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Why Nigeria needs a maternal healthcare revolution

by Toyin Saraki, Wellbeing Foundation Africa
Thursday, 12 May 2016 11:04 GMT

A nurse inspects a pregnant woman outside a ward at a maternity hospital renovated by Royal Dutch Shell in Obio district in Nigeria's oil city of Port Harcourt March 24, 2011. REUTERS/Akintunde Akinleye

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* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

By investing in one midwife for each mother and her pregnancy, we can save, and improve the quality, of at least 2 lives

As with most of Africa, Nigeria needs a healthcare revolution. This is especially the case in maternal care where we currently have one of the worst indices for maternal and child mortality in the world, an inglorious position shared with Afghanistan. However, the narrative surrounding healthcare in Nigeria is far more nuanced than the outside world often care to understand. Great strides are being made, particularly with pledges to improve primary health infrastructure. But we know there is still huge work to be done.    

The disparities in survival rates for mothers and newborns around the world alludes to the fact that a global lottery exists surrounding the location of one’s birth. According to UNICEF, Nigeria is the second largest contributor to under-five and maternal mortality rates, with a majority of newborn deaths occurring within the first week after birth.  The chance of dying during pregnancy in Nigeria is 1 in 13; a shocking statistic that relates directly to the lack of skilled and equipped healthcare-attended births and to the fact that many mothers simply do not receive antenatal care. These stark statistics expose the health crisis in which Nigeria finds itself, these problems must be addressed quickly and effectively.

However, the reliance on raw statistics alone are part of the challenge. Our simple registers of births and deaths cannot lead us to solutions because they reveal neither the social determinants nor the ultimate causes. They also do not reveal stillbirths, or those that survive with permanent birth injuries. Only 50 % of births are registered in urban areas in Nigeria and just 21 percent in rural areas.  The absence of these essential details has produced a difficult challenge for healthcare policy makers and professionals to produce solutions that reflect and address the reality of the problem.

This is why at the Wellbeing Foundation Africa we have lobbied for health enhanced vital statistics, civil data and birth registrations through the deployment of personal health records.  The personal health record stores all the essential information of the pregnancy for the mother and healthcare professionals and also officially registers the pregnancy.

We believe in tapping into a mother's natural protective instinct to nest and nurture by empowering her as principal custodian of her own health history.  We also help mothers with financial inclusion through savings accounts and health insurance, along with practical birth and lactation classes. Through these programmes, we hope to address all the unmet need and transform the lives of mothers, newborns and families, by creating both demand and compliance of best practice behaviour and delivering higher continuum of care.

I believe at the heart of the solution are midwives. Without supporting, training, and resourcing midwives in Nigeria, we cannot address these dire health outcomes. For the safe and responsible delivery of a child, the presence of a midwife is vital. So it is crucial that we arm our midwives with skills, education and equipment, to ensure safe deliveries and healthy mothers. It is also essential that all women no matter their income have access to antenatal and postnatal care. By investing in one midwife for each mother and her pregnancy, we can save, and improve the quality, and value, both real and statistical, of at least 2 lives.

Last week, over 200 policymakers, healthcare professionals and activists joined the Wellbeing Foundation Africa at the Inaugural Global Midwifery Conference in Abuja. This was the first conference of its kind in Africa. The conference aimed to address the healthcare challenges that Nigeria and the rest of Africa are facing with regards to child and maternal health. 

The momentum of the conference was felt across Nigeria, and subsequent to it, the Nigerian Health Minister, Professor Isaac Folorunso Adewole, pledged his commitment to strengthening the healthcare workforce, vowing to deploy midwives to all parts of Nigeria.  The Federal Government ensured that it will revamp primary care, placing midwifery at its core. We are delighted that the Government has joined us in bettering the lives of the mothers and the children of our country.

The Wellbeing Foundation Africa (WBFA) has always centered its policies on midwifery, ensuring midwives and mothers are equipped with the right tools and skills. The WBFA’S Mamacare programme is a prime example. Our Mamakit package contains essential sterilised items that ensure a hygienic and safe birthing process; antenatal classes; and also Emergency Obstetric and Neonatal Care (EmONC).

Even if care is available and accessible, the next step is to ensure that it is of the highest quality. As the ICM President, Mrs Frances Day-Stirk noted at the conference: ‘‘educated, trained, licensed and regulated midwives prove the full scope of midwifery”. The ICM have created a Midwifery Services Framework, which guides countries on how to apply global best practice models and improve national policies and programmes for midwifery services. The framework will help to ensure that at every birth, the hands that care for our children are the best.

As we move forward in achieving our targets in reducing maternal, newborn and child deaths in Nigeria, we need to ensure that the midwife is at the centre of the all policy recommendations. They are essential in giving every woman and child in Nigeria and Africa the best and safest start to life. We cannot use deaths as population control when cost effective contraceptive should be readily available.

Toyin Saraki is the founder of women's rights charity Wellbeing Foundation Africa

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