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Leading obstetricians and gynaecologists have given reasons why at least 145 women in Nigeria lose their lives to pregnancy-related complications daily with most of the deaths occurring in the northern regions.
The maternal health experts attributed the avoidable and worrisome deaths to factors such as poverty, malnutrition, lack of skilled birth attendants, delays in hospital referrals, and hard-to-reach health facilities.
They noted that obstructed labour, uncontrolled bleeding after delivery, and pregnancy-related convulsions, particularly among young mothers, significantly contribute to the region’s high maternal mortality rate.
The maternal experts’ comments followed a recent statement by the Executive Director of the National Primary Health Care Development Agency, Dr Muyi Aina, revealing that Nigeria loses about 145 women daily to pregnancy and childbirth complications and 2,300 children to preventable diseases.
PUNCH Healthwise reported that the NPHCDA boss emphasised that most of these deaths occur in the northern regions and stressed the need for regular antenatal care, skilled midwife deliveries, and ensuring that every child completes their routine immunisations to reduce these preventable fatalities.
Aina said, “Every day, Nigeria loses about 2,300 under five years old children and 145 women of childbearing age. Most of these deaths are occurring in northern Nigeria.”
The experts, in separate interviews with PUNCH Healthwise, confirmed the estimated figures and advocated free delivery for pregnant women and treatment for children under the age of five.
Already, Nigeria accounts for the second-highest number of maternal and child maternal deaths globally.
Nigeria’s maternal mortality rate, according to the National Demographic and Health Survey 2018, was a ratio of 512 per 100,000 live births.
A 2023 progress report by the World Health Organisation showed that in 2020, 540 women and children “per thousand” died in Nigeria.
The report shows that Nigeria accounts for 12 per cent of global maternal and neonatal deaths.
Speaking with PUNCH Healthwise, a professor of Obstetrics & Gynaecology at the Usmanu Danfodiyo University, Sokoto State, Abubakar Panti, confirmed the figures of the daily estimated maternal deaths, stating that a state-by-state analysis of the 2018 NDHS showed that the northeast had an MMR of 1,549 per 100,000 live births.
“If you go by the state-by-state statistics of maternal mortality, you will notice that the northeast of the country has the highest maternal mortality rate of 1,549 per 100,000 live births. If you compare the MMR of 1,549 in the northeast to the 165 in the southwest, the difference is just too much and so the gap is too wide.
“MMR is also high in the northwest because this is the farthest part in the northern part of the country,” he said.
Commenting on the factors responsible for the high figures in the north, the maternal care expert highlighted poverty, worsened by the current hardship in the country, early marriage, lack of antenatal care, lack of appropriate health care facilities and lack of skilled birth attendants.
The gynaecologist added, “If you look at age, for example, there is early marriage in the north where a young teenage girl of 14, 15, gets married.
For example, early marriage is prone to pregnancy-induced hypertension, preeclampsia and eclampsia, and prolonged obstructed labour.
However, getting married early does not cause mortality but the lack of seeking antenatal care and hospital delivery is what will lead to the mortality. Asian countries also do early marriage and there are no mortalities.”
The Honorary Consultant Obstetrician and Gynaecologist at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, further noted that the low uptake of family planning in the north due to religious and cultural reasons contributed to the MMR.
He further mentioned that malnourished women with low blood packed cell volume level who gets pregnant were at risk of postpartum haemorrhage and bleeding to death.
Panti noted that convulsion during pregnancy, obstructed labour, bleeding during delivery and sepsis were common causes of MMR in the north.
He said, “Also, we have haemorrhage, that is bleeding during childbirth. Convulsion during pregnancy, which is common in young pregnant ladies, is one of the most common causes of MMR in some parts of the north. Then you now have obstructed labour. Also, some of them are delivered in areas that are not hygienic and infection can occur. They use all sorts of instruments at delivery and they can develop and die of sepsis.
“Then the last one is unsafe abortion, which is one of the commonest causes down south.”
The don also noted that delay in decision-making, delay in getting to the referred health facility person to the hospital due to living in hard-to-reach areas and unmotorable roads and the delay at the health facility in attending to the patient are the three delay models that contributed to MMR.
The fertility expert asserted that free maternal and child healthcare nationwide would considerably reduce maternal mortality in the north.
He further called for establishing well-equipped health facilities and trained personnel in rural areas and early referrals of cases to urban and better-equipped facilities.
Panti advocated improvement of the socioeconomic status of the populace and women’s empowerment.
Also, a professor of Obstetrics and Gynaecology at the Obafemi Awolowo University, Ile-Ife, Osun state, Ernest Orji, stated that the care of pregnancies and delivery by unqualified personnel, lack of antenatal care, late hospital presentation and underage marriage were responsible for the high disparity in the MMR between the north and south.
The researcher on Reproductive and Feto-Maternal Health said, “Also, there is what we call a delay model. Phase one delay is caused by the patients who delay in seeking care for complications during pregnancy or labour. Some don’t recognise the problem and don’t seek appropriate healthcare.
Phase 2 delay is where the patient requires immediate care but for some reason or another, cannot get access to qualified care. This may be due to the lack of means of transportation and fear of being attacked by bandits or kidnapped. Then, Phase 3 delay is that the patient has reached the healthcare facility and for one reason or another, could not receive the appropriate care needed during pregnancy or delivery. This could be due to lack of personnel, no light or water, no blood supply or equipment.”
The don noted that the delays could be tackled if the government had the political, moral and financial will.
Orji called for free treatment, antenatal care and delivery for pregnant mothers and the availability of well-equipped hospitals and health care providers to curb MMR.
