MP4Accountability to Needless Maternal Deaths END

Oct-Nov. 2014 Edition

· Institutionalise an effective Death

Monitoring and Review system that tracks

all deaths of women during pregnancy,

delivery and postpartum period to

strengthen responses and avoid future

deaths

Increase budgetary allocations and

release same to improve Primary Health

Care operations.

Provide essential drugs and other

commodities at no cost for pregnant women

Strengthen referral as well as

effective ambulance services for pregnant

women during emergency.

Make free and accessible quality

antenatal services, provided by trained and

skilled health workers at primary, secondary

and tertiary health facilities.

Train and retrain health workers on

interpersonal relations and communications

as well as socio-cultural factors peculiar to

the community of operations

''Policy Action Points’

and government work together to reduce needless he benefit of community participation in maternal deaths.mobilizing women for antenatal care and T Orisumbare PHC is located at Orisumbare holding government accountable has been Junction in Alimosho local government of Lagos established in Alimosho local government area. A State. The local government which was known for its media tour to Orisumbare PHC in Alimosho local high maternal mortality of 826 per 100, 000 live government reveals increase in antenatal care when births is also the most populous local government community members, Civil Society Organisation

area in Lagos State. It has about 30 PHC

which serves the over 2 million

population based to the parallel count

conducted by the state during the 2006

National Census. A community based

survey conducted by the Lagos State

Ministry of Health in 2011 indicates that

the lifetime risk of maternal deaths in

Alimosho is 1 in 27 women.

Orisumbare PHC was offering

immunisation, outpatient and family

planning services before series of

intervention by community members.

How Community participation improves maternal health care in Lagos hospital

- Ayodele Adesanmi

Nutrition experts have advised husbands, government and

families to encourage adequate nutrition in pregnancy for the

wellbeing of the mothers and children.

The President, Nutrition Society of Nigeria, Prof. Ngozi Nnam

said this during an interview with NOTAGAIN Campaign in Lagos

recently. According to her, it is important that mothers be in a state of

adequate nutrition before and in between pregnancies because of

rapid change during conception.

She noted that, "if the mother is not in a state of adequate

nutrition prior to conception there might be some distortion of

developmental stage and that could really affect the outcome of

pregnancy".

The nutrition expert added that "nutrients like

folate, iodine, and even protein start playing a

significant role and even protein as soon as

conception takes place. That is why it

is important that prior to pregnancy

women should be in a state of

adequate nutritional status to

ensure adequate pregnancy

outcome and it should be of interest

to note that during pregnancy".

Experts urge adequate nutrition in pregnancy

“Maternal Death is tragic - they are like According to him, teenage pregnancy is often Dr. Wilson said, "it is a marker of our health

accident, a woman hale and hearty goes to the result of lack of education for the girl service delivery and a marker of our

the labour ward to give birth and doesn't child. economic wellbeing. We now know that the

come back. What should have been a joyful "When you do not empower the girl child, human being is crucial to the national

event for everyone becomes a thing of the tendency is that that girl child will be development and the health care is central

sadness to the family and friends". Those involved in teenage pregnancy and we know to this, if we don't have a healthy population

were the words used by Dr. Wilson Imogan that teenage pregnancy and teenage we will not be able to give services, we will

to describe maternal deaths. motherhood creates a major crisis for our not be able to generate revenue, and so they

The World Health Organisation development and for the wellbeing of the will become dependent on government and

(WHO) describes "maternal death as the female population." He said.

death of a woman while pregnant or within In Nigeria, Maternal deaths

42 days of termination of pregnancy, account for 32 percent of all deaths

irrespective of the duration and site of the among women age 15 - 49 in Nigeria

pregnancy, from any cause related to or and the lifetime risk of a woman dying

aggravated by the pregnancy or its from maternal deaths is 1 in 30

management but not from accidental or women according to the Nigerian

incidental causes." Demographic Health Survey (NDFS

Causes of deaths 2013). The lifetime risk of maternal

Dr. Wilson, a deputy director at death is the probability that a 15 -year-

Women's Health and Action Research old woman will die eventually from a

Centre (WHARC), attributed the low pace maternal cause.

in reducing maternal deaths to gender Maternal deaths do not

discrimination and lack of education and only affect the woman, it also becomes

empowerment of the girl child in Nigeria. a burden to the family and the nation.

