“Broken Promises”: Accounting for high maternal mortality in Nigeria

“Broken Promises”: Accounting for high maternal mortality in Nigeria

Maternal mortality in Nigeria is second only to that of India. Every ten minutes we lose a mother in the process of giving life or childbirth-related diseases. The Nigerian government identified maternal mortality as a pressing problem and developed laws and policies in order to respond to it, but all these actions have not led to a significant improvement in maternal health throughout the country yet.
In spite of the actions taken so far, especially those in developing new policies and signing international treaties, the annual number of women dying during pregnancy, labor and shortly afterwards is shockingly high (approximately 59.000) and has shown no decrease at all. If you break that number down, it means that a woman in Nigeria has a 1-in-18 risk of dying from pregnancy-related causes during her lifetime.
To attract more attention to this unacceptable high number of needless deaths, The Center for Reproductive Rights (CRR) and the Women Advocates Resource and Documentation Centre (WARDC) launched a new report on the condition of maternal health in Nigeria. Its main objective is targeted at unmasking the role of the government in every single maternal death and stressing its responsibility to guarantee the implementation of international health standards and human rights.
“Broken Promises-Human Rights, Accountability, and Maternal Death in Nigeria‘’ connotes that, despite the undeniable high rate of maternal mortality in the country and the promises made by the political establishment to address it, the results of the government’s initiatives are almost invisible. Blamed for that poor outcome are failures in health-care financing, leadership and governance. Some of them are obvious, for example systemic corruption which swallows huge amounts of money meant to improve health care facilities. Others are often over-looked as for example the lack of political will to address maternal mortality or the absence of gender-responsive budgeting. Furthermore, lack of implementation of laws and policies, inadequacy of counteractions, weak infrastructure, ineffective health services and lack of access to skilled health-care providers are highlighted.
The separation of responsibilities between the federal-, state- and local authorities is liable for the missing control over the cost and effectiveness of health services. As a conclusion : The government failed to fulfill its duties.
The book presents a focused analysis of the mistakes that have been made in the past and the financial and institutional barriers which prevent a better maternal health care in Nigeria. The financial aspects contain user fees in health facilities ( In Nigeria, there is evidence that maternal deaths increased by 56% and hospital deliveries fell by 46% after user fees were introduced) and lack of capacity to sustain free services, especially in terms of medication and inadequate staffing.
The infrastructural barriers concentrate on the locations of the health-care centers which are often very hard to reach for women in rural areas, long waiting periods and negative attitudes of overworked and underpaid medical staff. Some health facilities are even closed on weekends and only 18.5% of all health facilities in Nigeria meet the international standards for emergency obstetric care.
Another issue drawn up by the report is the low rate of contraceptive use in Nigeria: Only 11.6% of sexually active adults use modern contraceptive methods. The lack of availability, affordability and information discourages the average Nigerian from utilizing birth control, which manifests in a high occurrence of unplanned pregnancies. About half of these unwanted pregnancies are terminated which leads to one more crucial contributor to maternal mortality: Unsafe abortion. An estimated number of 456.000 unsafe abortions are executed every year in this country and about 34.000 women die from the consequences. The sixth periodic Report of Nigeria to the CEDAW Committee states: “Of the main causes of maternal mortality, unsafe abortion is the single most preventable cause of death”.
In the end some possible strategies to help overcoming the dire present situation are drawn up: It is essential to strengthen the framework of human rights, develop accountability mechanisms to prevent corruption, improve access to family planning services, remove financial barriers and establish a better infrastructural system if Nigeria really want to reduce the maternal mortality rate.
The report is based on field research undertaken between October 2007 and May 2008 by the Center of Reproductive Rights, as well as desk research by means of literature review of research publications (like WHO reports, journals and documentary analysis) and national demographic and health surveys. Over sixty persons were interviewed in order to get as much opinions on the condition of maternal health care as possible. All the statistics and numbers in the report are highly up to date, thus it provides greatly useful material for every journalist reporting on health care and everybody concerned with health issues in general.

--Sofia Krautz