Reversing Maternal Mortality

Many Nigerian women die giving birth as a result of pregnancy-related complications. But one woman is trying to reverse this trend, writes Ayodeji Rotinwa

Lightning may never strike the same place twice but death does not indulge such restraint.
In June 2011, Adepeju Jaiyeoba received news that a sister of a close friend, Ramatu had passed away in the hospital after a ‘complication’. The complication turned out to be anything but pregnancy. Ramatu lived in Lagos. However, she planned to give birth in University College Hospital (U.C.H.) Obafemi Awolowo University, Osun, four hours away from Lagos by road. She had made this decision because her mother had delivered all of her 11 children at U.C.H. safely.

She also decided she was going to give birth to her child via a voluntary caesarean procedure because she had had preeclampsia complications with a previous birth. On due date, she arrived at the hospital and was informed that her consulting doctor was not available. The surgery would have to be performed by a Matron and a House Officer. She delivered the baby safely but soon blood was freefalling from her body. Her caregivers could not figure out why. Even after several blood transfusions, there was no change. Eventually, she exchanged a maternity bed for one in the morgue. It was only after this it was discovered that the House Officer had severed an artery during the procedure and forgot to close it up.

Four pints of blood was removed from Ramatu’s lifeless body.
In July 2011, barely a month after Ramatu’s passing, another friend of Jaiyeoba’s passed away right before entering the hospital that would hopefully deliver her child and preserve her life. She had had high blood pressure throughout the pregnancy that had apparently gone undetected.

A brace of deaths caused by too similar circumstances, less than 30 days apart.
Jaiyeoba tells these stories, with her three-month-old baby in her arms and a hint of a regretful smile on her face. She recounts them with her friends in the present tense. As if they were still alive. It is because of these events she founded the Brown Button Foundation and the Mothers Delivery Kit company.

“It could have happened to anybody. I have four sisters; it could have been anyone of them. I had to do something.”
The Foundation is a non-profit organisation that seeks to improve women’s access to quality healthcare, train and improve the skills of those providing this healthcare and championing their sexual and reproductive rights of women to access care for themselves. The Mother’s Delivery Kit is a product (and social business) designed to ensure safer births, instigate behavioural changes in birth delivery procedures and also create income-earning power for women selling and distributing the kits across 30 of Nigeria’s 36 states.

Jaiyeoba does not have a medical background. She is a practising lawyer and a Senior Associate at a leading legal firm in the country, Aboyade & Co. Her experience spans commercial law, litigation. She was however not going to let a knowledge handicap stand in the way of her Foundation’s vision, to “eradicate infant and maternal mortality in Nigeria.” She recruited her brother who is a trained medical doctor to the cause.
“My role is just to develop ideas, growth and strategies for the business,” She says in an offhand matter as if this function is dispensable.

The impact of her work has been swift and far-reaching across Nigeria’s six geo-political zones as it counts birth attendants, primary healthcare centres, maternal health organisations, private and public hospitals as clients and partners.
Jaiyeoba, on starting out quickly zeroed in on the fact that it was mostly rural communities unattended to by functional or existing public health services that needed most help.
“In most of these communities, primary health centres aren’t headed by trained doctors/nurses because they don’t have enough staff. They are run by those who have interest in healthcare and are trained to work as community extension workers,” she says.

Birthing mothers in these areas have had to rely on traditional birth attendants who solve complications with untested herbs and prayers and who in many instances will tell a bleeding woman post-birth to hold her legs close together to stop the outflow instead of finding a stop-gap solution and transferring her to a medical centre.

To kick off her work, Jaiyeoba contacted a serving Senator in Sagamu, Ogun State, to grant her access to the community he represents, to provide skilled training to traditional birth attendants there. She lobbied him to build the first maternity health centre for the community as well, which he did. Previously women in the community had to travel 40 minutes away to access any kind of healthcare at all. She leveraged on the success of the training and moved up the country.

