MP4Accountability to Needless Maternal Deaths END
Aug 2014 Edition
Mrs. Folorunso is just one among many or the Abisugas, the belief in
Epe indigenes with this belief, which has traditional birth attendants dates
contributed to poor health seeking Fback to several years of worship
attitude of women during pregnancy and and belief in deities, as a family way of
a high maternal death rate recorded in raising children. Folorunso Abisuga, a 32
the locality. "We found evidence in our year old mother of five had had four
data collation in the State, maternal children delivered at home by a
mortality was particularly high in Epe traditional birth attendant and is willing
from where women who had attended to deliver the fifth at home owing to her
traditional birth homes develop strong affiliation to her family's tradition
compl icat ions ," sa id the Lagos which takes root in the Yoruba adage that
Commissioner for Health, Dr. Jide Idris.says 'no midwife takes delivery of animal,
However, the chairman of the Lagos State thus women don't need midwifery but
Traditional Medicine Board, Dr, Bunmi supernatural powers.'
· Institutionalise an effective Death
Monitoring and Review system that tracks
all deaths of women during pregnancy,
delivery and postpartum period to
strengthen responses and avoid future
deaths
Increase budgetary allocations and
release same to improve Primary Health
Care operations.
Provide essential drugs and other
commodities at no cost for pregnant women
Strengthen referral as well as
effective ambulance services for pregnant
women during emergency.
Make free and accessible quality
antenatal services, provided by trained and
skilled health workers at primary, secondary
and tertiary health facilities.
Train and retrain health workers on
interpersonal relations and communications
as well as socio-cultural factors peculiar to
the community of operations
''Policy Action Points’ How to reduce Maternal Deathsamong culturally inclined women- Expert advocates monitoring and training of TBAs
group of media and government at all levels to reduce maternal and child Network brought together
c i v i l s o c i e t y prioritize investments in mortality. about 20 media practitioners
o r g a n i z a t i o n s quality maternal health care The forum which was and 10 members of the civil A(CSOs), during a CS-Media in low income and rural organized by Development societies to deliberate on
forum in Lagos has urged communities in Nigeria to Communications (DevComs) need to increase demand and
CS-Media group advocates for quality maternalhealth care in low income communities
Health Demographic Health Survey and agreements by the World Health access to maternal health care needs of
(NDHS 2013) has called for a review of Organisation amongst other institutions. women by strengthening the primary
maternal and child health strategies, health centres (PHCs) which he said were
policies and programs in Nigeria. Nigeria has close to 60% home deliveries not at par with the general hospitals
The country is still battling with the and will need to reduce this proportion where most women prefer because of
challenges of reducing about 40,000 drastically to achieve the millennium better infrastructure and friendly
annual deaths due to child birth, development goal 5 aimed at reducing environment which are lacking in most
despite numerous programs being maternal mortality ratio by 75%. In doing PHCs. According to him, the Lagos State
implemented by state and federal that, experts have stressed the need for government has already commissioned
governments in addition to the efforts improved availability, accessibility, some flagship PHCs out of the 57 PHCs
of donor agencies and private sectors. funding and quality of maternal health which will have basic laboratory services,
services in the country. treated water and at least three doctors
As a matter of fact, monitoring of on rotation. He said the PHCs will work 24
maternal deaths and emergency The Chairman, Lagos State Primary Health hours a day and have back up power. '' we he recent maternal mortality ratio
obstetric care are two important Care Board, Dr. Babs Sagoe, recently told are trying to decongest general hospitals of 576 per 100, 000 live births
strategies that have not received NOTAGAIN campaign that Lagos State as practiced in the developed world'', he Trecorded by Nigeria National sufficient attention despite guidelines was working to improve quality and said.
How to improve Emergency Obstetric Care (EmOC) policies -Expert calls for coordinated ambulance system in Lagos state
The long practice of birth delivery at home has stirred up arguments in various quarters of Lagos State with the realization that Epe, an ancient city in
the State recorded the highest maternal deaths in a 2013 study conducted by the Lagos State Ministry of Health to assess the maternal mortality
rate. In this report, Abiose Adelaja presents experts' opinions on reducing maternal deaths among culturally inclined women.
