Maternal Mortality
Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
Maternal mortality continues to claim the lives of women of child bearing age in the world and this problem remains a challenge for many countries that still struggle to prevent it. This greatly and adversely affects not just women, but families and communities. Interestingly, many countries over the last decades have reduced their maternal mortality levels and contributed to the global reduction of maternal deaths. However, in Sub-Saharan Africa, where 50% of all maternal deaths occur, maternal mortality rates have largely stagnated.
Nigeria, the most populous black nation in Sub-Saharan Africa has a population close to 200 million people. Maternal mortality is still a major risk for women of child bearing age.
According to the World Health Organization (WHO), Nigeria had the highest number of annual maternal deaths in the world in 2010 and contributed 14% of all maternal deaths globally.
Irrespective of strategies laid down by relevant agencies and the Nigerian government like promotion of institutional deliveries, training and deploying new skilled health workers, the issue and challenge of maternal mortality is still persisting and remains a very major problem
In order to address the issues and policies surrounding maternal mortality, the actual medical causes of maternal death must be well understood. The World Bank has organized the global distribution of causes of maternal death into five categories:
Indirect causes like abortion, embolism. hemorrhage, hypertension, sepsis (infection), and other direct causes such as obstructed labor.
Data on the medical causes of maternal death in Nigeria are unknown and are frequently just an estimate. Mojekwu and Ibekwe state that 70% of maternal deaths in Nigeria are attributed to the complications outlines above. Additionally, the authors moved beyond medical factors and drew special attention to the poor access and utilization of reproductive health services.
Nigeria’s health system is actually a major challenge that contributes to maternal mortality. Nigeria’s health system operates three tiers which are: Primary health care (Local Government), Secondary health care (State Government) and Federal health care (Federal Government).
Major incentives to improve maternal health in Nigeria tend to come to a piecemeal and depends on the current political leadership. Medical providers describe experiencing delays in receiving approval to refer patients to specialists. Rural survey participants were less likely to experience quality care. Transportation to health facilities is a major challenge faced by women living in rural areas of Nigeria.
Barayonwa Dere is a community in Gokana Local Government Area of Rivers State in Nigeria. Currently, there is no private or state owned health facility that caters for the health needs of community dwellers. Community people will have to travel far distances in order to have access to health facility, hence, many times they resolve to traditional measures which is made available in the community by some individuals who are not formally trained health personnel. Due to the inability of the locals to handle complications arising from pregnancy, maternal death has become a very serious challenge in this community.
In an interview with a community woman, she explained that many families are poor and are not able to afford access to good health facility and in many cases cannot even transport themselves to government owned health centers. She ascribed this poverty rate to the destruction of their main source of livelihood. Barayonwa Dere is a rich oil community which now suffers environmental degradation as a result of oil spillage. This has made it impossible for villagers to fish or farm as they have lost their farm lands, mangroves and rivers to oil spillage. This has greatly affected their financial status thereby denying them access to good health care.
Government’s inability to provide access to education and educational facilities has led to increase in early girl marriage and pregnancy. Many young girls who should be in school and not up to the age of marriage have already been married. Issues emanating from girl pregnancy has led to the increase in maternity deaths. These young women do not have the necessary information they need to survive through pregnancy.
Critically and consciously engaging the general populace of the community especially women and girls can greatly cause a reduction in maternal deaths in the community.
Raising awareness on the existence of maternal facility, making it accessible and affordable may result to health utilization.
In Barayonwa Dere community, several women believe that having their babies in a non-institutional setting is better than in a modern facility because traditional birth attendants show more concern and compassion than skilled birth attendants. This will increase maternal deaths, because women’s perception of quality of care, influences health care service utilization.
Lack of knowledge of the importance of seeking medical attention during pregnancy and labor is commonly believed to negatively influence health behavior and decision making processes. The choice of seeking health care is embedded with cultural and social practices especially for women in rural villages. Women’s education, employment and affordability are the most commonly identified factors affecting antenatal care.
The majority of maternal deaths occur at homes in rural areas, among poorer communities and during the peripartum period – the last three months of the pregnancy to the first week after the end of the pregnancy, hence, engaging the community on maternal survival will give a clear strategic vision that prioritizes the intrapartum period in order to reduce maternal mortality.
There are a number of propositions on approaches to accessing the needs of the targeted audience. These perspectives border on sensitization, individual interest, health, some on wealth and some on empowerment.
It is of great importance to help the target audience identify their needs and priorities by themselves. This I believe will foster a sense of belonging to community and considerable benefits from working together on behalf of community and also empower community members with regard to issues that affect them.
