By Matthew Kucharski
The frequent occurrence of maternal mortality in Nigeria reflects a dire situation in need of relief. Although the United Nations Population Fund has reported that the number of maternal deaths on a global scale has been reduced by half since 1990, disparity exists with Nigeria accounting for 14 percent of all maternal deaths per year. From 1990 to 2012, Nigeria’s maternal mortality rate increased from 470 maternal deaths to 630 maternal deaths for every 100,000 live births. The consequences of maternal mortality go beyond the mother’s death as they also obstruct the development of families, slow economic growth and lead to global productivity losses. Many children in Nigeria will live their entire lives without ever knowing their biological mothers as a result.
The decline of maternal death rates on a global scale in the contemporary era of globalization illustrates that it is possible to avoid pregnancy-related deaths. Countries, including Chile and Rwanda, previously experienced high maternal mortality rates; however, they were able to drastically reduce their death tolls by focusing on making improvements to maternal health education.
The origin of high maternal mortality in Nigeria is rooted in the country’s poor economic state. According to Joe Brock’s book, “Thomson Reuters,” poverty in Nigeria is rising despite encouraging projections for future economic growth. Brock describes that the country has nearly 100 million people living on less than $1 per day while the percentage of Nigerians living in absolute poverty, which is the deprivation of basic human needs, rose from 55 percent in 2004 to 61 percent in 2010.
Kelsey Harrison of the “African Journal of Reproductive Health” reinforces the notion that poverty is a major factor in maternal deaths in her article “Maternal Mortality in Nigeria: The Real Issues.” Harrison explains this concept in detail, “…poverty greatly amplifies every other high risk factor for maternal mortality and morbidity from grotesque female oppression to maternal undernutrition to inadequate medical and physical infrastructure.” Harrison also explains that un-booked emergencies, which result from poverty, account for more than 70 percent of all maternal deaths in Nigeria. Many women fail to receive antenatal care and others arrive at a hospital for the first time when their labor is in a dangerous state.
Structural Adjustment Programs (SAP) implemented in sub-Saharan Africa in the early 1980’s have contributed to both Nigeria’s current economic state and the declining maternal health in the region, Harrison argues. SAPs were intended to use neoliberal ideology to promote long term economic growth, but instead have hindered the development of the region and subsequently increased maternal deaths in Nigeria. Harrison goes on to describe the SAPs effects in her article “The Struggle to Reduce High Maternal Mortality in Nigeria,” arguing, “weakening of governance structures, reduction of state machinery, drastic reduction in the size of the public sector, worker retrenchment…savage devaluation of the naira, increasing privatization, and the charging of user fees for cost recovery in the health care were all part of SAP. The consequences were damaging.” In addition to the SAPs, inadequate health plans produced by the Nigerian government have also played a role in the declining maternal health in Nigeria.
In regards to the current situation surrounding maternal mortality, the United Nations reported that from 1990 to 2010, the annual number of global maternal deaths declined from more than 543,000 to 287,000—which represents a 47 percent decline. Despite this positive news on a global scale, Nigeria’s rates have actually increased by 1.4 percent every year during this time period (Shapiro). The Nigerian Minister of Health, Onyebuchi Chuwu, and the Nigerian government have failed to implement effective plans to alleviate maternal mortality and have failed to save the lives of thousands of women per year. These stakeholders have not taken feasible steps in their efforts to reduce maternal mortality rates.
In 2001, heads of African Union countries met in Abuja, Nigeria to create a plan to improve the health sectors of their respective countries. The Abuja Declaration was formed and Article 26 describes the goal of this policy stating, “We commit ourselves to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized… we pledge to set a target of allocating at least 15 [percent] of our annual budget to the improvement of the healthcare sector.” The Nigerian government signed and ratified the Abuja Declaration, signaling their commitment to improve the health sectors, which has implications for maternal mortality rates. However, despite the agreement to allocate 15 percent of the annual budget to make health care improvements, the Nigerian government has fallen far short of this promise. The World Health Organization reports that in 2008, the Nigerian government had only pledged around 5 percent of its annual budget to the health care sector. The commitment of the Nigerian government to improve maternal health is questioned when promises to achieve health goals are not fulfilled.
In addition, Nigeria also implemented the National Health Policy and Strategy to Achieve Health for all Nigerians in 1988 and a revision to this plan in 2004. In the 2004 plan, the Nigerian government addressed the situation of maternal deaths directly, “our maternal mortality rate (about one mother’s death in every one hundred deliveries) is one of the highest in the world …[We plan] to reduce by three-quarters, between 1990 and 2015, the maternal mortality rate.”
