Intricacies of Maternal Mortality Rate

Nigeria’s Maternal Mortality ratio is 1,047/100,000 live-births, representing the highest number of maternal deaths with approximately 82 000 deaths, and accounts for more than a quarter (28.5 per cent) of all estimated global maternal deaths in 2020, writes Ugo Aliogo 

Every two minutes, one woman dies globally during pregnancy or childbirth, according to recent report by United Nations (UN) agencies.

The report titled: “Trends in Maternal Mortality 2000 to 2020,” which was unveiled recently by the World Health Organisation (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), World Bank Group and United Nations Department of Economic and Social Affairs (UNDESA) /Population Division, reveals alarming setbacks for women’s health in recent years.

The report said maternal deaths either increased or stagnated in nearly all regions of the world.

Commenting on the report, the WHO Director General, Dr. Tedros Adhanom Ghebreyesus, said: “While pregnancy should be a time of immense hope and a positive experience for all women, it is tragically still a shockingly dangerous experience for millions around the world who lack access to high quality, respectful health care. These new statistics reveal the urgent need to ensure every woman and girl has access to critical health services before, during and after childbirth, and that they can fully exercise their reproductive rights.”
The report, which tracks maternal deaths nationally, regionally and globally from 2000 to 2020, showed that there were an estimated 287 000 maternal deaths worldwide in 2020, indicating only a slight decrease from 309, 000 in 2016 when the UN’s Sustainable Development Goals (SDGs) came into effect.
While the report presents some significant progress in reducing maternal deaths between 2000 and 2015, gains largely stalled, or in some cases even reversed, after this point.

The UNICEF Report

The report said the current total for children under the age of five stands at nearly 31 million while each year at least seven million babies are born. It added that while a little over one in three of Nigeria’s population live below the poverty line among children, the proportion surges to 75 per cent.

According to the report, “Nigeria’s 40 million women of childbearing age (between 15 and 49 years of age) suffer a disproportionally high level of health issues surrounding birth. While the country represents 2.4 per cent of the world’s population, it currently contributes 10 per cent of global deaths for pregnant mothers. Latest figures show a maternal mortality rate of 576 per 100,000 live births, the fourth highest on Earth. Each year approximately 262,000 babies die at birth, the world’s second highest national total. Infant mortality currently stands at 69 per 1,000 live births while for under-fives it rises to 128 per 1,000 live births. More than half of the under-five deaths 64 per cent result from malaria, pneumonia or diarrhoea. Investment in this sector has been high in recent years although the proportion of patients able to access appropriate treatment remains low.”

UNFPA’s Position

The Country Director, United Nations Population Fund (UNFPA), Ms Ulla Mueller, said according to the UN Agencies report, Nigeria’s MMR ratio is 1,047/100,000 live births, representing the highest number of maternal deaths with approximately 82 000 deaths, and accounts for more than a quarter (28.5 per cent) of all estimated global maternal deaths in 2020.

She explained that the figures were slightly lower when compared to 1,148/100,000 in 2000 and 1,113/100,000 live births in 2015, indicating a 0.7 per cent annual rate of reduction, noting that these could be attributed to the impact of various interventions such as improved MPDSR coordination and reporting; the increased investments in midwifery education and regulation; reduction in HIV/AIDs related maternal deaths; and increased access to SRH/FP/MH services facilitated by the UHC initiative.

Maternal Death

Mueller remarked that the main causes of maternal deaths in Nigeria remain haemorrhage especially post-partum, pre-eclampsia and hypertensive disorders, sepsis and infections, and abortion complications.

She also averred that the underlying factors are socio-cultural and harmful gender norms against women and girls, dysfunctional health systems in relation to availability, acceptability, affordability and quality of SRHR services, and the preference for home delivery with traditional birth attendants.

According to her, “In the last two years, UNFPA efforts in addressing the maternal mortality in Nigeria include: strengthened capacity for coordination and implementation of Maternal, Perinatal and Child Death Surveillance and Response.