Accountability: How to reduce maternal deaths in Nigeria

Free and quality Maternal Health; Rights or Privilege?

- Expert advocates for girl child education and funding for health sector

Cont. on back page

Cont. on page 2

Cont. on page 3

-Ayodele Adesanmi and Biodun Owo

Dr. Abiola Akioyode; Executive Director, WARDC

Ambulance used in conveying pregnant women during emergency

Mrs. Giwa Folake, OIC at Orisumbare PHC, addressing pregnant women during antenatal

Fruits and vegetables are good in pregnancy

judging a performing administration. This ree maternal and child

repor t compi led by NOTAGAIN health care in Nigeria, since

Campaign reveals the inter-relationship Fpronouncement in Kano

between maternal health and human State in 2001 has been received

rights.with utmost privilege and fast

becoming a yardstick for

described as one of the rights of women

and children that should be upheld just

like any other general issues like HIV,

Ebola, Malaria, Polio and other diseases

affecting men and women.

Access to quality and free Dr. Abiola Akiyode, Executive

Director, Women Advocates and Maternal and Child Health care has been

Cont. on page 3

2

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health care workers and "Apart from resources, apart from budgeting for health, they

ensure there are doctors should also make sure that they follow up appropriately by

where there are none releasing those funds. It's not enough to budget funds but they

p r e s e n t l y . H e s a i d should release the funds to whatever health care Interventions

"government should provide they have planned so that at the end of the day, we'll have a robust

adequate roads, enough health care system."

ambulance resources to He encouraged the government to do some re-

these health facilities so that evaluation of the health system. According to him, the country

health facilities can send ought to know "where we are, where do we plan to be? how are

ambulance to the community we moving? have we done right or wrong? and what can we do to

and even the PHC Centers move forward? so that at the end of the day we have a holistic

when there is complications approach to health care delivery to our Nigerian women."

in pregnancy or during labour, Still on accountability, Dr Wilson Imogan said "it is their

so that they

can eventually

r e c e i v e

a d e q u a t e

treatment".

“Government

should make

s u r e t h a t

h e a l t h because we do not have social services, it will be further stressed workers are adequately trained, properly informed and a reduction on our GDP". He said. and properly guided to know how to dispose Reducing Maternal Deaths themselves to women that are pregnant." he said.

Speaking about ways to reduce maternal deaths in Similarly, Dr. Wilson canvasses for girl Nigeria, a health specialist and management consultant with the child education, provision of family planning World Bank and member of the Society of Gynaecology and commodities, well equipped maternity and Obstetrics of Nigeria, Dr. Segun Adeoye, said there was need to adequate skilled service providers in all health address maternal deaths from three types of delay in accessing facilities offering maternal health care. He also said

responsibility to look after the citizens, being a government, it is maternal health care. that consistent awareness on family planning commodities and their responsibility to look at the welfare of the people. So According to him, type 1 delay usually occurs at home services should be created to prevent unwanted pregnancies.services, education and empowerment should be in place to or at the community level where the woman cannot go to hospital Dr. Wilson lamented the practice of seeking maternal equip the girl child to be able to face the upcoming responsibilities because her husband is not around or has not given consent while health care in prayer houses and traditional birth homes. " It is a for her needs as she grows up and they should be sent to schools."type 2 delay occurs at the facility level when the road between the pity that in this 21st century, our women are still going to prayer

He added that "it's only logical that the government community and the health facility is too long and inaccessible. houses and traditional birth attendants even though many states should be accountable, worst of all, our maternal mortality of 576 "This is a type of delay where you find out that this woman is trying will tell you we have free maternal care services; but are they really death per one hundred thousand live births is scandalous, to go to the hospital but there is no transportation or the roads free?" he questioned.unacceptable, disgraceful, to a nation in Africa that is regarded as are not good and there is no fund to transport the woman to the Need for Accountabilityhaving the biggest and most rapidly growing economy."hospital" he said. Transparency and accountability have been adjudged

