Tuesday, 16 October 2007

It’s a Boy!...but she died

Somewhere in rural Nigeria...Zeinab had been pregnant six times within eight years, and had given birth to six girls. Though they had decided not to have another child, they felt they could not afford to see a family planning method just yet. During the time her husband was putting aside money so she could go and obtain a contraceptive method, she became pregnant for the seventh time.

The pregnancy proceeded normally, but when she went for her first and only visit to the village health post, the local nurse’s aide told her she was anemic and recommended that she take iron supplements.

Late one night, Zeinab began to feel abdominal pains and thought it was time to give birth, though the pain seemed different.

By dawn, eight hours later, the baby was still not coming out and she started to bleed. A local birth attendant was summoned who administered some herbal medications for the bleeding and attempted to manually manipulate the baby.

By then Zeinab’s husband was terrified, and gathered his savings to get a vehicle to take her to a health centre. Finally, at 1:00 in the afternoon, Zeinab’s husband managed to hail a truck to transport his wife. They arrived at the health centre, but had to wait for a doctor to eventually deliver her of a baby boy. However, the arrival of the baby boy rather than kickstart a phase of joy for the family, began what seemed an endless moment of grief. Zeinab began to hemorrhage shortly after child birth. There was no blood available for a transfusion, and Zeinab died.

This scenario depicts the social and health situations that give rise to the high maternal mortality rate in Nigeria. Lack of decision-making power and insufficient access to resources prevent women from making the strategic decision to seek medical help at the point where it can determine if she or her baby dies or lives. Often male members of the family, who largely control the resources, make these decisions. This underscores the importance of male involvement to ensure that resources are available to women in need. Effective male involvement will ensure that childbearing is made safer for mother and child.

Lack of resources is another reason why women fail to use available health facilities. 67 % of Nigeria’s population lives below poverty line, and bills for hospital treatment do not rank high for families, especially where traditional birth attendants are available. Low use of contraceptive contributes to high fertility rates thus increasing the risk for mother and child. Though family planning awareness is increasing, contraceptive use is still low. Place of delivery and the quality of maternal health care have a significant impact on maternal mortality. At present only 37 per cent of births take plaace in a health facility though the figure varies slightly in different regions of the country. Malaria is known to predispose women to anemia, low birthrate babies, spontaneous abortions and premature deliveries while HIV/AIDS make them vulnerable to opportunistic infections besides passing the virus to their babies during pregnancy, delivery and/or through breast feeding.

The goal of the Reproductive Health (RH) Policy is to create an environment for appropriate action and provide the necessary impetus and guidance to national and local incentives in all areas of RH. In this regard, greater attention shall be paid to reducing high maternal mortality through effective antenatal, prenatal, and neonatal care, delivery, post-natal and breast feeding programs. The overall goal of the Reproductive Health Policy are laudable but the issue at stake is how effective have the policy strategies to achieving this goal been?

*Reported by Nnenna Ike

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