Mothers Lives Matter — A Call to Action to Catalyse Accountability for Maternal Deaths in Nigeria
“In Rwanda, a combination of community-based health insurance, community health workers, and good external partnerships led to the steepest reductions in maternal mortality ever recorded.” — President Kagame of Rwanda at the WHO General Assembly in Geneva, 2018
Despite several discussions around “maternal mortality”, how much do people really understand about this term? Why would the president of a country allude to this as one of his greatest achievements? The official definition by the World Health Organisation describes maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”. But it really means a lot more- at a family, community and national level it demonstrates how a community takes care of its mothers and drives economic growth.
Every day, 830 women die from preventable causes related to pregnancy and childbirth around the world. A more familiar scenario to describe this would be if a Boeing 747 aircraft crashed and all the passengers died, every single day. A majority of these maternal deaths have been attributed to severe bleeding, infection, hypertension during pregnancy and unsafe abortions. Adolescent pregnancy also remains a major contributor to maternal and child mortality. Many adolescent mothers face higher risks of developing obstetric fistula. This is a potentially serious medical condition where a hole develops between the vagina and rectum or the urinary bladder, making it impossible to control urine.
Unfortunately, due to the fragmentation of child-bearing services across Nigeria, it is almost impossible to track and record factual practices and experiences in maternal mortality in Nigeria. Many of these maternal deaths occur outside health facilities and are never recorded; health workers especially in rural areas do not always know the causes of death and calculating the numbers seem complex. The factors driving this are sometimes outside the immediate control of the health sector.
Poverty fuels maternal mortality, which explains why death rates are higher in low-income countries like Nigeria than high-income countries. This possibly explains why 19% of the 358,000 annual global maternal deaths occur in Nigeria. Put differently, there are at least 50,000 maternal deaths per year in Nigeria. These abysmal figures succinctly depict the deepened crisis that Nigeria has continuously faced over the years.
Behind these numbers are real people like the late Uche (name changed to maintain anonymity), an energetic young lady in her late thirties. She owned a hairdressing salon in one of the south-eastern states. Beyond the story that she went to a church rather than a standard health facility to deliver her baby, nobody knows the actual reason why she died.
Despite advocacy efforts and implementation of programs geared towards reducing preventable maternal mortality, Nigeria’s most vulnerable women and children have continuously faced barriers to accessing quality health care at the right time. Many health facilities lack appropriately trained healthcare workers, a factor that also contributes to maternal deaths in Nigeria. With only 35% of births occurring in health facilities, several births occur outside of these health facilities without the supervision of skilled health personnel. Unfortunately, this exposes both mother and baby to avoidable complications. In many cases, these complications lead to death which in turn are not registered, reported or investigated- another gap in the system.
Most communities are eager to address the problem of maternal mortality and often have contextual knowledge about contributory factors. However, systems are not in place to engage them to understand, help capture and report these deaths. There is an urgent need to empower them with information and tools to achieve this. They need to understand that demanding accountability for maternal deaths is not to indict but rather to recognise the reasons for these deaths and plan effectively to mitigate them.
Some progress, albeit slow, is being made. Currently, the state-level implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) in Nigeria is inadequate and the newly established state MPDSR committees struggle to effectively turn available data into action. In addition, data on the direct clinical causes and underlying factors that contribute to maternal morbidity and mortality remain under-reported and under-utilised, limiting the government’s ability to deploy solutions to improve the quality of maternal care. The system has failed to capture deaths that occur outside health facilities, alternative maternal centres and private facilities. Consequently, when women die, there is little to no inquiry into the cause of death. Cultural, religious and socio-economic factors have also played a critical role in the lack of accountability for maternal deaths in Nigeria.
In 2017, Nigeria Health Watch launched the #GivingBirthInNigeria campaign, curating stories of infant and maternal mortality in Nigeria. As we continue to share the faces behind these statistics, we launch a new project fittingly called- Giving Birth In Nigeria. This is to enable a system where government at all levels, communities, social groups, healthcare providers and families are more accountable for safer deliveries. Where the outcomes are adverse, every maternal death, wherever it occurs, should be counted and investigated. Lessons learned should be used to take corrective action and drive improvements in maternal care. The project is a rallying call for greater accountability for maternal deaths, aimed at key stakeholders, primarily at the community level, who encounter women at various touchpoints of their pregnancy.
Expected outcomes of the project include; increased awareness of maternal mortality in Nigeria, increased reporting of maternal deaths, increased use of maternal death data for behaviour change communication. We also intend to establish new social norms where maternal deaths are seen as an anomaly and can be actively prevented by specific changes in behaviour and increased ownership in communities of maternal outcomes.
To kick-off the #GivingBirthInNigeria project, the consortium consisting of Africare, EpiAFRIC and Nigeria Health Watch organised the launch in the fishing town of Epe, one of the communities we will be working in. The meeting was a melting pot of ideas, challenges and solutions direct from the community with the media, health educators and the Lagos State Ministry of Health in attendance. At the project launch, the consortium expressed how this advocacy project will push for greater understanding of why women are dying in childbirth, gathering data to get a better picture of the underlying causes of maternal mortality at the community level.
The project will seek to elevate community voices in maternal death reporting and surveillance efforts and the community of Epe was well represented by women leaders, religious leaders and traditional leaders who shared their experiences and views. The aim moving forwards is to encourage participants at all levels to be part of the solution in ensuring that every death is captured so that solutions can be found to prevent future maternal deaths
The project implementation will seek to explore and establish new ways of capturing insights on maternal deaths strategically, as well as sharing the insights more broadly and systematically.
We therefore call for every one of us — mothers, mothers-to-be, husbands, health workers, professionals, community leaders and every well-meaning Nigerian to be a part of the campaign to account for maternal death in Nigeria. This is an opportunity for us to use our voices, individually and collectively to change the narrative of women dying in pregnancy or while giving birth. No woman should die giving life. The risks of having a baby in Nigeria remain unacceptably high. We must make a concerted effort to make childbirth a moment of joy.
Join us today by sharing your stories, whether first-hand or indirect across all social media platforms using the hashtag #GivingBirthInNigeria. Although it may be impossible to put an end to all maternal deaths, it is possible to lend our voices to accelerating accountability for maternal deaths in Nigeria so that mothers live.