Monday, 29 September 2008

Still On Maternal Death

Superstitious belief and poor attitude of work by nurses lead to patronage of traditional birth attendants by pregnant women resulting to high maternal death in the country

By Nathaniel Jonah

The death of Toyin Adesope and Aminat Abdullah are both cases of maternal mortality in Nigeria. Adesope an 18-year old SS3 student of Commercial Science Secondary School, Alagbado, Lagos was confirmed pregnant surprisingly because she was using contraceptives. She attempted to get rid of the unwanted baby but this could not work out. Barely seven months after, she began to feel some uncomfortable cramps in her lower abdominal region and was immediately rushed to the hospital by her cousin. Four days later, Toyin gave up the ghost after three days of excruciating labour pains. Neither Toyin nor the unfortunate baby survived the raw deal. “I am sure if there had been more sophisticated equipments, and better trained medical personnel, she would have made it,” lamented her cousin.

If Toyin's ordeal was sad, then, Aminat Abdullah, a middle aged pregnant house wife who resides in Nyanyan Gwandara, a sleepy suburb of Nasarawa state is even more pathetic. Aminat did not discover that she was pregnant until she was in the early stage of the second trimester. This she attributed to the irregular flow of her menstrual cycle. “When we eventually realized that I was pregnant, my husband ruled out any possibilities of visiting the hospital because according to him, no member of his family ever gave birth in the hospital; they all deliver at home through the help of local midwives,” she told this magazine.

Despite the state of her pregnancy, she continued to assist her husband on the farm until she felt severe pains in her bowels and the local midwife was summoned to assist as usual but Aminat's critical conditions defiled her local dexterity. By the time Aminat was taken to the hospital after five days of profuse bleeding and sever pains, the doctors said the baby's life was in danger. Eventually, she lost the baby and in the process Aminat had her womb removed as a result of complications.

Toyin and Aminat are just instances of Nigerian women who suffer complications as a result of poor primary healthcare and emergency obstetrics care associated with still birth, ill-equipped and badly-managed hospitals, and carelessness on the part of medical and health personnel.
A recent United Nations report said Nigeria has the second highest number of maternal mortality ratio, MMR in the world after India. The MMR is the number of maternal deaths during a given period per 100,000 live births. Available statistics also show that out of five million pregnancies that occur every year, 54,000 women die of pregnancy complications and child birth.

Mustapha Kolo is the chairman, Nigerian partnership for safe motherhood, NPSM. He is of the view that about 750,000 pregnancies which constitute 15 per cent of the total figure lead to complication requiring obstetric care which are largely unavailable in Nigeria. In a similar development, The Society of Gynaecology and Obstetrics of Nigeria, SOGON, equally brought to the fore the shocking high rate of maternal death in the country and the generally poor conditions of the nation's health institutions. According to SOGON, no fewer than 54,000 Nigerian women die yearly from pregnancy-related complications while about one million children die each year at birth.

Professor Friday Okonnofura, the immediate past provost of college of medicine, University of Benin, said women in Nigeria faced various challenges among which is poor access to family planning. It is estimated that only about 10 per cent of women who require family planning have access to it and that only about 30 per cent of the 64 per cent pregnant women who have access to antenatal care actually utilize it, thus placing Nigeria among countries with poor antenatal care practice. Investigation by this magazine however reveals that majority of the expectant mothers are plagued by insufficient information on the need to keep their health in top shape prior to their delivery. According to Dr. Chinedu Obinna of Mount Zion Hospital and Maternity home, Mararaba, Nasarawa state, “most women when they discover that they are pregnant are not aware of the need for them to pay regular visits to the hospitals for antenatal check ups where their health and that of the unborn child would be closely monitored. They prefer going to local and unskilled birth attendants and by the time they are rushed to the hospitals, chances are that the woman is in a life threatening situation.” However, Nonye Chukwuani, a six-month pregnant woman who spoke to this medium cited reasons why she prefers the services of local midwives to the ones in the hospital. “I have given birth to four children and all of them were through the assistance of local midwives; this is my fifth pregnancy, and you can be sure that I will not give birth in the hospital.” When asked why she prefers the local midwives, she was quick to retort that “most nurses in the hospitals are very cruel; the way they handle women during labour leaves much to be desired. They go as far as beating and screaming at women during labour, an action which further aggravates the woman' s situation.”

Dr. Kingsley Akinfenwa of the Defense Headquarters Medical Centre, Abuja however, disagrees with Nonye on the cruelty of the nurses as reasons for her patronage of local midwives. “While I don't doubt that fact that there are good local midwives, I still recommend that every pregnant woman visits a reputable hospital for antenatal services. That way, she would be sure of safe delivery. Besides, I strongly believe that if the government could give as much attention to women's reproductive health as it
appears to give to pregnancy prevention, maternal mortality will significantly reduce.”
An official of the Nigerian Medical Association who spoke to this magazine on the condition of anonymity opines that the earlier Nigerian women disabuse their minds from superstitious beliefs concerning pregnancies and childbirth, the better for the country. He said the government needs to do more than policy formulations and mere paper work and start taking holistic approaches to improve healthcare delivery in Nigeria.

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