Nigeria has been ranked by the World Health Furthermore, the third type of delay has to do with the the strength of a responsible government. Dr Segun Adeoye said Organisation among countries making progress even though a knowledge and attitudes of the health care workers at the facility "they (government) have made several commitments, even to put country like Cape Verde is on track and neighbours like Benin, level. a minimum of 15% of budget to fund health; they should follow up Ghana and Togo have lower maternal mortality ratios.In summarizing the way forwards, Dr Segun advocates with those commitments and make sure that these promises are

for enough funds and resources to health in Nigeria particularly not broken promises."maternal health, while urging government to recruit more skilled

the state. According to him, complications he delivery of a healthy baby, coupled during pregnancy and childbirth is the with a healthy post delivery period in a T leading cause of the death and disability positive environment, is the desire of among women in developing countries, every family – this is because it supports the especially Nigeria.physical and emotional needs of the mother,

Mallam Abdullahi who noted that the baby and the family at large.maternal mortality is on the high side in It is also a fact that pregnancy and Kaduna state compared to other states, childbirth have great effect on the health of appealed to the State Government to help women and their families. The death of a save the lives of pregnant women by woman during pregnancy, at delivery, or allocating and releasing funds around safe soon after delivery is a tragedy for her family motherhood commodities and services. “The and the society as a whole. primary thing for us is to reduce maternal Statistics show that maternal death mortality by increasing contraceptive related outcomes are sometimes influenced prevalance rate and for us to increase by factors such as race, ethnicity, age and contraceptive prevalent rate, we have to income. When individuals are helpless and ensure that every person understands the situation goes beyond the capacity of the significance and values of contraception”. He family, the citizens look up to the government said.who are expected to be responsive and fulfill

Speaking in the same vein, Hajiya their obligations. Hauwa Saulawa of Advocacy Nigeria said a In recognition of the role of the

Government need to expend more energy on childbirth delivery”. She said.woman's body, during pregnancy, goes government in saving women and children enlightening women on importance of Meanwhile, Dr. Lydia Umar of through hormonal changes, which are lives, the State Team Leader of Nigerian antenatal clinics and hospital deliveries. Gender Awareness Trust, has called on sometimes debilitating and called for Urban Reproductive Health Initiative "Health care providers, especially at the rural pregnant women to patronize antenatal provision of emergency services to cater for (NURHI) in Kaduna, Malam Kabir Abdullahi areas must help sensitize women as they clinics for continuous monitoring of their the need of such women should the need seeks efforts aimed at making quality approach pregnancy and for any potential pregnancies by health experts. arisematernal health care accessible to women in problems encountered during pregnancy till . Hauwa stated that Kaduna State

Stakeholders charge Kaduna government on funding and access to maternal health services

Cont. from page 1

BY MAGRET MAINA

Women accessing maternal health care

L-R: Dr. Segun Adeoye (SOGON) and Dr. Wilson Imogan, Deputy Director, WHARC

Accountability: How to reduce maternal deaths in Nigeria

MP4

3 Magret Maina- Kaduna

Ayodele Adesanmi, Lagos

Biodun Owo – Lagos

CONTRIBUTORSEDITORIAL TEAM

Ayodele Adesanmi – Editor

Chidiadi Onuoha – Graphic layout

Biodun Owo – Proof Reader

Nike Ogungbemi –member

Desmond Buchi –member

Omolade Adeshina –member

Catherine Odum - member

Bola Kolapo - member

Toyin Adeleke-member

Bisi Ogunbode

The PHC now offers labora tory, generator was acquired.

pharmaceutical, antenatal, child delivery “Even when we br ing

and family planning services in addition to patients by midnight, they

outpatient clinics. don't grumble when opening

The partnership between the the center's door,” she said.

community, donor organisations and the She added that “we

government was seen to be yielding results were trained around March

as it has resulted into greater utilization of 2014, we were trained on

the health care facilities by women and how to mobilise people to our

antenatal attendance has grown within the PHC, to make sure that the

last 4 months preceding NOTAGAIN PHC is functioning and we

Campaign visits. use to go to our CDAs and

The community members were talk to them. We also work

said to have been trained by PATH 2, a hand-in-hand with CDA's

DFID project in Nigeria. The organisation chairman and the Traditional

formed the Ward Health Committee (WHC) Birth Attendants (TBAs) in

from the community and donated electricity the community. We also

generating equipment, which was installed make use of 'Baales' in the

by the local government after about series of community to encourage

follow-up calls by the community members. their people to attend the

The Ward Health Committee PHC”.

