The vulnerability of pregnant women and children

Less than five years to 2015, Nigeria accounts for 10 per cent global infant, child and maternal mortality. These are some of the public health challenges Nigeria face. Many multilateral as well as bilateral government agencies have invested so much in dropping the number of women dying each year from pregnancy and childbirth. Despite the annual decrease of 1.3 per cent in maternal mortality ratio from 181 countries according to a study conducted by The Institute for Health Metrics and Evaluation (IHME) at Washington University, Nigeria had a 1.4 per cent increase each year. For every woman who dies, 20 will face serious or long-lasting medical problems. Women who survive severe, life threatening complications often require lengthy recovery times.

This is the current situation in Nigeria. A report by UN and World Bank says that 144 women die in Nigeria every day from pregnancy and childbirth complications. It is generally believed that these deaths could be prevented with the availability of resources and services. High quality and accessible health care has made maternal death a rare event in developed countries. But infant, child and maternal mortality has continued to increase due to the inability of primary health care centers to serve the purpose for which they were established. Primary health care centers are not adequately equipped to provide the services which are essential to improving the health of Nigerians. Many pregnant women do not have access to health services due to geographical, financial and cultural barriers.

The essence of re-orienting health services towards primary health care is to provide essential health care that are universally accessible and with a cost that is affordable. We cannot achieve the goal of health for all when resources for health are not evenly distributed. Curative services get over 70 per cent of health budget while only about 1 per cent is allocated to preventive services. Also, over 70 per cent doctors are in urban area where only 48 per cent of the populations live leaving 52 per cent of the population who live in the rural area at the mercy of inadequate health personnel. These are the problems Nigeria faces and something must be done urgently to improve our health indices.

Women and children are high risk groups due to pregnancy complications as well as growth and development of the child and our failure to provide essential services to this group has led to high maternal, infant and child mortality. If we get it right at this level, then our health indices will improve. These deaths are preventable if only we allocate resources and provide services for all pregnant women. An effective primary health care system will no doubt help to reduce maternal, child and infant mortality.

The 2011 World Health Statistics by WHO puts births attended by skilled health personnel in Nigeria at 39 per cent. This means that 61 per cent of births in Nigeria are attended to by unskilled health personnel. Many pregnant women go through child delivery without the help of skilled attendants such as doctor, midwives or nurses due to cultural beliefs and lack of women empowerment besides a pregnant teenager and her child runs a high risk of illness, injury and death more than a mature woman in her 20’s.
It is estimated that over 600,000 Nigerian seek abortion each year. One-third of women obtaining abortion were adolescents and up to 80 per cent of Nigerian patients with abortion related complications are adolescents, this is a report by UNFPA. About 12 million girls are married before age 15 and in most cases to older men in the northern part of the country. This due to poverty and cultural values.

Reduction of poverty, promiscuity and the likely shame a girl brings to the family when pregnant out of wedlock has been cited as the advantages of early/child marriage and early child bearing. But little do these people know that the disadvantages of denying girls of school going age their rights to education and marrying them off around 13-14 years far outweighs the advantages. According to UNFPA, 45 per cent of women in northern Nigeria married by age 15 in a study conducted among women between the ages of 20 to 24 years and 73 per cent were married at the age of 18 years unlike in the South-West where there is delay in marriage (median age in marriage among 25 to 29 years old was 20.5).

Sadly, this trend is continuing. There has been efforts to reduce teenage pregnancy and discourage child marriage in Nigeria but despite this, the adolescent fertility rate (per 1000 girls aged 15-19 years) in Nigeria was reported to be 123 per 1000 by the 2011 World Health Statistics while the HIV infection rates among young people aged 15-19 was put at 3.3 per cent by UNFPA.

The adolescent health is a major issue that needs to be addressed. There are 1.2 billion adolescents across the world, 9 out of 10 of these young people live in developing countries says UNICEF besides just 26 per cent girls in northern Nigeria make it beyond primary school.

Undoubtedly, the disadvantages of child marriage and early childbearing include vesico vaginal fistulae, HIV, prostitution, poverty, death, long-term disability, illiteracy, infringement on the wishes/right of young girls’ etcetera. This shows that child marriage and early childbearing causes more harm than good hence it should be discouraged so that we can make much faster progress on maternal and child health indicators. According to USAID, Nigeria is making much slower progress on maternal and child health indicators than most other African countries. About 1 million children die each year before their 5th birthday. The 2011 WHO World Health Statistics reports that Under-5-Mortality rate per 1000 live births in Nigeria is 138. This is unacceptable. The Africa regional average was 142 per 1000 live births. Indeed in the words of the UN Secretary General Mr. Ban Ki-Moon during his two day working visit to Nigeria “the world must rise up against deaths of 22,000 children and maternal death of 1000 daily”.

Long before his visit, it was estimated that approximately 52,560-54,000 women and girls die each year due to pregnancy related complications. Additionally, another 1,080,000 to 1,620,000 Nigerian women and girls will suffer from disabilities caused by complications during pregnancy and child birth each year says the USAID. A woman dies approximately every 3 minutes from childbirth in Nigeria.

Statistics are there for all to see. The susceptibility and vulnerability of pregnant women and children calls for more action on the part of governments to make sure health care is affordable and accessible to all pregnant women and children in the country. Our inability to reduce the high rate of maternal and child mortality has been partly due to lack of affordable and accessible health services to mothers and children as well as primary health care that is poorly equipped to deliver maternal and child health services needed by both mothers and children.

However, it is hoped that the visit of the UN Secretary General Mr. Ban Ki-Moon to encourage Nigeria towards achieving the Millennium Development Goals (MDGs) would bring about a reduction in child mortality rates and the improvement of maternal health. President Jonathan and the Minister of Health must make concerted effort to reduce Under-5-Mortality rate, infant mortality rate, maternal mortality ratio and adolescent birth rate and increase measles immunization coverage among 1-year-old children, proportion of births attended by skilled health personnel, contraceptive prevalence rate, antenatal care coverage and unmet need for family planning. These targets if achieved during the life of the present administration will be a landmark achievement in the history of Nigeria. President Jonathan must work towards strengthening the health system with a view to providing quality and accessible health services which will in turn improve the country’s health status and those of her citizens

especially the mothers and children.

Written by
Bolaji Aregbeshola
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