With an estimated 512 deaths per 100,000 live births, Nigeria’s maternal mortality rate is still among the highest in the world. Why is investment in public health so low, particularly in this age of marked improvement in maternal health care delivery globally? Sadly, the Government’s record will take us nowhere near the Sustainable Development Goals (SDGs) target of 70 per 100,000 live births by 2030 due to gross underfunding of public health. We need a major campaign by the trade unions to change this situation.
The President of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), Dr Habi Sadauki, lamented recently that: “There is still a lack of access to and utilisation of family planning services, with only 22 per cent of women using any method of family planning. Gender-Based Violence is still dominant in Nigeria, with one in three women reporting one form of physical, sexual abuse, among others.”
A recent report, Trends in Maternal Mortality, shows that every two minutes, a woman dies during pregnancy or childbirth. This is unfortunate. With modern developments in the medical world, no woman should die giving birth to a child. In the words of UNICEF Executive Director, Catherine Russell, “No mother should have to fear for her life while bringing a baby into the world, especially when the knowledge and tools to treat common complications exist.”
The Report also stated that maternal deaths continue to be largely concentrated in the poorest parts of the world and in countries affected by conflict; and about 70 per cent of all maternal deaths were in sub-Saharan Africa.
So, what is responsible for this situation? Roughly a third of women do not have even four of a recommended eight antenatal checks or receive essential postnatal care, while some lack access to modern family planning methods.
Severe bleeding after birth, called postpartum haemorrhage, is one of the most common causes of death and can kill a healthy woman within hours if she is unattended to. Other leading causes of maternal deaths are high blood pressure, pregnancy-related infections, complications from unsafe abortion. Underlying conditions such as HIV/AIDS and malaria can be aggravated by pregnancy. Many deliveries are attended to by unskilled birth attendants, lateness in taking a decision to go to a health facility, poor logistics to a health facility, and waiting time at the health facility make situations worse.
In Pakistan, among adolescent women aged 15–19, the maternal mortality ratio attributed to unsafe abortion is 41 deaths per 100,000 live births annually. This is the second highest cause of death for this age group. The situation is likely to be similar in Nigeria.
Maternal deaths are largely preventable with proper funding for public health services allowing access to high-quality and respectful healthcare for all. We can save maternal lives, improve their health and well-being, and advance their reproductive rights through increased Government funding for public health allowing access to high quality care in pregnancy, and during and after childbirth.
In 2001 African governments pledged to spend at least 15% of their budgets on health in the Abuja Declaration. Buhari increased the proportion spent on health from 4.2% for 2021 to 5% for 2022. At this rate it will take at least another 12 years to reach the 2001 target.
We will only have enough doctors and nurses if they are paid a decent salary. Trade unions in the health sector need to be more active and pursue their salary claims with more vigour. We need more unity and solidarity – the doctors and health workers in the trade unions of JOHESU cannot afford to fight each other. JOHESU needs to take more action. It suspended its strike in October 2021, what is it waiting for? It needs to provide a clear warning to the new government. Doctors, nurses and other health workers in Britain are taking strike action over their annual pay awards.
Non-governmental organisations (NGOs) should also join hands in the provision of reproductive health information, because achieving individual behavioural change for the reduction of maternal mortality requires sensitisation on prevention and response to emergency obstetric services.
We need more investments in primary public health care. The new government should give priority to interventions targeted at reducing the high maternal mortality rate; ensure basic improvements in reproductive health services, including family planning.
We need the trade unions to take an active interest in this area. We need branches to discuss these issues, pass motions on the subject and send letters to the state and national trade unions.
The trade union movement needs to take resolute action to ensure that the new government gives adequate funding for health care services.
