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Maternal and Child Health in Nigeria. Professor Friday Okonofua Provost, College of Medical Sciences, University of Benin, Executive Director, International Federation of Obstetricians and Gynecologists (FIGO), and Hon Adviser to the President on Health. Background.

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Maternal and Child Health in Nigeria


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    1. Maternal and Child Health in Nigeria Professor Friday Okonofua Provost, College of Medical Sciences, University of Benin, Executive Director, International Federation of Obstetricians and Gynecologists (FIGO), and Hon Adviser to the President on Health

    2. Background • The 1991 national census reported life expectancy of 52.6 years for males, and 53.8 years for females • However, the crude birth declined from 27 to 14 per 1000 in 1991 • Despite this, the WHO ranked Nigeria low (163rd out of 191 countries) in terms of Disability Adjusted Life Expectancy (DALE) with a value of only 38.3 years

    3. Disability Adjusted Life Expectancy (DALE) • DALE adjusts life expectancy for disability, and is a more robust measure of survival • In DALE estimation, Nigeria ranked higher than countries like Sierra Leone and Liberia, but was behind countries like Ghana and South Africa • Further analysis showed that the low DALE ranking of Nigeria was due to the high maternal, neonatal, infant and under-five mortality in Nigeria

    4. Global Comparison of Score and Ranking of Disability adjusted life Expectancy Country DALE (years) DALE ranking (out of 191 countries) Sierra Leone 25.9 191 Liberia 34.0 181 Nigeria 38.3 163 South Africa 39.8 160 Ghana 45.5 149 USA 70.0 24 UK 71.7 14 Sweden 73.0 4

    5. Objectives of this Presentation • Present current statistics relating to maternal and child mortality in Nigeria • Identify some of the most important determinants of maternal and child mortality in Nigeria • Review the development of the enabling frameworks for the delivery of MCH services in Nigeria, and • Make substantive recommendations on ways to improve maternal and child health in Nigeria

    6. Maternal Deaths in Nigeria • An estimated 500,000 women die each year throughout the world from complications of pregnancy and childbirth • 55,000 of these deaths occur in Nigeria • Nigeria is only two percent of the world’s population but accounts for over 10% of the world’s maternal deaths in childbirth • Ranks second globally (to India) in number of maternal deaths

    7. Maternal Mortality Ratios in Nigeria

    8. Maternal Mortality Ratios in some States (SOGON, 2005)

    9. Other indicators of Maternal Morbidity and Mortality • Risk of a woman dying from child birth is 1 in 18 in Nigeria, compared to 1 in 61 for all developing countries, and 1 in 29, 800 for Sweden • For every woman who dies from childbirth in Nigeria, another 30 women suffer long term chronic ill-health • The UNFPA estimates that 2 million women suffer vesico-vaginal fistula globally, 40% of these (800,000 women) are in Nigeria

    10. Medical Causes of Maternal Mortality in Nigeria Hemorrhage - 23% Infection - 17% Malaria - 11% Anaemia - 11% Abortion - 11% Eclampsia - 11% Narrow Pelvis - 11% Others - 11%

    11. Unsafe Abortion in Nigeria • An estimated 610, 000 women undergo clandestine abortion annually in Nigeria • The FMOH (1991) estimates that 20,000 Nigerian women die from abortion complications each year • Abortion complications also predispose women to infertility and ectopic pregnancy

    12. Child Mortality Statistics in Nigeria • Infant mortality rate 71 per 1000 live births • Under -5 mortality rate 140 per 1000 live births • Perinatal mortality rate 51 per 1000 live births 103 per 1000 live births

    13. Comparative Performance in Reducing U5MR

    14. Indicator of Equality of Child Survival (ECS), WHO • Equality of child survival (ECS) measures the extent to which under–five mortality reflects pure chance of death (equal to all children) rather than variations in underlying factors • A value of 1 represents complete equality of child survival, unaffected by underlying factors • The more the value lies below one, the greater the degree of inequality in child survival, due to these underlying factors

    15. Performance of Nigeria in ECS Ranking • Nigeria scored 0.336 in the ECS ranking meaning a high probability of child mortality from underlying factors • Nigeria ranked 4th lowest out of 191 ranked countries • Nigeria was only ahead of Central African Republic, Mozambique and Liberia • Nigeria ranked worse than war-torn Sierra Leone and Angola

    16. Factors contributing to Maternal Mortality in Nigeria • Lack of antenatal care • Low proportion of women attended to by skilled birth attendants • Delays in the treatment of complications of pregnancy • Poverty • Harmful traditional practices • Low status of women

