Friday, 17 April 2009

Which way to 2015, Nigeria?

Creating a supportive environment for maternal and newborn health

Despite the relatively short time left until 2015, Nigeria still lags behind in reaching her Millennium Development Goals. The gap becomes most obvious in the area of maternal, newborn and child health, encapsulated in the MDGs 4 & 5. Nigeria is the world's second largest contributor to maternal mortality, accounting for 10% of all global maternal deaths. This sad second-highest ranking is also found in under- five mortality rates, resulting in the death of one out of every five Nigerian children before their fifth birthday (191 out of every 1000 children). This number is shockingly high, especially compared to the target of 77 out of 1000 which is to be achieved in only six years time. If we look at maternal morbidity the condition seems similarly grim: MDG 5 aims at curbing maternal mortality from presently 1000 per 100.000 life births, signifying mothers dying in the course of pregnancy, delivery or immediately after childbirth, to 250 out of 100.000, a reduction of about three quarters. The key question remains: Can these goals ever be met?

The most reasonable response is: Yes, they can. But there are many steps to be taken to effectively curb maternal and infant deaths in Nigeria. A supportive environment for maternal, newborn and child health must be created through various approaches, programs, community interventions and involvement of all stakeholders, most importantly the Nigerian society. Education for women and girls is essential, as women are the center of all interventions in maternal and child health issues. Research has shown that education until at least secondary level lowers maternal and child mortality drastically. On the one hand, these women are less likely to marry early which delays their first pregnancy and lowers their exposure to maternity risks. Complications from pregnancy and childbirth are an important cause of mortality for girls aged 15-19 worldwide, accounting for 70.000 deaths annually.

If the first pregnancy can be delayed till at least 20 years of age maternal mortality risks are curbed drastically and the babies of women over 20 are most likely to be healthier. These women are far more likely to immunize their children and provide adequate nutrition and disease prevention, resulting in reduced infant deaths. Furthermore, women's education sustains economic growth, thereby automatically creating a better health system. Children of underage mothers often suffer from low birth-weight, malnutrition, and late physical and cognitive development. To create a supportive environment for mothers and children, women must be more involved in decision making processes, both at household level (studies have shown that when women are able to participate in key decisions in the household, they are more likely to ensure that their children are well nourished and seek appropriate medical care for themselves and their children) and within the communities. Community initiatives are highly effective in improving the health of mothers and children as they can challenge attitudes and practices that entrench gender discrimination. Women can share work and pool resources, for example in contributing money to pay transport to the hospital in case of an emergency.
Regular visits and basic health education through community health workers is a key pillar of necessary interventions. The health workers advocate for key household practices such as sleeping under insecticide treated bed nets to prevent mosquito bites and malaria, exclusive breastfeeding, and hand-washing with soap or ash. All these interventions have been proved highly effective in ensuring the health of children and mothers and prevent the most common causes of child death. And they are practically for free.

These initiatives aiming at women empowerment need to be backed up by community support, above all by from ment. Present attitudes of gender discrimination need to be addressed and challenged. This calls for the help and commitment of religious & community leaders towards improving the situation for women in Nigeria. Harmful traditional practices such as child marriage and female genital mutilation (FGM) need to be abolished completely. Another field of action is the prevalence of physical violence against women, which causes many health problems for women and their born or unborn babies. Legislation against woman-battering must be implemented and effectively enforced throughout the country.
Without a doubt, the government also has to play its role and deliver the adequate services at critical points. This includes investment in infrastructure to ensure the access to safe water, good nutrition, adequate sanitation and hygiene facilities, as well as disease prevention and treatment for every Nigerian citizen. Facilities must have sufficient medicines, supplies, equipment and trained personnel. Every pregnant woman must be granted the access to quality antenatal care, skilled assistance at delivery and clean delivery facilities to prevent severe infections. In case of an emergency, EOC (Emergency Obstetric Care) should be available at every secondary and tertiary health facility to save the life of mothers and newborns alike.

After giving birth post-natal care and neonatal care should be easily available at every health facility. Antenatal and postnatal care also serve as a means of educating the mother on best practices with her newborn, stress the importance of exclusive breastfeeding and promote hygienic child care. In order to put all this initiatives in place it is essential to expand the Maternal, Newborn and Child health workforce and establish solid financing mechanisms. Government must be prepared and willing to allocate more resources to MNCH- because it is the nation as a whole who will finally profit from living mothers and healthy babies.

--Sofia Krauss

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