Contending With Alarming Maternal Death Rate

News Introduction: 
The parlous state of healthcare services especially in rural areas, coupled with inadequate funding and the dearth of qualified personnel, has earned Edo State the highest mortality rate in the country. - Victor Osehobo

Two years ago when the United Nations report on Millennium Development Goals, MDGs, excluded Nigeria from about 40 developing countries making appreciable progress in the reduction of maternal mortality, not many saw it as a reminder of the danger posed by not taking seriously the various objectives outlined by the UN to be met before 2015. Rather than set the pace, Nigeria was among the eight countries that did not make significant progress.
The number of women dying during pregnancy remains very high in Nigeria.  Study carried out by the Nigeria Demographic Health Survey, revealed that 545 women die out of every 100,000 live births. This is contrary to the universal efforts to reduce maternal mortality by 75 percent by the year 2015. 
Information available to this magazine shows that Edo State has remained high in maternal mortality rate and towers above the national average at 2,760 per 100,000 birth deliveries; 100 per 1000 live births; under-7 mortality rate of 191 per 1000 live births and maternal mortality of 700 per 100,000. 
These figures are manifest in Edo State despite the existing law on the reduction of maternal mortality. The law requires investigation of maternal deaths as a way to finding solutions to the high mortality rate in the state. It was designed in tandem with the United Nations’ Millennium Development Goals, MDGs, which seek to reduce maternal mortality by three-quarters in 2015. 
Apart from the law, over 30 secondary healthcare centres operated by the state government with a total of 2,006 bed spaces located in the 18 local government council headquarters and adjoining semi-urban centres across the state, were also established to help achieve the goal. The hospitals are manned by a combined team of doctors, pharmacists, nurses and allied personnel numbering about 2,000. These are outside the primary and tertiary health centres operated by the state and federal governments. 
Medical experts have pointed out that anemia, malaria, obstructed labour, unsafe abortion, toxemia, maternal infections, and hemorrhage are some of the causes of death during pregnancy. They also revealed that non access to healthcare delivery appears to be the major factor leading to these deaths. “If there is a skilled birth attendant whether doctor, nurse or mid-wives during delivery, it will be easier to identify danger signals during delivery. In this country, the ratio of skilled attendants is barely 50 percent. That means that the women are left at the mercy of complications of pregnancy.” Report says.
Exact statistics of consultants, resident doctors, nurses/midwives and other healthcare personnel, according to areas of specialization, is unavailable. Can this alone not be responsible for the high mortality rate? Although a critical aspect of the Edo State health policy is to reduce the current mortality rate over the years, the health sector has always been under-budgeted for. 
Poor health budgeting also poses serious danger to the UN target. For instance, Edo State has been giving less than five per cent of its total budget to health, whereas the World Health Organisation, WHO, requires that 15 percent of the annual budget be reserved for the health sector. In addition, poor remuneration for health workers also scares job seekers from taking up employment in the public health sector.
Ms. Osasu Aigbogun, who is the Programme Officer of the Women’s Health Action Research Centre, WHARC, in Benin City, said it is alarming that mortality rate has compounded the challenge in the sector after government failed to address issues like high rate of HIV/AIDs, post-partum hemorrhage, eclampsia, prolonged obstruction of labour and puerperal infection. 
 “Consequently, most maternal deaths occur in the state because women deliver in unlicensed private maternal homes, primary health centres with limited clinical facilities and in homes of traditional birth attendants, where cost is cheaper but quality of care is compromised.”  She said. Aigbogun, who was speaking at the launching of the T.Y Danjuma Foundation Maternal Mortality Alleviation Project, DAFOMA, a collaborative project with WHARC designed to roll-back cases of maternal mortality using three rural communities in Edo State for pilot scheme, also said that there is an urgent need to checkmate this upsurge of cases of maternal mortality. She said the pilot scheme would upgrade three Primary Healthcare Centres, PHCs, in designated rural communities, (Urhonigbe PHC, Oligie PHC and Evbuonogbon PHC) all in Orhionmwon local government area of the state with funding by the T.Y Danjuma Foundation. 
The scheme is expected to involve capacity building for PHC workers, public health education to promote the use of evidence-based maternity care by pregnant women and the training of Traditional Birth attendants, TBAs, on the need for early referral of women experiencing pregnancy complications.  It will further provide free maternal care to rural women, while WHARC and DAFOMA will provide transport and communication to link the women experiencing serious complications of pregnancy to secondary and tertiary healthcare centres. 

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