to a serious problem:
According to Chinenye K. Ugbona a nurse with Vicas Specialist Hospital kaduna said Maternal specialists like us are tasked with caring for women with “high-risk” pregnancies, usually defined as pregnancies complicated by chronic or acute maternal illness, fetal concerns, or problems related to pregnancy itself (e.g. preterm labor).
One of the worst things that can happen when we practice, is a mother dying. Maternal mortality in the their hospital is rare.
The Nation Maternal mortality ratio has hit 576 deaths out of every 100,000 lives birth daily, as at 2016. Not only are more Nigeria mothers dying than in our peer countries, but we’re one of the only developed countries where the death rate is increasing, not decreasing. That’s a frightening trend, according with UNICEF.
For women who are now facing pregnancy with fear, Nurse Chinenye said she would like to offer more context. It’s important to recognize that even though our country’s numbers are higher, maternal death following birth is still very high—your chances of dying in childbirth are still lower than your chances of being killed in a car accident.
Are maternal deaths always due to medical error? It is true that many maternal deaths are preventable and result from suboptimal care, as described by Nurse Chinenye. But human technology hasn’t gotten far enough to guarantee no level of maternal death, and it probably never will. Even with the best medical care, there are still catastrophic events—events in which disease moves too far, too fast—and no matter how quickly we act, how well we train, or how much we do, in those cases, outcomes are still direct.
To combat the outsize rate of maternal mortality, national and international health organizations have been working on maternal mortality by introducing evidence-based “toolkits” and protocols, which aim to standardize and improve care for common obstetric complications. Beyond that, as individual providers, we care for every patient with the knowledge that quality improvement committees are assessing what we’ve done, when we’ve done enough, when we’ve done too much. When we make mistakes, we must take responsibility, and increased attention will help ensure we do.
But this won’t help us address the real problem, the problem doesn’t even ask, that huge and ugly central question of maternal mortality in Kaduna: Why are more women dying in the State during pregnancy? There are many answers, but here’s a big part of it: poverty. Here’s another large part: access to health care. And here’s a third large part: access to family planning, including contraception and abortion services.
Why are more women dying during pregnancy? Poverty.
According to the U.N. Population Fund, “the poorer and more marginalized a woman is, the greater her risk of death. Within countries, it is the poorest and least educated women who are most vulnerable to maternal death and disability.” Maternal mortality in the U.S., for example, disproportionately affects black women, who die in childbirth more than three times as often as white women. Medical studies show that planned pregnancies are safer for women, especially those with underlying health problems or previous pregnancy complications. That’s because a planned pregnancy is more likely to allow the woman to understand and address her health issues prior to conception. This is vital to the success of any pregnancy.
In many cases of maternal mortality, what happens in the hours before or after birth matters greatly. But what happens in the months before birth and even before conception matter too. Unfortunately, many recent policies put forth by both state legislatures and our current federal government will greatly decrease the access to this kind of health care. The loss, or forced dysfunction, of Obamacare will only increase the problems that lead to maternal mortality; Trumpcare will likely make those changes dramatic and sustained. The new budget coming out of the White House limits funding for health care and women’s health care in particular. These changes will widen the gap between the healthy pregnant woman and sick pregnant woman.
As part of those policies, decreased access to contraception will mean that fewer pregnancies will start at times when women have planned—financially, emotionally, and yes, medically—to have the best pregnancies they can have. This will be especially true for women at the margins, women who can’t afford contraception, and women who have not had regular access to medical care throughout their lives. It is the poorest and most vulnerable women who will come into pregnancy sick and leave sicker than ever.
And that brings us to another vital aspect of reducing maternal mortality: abortion. As maternal-fetal medicine doctors, we have both had many patients whose pregnancies have become high risk, higher risk, and ultimately catastrophically risky, only after conception. In those situations, as experts in saving women’s lives in pregnancy, we have been able to offer termination of the pregnancy as an option. We do so with grief, in any desired pregnancy; we do so with tremendous responsibility and humility. We have both seen what has happened when a woman continues a dangerous pregnancy; we both know first-hand that sending a woman home safe from a pregnancy that might have killed her is a gift of irredeemable value. Abortions can, and regularly do, save women’s lives.
It is disingenuous of us as a society to claim to care about reducing maternal death and disability while at the same time limiting women’s health care, including routine health care, contraceptive care, and abortion care.
There is need for strong policy that will increase access to care. Instead, as a nation, we are heading in the opposite direction. Ultimately, we must recognize that there are some very difficult reasons why our maternal mortality rates are higher than our peer nations and that correcting these differences ought to be our first order of business.
There is at least one simple thing you can do to limit maternal mortality in this country: Call your representatives and tell them what we all deserve—access to care, which includes health care, contraceptive care, and abortion care. It won’t solve every single problem, but it’s a big step toward saving the lives of Nigeria mothers.