Amoo Kemi

A PAPER PRESENTATION ON MATERNAL MORTALITY IN RURAL

AREAS OF OSUN STATE.

BY

AMOO OLUWAKEMI CATHERINE

UJ/SS/BSW/07/0023.

COURSE: SEMINAR ON SOCIAL PROBLEMS CODE; BSW 357.

DECEMBER 2010.

Amoo Kemi

INTRODUCTION

Even the most fanatic theologians shouldn’t say the Almighty God purposed such great loss of women at child birth when he cursed mother of all humans Eve saying: “unto the woman, I will greatly multiply thy sorrow and conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee” Genesis 3:16. This is because, as the italicized phrase denotes; the creator only wanted a painful conception and not a fatal one.

However, over the centuries and now well into the present millennium; the issue of women of all classes giving up the ghost at child birth abounds. Some have been as a result of insufficient technology of their time while others are just victims of human non-chalancy and myopic actions. Our part of the world is plagued with situations of the latter and Nigeria is a prime example, exhuming juicy statistics on such issues as per its status as most populous black nation on the planet. It is indeed, a shame that despite the enormous human and natural resources, Nigeria continues to top the list of countries with sorry statistics of maternal mortality, ranking only second to India (one of the few countries with over a billion population) as the country with the highest maternal mortality rate in the world according to UNICEF and World Health Organization. The lack of basic infrastructure required to efficiently support primary healthcare has remained one of the most visible maladies of the nation, and this is worse in the country’s hinterland states with a significant rural population like Osun State.

It is quite important to highlight the demographics of the state to better appreciate the numbers put forth in this article. Hence; According to the 1991 National population census; Osun State has a population of 2.158 million inhabitants made up of 1.043 million males and 1.11million females. It may be classified as largely rural with 19 out 30 LGAs been non- urban local government councils, accounting for 60 percent of the 1991population. That is, local governments with one or two small towns are the principal settlement while the remaining populations are in the rural areas. Since the last census in 1991, the population in each local government has increased tremendously. Using a growth rate of 3.5 percent from the census bureau; projected population of Osun State for 2001 now stood at 3,044,276, while the rural population has risen to 1.817,290

PROBLEMEarly last year; there were reported cases of protest by pregnant women at a general hospital in Asubiaro, Oshogbo as a result of frustration over quality of services provided them for ante-natal care. These women claimed two of their colleagues had even collapsed after several hours of long wait and have observed with great displeasure, the continuous rise in maternal and morbidity rates in the state. Other complains included shortage of staff and inadequate power supply, the former which could be as a result of reluctance of health staffs to work in such places

Amoo Kemi

with little or no incentive or exodus of existing staffs to other countries that offer greener pastures while the latter is obviously our perennial national shame of low electricity generation.

The mechanical failure of policy makers in Osun state and Nigeria at large as regards standard of living is a similar culprit. Lack of implementation of family planning; a direct scion of poverty is rife in many parts of Osun state leading some women to go as far as the archaic methods of traditional medicine and local doctors for antenatal and disease treatment; and results to high rate of maternal mortality as admitted by the Federal Ministry of Health. Convergence of opinions agree that lack of basic health care facilities have led to inefficiency in production, declining productivity, reduced life expectance, increased maternal mortality with corresponding increase in infant mortality rate. As regards the availability of these infrastructure in Osun; spatial distribution of public health care facilities, include Teaching Hospitals, State Hospitals, General Hospitals, Comprehensive Health centers and Primary Health centre or local government health centers. The levels of operation and availability of supporting equipments at each level decline from the Teaching Hospitals down the scale to primary health centre. While specialized services are carried out in the Teaching Hospitals, General and State Hospital perform consultations and minor operations depending on the available consultant and necessary equipment. The comprehensive and primary health centers mostly provide outpatient clinic, maternity and dispensary services. There are three Teaching Hospitals at Ile-Ife, Ilesha and Oshogbo as a result of University Institution at Ile- Ife and Ladoke Akintola University, which have its teaching Hospital at Oshogbo. By the nature of the establishment and the type of service been rendered, one cannot expect too many teaching hospitals in the state. Osun State may even be counted luck to have the three, since there are other states that cannot boast of one. The distribution of other types of hospitals, which are the sole responsibility of the state government, is therefore used to illustrate the inequality in health care facilities among the LGAs in the State. There are 6 state and 5 General hospitals distributed among 10 LGAs. These are Ede North, Ife Central, Ife North, Ifelodun, Ila, Ilesha West, Irewole, Iwo, Oriade and Oshogbo. Out of these LGAs only four belong to the rural LGAs, i.e. Ife North, Irewole, Iwo, and Oriade where the services are most needed. It implies that the state and general hospitals are located in the urban centers and at the headquarters of the LGAs. Considering the nature of road networks in Osun State, particularly the rural roads, and the location of these hospitals put the rural inhabitants at disadvantage than their urban counterpart who have better access to maternity care. The distribution of comprehensive health centers also revealed the disparity between local governments. All the five belong to urban LGAs and the location of these hospitals is in all major cities of the state which include Oshogbo, Ilesha, Ile- Ife and Ikirun. Eighteen LGAs have less than ten private hospitals the highest been seven. The rest seven LGAs have none.The distribution of maternity/ clinic is more wide spread as there is no local government without at least 2 maternity at the local government headquarter. In the there are 24/7 private maternity clinics in the state. It also depict the disparity in health care facilities in the state as 13 LGAs have private maternity/clinic in the range of10-20, the highest been nineteen. The rest 17 LGAs have less than ten each while the highest in the group is seven.