members mobilizes pregnant women to The Off i ce r - in -

attend PHC. A member of the WHC, Chief Charge (OIC) of Orisumbare

Samuel Uju Chukwuenu said, "we go to the PHC, Mrs. Giwa Folake said accounts for 27% of all maternal deaths accountability to the electorates whose market women, go around the places to tell the Ward Health Committee fuel the globally. interests and rights must be protected.them about this place; one that they can generator sometimes to complement While describing the relationship Furthermore, a local government access medical treatment free here. And government's effort. with traditional birth attendants (TBA), Dr known for such a high maternal mortality again they could deliver safely here. So we Speaking about improvement in Odufunwa said his team holds regular ratio need to engage more in creating carry out like evangelism programme to service delivery and the impact of the WHC, meeting with TBAs and faith-based awareness about antenatal visits and them to create the awareness." Mrs. Giwa said “here we have antenatal organisations. "We do not send them away, discourage delivery by quacks. It is also

However, the PHC is not without its clinic, child delivery, immunisation center, we encourage them to send their patients for essential for other state and local challenges. Mrs. Funmi Odedoyin and Mrs. patient department and family planning unit. tetanus-toxoid (TT), mosquito nets. They governments to emulate the success at Olumatoyin Eken, pregnant women Before it was eight hours duties we were send the patients to us and we give them Orisumbare community in order to cater for accessing antenatal care at the PHC having but now more staff including nurses, 'TT' and mosquito nets. It's not that we are the grassroots adequately. disclosed to NOTAGAIN Campaign in midwives and laboratory technicians, have taking the patients away from them, all we Governments at all level need to Yoruba that the hospital needed basic been employed. We now work for 24 hours.” are interested is that the mother and the adequately fund health facilities and invest facilities like chairs, bed sheets and fans for The Medical Officer of Health baby should come out alive, so we have a in referral systems as well as provision of the comfort of the patients. Other patients (MOH), Dr. Odufuwa Kayode, while robust relationship with them" he said. drugs and family planning commodities. appeal for more space to contain speaking on the efforts of the government The experience in Orisumbare NOTAGAIN Campaign gathered that According to the Chairperson, Ward Health said the local government fuels the PHC shows that government need to Orisumbare has a standby ambulance at Committee, Alhaja Afisatu Quadri said generator while Lagos State Primary Health integrate community part ic ipat ion, Vulcaniser junction in Alimosho while the electricity used to be the greatest challenge Care Board supply Misoprostol to reduce transparency and accountability in the day MoH hopes to have an additional one that at Orisunbare PHC but the donated haemorrhage, which is a common thing to day management of health facilities in could convey women from their homes generator has changed the situation. The after delivery. Haemorrhage is the single Nigeria, especially the PHC for better when called upon. centre now offer 24 hours service since the highest cause of maternal deaths and a c c e p t a b i l i t y, t r a n s p a r e n c y a n d

to death." So, maternal nutrition is government priority

Role of government in the next five years for promoting

According to Dr. Chris, there is direct adequate nutrition" he said.

cor re la t ion between pover ty and Speaking about the impact for the

malnutrition because the later reduces the policies for women, Dr. Chris said, "it means

earning capacity and increases cost she (pregnant woman) is going to have

because there is high level of illnesses in a access to adequate nutrition, she will have

malnourished state, coupled with high cost access to supplement: iron and folic acid

of hospital bills. and of course we will encourage the

H o w e v e r , h e n o t e d t h a t promotion of attendance in focused ante-

government has done so much to improve natal care." Also speaking on the role of that taking the right amount of folic acid maternal health through making family Nigerian government has made