    17. Utilisation of MCH Services in Nigeria • Contraceptive prevalence rate 8% • Unwanted pregnancy rate among adolescents 60% • Use of antenatal care by a trained provider 64% • Proportion of pregnant women delivered by a trained provider 37% • Proportion of pregnant women who deliver at home 57%

    18. Delays in Treatment of Pregnancy Complications Type I Delay - when a woman with a pregnancy complication fails to get to a hospital in time Type II Delay - when the delay is due to difficulty with transportation Type III Delay - when there is delay in treatment after the patient has reached the hospital

    19. Contribution of “Delays” to Maternal Mortality in Nigeria • No delay 10% • Type I Delay 30% • Type II Delay 20% • Type III Delay 40%

    20. Causes of Type III Delay • Non-affordability of antenatal costs, delivery costs and post-natal costs • Delays in seeing staff in health facilities • Incessant strikes and lockouts • Delays due to poor supplies and consumables • Delay in referral of patients • Basic essential obstetrics care not available in most facilities • Systemic problems – doctors and midwives refusing rural postings • External brain drain

    21. Characteristics of Nigeria’s Health System • Weak and inefficient • Under-capitalized • Poor motivated health units • Costly • inaccessible

    22. Comparative Performance of Nigeria’s Health System, out of 191 Countries

    23. MCH service delivery in Nigeria: Historical milestones • 1980s - Emphasis on family planning/MCH services • 1989 - International Safe Motherhood Conference in Nairobi, Kenya • 1990 - National Safe Motherhood conference, Abuja • 1994 - International Conference on Population and Development (ICPD), Cairo, Egypt • 1995 - Fourth World Conference on Women Beijing, China • 1995 – 2005 - ICPD + 5, Beijing + 5, ICPD + 10, Beijing +10 • 2000 - UN Millennium Development Goals

    24. Millennium Development Goals, UN (2000) – how far? • Goal 4: Reduced child mortality - To reduce mortality rate among children under 5 by two thirds by the year 2015 • Goal 5: Improved maternal health - To reduce by 75%, the maternal mortality rate by the year 2015 • Six years into the 15 years deadline for achieving these goals, there is no clear evidence that Nigeria has yet achieved any remarkable achievements.

    25. Recommendations • Political leadership is needed. The Presidency should personally speak to the problem of the high rate of maternal and infant mortality in Nigeria, just like he has done for HIV/AIDS Executive Governors and Local Government Council chairmen should do the same in their States and LGAs • A multi-sectorial approach should be adopted whereby all sectors (Legislative Assemblies, Information, Education, Women Affairs etc) should include MCH programming in their portfolios 3. Costs alleviation for women seeking antenatal care and delivery services. Such a policy has been successful in reducing maternal mortality in Kano State 4. The creation of a National Institute for maternal and child health

    26. National Institute of Maternal and Child Health • Will provide an avenue through which government will providing funding for MCH • Will reduce donor dependency on MCH programming • Will provide an avenue for research and data collation on matters related to MCH • Will develop guidelines, policies and strategies for reducing maternal and child mortality in Nigeria • Will provide a forum for capacity building and resource mobilisation for MCH

    27. Programs to reduce Maternal and Perinatal Mortality in Nigeria • Provision of information and services about family planning and contraception • Programs to encourage all pregnant women to receive antenatal care and to be delivered by skill birth attendant • Improvement of antenatal and delivery services in hospitals, especially emergency obstetrics care • Government should address the problem of women dying from poorly performed abortions

    28. Recommendation Contd. • The government should make compulsory the registration of all maternal deaths in the country, as recently legislated in Edo State • Disease – specific preventive measures for child mortality • Promotion and scaling up of childhood immunization

    29. Conclusions • There can be no doubt that maternal and child morbidity contribute significantly to the low life expectancy in Nigeria • The disease conditions that lead to maternal and child mortality in Nigeria are the same as in most parts of the developing world • However, it is the adverse socio-economic and cultural circumstances under which these diseases occur that increase the risks of these deaths in Nigeria

    30. Conclusions 4. A case is being made for a purposeful, multi-disciplinary and multi-sectorial approach for addressing the problem 5. An increased prioritization of the problem and impetus from the Presidency, the State Governors and Local Government Councils will greatly accelerate the pace of attainment of the MCH aspects of the MDGs in Nigeria 6. Indeed, addressing the high rate of maternal and child mortality will be a visible contribution to socio-economic development and transformation, and a major legacy of this administration

    31. THANK YOU