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In Osun State that serious inadequacy exist in the provision of maternal health care facilities and service by both private and public sectors in rural areas. Also, it was revealed that inequalities persist in the distribution of the existing facilities among the LGAs and between Urban and Rural Settlements in the state; the most deprived people being the rural inhabitant. The deprivation suffered by these people has resulted in the many preventable deaths.MEASURES THAT CAN MITIGATE THIS SOCIAL PROBLEMThere are definite measures that can be taken by all stakeholders in the state to mitigate the rates of maternal mortality, and it includes the victims themselves. As a start, the Osun state and federal government must be trained and attracted back to the region, especially the rural areas with additional incentives where the bulk of these women lack access. The state government should seek improved private sector participation and come to terms with the fact preventable deaths such as that of maternal mortality are pressing human right issues for which they would be held accountable. It is heartening that Rauf Aregbesola, the present governor keeps re-iterating his desire for quality antenatal and general healthcare as a precursor for development in the state. The governor believes the contributions of women to the economy are, indeed critical to the well being of the state and should therefore take concrete steps to stem the tide of maternal mortality. Improvements in maternal health, no doubt, impact positively not just on the lives of the women, but also on those of their children, families and communities at large. Finally, interventions must be scaled up so that essential care can be provided throughout pregnancy and childbirth especially in the 19 rural communities of the state, and also during the post-natal period, so that those who give life do not lose theirs in the process.

However; it is not an entirely dim situation as there still are some very good citizens that have decided to put out the conflagration in the state. One such group is the Sweet Mother International (SMI) who have brought succor to the health-thirsty living spring of Nigeria with the ‘Save African Women from Pregnancy-Related Deaths’ initiative, and received overwhelming support. So far; it has received support from the Ataoja of Oshogbo, paramount ruler of Osun State, Osun State Chapter of the National Association of Women Journalist, an influential group in the state, the Nigerian Civil Defense Corps Osun Command, the Grace Bible Mission, the 7Up Bottling Company, Kwara State and the Osun State Commandant of the Nigerian Civil Defense. Some parliamentarians have also expressed their interest to assist SMI in putting forward an action plan to address the issue of maternal mortality at the National Assembly according to their website. The situation is presently dark but there could be light at the end of the tunnel after all in the southwestern state of Osun. Keywords

TH- Teaching Hospital PHC -Primary Health Centers. SH -State Hospital GH- General Hospital CHC -Comprehensive Health Centers

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REFERENCE

Adejuyigbe, O.: The Location of Rural Basic Health Facilities in Life, Ijesa Area of Southwest Nigeria. Unpublished Departmental Monograph (1977).

Onokerhoraye, A. C.: A suggested Framework for the provision of Health Facilities in Nigeria. Social Science and Medicine 10: 50-56 (1976).

Osun State Hospital Management Board, Oshogbo Osun State.

Osun State Ministry of Health, Oshogbo Osun State.

WHO: 19938 World Report, WHO, Geneva (1998).