Lagos speaker endorses NOTAGAIN CampaignPage 2
-Ayodele Adesanmi
This report highlights the thoughts of Dr. Joe Odumakin on the need to avoid needless deaths of women and children. According
to her, improving access to maternal health means fighting poverty, synergy between government and other stakeholders,
sensitization and empowerment of women and better attitude of health workers.
Dr. Joe Odumakin
Dr. Babs Sagoe
Cont. on Pg 4
Cont.on Pg 4
Cont. on Pg 2
2
Katampe mothers, community seek Health Facilities- Resort to Home deliveries
this village is hospital clinic. As you can see will be happy so that we can ong distance from a health facility -now we have light and we have water'' he stop giving birth at home
'Too far' - is a long known factor that added. because sometimes when Lpredisposes pregnant women to Hadiza Sani, a mother of three said, “If some women want to give
mate rna l mor ta l i t y . The N iger i a government wants to do something for us, I birth at home, they end up
Demographic and Health Survey (NDHS) would want them to build hospital and road losing their children which is
. Sometime if I am in labour, because there not good after carrying our 2013 revealed that about 28.8% percent is no hospital in this village, I will enter bike baby for nine months.”
women in Nigeria (12.4 percent in Abuja) and go to Maitaima hospital.” She revealed A community member,
complained about distance to health that because of the absence of hospital in Obinna Aneke described the
facilities as a challenge accessing health the village, they have resorted to traditional visit of journalists as a
care. way of giving birth. “Some of us used to give welcome development,
Katampe community dwellers are typical of adding that building a
the women who complained about long hospital in the village would
distance to health facilities because of lack be helpful as some women
of one in the community. Katampe is a don’t have money to go to
settlement in the suburbs of Abuja in the hospital in the town.
Federal Capital Territory (FCT) situated in
Mpape town, Bwari Local Council. Mrs. Jaicita Omego, a nurse
Pregnant and nursing mothers in this in the village, confirmed that
community have to walk long distance to she has been helping the
obtain antenatal and post-natal service in women to deliver their
major towns, a condition that discourage babies in the community. She
most of them from accessing maternal said ''I have delivered many
health services. The discouragement in children in my house here
accessing health care is also hinged on the and no woman has ever died
lack of good roads and other social in my hand. They use to come to my house women and children, not to mention an
amenities. to deliver because there is no hospital to emergency services during complications.
NOTAGAIN gathered that the community deliver their children here. I use to collect It is unimaginable how these people will
had recorded some deaths of children due between N 2, 000 to N3, 000 from them handle an outbreak of epidemic in the event
to the situation of the healthcare system in because some of them don’t have money to of one.
the community. The Chief of Katampe, go to the city centre where there is hospita.” More so, considering the proximity of the Adamu Diga, lamented that “we do not “I want the government to train me to a
community to the Federal Capital Territory have health facilities here. Katampe has birth at home because we don’t have any higher level than I am today so that I can
of Nigeria, the villagers feel it will be fair for taken a long time in its existence. Some hospital here and sometimes, when a serve them better because they need help”
government to prevent deaths of women people have promised to bring a medical woman is seriously in labour, some women she said.
center here but we are yet to see them. and children, and meet the health care will come and help her deliver.” Meanwhile, NOTAGAIN gathered that the
Since the beginning of the village there has A 39 years old mother of five, Mrs. Serah nearest health facility to Katampe village is needs of their people.never been a hospital here. Sometimes Tanka, confirmed that she had been located in Mpape, about 5km away from
when emergency happens we use to take delivering her children at home due to lack the village. This is how Katampe community
them to Mpape or Maitaima hospital.” of health care facilities in the village. “ If dwellers have lived their lives since
“One of the things that is bothering us in government can build a hospital here, we inception, without a health facility for
MP4
MacArthur Foundation.
According to him, women he Speaker of the Lagos House of Assembly, Hon.
should realize that they are better Adeyemi Ikuforiji has advised pregnant women to
and safer when they access care Tpatronise only registered health facilities, while also
centers early enough in pregnancy. commending the NOTAGAIN initiative.
Ikuforiji made the plea in Lagos during the launch ''Immediately a woman discovers
of ‘NOTAGAIN Campaign’, a nationwide grassroots that she has missed her period, she
advocacy for the reduction of maternal mortality in Nigeria should go to a nearby health
organised by Women Advocates’ Research and facility to register in order to get
Documentation Centre (WARDC), with the support of the adequate maternal healthcare for
the safety of the mother and the
child,” Ikuforiji said.
