REDUCTION OF MATERNAL MORTALITY:

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REDUCTION OF MATERNAL MORTALITY

• UTILIZATION OF MATERNAL HEALTH SERVICES IN 15
  UNFPA ASSISTED STATES IN NIGERIA (BASED ON
  THEMATIC EVALUATIONOF THE 5TH COUNTRY PROGRAM OF
  ASSISTANCE (2003 2007)
• By
• Prof. Pauline N. Otti.
• Lead Consultant,
• UNFPA, Abuja, Nigeria
• A PRESENTATION MADE AT THE THREE DAY MEETING WITH
  KEY STAKEHOLDERS IN BENUE STATE ON REDUCTION OF
  MATERNAL MORTALITY, ORGANISED BY OFFICE OF THE
  WIFE OF THE BENUE STATE GOVERNOR 15th 17th
  JANUARY 2009

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OUTLINE OF PRESENTATION

• 1) INTRODUCTION/BACKGROUND
• 2) UNFPA ASSISTANCE TO NIGERIA
• 3) UTILIZATION OF RH SERVICES IN NIGERIA
• 4) REASONS FOR NIGERIA PRESENT SITUATION
• 5) SOME GOOD PRACTICES IN NIGERIA
• 6) WHAT CAN BE DONE TO INCREASE RH SERVICES
  UTILIZATION
• 7) CONCLUSION

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REDUCTION OF MATERNAL MORTALITY UTILIZATION OF
PRIMARY HEALTH CARE SERVICES IN15 ASSISTED UNFPA
STATES IN NIGERIA

• Global concerns,
• reflected in consensus document such as in
  CEDAW but in particular
• Cairo 1994 ICPD
• womens right to make decisions concerning
  Reproductive Health (RH) face of discrimination,
  coercion and violence

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REDUCTION OF MATERNAL MORTALITY UTILIZATION OF
PRIMARY HEALTH CARE SERVICES IN15 ASSISTED UNFPA
STATES IN NIGERIA Cont.

• Implicit also, is the right to access
  appropriate health care, for safe pregnancy and
  delivery
• 1995 FWCW
• upheld Cairo ICPD action plan Reproductive
  Right (RR) as central to the agenda for advancing
  gender equity
• 2000-MDGs
• goals 3 5 on reduction of maternal
  mortality and empowement of women respectively.

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STILL PREVAING IN DEVELOPING COUNTRIES HOWEVER,
IS LOW UTILIZATION OF MH SERVICES.

• 1/3 of all pregnant women receive no health care
  during pregnancy
• 60 of deliveries take place outside of health
  facilities
• Only ½ of all deliveries are assisted by skilled
  personnel (UNFPA (2004) STATE OF WORLD
  POPULATION p.7 )
• NIGERIA
• While 59 of women attended antenatal care
  services only 30 returned to deliver in a health
  facility (UNFPA (2004) BASELINE SURVEY STUDIES
  FMOH (2007) IMNCH STRATEGY)

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STILL PREVAING IN DEVELOPING COUNTRIES HOWEVER,
IS LOW UTILIZATION OF MH SERVICES Cont.

• Therefore, in the 5th cp, UNFPA invested 60 65
  of its assistance in RH and one specific output
  stated
• Increased the availability of and accessibility
  to quality maternal care and emergency obstetric
  care services

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THUS UNFPA

• Trained considerable no of health providers at
  different level on life saving skills
  particularly in emergency obstetric care
• Equipped health centres
• Supported both HIV/AIDS and VVF management
  initiatives in collaboration with other
  Development Partners

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THUS UNFPA Cont.

• Engaged in high level dialogue and advocacy for
  gender equity, maternal health and facilitated
  sex disaggregated data, laws policies against
  Harmful Traditional Practice
• Provided information education materials on
  pop. issues, Sexual Reproductive Health, gender
  youth concerns

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THUS UNFPA Cont.

• Thematic Evaluation in 2007, however revealed the
  following patterns of utilization of ANC, PNC
  services.

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REASONS

• Cultural appropriateness, traditional practices
  and community perceptions
• Religious misrepresentation
• (cite emir of kebbi)
• Low social econ. status of girls and women
• - lack of decision making power
• men as head of HH/male in the family

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REASONS Cont.

• Low level of education
• to recognise danger signs
• Poverty
• - men control resources decide when where
  the women should seek health care
• - dependency of women

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REASONS Cont.

• - HH economics delimit choice and affordability
  to access health care facility
• Infrastructural limitations
• - lack of transportation to/fro
• Limited facility for ready access
• - limited provision of Basic Emergency Obstetric
  Care
• - time factor

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REASONS Cont.

• Shortage of skilled manpower
• (low moral attitude of skilled staff)
• Attitude of some health workers and complaints of
  abuse
• Mal distribution of trained staff. Rural-urban
  distribution
• Existence of active pluralistic alternative
  health care system

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REASONS Cont.

