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