adequate nutrition during pregnancy, the before and during pregnancy helps prevent planning commodities free to all women in several commitments aimed at improving head of nutrition in the federal ministry of certain birth defects involving the brain and Nigeria; declaring Maternal Newborn and the general wellbeing of the populace in the health, Dr. Chris Isokpunwu said, "a mother spinal cord, as well as anaemia. Folate is a Child Health Week, and putting in place the past, yet have failed to leave up to needs to be adequately nourished, she vitamin that occurs naturally in foods and right policies that support promotion of expectation in the implementation of such should have the right kind of food and have blood. It can also be found in supplements health of women and children. commitments as the Abuja declaration. The iron and folic acid supplement during and fortified foods as folic acid. More importantly, he stressed that role of government in reducing maternal pregnancy because if she is well nourished, Nutrition and maternal deaths the federal ministry of health was finalizing a deaths is therefore hinged on the level of the nourishment also translates to a When asked if nutrition could health component of the national food and t ransparency, accountab i l i t y and nourished child at birth." "Statistics are prevent maternal deaths, Professor Ngozi nutrition policy as well as a costed plan for responsiveness to fulfill what has been showing that many children are being born said "mothers that are malnourished could nutrition. "This policy and plan has five promised.stunted and that is because of the die as a result of micronutrient deficiency priority areas, maternal nutrition is number Meanwhile, Professor Ngozi has malnutrition that starts within the womb." he like anaemia because the mother is trying to one priority area, infant and young child advised husbands to allow their wives to added. supply iron to the growing foetus as well as feeding is number two, micro nutrient breast feed up to two years and recoup

Folate like other nutrients is meet her own nutritional needs for iron and if deficiency control is priority area number before getting pregnant again. "It is for the needed by pregnant women to help cells this is not taken care of the mother might three, the fourth one is nutrition information interest of their children because it has a and tissue work optimally. Study has shown suffer from anemia which could really lead system for promotion of research and data. great repercussion on children, if the nancy

How community participation improves maternal health care in Lagos hospital

Experts urge adequate nutrition in pregnancy

Ward Heath Committee members at Orisumbare PHC

L-R: Prof. Ngozi Nnam, President, Nutrition Society of Nigeria and Dr. Chris Isokpunwu, Head of Nutrition, FMOH

Cont. from page 1

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Cont. on back page

4

urge contain the various food groups: protein, during pregnancy for the woman increases up

carbohydrate, fats and oil, minerals and to 50% in some cases depending on the kind

vitamins. She should have adequate of nutrients and this demand needs to be met woman has not rested from the stress of the d them to attend antenatal care as early as amounts of vegetables and fruits, dairy by the woman." He said.previous pregnancy and she is pregnant possible, be on folic acid and iron products, milk, meat and carbohydrate foods again, she may not supply all the nutrients supplements, sleep under mosquito nets, and like tubers, legumes, grains and likes. needed by the baby and the baby may not be eat adequately during the course of her There should be a diversification of well formed to actualize his or her potentials." pregnancy. nourishment and she should have iron and she said. “ We advocate diversification of folic acid supplements especially during

Dr. Chris in his advice to women foods, a woman should have foods that pregnancy because the demand for nutrient

Research Documentation Centre (WARDC), during a CS- Dr. Akiyode said the right to health could be construed as right While summarising the role of government in

Media Forum organized by Development Communications to health care and right to conditions that promote good ensuring that the rights of women are protected, Dr. Akiyode

(DevComs) Network said many deaths that occur as a result health. said the government should provide access, stability, and

of giving birth are preventable with adequate plan and "When a woman is denied her right to give birth in a enabling environment in terms of adequate and effective

provision of quality care. conducive environment or when she is denied because of policies. She also charged the government and concerned

Evidence has shown that prompt access to emergency fees, she has to go to the Traditional Birth Attendants (TBAs) authorities on remedy when there is negligence in

obstetric care, including referral and ambulance services, or to a place where she cannot get good quality health care. government hospitals so that people have a right to

drugs that prevent hemorrhage, and presence of skilled

health workers at the point of service delivery

Maternal health status

According to the WHO estimates of 40,000

maternal deaths in 2013, Nigeria looses about 110 women

daily due to child birth because current progress and pace

are not sufficient to stem the tide even though the

government, in collaboration with development partners, has

continued to improve access to quality maternal health

services through the Community Health Insurance Scheme,

Midwives Service Scheme and other policies and programs.

