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