In Gusau, Zamfara, she encountered a child who died as a result of his umbilical cord being severed with a rusty blade. This would inspire the idea for providing sterile supplies through the Mother’s Delivery Kit which is sold at a subsidised cost of N1, 700 ($5.30) – because she orders the materials herein in bulk – and which most expectant mothers in fairly low-income communities can afford as opposed to buying the goods in the kit separately on the open market. This would cost them an estimated N3, 500.

The supplies and training have proven to be the difference between life and death for mother and child.
“We have saved an estimated number of 500 women as a result of training from the Foundation. The women are encouraged to go for ante-natal care and hospital delivery as opposed to birthing at home so as to reduce the risk of infection and so on,” says Shafaatu Abubakar, a Skilled Birth Attendant/Community Health Worker, Head, Sabon GARI Health Centre, Gusau who has seen the impact of Jaiyeoba’s work, first-hand. And that’s in one community alone.

In the supplies is the drug misoprostol, a deal breaker that helps stop postpartum haemorrhage which, according to Jaiyeoba, is the leading cause of maternal deaths. Now, women – finally – have a solution that works. Also in the kit, is a mucus extractor which has saved many new-borns from asphyxia. It’s important to note here that these supplies are not readily available even in some supposedly modern hospitals many of whom rely on the kits to care for their patients. Dr. Alalade, resident in a hospital in Kaduna, who joined in on the conversation over the phone orders the kit in hundreds and prescribes it as a must-have in his facility.

“With the kits, we have been able to not only encourage but create behavioural change in ensuring a clean, safe and hygienic delivery,” Jaiyeoba says of other ways where her work is being instrumental.
Before the Foundation’s training and the kit, in many birthing homes, plastic sheets were used for the woman to lay and birth on. These sheets would be disinfected and re-used. The kits have provided an alternative of an absorbent, woollen-surfaced, stark white delivery mat that is good for one use only and does not “tempt the attendants to use again.

“The training has encouraged traditional birth attendants to refer women to better facilities for cases they cannot handle. We have been able to train attendants to identify complications in pregnancy promptly.”
Building a business and a product that is being distributed across 30 states and training women in eight of those states are certainly not as effortless as the above text may have come across as. Not in a production-challenged country like Nigeria. More so, a business run by a woman that caters to areas (North-east, predominantly Muslim) where women are supposedly only seen and not heard, their voices in the iron clutch of Sharia Law, one would have thought Jaiyeoba’s chances to succeed, would be slim.

As always, she found a way. The first challenge was funding and expanding the business’s production. At the start she was depending on manual processes to manufacture the kit and her output fell far short of demand. She was able to obtain funding from the U.S. African Development Foundation in the sum of $10,000 with which she used to automate her manufacturing processes. In her work on the ground, where her gender may pose a disadvantage she has learnt to lobby influential men in the communities in need who are respected and listened to. She sells her vision of ending maternal mortality to them. More often than not, they buy into it.

“When we mention our work in maternal health, it brings memories of people who have died: mothers, wives, sisters, it is not abstract to them. It would be hard for them to say no to anyone trying to improve maternal health indices in the area.”

They lead her into the community and provided her with all the assistance that she needs: free venues, chairs. An argument may even break out over which area in the community should host the training.

In Jaiyeoba’s case, tragedy has been the mother of invention, and her personal tragedy has helped in stopping occurrence of same in others’ lives. Yet, according to a UNICEF report, a woman’s chance of dying from pregnancy and childbirth is 1 in 13 in Nigeria. The mountain of odds will not be conquered so easily.

“The government needs to pay more attention to healthcare at the grassroots level. Primary healthcare is the closest to the people, planted in these rural communities and abandoned there,” Jaiyeoba says.
She is well aware she is filling a gap in what should be a public health service.
She does not mind the fight being no longer hers to lead and handing over to the government. Her business has sold 30,000 kits this year alone and has made N45m ($140, 625) in sales.
“I hope we run out of business soon,” she says.