The speake r u rged
relevant stakeholders including
medical practitioners, media and
non-governmental organisations maternal healthcare. The Lagos State Government has been
to create better awareness on the need for women to access doing its best ensuring that maternal and child mortality is
healthcare during pregnancy.reduced. This informed the establishment of Maternal and
“It is a collaborative effort because government alone Child Mortality Reduction (MCMR) Programme in 2012,” she
cannot reduce maternal mortality in the country,” he said.said.
Also speaking at the event was the Medical Officer According to him, the programme is geared
of Health, Local Community Development Area (LCDA), toward addressing some delays in seeking assistance and
Onigbongbo, Dr. Ibiwunmi Akinde who said that most accessing qualitative care for pregnant women and
maternal deaths in the country were preventable and children.“Since the commencement of the MCMR
unacceptable.programme, there has been increase in antenatal
“Nigeria today has the second highest maternal death rate in attendance and increase in deliveries as well as
the world, which means that there is a need to improve our infrastructural development,” she said.
Lagos speaker endorses NOTAGAIN Campaign- Charge pregnant women to visit antenatal
Hon. Adeyemi Ikuforiji
MP4
3Ayodele Adesanmi, Lagos
Abiose Adelaja, Lagos
Biodun Owo – Lagos
Faruk Umaru - Dutse
CONTRIBUTORSEDITORIAL TEAM
Ayodele Adesanmi – Editor
Chidiadi Onuoha – Graphic layout
Biodun Owo – Proof Reader
Nike Ogungbemi –member
Desmond Buchi –member
Omolade Adeshina –member
Catherine Odum - member
Bola Kolapo - member
Toyin Adeleke-member
Bisi Ogunbode
advocacy for improved maternal and child health care
rendered in low income communities in Nigeria.
The group observed that maternal mortality ratio is
higher among women who reside in rural areas that their
urban counterparts while women who are illiterate and
poor are less likely to access quality maternal health care
facilities, especially when such facilities are too far from
their residence.
Speaking about current practices of maternal health care
in selected low income communities in Lagos State, the
Programme Manager, Humanity Family Foundation for
Peace and Development (HUFFPED), Mr. Thompson
Eniobong described poverty, poor health care facilities,
inadequate skilled health workers as well as socio-
economic and cultural factor as major factors affecting
women’s access to maternal health care in most low-
income communities within and outside Lagos.
According to him, some women fail to access maternal
health care even when the services are available due to
illiteracy, lack of information regarding the availability of
health services/providers, lack of control on household
resources and inability to make decisions on their own.
The Executive Director of Women Arise and President,
Campaign for Democracy, Dr. Joe Odumakin, while
speaking on role of stakeholders said everyone is a
stakeholder in ensuring improved access to maternal synergy with government and encourage women to go to emulate the 'Abiye' Programme of Ondo State to ensure
health care but the role of the government is critical. hospitals for maternal health care. According to her, it is women have access to quality maternal health care.
"Government will have to galvanize all stakeholders" she the duty of government to provide standard In another presentation on 'mainstreaming good
said. infrastructure and facilities, like drugs, blood screening, governance in maternal and child health Care', the
Dr. Odumakin said the lackadaisical attitudes of health emergency and Caesarian section facilities, and other representative of Lagos State Civil Society Partnership
workers is worrisome and hampers the confidence of relevant facilities which must be cheap and affordable to (LASCOP) and Executive Director, Grassroot People and
women. She also charged traditional birth attendants the women. Gender Development Centre, Mrs. Vivian Emesowum,
(TBAs), religious leaders and other stakeholders to build The human rights activist then urged other states to said government ought to adequately
CS-Media group advocates for quality maternalhealth care in low income communitiesCont. from Pg 1
Patients disapprove registration fee hike in Jigawa hospitalby Umar Faruq, Dutse
Women accessing health care at Birnin Kudu Federal Medical Centre in Jigawa State have
expressed their disapproval of a registration fee hike in the hospital. Some of the women
who spoke with NOTAGAIN Campaign disclosed that the fee hike from N200 to N2000 naira
has reduced the number of women who could have accessed maternal health care in the
hospital.
