Maternal death is the death of a woman
while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, from any cause
related to or aggravated by the pregnancy or its management; but not
from accidental or incidental causes.
In September 2000, building upon a
decade of major United Nations conferences and summits, world leaders
came together at the United Nations headquarters in New York to adopt
the Millenium Development Goals, committing to a new global partnership
to reduce extreme poverty, and setting out a series of time-bound
targets with year 2015 as the deadline. In all, there are eight
millenium goals and 21 targets.
In summary, the MDG5 seeks to “improve
maternal health;” while Target 5.A. seeks to “Reduce by three quarters,
between 1990 and 2015, the maternal mortality ratio;” and achieve
universal access to reproductive health by the same targeted year.
Despite these laudable goals, however,
every day, approximately 800 women die from preventable causes related
to pregnancy and child birth. Worse still, 99 per cent of all maternal
deaths occur in developing countries, including Nigeria; and only one
per cent occurs in the developed nations.
In the case of Nigeria, with a
population of 162 million out of the world population of over seven
billion, we contribute a whopping 10 per cent of the world’s maternal
death rate.
The five major direct causes of maternal
deaths in pregnancy, during labour and immediately after birth include
severe bleeding (25 per cent), infection (15 per cent), eclampsia (12
per cent), obstructed labour (eight per cent), and unsafe abortion (13
per cent).
If all maternity centres are well
equipped with facilities and manpower, controlling excessive bleeding
during labour and, especially after child birth, will reduce one quarter
of all maternal deaths world wide.
Indirect causes of maternal death, such as HIV and malaria, may also be aggravates in pregnancy.
Because most causes of deaths in
pregnancy can be prevented, the World Health Organisation discribed them
as avoidable causes of death.
There have been various interventions at
national and international levels to reduce maternal death, and these
include: prevention of unwanted pregnancies, child spacing through
unfettered access to family planning methods, antenatal care and skilled
attendance at delivery, availability and access to emergency obstetric
care (including Caeserean Section and blood transfusion). There’s also
the need for greater empowerment of women and reinforced women’s rights,
as well as active promotion of gender equality.
Experts note that most deaths from pregnancy and childbirth are due to lack of access to skilled routine and emergency care.
Again, an assessement of maternal deaths
revealed that over 80 per cent of most deaths are preventable by simple
prophylactic measures, coupled with timely diagnosis and treatment of
the complications of pregnancy.
In over 60 per cent, the patient did not
register for antenatal in a standard health facility and had
unsupervised labour for two to three days or even more, either at home,
in religious maternity homes or in other maternity homes where there is
no single skilled attendant to provide standard care in pregnancy,
labour or after delivery; hence, making pregnancy a road to maternal
death.
However, the key to necessary
improvement is the institution of full professional maternity care. It
must be noted that it is considerably easier and quicker to train
effective midwives who are expected to handle the primary health
centres.
Also, improving access to health
facilities is a must. A long-term strategy must include a more
geographic spread placement of health centres, with improvment in road
networks. As part of short-term strategies, there is the need to
encourage communities and individuals to arrange for some form of
transportation when patients go into labour. For example, getting the
local transport union involved could be considered.
More important, improving the quality
and availability of emergency obstetric care and family planning
services must also be given high consideration. Facilities where labour
and deliveries take place should be able to provide adequate emergency
obstetric care. Interventions to manage common causes of maternal
mortality should be prompt and efficient. Blood bank facilities should
be readily available and medical personnel competent in managing these
emergencies and undertaking Caesarean Section should be within reach.
Grand multiparity is a major
predisposition to obstetric haemorrhage and, sometimes, obstructed
labour. When family planning services are readily available, affordable
and accessible at the grass roots, child spacing, with smaller family
sizes, would become the norm. This would reduce significantly the
maternal mortality rate in Nigeria.
by Samuel Adebayo (dayspringsk05@yahoo.com)
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