It is also on record that some state governors have

inaugurated free maternal and child health programs in their

states to encourage women to access maternal health care.

Delta, Kaduna, Jigawa, Kano, Bauchi, Niger, Sokoto, Ondo,

Lagos and others are among the states where free maternal

and child health care has been practiced up to varied

degrees.

Where available, they are often devoid of intents,

strategies, legal backings and quality. Administrators see it

as a way of showing the citizens that they care for their people

who they want to enjoy dividends of democracy. Many

campaign groups often lay claims to it as the achievements of

their members and politicians are beginning to make it a point

in their manifestoes.

While, the presence of free maternal and child health care

and services are indication of hope for women and children,

experts have said that maternal health is a human rights

issue and not negotiable. In a way, what you have done indirectly is denying her 'right to compensation. According to her, all these cannot be Rights Issues in Maternal health life'." She added. achieved without increase in health and maternal health

According to the women and rights activist, Lamenting the discrimination against women, she budget so that there is enough fund to be able to ensure that maternal health should be conceptualized not only from the said many women have failed to access maternal health care people have adequate health care services.medical or public health perspectives, but also from other on the ground that they were unable to produce their "I think that generally, the government is not willing, it's a aspects of life such as right to life. 'We must be able to husbands for blood donations. Such act was labeled by Dr. political will issue while I also think that probably if it's a conceptualize maternal health from a rights-based Akiyode as discriminatory against women. "What happens general problem like Ebola they would have taken it much perspective, in a way it gives us a much better understanding when a woman was raped or her pregnancy rejected? A more seriously. In that context I can then say one of the of what maternal health is, so that we are not just seeing it as woman usually appeared tortured in a situation whereby she reasons why it has not been done is because it is seen as a medical or public health discussion.' says Dr. Akiyode. feels like going to the hospital but the husband wouldn't go women's issue".

The right to life is fully guaranteed in the 1999 because he is afraid that he might be tested for HIV/ AIDS or Way forwardconstitution of the federal republic of Nigeria under Chapter for Hepatitis B and other screening". The secretary of MCH-CS partnership in Kaduna iv, Section 33 (1) that says "every person has a right to life, "... this is seen from the perspective of discrimination State, Haj iya Amina Kazaure told NOTAGAIN and no one shall be deprived intentionally of his life, save in because it is only the woman that carries baby. In a Correspondent in an interview recently that the free maternal execution of the sentence of a court in respect of a criminal way you are discriminating against her because a woman is and child health policy in the state was laudable but needed offence of which he has been found guilty in Nigeria”. seen as a target by asking her to bring her husband to come to be translated into law. "We know that the State Primary

Quoting article 12 (1) of the International Covenant and donate blood before you can allow her to access health Healthcare Development Agency is in place now and on Economic Social and Cultural Rights (ICESCR ) which care". functional, so also the Drug Management Agency. However, deals with the "…right of everyone to the enjoyment of the Akiyode also cited several conventions like the something stronger is needed to back the sustainability of the highest attainable standard of physical and mental health," Convention on the Elimination of All Forms of Discrimination programme - if there is no law in place to back the

against Women (CEDAW) which establishes that, sustainability of the programme, another Government could

“States parties shall ensure to women appropriate come and scrape it completely." She said.

services in connection with pregnancy, confinement The former Commissioner of Health in Lagos State,

and the post-natal period, granting free services where Dr. Leke Pitan has also revealed to NOTAGAIN Campaign

necessary, as well as adequate nutrition during recently that there was need to declare emergency in

pregnancy and lactation” maternal health care delivery in Nigeria.

Maternal health and Accountability issues ‘'Making antenantal care as well as delivery,

Discussing the need for accountability in maternal whether natural vaginal delivery or assisted delivery by

health, participants at the Civil Society- Media forum Cesarean Section or otherwise free will go a long way'.

agreed that the government has the mandate to fulfill 'They must declare an emergency in obstetric care and

their obligations and also to respect women's rights as put it in the front burner'',headded.

human beings and citizens of Nigeria.

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Free and quality Maternal Health; Rights or Privilege?Cont. from page 1

Women accessing maternal health care

Experts urge adequate nutrition in pregnancy