MORE than 70 percent of maternal deaths in Nigeria are due to five major complications: hemorrhage, infection, unsafe abortion, hypertensive disease of pregnancy and obstructed labour. Also, poor access to and utilization of quality reproductive health services contribute significantly to the high maternal mortality level in Nigeria. According to the 2003 Nigeria Demographic and Health Survey, 30 percent of Nigerian women cited the problem of getting money for treatment, while 24 percent cited the problems of accessibility to health facilities and transportation.
Also, 17 percent reported the problem of not getting a female provider in the hospital, while 14 percent reported the problem of not wanting to go alone. Again, 14 percent reported the problem of ignorance of where to go for treatment, while one in ten women complained of the bottlenecks in getting permission to visit hospitals. Majority of births in Nigeria (66 percent) occur at home and only one-third of live births during the five years preceding the most recent demographic health survey occurred in a health facility. A smaller proportion of women receive postnatal care, which is crucial for monitoring and treating complications in the first two days after delivery.
Only 23 percent of women who gave birth outside a health facility received postnatal care within two days of the birth of their last child. More than seven in ten women who delivered outside a health facility received no postnatal care at all. The Nigerian health system as a whole has been plagued by problems of service quality, including unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, chronic shortages of essential drugs and the well-known “out-of-stock: syndrome. In some hospitals, equipment such as sphygmomanometers, thermometers, weighing scales, delivery kits, waste bins and mucus extractors are unavailable. Many do not have regular supply of electricity because they cannot maintain a standby generator. Some do not even have a regular water supply and thus require their patients to provide their own water. Coupled with all these, staff are demoralized by inadequate and irregular remuneration. Many have relocated to industrialized countries where they will be adequately remunerated.
Evidence exists on the relationship between the density of health workers and maternal mortality rates in Nigeria. Slightly more than one-third of births in Nigeria are attended by doctors, trained nurses and midwives. This is in spite of the fact that the level of assistance a woman receives during delivery can reduce maternal deaths and related complications. The attitude of many nurses/midwives towards pregnant women and those in labour is poor. In the course of their professional duty as nurses/midwives, they act inappropriately to the woman in labour. Such attitude raises the question of what the duties of a nurse/midwife are to a woman in labour. Sometimes, one wonders if they have any knowledge of the literal meaning of their profession or even what their profession entails. The situation becomes worse if the woman in labour is an HIV-positive patient. Their attitude ranges from that of neglect to abandonment such that one questions the professional training they had and knowledge about the mode of transmission of HIV and the skill to prevent it. However, the fact that health facilities physically exist in the sense of bricks and mortar do not necessarily mean that they are functional.
Many hospitals in Nigeria are poorly equipped and lack essential supplies and qualified staff. In fact, a 2003 study revealed that only 42 percent of public facilities in Nigeria met internationally accepted standards for obstetric care. The health sector as a whole is in a dismal state. In the year 2000, the World Health Organization ranked the performance of Nigeria’s healthcare system 137th among 191 United Nations member states. The prevailing problems then are still persistent and are yet to be addressed due to Nigeria’s long-standing socio-economic situation and crises of leadership.
User charges coming at a time of spreading deepening poverty have become a great barrier to access for many Nigerian women who are not educated, and hence economically disempowered. Getting money for treatment was the problem most commonly reported by Nigerian women of all backgrounds. There is a strong negative correlation between both levels of education and wealth quintile. For instance, 41.6 Nigerian women had no education at all while 21.4 had primary education. 31.1 had secondary education while only 5.9 had higher education. The lowest wealth quintile for women is 68.7, the second being 63.3, the middle 49,2, the fourth 29.2 and the highest was 5.8 (35). It is worthy of note to point out that even educated women may not have access to healthcare either due to the problem of poor attitude of health care providers or that of proximity to quality health care facility. Graham, Fitzmaurice, Bell and Caims examine the link between poverty and maternal mortality. According to them, there is evidence of major differentials in access to and uptake of maternity services across a wide variety of developing countries, and recently a technique has been developed to expose similar discrepancies in the risk of maternal mortality. These risks, they explain: are a culmination of disparities in underlying health status differential lifetime exposure to pregnancy, different access to the means to avoid unwanted pregnancy, unequal physical, economic and social access to preventive services for normal pregnancy and delivery and major discrepancies in utilization of quality emergency obstetric care. Poverty greatly amplifies every other risk factor for maternal mortality and morbidity from grotesque female oppression to maternal under nutrition and to inadequate medical and physical infrastructure. The synergistic interrelationship between poverty and maternal mortality calls for the need to address this reproductive health problem
Source: Cyril Onoja