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 facilities63.5%  access to potable water 54.1%  school attendance55.1%

 Total Population120 Million  Women of Reproductive Age 27 Million  Married by Age 3495%  Median Age at 1 st Marriage18 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

High Risk Fertility Behaviour

Place of Delivery  Health Facility: 37%  Home: 58%

Zonal Disparities: Health Facility Delivery

Selected Maternal Mortality Ratios in Africa

Maternal Mortality Ratio by Zone

Death in the First 5 Years of Life

Causes of Maternal Death

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

 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 ( ) 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 Mortality 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 Mortality No interventions 1,500,000 children will die

Disability Consequences  Chronic anemia  Stress incontinence  Fistulae (VVF,RVF)  Chronic pelvic pain  Emotional depression  Maternal exhaustion $1.9 billion or 217 billion naira

Economic Losses 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 Gains 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 Deaths

Interventions Implementation 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 2 All 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.

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