A concerned patient, Hajia Asabe stated that most of the households were not able to afford
the cost of the registration forms. She explained that a lot of the women have switch to the
state general hospital as a substitute while others may not patronize any because their
husbands could not afford the new price.
Another patient, Hauwa muhammed usman said pregnant women are facing the brunt of the
difficulties largely due to lack of man power at the hospital which was exacerbated by the
nationwide strike. She said, ''Only nurses are attending to patients, a single nurse attends to
20 - 30 patient a day”.
An anonymous source within the hospital confirmed that the increase in cost of patient's
registration card may reduce the inflow of patients to the centre if they are unable to afford
N2000 naira to buy the medical form.
regnant women
a c c e s s i n g Pantenatal care at
Yakasai Primary Health
Centre in Soba Local
Government area of
Kaduna has appealed to
the authorities of the
hospital to upgrade the
facility to operate 24 hrs
a day and increase
health workers in the
centre.
This appeal was made during a visit to the community recently by NOTAGAIN
Campaign and other civil society organisations (CSOs) in the state. It was
gathered that bad roads, inadequate health workers and lack of care for women
undergoing labour at night, were major challenges facing the residents of the
community.
An expectant mother, Talatu Haruna while speaking with journalists said ''we
don't have doctors and the health workers don't work at night. I know of a lady
who started having labour pains around 1am. Many get to have complications
at about then even when they are brought here because the staff don't work at
night.
Another patient who spoke anonymously said ''they don't have people here
working at night. It won't be a bad idea if health personnel are added to those
working here''.
Fortunately, observers from Civil Society Organisations have confirmed that the
facility was trying its best to provide antenatal care for women in the
community and traditional birth attendants (TBAs) have played key roles in
encouraging women in the community to enroll for antenatal care.
Yakasai Community demands 24 hours facility
4
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Omoseyindemi, has lamented the provision of care. According to her, lots of service which includes antenatal care, they remain relevant. And we have been
continual attribution of maternal deaths to the traditional attendants accept women delivery, family planning services as well as doing a lot of that, training and retraining
the traditional birth attendants, saying, with high risk pregnancies such as women immunization and out-patient exercises. them on simple hygiene, safety precaution;
faith-based organizations and private with high blood pressure and diabetics; The other fifteen only offer a 12 hour we teach them on how to identify danger
hospitals also take deliveries. According to they accept cases of multiple pregnancies service, ante natal care, immunization and signs using modern day tools; how to make
him, the people collating the data are not (twins, triplets, etc); and admit women out patients. referrals and so on". said Dr. Omoseni. It is
using the right nomenclature. "When the pregnant after four children as is the case of This explains why women continually seek reported that there are up to 2350 trained
case gets bad and they cannot trace it to Mrs. Abisuga. help from traditional medicine which is TBAs in the state.
any hospital, they say it is us the traditional Omowunmi described such practices as considered to be as old as nature, closest to Furthermore, he advocated for the services
birth attendants(TBAs) that are causing the dangerous since the birth homes do not the people and culturally acceptable. of community health workers to act as
deaths." have laboratories or equipment, to monitor Reports have it that 60 per cent of births are community police, monitor the TBAs
Meanwhile, the chairman of the Traditional blood pressure, blood sugar or heart rate by TBAs in Epe, 21.4 per cent by TBAs in through mutual respect and encouraging
Birth Attendants in Epe admitted that and to intervene in emergencies. Lagos Island and 8.3 per cent in Badagry. them to register and be trained. Nigeria has
Why Maternal Health Accountability? Way forwardunregistered TBAs have continued to give an unacceptably high maternal mortality
For most women, the health facilities are Experts have suggested that aggressive them bad names and representation. rate of 576 per 100,000 live births,
not near enough. For instance, Epe local behavioural change advocacy as well as Speaking about risk factors in pregnancy, according to the 2013 Niger ian
government has eighteen primary health training and registration of unregistered the State Health Educator of the Maternal demographic health survey. It is believed
centers in its local council development TBAs will reduce maternal deaths .Death Review program, Mrs. Omowunmi that accountability of government to
areas. Only three out of these have skilled “What government needs to do really is to George, has highlighted certain errors promises and commitments made will help
doctors and midwives, offer 24 hours work hand in hand with the TBAs, because made by TBAs in admission of patients and reduce maternal deaths.