Media Advocacy and Public Health: The purpose of public media advocacy is to use media strategically to apply pressure for changes in lifestyle of individuals in order to promote public health discussion, from a primary focus on the health behavior of the general community.
Other ways to accessing the needs of my target audience are:
Taking an inventory of women in the community and identify those who visits health centers and those who do not.
Engaging in a robust grass root educational and sensitization program that will reach out to every women group in the community from market women, farmers, age grade, religious etc.
This exercise is to thoroughly and painstakingly hear and know the needs of the target audience, their peculiarities and how to plan an intervention program for them.
Home visits, home management and referrals. Home visits involve promotion of birth and new born care preparedness via home-based antenatal care.
Organize group sessions at the community to promote antenatal care, use of clean delivery kits, institutional delivery, newborn care, danger signs identification and promotion of health workers
Provide a Mother Delivery Kit targeted to low-income, rural communities who may not be able to afford institutional care or do not have access to any. This delivery kit will help community health workers and traditional birth attendants who are often the sole health care provider in the community to deliver babies safely and hygienically. In carrying out this project, I have already factored in the 4Ps of social marketing.
Product – A mother delivery kit for the target audience and all participants
Price- Participants will only have to pay a one-time fee of N500($1.10)to show commitment,paticipants (expectant mothers)will be given delivery kits as incentives for participation and financial awards for mothers who complete antenatal care and delivers in a government/private recognized health facility.
Place – Village town hall will be the venue, with churches and market places alternatives to be sure everyone participates.
Promotion – The promotional message will be printed in English and local language of the people with emphasis on how women must not die during pregnancy and after child birth. messages will be delivered by healthcare personnel and will be on bill boards in strategic locations in the village.
Establish a community-based health insurance (CBHI) scheme. This is a voluntary form of health insurance that will be organized in community with the principles of risk-pooling and regular payments of a small premium. It aims to prevent catastrophic health expenditure, particularly among the underserved and the poorest of the poor. Community members will be involved in the management of the insurance and the selection of the health services that this scheme covers.
Set up and administer loan funds for emergency obstetric transport to overcome difficulties in paying for transportation. This loan funds aim to tackle the problem of insufficient funds for health care by the poor.
Set up a call center where women can call to speak with a medical professional at any time during and after the pregnancy or in case of emergency and also book an appointment to see some health personnel in the nearest health facility.
Deeper Life Bible Church (DLBC): This is a faith based religious organization that is particular about the spiritual, physical, emotional and more importantly, the health being of the community dwellers. Over the years, they have conducted medical outreaches and carried out educational programs for women in the community. They know and understand the people very well. It is certain that partnership with them will yield good result as the community already have faith and trust in them. Using asset-based community development approach, this religious organization believes that change will only happen if we identify and mobilize the gifts and capacities of the local people and the social, physical and economic resources of the people. Partnering with this organization using this approach will build a strong and sustainable developmental strides through forging and nurturing of relationships of care and creativity.
Friends of the Delta (FotD): This is a non-governmental organization that carries out environmental awareness campaigns in the community. The community has suffered greatly from environmental degradation. This NGO helps to sensitize the community members on environmental issues and stand as an advocacy group that influences government’s policy and individual’s decisions on environment. This NGO and I have a common vision and goal to see that community members live well and long.
Community engagement I believe is the heart of community development that will improve the policy and make the intervention programs more practical and relevant.
I have already accessed and identified the needs of my targeted audience through a comprehensive community assessment. This will enable me start up a transparent community selection process and share results.
I will hold preliminary meetings with partners and community leaders and seek their support to mobilize community participation.
I will hold community assembly meetings to elect local representatives to coordinate intervention program activities.
My partners, community members and I will collectively choose and start up with a project that can be completed in a short period of time. Quick impact projects I believe will build enthusiasm and continuity.
References
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Brunton, G., Thomas, J., O’Mara-Eves, A. et al. (2017) “Narratives of Community engagement: A Systematic Review-Derived Conceptual Framework for Public Health Interventions. BMC Public Health 17, 944
Cohen, Susan A. (1987) “The Safe Motherhood Conference.” International Family Planning Perspectives 13(2):68-70
De Brouwere, Vincent, René Tonglet, and Wim Van Lerberghe (1998) “Strategies for reducing maternal mortality in developing countries: What can we learn from the history of the industrialized West?” Tropical Medicine & International Health 3(10):771-782.
De Weger, E., Van Vooren, N., Luijkx, K. G. et al (2018) “Achieving Successful Community Engagement: A Rapid Realist Review. BMC Health Serv Res 18, 285.
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