Pregnancy and the delivery of babies are seen as natural occurrences with joy. However, given the complications which often lead to the death of mother and child, pregnancies in Nigeria, particularly in the northern parts of the country, have become the biggest killers of our women, a sad story for Nigeria.
Facts have it that abortion complications, puerperal sepsis, postpartum haemorrhage (bleeding), ruptured uterus, and preeclampsia/eclampsia are the five major causes of maternal mortality in Nigeria.
As a woman and mother of six children, I am really challenged when I see women and mothers dying as a result of health complications that could easily have been prevented if these women had access to healthcare that is qualitative as well as affordable.
For example, in my place of Zango-Kataf in Southern Kaduna, a lot of women and children have been lost in the process of childbirth. The reasons for these deaths are not farfetched as a number of these women basically do not have access to good healthcare centres or hospitals. Even where these health centres are functional, one would find that there is a dearth of skilled birth attendants or midwives in these centres. There are also no drugs and the amenities required for the health facility to function.
Before now, pregnant mothers in under the most excruciating of situations were forced to either rely on roadside chemists or had to travel long distances to receive proper antenatal services. The picture indeed was so bad I cannot graphically paint it enough.
However, with the entrance of SURE-P Maternal and Child Health Care as a PIU, things have started to look up in Zango Kataf.
Of a truth, with the intervention of SURE-P MCH, Nigeria as a nation in three short years has made much progress in lowering maternal mortality rate despite the weak health system. Prior to SURE-P MCH’s emergence, the UNFPA via its yearly publications pegged Nigeria’s maternal mortality at 33,000 and estimated that at least over 2,000,000 suffer from lasting disabilities as a result of pregnancy and child complications.
Children too were, sadly, not excluded as such complications resulted in over a million children dying between the ages of childbirth and five years.
With understanding these figures comes the knowledge that apart from the fact that maternal and child mortality is a health issue, it is also a societal malaise as in most communities, the upbringing of most children is left to the mothers. Robbed of this vital parental care as most men either remarry or abandon their children to friends and relatives, oftentimes these children are maltreated, starved and abused, becoming later the dregs of our society. Also the loss of a million children, the future leaders, workers, etc, is a loss to any economy where populations factor largely.
It will be unfair to suggest that prior to the emergence of SURE-P MCH there had not been interventions, but the impact these interventions made was quite insignificant owing to the weak health system which made achieving of health outcomes in these rural areas very difficult. For example, most PHCs, prior to the SURE-P MCH era, were not functional, most were lacking electricity, accommodation and pipe-borne water.
Today, SURE-P MCH through its numerous interventions has achieved four cardinal objectives, namely, the recruitment, training and staffing of these PHCs with skilled birth attendants – that is, midwives that are trained. In all, SURE-P MCH trained 12,100 midwives as well as Community Health Workers or ‘CHEWs’. These trainings emphasized majorly on saving lives and skills training, making the midwife much more adept at handling the most adverse of situations. SURE-P MCH also improved women’s access to these skilled midwives during delivery, a rare occurrence before its intervention.
This way numerous lives were saved as these midwives were able to help the pregnant women receive counselling vital to the survival of mother and child. This intervention alone raised the number of expectant mothers who delivered with the help of a skilled birth attendant from 17 percent in 2012 to 57 percent in 2015 and reduced maternal mortality by 40 percent in communities where SURE-P had presence.
These measures, one would agree, have succeeded in curbing maternal deaths. Its scorecard which has been used to track the number of births at each facility attests to SURE-P MCH’s claims to success.
Understanding that new approaches were particularly needed in these areas, that reducing maternal deaths, especially in rural areas, would require not just medical care but a whole societal engagement, SURE-P MCH partnered with the communities in these areas to form Ward Development Committees (WDCs) in the areas that it had presence.
Another form of societal engagement was the introduction of the Conditional Cash Transfer or CCT. Prior to its introduction a huge number of pregnant women were doing the antenatal but still preferred to give birth at home. The probability of most maternal deaths occurring this way urged the SURE-P MCH team to conceive of a means of ensuring that these women preferred to deliver at the facilities. Under this scheme, pregnant women were given a stipend of N5,000 each if they went through the whole continuum of healthcare offered, from antenatal to post-natal services. This measure also helped reverse the maternal and child death burdens and provided a way of getting many mothers to deliver at the facilities. The CCT scheme also helped improve the uptake of family planning services as it provides that beneficiaries of the scheme aren’t entitled to it for a period of two years, helping reduce a number of unwanted pregnancies.
With SURE-P MCH’s interventions and achievements, I am optimistic that the goal of reducing child and maternal deaths is achievable because I have seen with my own eyes how it has reduced maternal mortality in my own environment in Zango Kataf in the last three years and I am hopeful that given more time, Nigeria will fully reverse the plague of maternal and child mortality. This goal is within our reach, we cannot stop now.
Amina Saleh