The overall goal of the National Health Policy was to establish a comprehensive health care system to enable all Nigerian citizens to achieve socially and economically productive lives. Despite the efforts of policies including the Abuja Declaration and the National Health Policy, improvements have not been made to reduce maternal deaths. Dr. Joseph Nnamdi Mojekwu described the regression of conditions in Nigeria in his article “Maternal Mortality in Nigeria: Examination of Intervention Methods,” writing, “in Nigeria, the Federal Ministry of Health had set Year 2006 as the target year that maternal mortality would have been reduced by 50 percent. However, not only were these targets not achieved but also the maternal health situation in Nigeria is now much worse than in previous years.” Dr. Mojekwu also notes that efforts to make direct improvements to the health system in Nigeria have not involved enough resources to successfully reduce the rates of maternal mortality in the country.
While approximately 40,000 Nigerian maternal deaths occur per year, it is clear that these aforementioned policies have been insufficient in reducing these maternal mortality rates. The inadequate plans of the Abuja Declaration and the National Health Policy have proven that a focus on improving the entire healthcare sector to reduce maternal mortality is a difficult task to accomplish given Nigeria’s current economic climate.
My recommendation to reduce the rates of maternal mortality in Nigeria is to implement a maternal health education program. While improving the entire healthcare system would be ideal to reduce maternal mortality rates in Nigeria, the economic state of the country and ineffectiveness of previous governmental policies make the objective unlikely at this time. However, improving maternal health education is a feasible option that has proven to be effective in other areas with previously high maternal death rates. In 2012, a research project titled “Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths” was completed by the Chilean Maternal Mortality Research Initiative (CMMRI). This research project concluded that during the 50-year study period, the maternal mortality rate in Chile decreased 93.8% percent between 1957 and 2007 (from 294 to 18 deaths per 100,000 live births) as a result of increasing maternal education. The study explained that Chile’s education plan, which included natural family planning methods, artificial contraception, delivery by skilled birth attendants, antenatal care, and post natal care, appears to favorably impact the downward trend in the maternal mortality rate.
In addition to Chile, Rwanda has also had success in reducing maternal mortality rates through improving maternal education. Results from Rwanda are described by USAID in a report saying, “working with the World Health Organization, the Rwandan Ministry of Health has prioritized hiring and training community health workers to provide family planning education, services, and counseling to men and women throughout the country. As a result, Rwanda’s maternal mortality rate fell by more than 25 percent in five years.”
This type of policy will help remedy the inadequate National Health Policy and Strategy to Achieve Health for all Nigerians because, instead of focusing on remodeling the entire healthcare system to reduce maternal deaths, it will simply focus on improving education to solve this issue. Fixing the entire healthcare system is an arduous task that will take a large financial investment from the government and also an extended period of time. Shifting focus to improve the maternal education of Nigerians will allocate resources and attention to an area that has proven to deliver positive results, as evidenced by the cases in Chile and Rwanda. While targeting healthcare is an admirable goal, improving education is more realistic in the short-term to reduce maternal mortality rates.
A potential challenge that could result from such a program could be the sustainability of low maternal mortality rates once the educational programs are implemented. When the rates are decreased, however, it is believed that the results could be sustainable as the education will be passed on through generations and families to ensure that these rates stay low. Nigerians with maternal education will be instructed to teach their knowledge to their children and others so that the maternal knowledge, including family planning and birth-attendant training, can be sustained in the long term. When maternal death numbers are reduced and families are no longer affected by maternal mortality, the positive results will make the knowledge a priority among Nigerians to pass on to the next generations.
Another potential challenge regarding the implementation of maternal education programs could be the complexity of the information that is being translated to the community health workers. In order to make maternal education easier to understand, the administrators will make a great effort to have the health workers specialize in a specific area in which they will have expertise. For example we will train a group of workers to become experts in prenatal care, while a different group will focus on family planning. Having workers specialize in a specific area of maternal health education will enable individuals to clearly understand their roles. By focusing on one area of maternal education, the health workers will have the proper understanding to train and help others.
As Nigeria maintains one of the highest maternal mortality rates in the world, it is essential that proper action is taken to improve these conditions. Thousands of Nigerian women are losing their lives each year and feasible options must be pursued to stop this trend. While the Nigerian government has attempted to alleviate this situation through the Abuja Declaration and the National Health Policy and Strategy to Achieve Health for all Nigerians, these policies have proven to be insufficient to reduce the maternal death rates to acceptable levels. These programs have targeted significant changes in the healthcare system which is a difficult task given the state of the Nigerian economy.
A maternal educational initiative will improve the maternal health education of the country by training the citizens in crucial areas such as family planning, birth-attendant training, postnatal care and antenatal care. Increasing maternal health education has produced positive results in reducing maternal mortality rates as shown in areas including Chile and Rwanda. Maternal educational programs have demonstrated prior success and are feasible given the limited resources of Nigeria. Improving maternal education could keep families together and save the lives of numerous women in Nigeria.
Photo by World Bank Photo Collection