How to reduce Maternal Deaths among culturally inclined womenCont. from Pg 1
t h a t t h e authorities to include
LASAMBUS policy decisions and
coordinate funding of the new
ambulance a g e n c y l i k e
services at LASAMBUS.
state level
while local D e s p i t e t h e s e
governmen challenges, Lagos still
t s a r e has one of the best
responsible ambulance system in
for ambulance operations at primary health Nigeria with dedicated
care centres, a system which hampers maternal and child Dr. Sagoe, while speaking with NOTAGAIN
effective emergency obstetrics care as hospitals located at also revealed that ''there are cases they Furthermore, Nigeria will be able to avert
most ambulances at the local government strategic places in the state. The need to (PHCs) cannot handle at the primary health needless deaths of women if the World
level were said to be non functional or used improve emergency obstetric care is the care level, when a woman is bleeding and Health Organisation (WHO) EmOC
for other purposes. Where available, most responsibility of all government from local, she has not delivered, she is supposed to be standards are adhered to. The world health
of the buses were said to lack basic life- state to federal level, in the quest to reduce transferred. When a labour is taking longer body in a 2009 publication titled
saving infrastructures. maternal mortality.than necessary, especially if is a first time 'monitoring emergency obstetric care: a
person having a baby, or the nurse feels handbook' had recommended at least five
The role of effective emergency obstetric According to the UNFPA, timing proves to that the baby is not lying properly, the emergency obstetric care facilities for every
care especially ambulance services has be critical in preventing maternal deaths. patient should be transferred to the 500 000 population. The need to review the
been limited by the interplay between the Although post-partum haemorrhage can general hospital. And this system is what we proportion of facilities providing such
state and the local governments, who are kill a woman in under two hours, for most are trying to strengthen now''.facilities, their distribution, proportion of
custodian of the PHCs. According to the other complications, a woman has between women assessing them, and quality of the
PHC Board chairman, the merging of the 6 and 12 hours or more to get life-saving However, health experts in the state during services; is also paramount to effective
two arms require dialogue between emergency care. Similarly, most perinatal an ambulance review meeting organised Emergency Obstetric Care (EmOC).
stakeholders, including local government deaths occur during labour and delivery, or by PLAN/CEDPA have expressed their
chairmen but goes beyond mere within the first 48 hours thereafter.worries about the uncoordinated activities
pronouncement by local government of ambulances in Lagos State. It was learnt
How to improve (EmOC) policies
Did you have discussions with before or pregnant woman who died as a result of was too critical when they rushed her to
after delivery? pregnancy? the hospital even the doctor said they will
Yes, I think one told me that among three I just heard of like two that is around my only try but the condition at time was
of them, one delivered through CS, so neighborhood there, so when I got to find critical they tried to bring out the baby but
when I got there to find out they said she out they said the lady was just bleeding, after some time she died and the baby died
didn’t really understand anything until the that was what they told me and she has too.
day she want to deliver, they were now been attending antenatal, all of a sudden Do you know why she wasn’t attending This is an account by Mrs. Folashade Giwa, telling her that the baby was too big so that just happened and she bled to death. antenatal?
a trader at Oyingbo market in Lagos. Her that was why she go through the CS. The other one was through CS too she had Like I heard they said the husband was not
conversation with NOTAGAIN Campaign Do you know if she used to attend the baby and after some time the mother well to do he didn’t have a job, she was the
correspondent reveals how her neigbour antenatal? died and the baby died too one taking care of things all alone and at
died due to child bearing Yes ma, she used to What was responsible? that time it’s like business was not really Do you have any relative, neighbour or And they did not tell her about it? They said maybe she wasn’t attending moving for hersomebody that has just had a baby in No, they did not; they said they didn’t tell ante-natal very well even when she saw the So she did not attend because she didn’t the last one year? her anything like that until the day she have money? signs of those things, she didn’t even go to Yes, I know of very good neighbours that wanted to deliver Yesthe hospital she was using other live in the same house or street with me. Have you had anybody, maybe like a medication herself, so when the condition
EYE WITNESS ACCOUNT
Cont.from Pg 4