UNICEF releases 'The state of the world's children report' 2009

On January 15 2009, UNICEF launched the new "The State of the World's Children" report whose focus is on maternal and newborn health. Those are known to be very pressing problems all over Africa and Asia. The lifetime risk of maternal death for a woman in a least developed country is more than 300 times greater than for a woman living in an industrialized country. Nigeria is one of the major contributors to maternal and infant mortality; and an extra chapter is dedicated to maternal health in Nigeria:

Nigeria is Africa’s most populous country, with 148 million
inhabitants in 2007, 25 million of them under age five. With
almost 6 million births in 2007 – the third highest number in
the world behind India and China – and a total fertility rate
of 5.4, Nigeria’s population growth continues to be rapid in
absolute terms.
In addition to its sizeable population, Nigeria is known for
its vast oil wealth. Nonetheless, poverty is widespread;
according to the latest World Development Indicators 2007,
published by the World Bank, more than 70 per cent of
Nigerians live on less than US$1 per day, impairing their
ability to afford health care.
Poverty, demographic pressures and insufficient investment
in public health care, to name but three factors, inflate levels
and ratios of maternal and neonatal mortality. The latest
United Nations inter-agency estimates place the 2005 average
national maternal mortality ratio at 1,100 deaths per
100,000 live births and the lifetime risk of maternal death at
1 in 18. When viewed in global terms, the burden of maternal
death is brought into stark relief: Approximately 1 in
every 9 maternal deaths occurs in Nigeria alone.
The women who survive pregnancy and childbirth may face
compromised health; studies suggest that between 100,000
and 1 million women in Nigeria may be suffering from
obstetric fistula. Neonatal deaths in 2004 stood at 249,000,
according to the latest World Health Organization figures,
with 76 per cent taking place in the early neonatal period
(first week of life). Inadequate health facilities, lack of transportation
to institutional care, inability to pay for services
and resistance among some populations to modern health
care are key factors behind the country’s high rates of
maternal, newborn and child mortality and morbidity.
Disparities in poverty and health among Nigeria’s
numerous ethnolinguistic groups and between its states
are marked. Poverty rates in rural areas, estimated at
64 per cent in 2004, are roughly 1.5 times higher than the
urban-area rate of 43 per cent. Moreover, the poverty rate
in the north-east region, which stands at 67 per cent,
is almost twice the level of 34 per cent in the more
prosperous south-east.
Low levels of education, especially among women, and
discriminatory cultural attitudes and practices are barriers
to reducing high maternal mortality rates. A study at the
Jos University Teaching Hospital in the north-central region
shows that nearly three quarters of maternal deaths in 2005
occurred among illiterate women. The mortality rate among
women who did not receive antenatal care was about 20
times higher than among those who did. Of the several ethnic
groups represented among the patients, Hausa-Fulani
women accounted for 22 per cent of all deliveries and 44
per cent of all deaths. The Hausa-Fulani represent the
largest ethnic group in northern Nigeria and are therefore
critically affected by this region’s higher poverty rates.
Cultural attitudes and practices that discriminate against
women and girls contribute to maternal mortality and morbidity.
Child marriage and high rates of adolescent births
are commonplace across Nigeria, exposing girls and
women of reproductive age to numerous health risks.
Given these complex realities, developing strategies to
accelerate progress on maternal and newborn health
remains a considerable challenge. But the Government of
Nigeria, together with international partners, is attempting
to meet the challenge. In 2007, it began to implement a
national Integrated Maternal, Newborn and Child Health
(IMNCH) Strategy to fast-track high-impact intervention
packages that include nutritional supplements, immunization,
insecticide-treated mosquito nets and prevention
of mother-to-child transmission of HIV.
The strategy is to be rolled out in three phases, each lasting
three years, and has been designed along the continuum of
care model to strengthen Nigeria’s decentralized health system,
which operates at the federal, state and local levels. In
the initial phase, covering 2007–2009, the key focus will be
identifying and removing bottlenecks, while delivering a
basic package of services using community-based and
family-care strategies. A sizeable proportion of expenditure
will go towards artemisinin-based combination therapy to
combat malaria in women, children and newly recruited
and trained health workers, particularly in rural areas. As
basic healthcare improves, it is anticipated that the demand
for clinical services will increase.
The second and third phases of the IMNCH will place
greater emphasis on building health infrastructure. Over
nine years, the strategy aims to revitalize existing facilities,
construct clinics and hospitals, and create incentives –
such as dependable salaries, hardship allowances and
performance-based bonuses – that will help retain skilled
health professionals in Nigeria’s health system.
The IMNCH strategy, if implemented in full and on time,
can markedly improve maternal and newborn health.
Together with this package, the country has recently passed
the National Health Insurance Scheme, which integrates
the public and private health sectors to make health care
more affordable for Nigerians. If the government passes
the National Health Bill, which is currently before the legislature,
a direct funding line for primary health care will
become available. These health-system improvements have
the potential to set a new course for meeting Millennium
4 and 5 in Africas largest nation.