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REDUCING MATERNAL AND NEWBORN DEATHS
in
Nigeria
United Nations Human Development Index
136/162 countries
Socio-Economic Indicators per capita income N35,340
(US$310) access to health facilities 63.5% access to potable water 54.1% school attendance 55.1%
Total Population 120 Million Women of Reproductive Age 27 Million Married by Age 34 95% Median Age at 1st Marriage 18 Years Adult Female Literacy Rate 41% Contraceptive Prevalence Rate 8.9% Total Fertility Rate 5.1
Characteristics of the Population
Total Fertility Rate by Zone
4.5 4.5 4.6
6.56.8
0
1
2
3
4
5
6
7
8
Central Southwest Southeast Northwest Northeast
High Risk Fertility Behaviour
0 5 10 15 20 25 30
Mother's Age <18years
Mother's Age > 34years
Birth Interval < 24months
Birth Order 4+
Percent of all births
Place of Delivery
Health Facility: 37%
Home: 58%
Zonal Disparities: Health Facility Delivery
0
10
20
30
40
50
60
70
percent
Southwest Southeast Central Northeast Northwest
Selected Maternal Mortality Ratios in Africa
340
480
610
800
980
0
400
800
1200
South Africa Botswana Zimbabwe Nigeria Mozambique
Ma
tern
al D
ea
ths
/ 1
00
00
0 L
ive
Bir
ths
Maternal Mortality Ratio by Zone
1549
1025
286165
0
500
1000
1500
2000
Southwest Southeast Northwest Northeast
per
100
,000
liv
e b
irth
s
Death in the First 5 Years of Life
0
20
40
60
80
100
120
140
160
180
200
North-east
North-west
South-east
South-west
Central Nigeria
Dea
ths
per
10
00
live
bir
ths
Newborn (<1 month) 1-11 months 12-59 months
Causes of Maternal Death
Haemorrhage23%
Infection17%
Toxemia/ Eclampsia
11%
Unsafe Abortion
11%
Obstructed labour11%
Malaria11%
Anemia11%
Other5%
Women’s Low Status
•Lack of access to and control of resources
•Limited access to education
•Lack of decision- making power
The First Delay
Lack of information and inadequate knowledge about signs of complications of pregnancy and danger signals during labour
Cultural practices that restrict women from seeking health care
Inability to access health facilities
Poor siting of health facilities
Poor roads and communication network
Poor community support
The Second Delay
Carolyn Kruger
Delay between arriving and receiving care at the health facility
inadequate skilled attendants inadequate equipment and
supplies
The Third Delay
Health Facilities with Midwives
No Midwives 54%
At Least One Midwife
46%
Unsafe abortions- 610,000 per year High prevalence of malaria High rate of malnutrition – 16% HIV/AIDS pandemic 5.4%
Other Factors Contributing to Maternal Mortality
Adolescent pregnancy- 16% of total births
REDUCE MODEL
Impact on survival and productivity (2001 - 2010)
Data on Maternal Health
Estimating the Consequences of Poor Maternal and Newborn Health
Data Sources
Nigeria Demographic and Health Survey,1999 Nigeria Common Country Assessment, 2001 HIV/Syphilis Sentinel Sero-Prevalence Survey in
Nigeria, 1999 Multiple Indicator Cluster Survey, 2000 The Global Burden of Disease, 1996, 1998 The Human Development Report, 2001
Maternal Mortality2001-2010
No interventions
437, 000 maternal deaths
Effects of Mothers’ Death
The death of a woman and mother is a tragic loss to the family, community and nation as a whole.
Child Mortality2001-2010
No interventions
1,500,000 children will die
Disability Consequences2001-2010
Chronic anemia Stress incontinenceFistulae (VVF,RVF)Chronic pelvic painEmotional depressionMaternal exhaustion
$1.9 billion or
217 billion naira
Economic Losses2001-2010
The loss of productivity due to maternal deaths
will be $341,000,000
or about 39 billion Naira
N
N
N
N
N
N
Economic Gains2001-2010
Interventions
$536 million or 61 billion naira gained
N
N
N
N
N
N
Commitment to Reducing Maternal and New Born Deaths
Goal:
50 % by 2010
(Vision 2010)
Reduction in Maternal Deaths2001-2010
0
250
500
750
1000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Mat
ern
al d
eat
hs
/ 100
000
liv
e
bir
ths
No change in maternal careImproved maternal care
InterventionsImplementation of existing policies, guidelines and programmes related to maternal health issues should be faithfully implemented immediately and nationwide.
Allocate and release at least 15% of total annual budget for health and at least 10% of that budget for reproductive health services.
Ensure partnerships: private sector, civil society, religious and other community-based organizations.
Interventions 2All health facilities must have regular supply of water and electricity;
All facilities that offer maternity services must implement the Baby Friendly Initiative (BFI) which includes breastfeeding within 30 minutes of delivery, warmth, and general cleanliness ;
In each health district, equip one facility to provide basic obstetric care (Cost 3 million Naira), which offers:
•intravenous sedatives
•antibiotics
•oxytocic drugs
•manual removal of the placenta and retained products.
Interventions 3
In each LGA equip one secondary health facility to provide comprehensive essential obstetric care;
Keep facilities open for 24 hours;
All obstetric emergencies must be treated free for the first 24 hours.
Maintain two way referral system;
In each LGA equip one facility to provide comprehensive essential obstetric care (Cost 7 million Naira) which includes basic obstetric care as well as surgical procedures including ceasarian section under anesthesia and safe blood transfusions;
Interventions 4
Community involvement and improvement of
the social and infra-structural amenities in the
rural areas
Capacity building and improvement of skills:
Train more midwives and obstetricians
Train CHEWs to offer basic obstetric care
Incentives for these cadres to attract and retain them
If we act now…
$ 536 million (N61billion) in productivity gains
108,000 women’s lives saved
2,000,000 disabilities averted
340,000 children’s lives saved
Conditions Needed
strong commitment to maternal and newborn survival and health by political leaders and decision makers at national and local levels
realistic and appropriate investment in women’s education, health and economic empowerment
implementation framework with clearly defined supervision, monitoring and evaluation mechanisms.
The Way Forward
lead the fight against maternal and newborn death and disability
enable women to fully enjoy their rights
fully contribute to the social, economic and political development of Nigeria
Conclusion
To guarantee the right of Nigerian women to health and life, they must have access to quality reproductive health services, including skilled attendance at childbirth.
THANK YOU
FOR JOINING THE REDUCE TEAM
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