 “Yes, the federal government is committed to tackling malnutrition in Nigeria and various ongoing interventions, for example, the UNFPA Iron-Folic Acid supplementation initiative addressing maternal nutrition and anaemia, a leading cause of maternal death in Nigeria.”

Expert Opinion

Experts believe the maternal mortality rate in Nigeria is at an alarming rate due to myriad factors.

Programme Manager, Hacey Health Initiative, Chioma Osakwe, said the deductions from available data shows that for every 100,000 births in Nigeria, 557 mothers have been lost to maternal health complications. She added that the data could get worse when it narrowed down to pregnant young/adolescent girls.

She said: “The problems faced by pregnant women in accessing healthcare services contribute significantly to maternal mortality; however, in other not to dwell so much on the problems as unnecessary as they may seem, as an organization, we have engaged with a partner and relevant stakeholders at various levels with the aim of proffering solutions to the challenges faced by pregnant women, especially young moms.”

She further explained that interventions from Civil Society Organisations (CSO) and International Non-Governmental Organisations (NGOs) have contributed significantly to providing modern maternal health facilities and equipment to state-owned health facilities; stating that as an organization, HACEY Health Initiative has trained and equipped traditional midwives and birth attendants to support healthcare workers in rural/underserved communities in Nigeria.

Osakwe remarked that the Impact Health project is also an intervention at HACEY Health Initiative, supported by Intellectual Property and Research Development (IPRD) solutions and Argusoft, that aims to reduce maternal mortality by improving the quality of maternal health services in primary health centres (PHCs), improving health data collection and management system towards providing accurate evidence to inform policy formation and enhancing the quality of service.

Continuing, she added: “The Interventions so far to reduce maternal mortality have witnessed good positives, though slowly; the bureaucracy of the public health systems in Nigeria is a limiting factor because, as usual, the policies are great, but the problem stems from implementation, and also the local government unit needs to be held accountable in the implementation of some of these policies being the tier of government closest to the people.”

Increasing Commitment

The UNFPA Country Director espoused that about 22 per cent of the population were made up of adolescents, adding that the leading health challenges among adolescents and young people in Nigeria are issues of sexual and reproductive health and rights, mental health disorders, substance use, nutritional problems, violence and injuries, physical disorders and chronic conditions such as asthma, sickle cell disease disorders, and oral health problems and communicable diseases.

She expressed confidence that efforts can be doubled to address the commitment through investment in education and training especially girl child education, livelihood and social skills acquisition; peer-educators training and peer-to peer engagements; enable adolescent/youth leadership by strengthening participation in health decision-making, personal agency and self-efficacy; increasing financing for adolescent and youth health and universal health coverage; and improving service delivery and the promotion of sexual and reproductive health and rights of Adolescents and young persons.

On her part, the Programme Manager, Hacey Health Initiative, said factors contributing to maternal mortality in Nigeria were a combination of multiple sectors, while noting that it is not just health facility or birth attendant availability problem alone; and no prejudice to the health ministries, local and international Non-Governmental Organizations (NGOs) have achieved wonderful strides in supplementing the gaps created in the health sector.

According to her, “As an organization HACEY Health Initiative through the Project ‘Agbebi’, a community health project is aimed at contributing to the reduction of deaths resulting from pregnancy and childbirth. We strengthen and support strategic alliances with these Traditional Birth Attendants (TBAs) leading to the implementation of newborn health programs at scale. Coined from the Yoruba word “Agbebi” meaning “the midwife”, the project has been empowering a network of Traditional Birth Attendants (TBAs) and maternal health providers across Southwest Nigeria.

“Through an effective referral system, members of the network are trained and supplied with birthing kits. With the introduction of evidence-based prevention and treatment interventions, we have been able to improve traditional birthing methods used by women in 14 underserved communities and over 62,000 birthing kits distributed across southwest Nigeria.”

Increasing Investments in PHCs

Osakwe is of the view that the decentralisation of the system and essentially opening the channel for Public-Private Partnerships in the process, will invite greater investments in the sector/system. She also said there was need to allocate more resources to the primary healthcare system in other to make it more stable enough to provide sexual and reproductive health services and accompanying/related services.