• - TBAs Advice of older women
• - Rural based therapists
• (indigenous healers)
• - Faith/spiritual healers
• - Self medication

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HOWEVER, GIRL- CHILD EDUC. REMAINS FUNDAMENTAL-

• EDUCATED GIRL-
• Marries later thus acquires maturity for
  parental responsibilities
• Has fewer children
• Provides better care and nutrition for self/
  children
• Makes better judgement to seek medical attention
  sooner for self/children, thereby

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HOWEVER, GIRL- CHILD EDUC. REMAINS FUNDAMENTAL-

• - Has higher probability of survival for
  self/children
• - With better learning/educ.Has more
  opportunities. To be A bread winner
• The Benifits of Girls Educ. accrues From
  Generation To Generation ( unicef1999p.7)

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GOOD PRACTICES

• Active village/community support and referral
  system. (e.g Anambra State)
• Provision of transportation for emergency by
  NURTW. (e.g. Plateau State)
• Adjusted school session to cater for
  married/unmarried older female (e.g. Bauchi,
  Sokoto).

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GOOD PRACTICES Cont.

• Community leaders become advocates to improve
  gender relationships (e.g. Borno, Kebbi).
• Emphasizing koranic injunctions which challenge
  husbands to ensure welfare health of wives to
  access health care.

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GOOD PRACTICES Cont.

• Financial contribution by associations at
  Mosques to assist mothers with transportation
  during emergency (e.g.Kebbi, Sokoto).
• Husbands sanctioned by traditional rulers if they
  failed to encourage wives to access maternal care
  (e.g. Plateau State).

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GOOD PRACTICES Cont.

• Traditional healers abandon Female Genital
  Cutting to become Community Based Distribution
  Agents (e.g. Ogun, Osun).
• Free maternal health care services (e.g. Anambra,
  Bauchi, Edo, Katsina, Nasarawa, etc).
• Enhancing laws against FGC, widowhood rites,
  trafficking in persons (e.g. Edo, Rivers)

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WHAT THEN CAN WE DO TO INCREASE SERVICE
UTILIZATION LEVEL--- SINCE HIGH MMR IS
UNACCEPTABLE!!

• Stronger voices for RH RR needed for-
• Establishing/supporting initiatives to empower
  women as users, with knowledge about RHRR, educ.
  Increased access to resources to make informed
  choice, reduce type1 delay increase utilization
  of mh services .

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WHAT THEN CAN WE DO TO INCREASE SERVICE
UTILIZATION LEVEL--- SINCE HIGH MMR IS
UNACCEPTABLE!!

• Encouraging men as advocates for gender and RH
• Mobilising communities to push for higher quality
  health services, posting of skilled birth
  attendants and also developing community mechs.to
  tackle type2 delay access appropriate MH
  medicare

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WHAT THEN CAN WE DO TO INCREASE SERVICE
UTILIZATION LEVEL--- SINCE HIGH MMR IS
UNACCEPTABLE!!

• Advocate for enhancing policies and laws for the
  wellbeing and health of women, girl children and
  implementation of the integrated maternal,
  newborn child health strategy

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CONCLUSION

• RH is a life time concern for both men women.
• But women will remain the focus of RH activities
  since the burden of ill-health associated with
  reproduction affects women to a much more large
  extent than it does men.

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CONCLUSION Cont.

• Ensuring equity and empowerment of women will
  therefore remain fundamental and pre-requisite to
  effective maternal, newborn child health
• Thus, it is compelling that a life cycle approach
  cannot be avoided if we are to achieve the MDGs
  target of reducing maternal death by 2/3 (MDG 5)
  by the years 2015
• i.e. intervention at different stages

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CONCLUSION Cont.

• - Infancy childhood (0 9yrs) e.g. FGC, girl
  child education.
• - Adolescence (10-19yrs) e.g. Early child
  bearing,
• - reproductive years (15 49yrs) e.g.
  Unplanned pregnancies, pregnancy complications,
  poor utilization of MH services
• - Post reproductive years (45yrs) e.g.
  Gynaecological concerns

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CONCLUSION Cont.

• -Life time health problems e.g. Gender based
  violence.
• ( Select your priority concern)

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A GUIDING DICTUM THAT SHOULD BE REMEMBERED ALWAYS
IS THAT-

• A person does not walk very fast on one leg, how
  then can we expect half of the people (men) to be
  able to develop a nation without the other half
  (women)- (The late elder statesman- Dr. Julius
  Nyerere, fmr. Pres. Tanzania)
• Your Excellencies,
• Our Royal Fathers,
• My Lords Spiritual and Temporal,
• Distinguished guests,
• PLEASE SAVE THE LlVES OF
• OUR WOMEN!!!!!!!!!!

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• TOGETHER, WE CAN MAKE IT HAPPEN!!
• THANK YOU FOR YOUR
  ATTENTION!!!