Through the perspective of prevailing cultural norms in Nigeria, marriage is one of the main sources of validation for a woman. Post-wedding day, the act of giving birth is a key rite of passage. Unfortunately, the culture makes no provision for giving the Nigerian woman access to proper maternal care. From insufficient health workers to long delays to give birth, it is clear that Nigeria has a long way to go to keep its mothers safe.
It is no wonder that the World Health Organisation estimates that nearly 20% of all global maternal deaths happen in Nigeria. Between the years 2005 and 2015, there were over 600,000 maternal deaths and at least 900,000 near-miss cases in the country. What this means is that the average Nigerian woman has a 1 in 22 chance of dying during pregnancy, childbirth or post-abortion. In developed countries, the odds are 1 in 4900.
So, what are we doing wrong?
It's all about delays
There’s a very useful model—called the Three Delays Model—that helps us identify what stops women from getting the type of maternal care they need.
The first identified delay is in the decision to seek care. Non-medical factors like poverty, low education, and a lack of trust in the healthcare industry may dissuade women from seeking care in the first place. Low income, in particular, makes it more expensive to get care. For example, taking a day off could be more costly for low-income earners who are market traders or farmers.
Another delay occurs when women try and get care. Nigeria has five hospital beds per 10,000 people, much lower than 28 in South Africa, which is also the global average. Access to health facilities also varies across regions. According to the National Bureau of Statistics (NBS), it takes a female in the South West 16 minutes on average to get to a health facility, whereas a woman in the South East would reach one in 28 minutes on average.
The difficulty of accessing health facilities makes it less likely that a woman will reach one, and also less likely that she will seek one in the first place.
And, finally, women face delays when they receive care. We’ve all heard how Nigeria only has 35,000 registered doctors—about 5,000 people per doctor, but the worst part is that even with the little we have, we are constantly losing doctors to other countries. In 2004, Nigeria was the only African country listed as one of the top 20 exporters of physicians, losing an estimated 5,500 doctors. More recently, we learnt that over 50% of Nigerian-registered doctors practise abroad.
Nigeria’s mass medical emigration is merely a symptom, and the root of the crisis can be traced to deficiencies in remuneration, working conditions, and health systems. Put together, the situation means that pregnant women are not cared for in a healthy and timely way. It should not surprise us that having skilled medical professionals in attendance during birth would lead to safer deliveries.
What can be done?
Nigeria needs to invest in primary healthcare in order to rebuild its health system.
Improving maternal mortality rates is a big part of the United Nations 3rd Sustainable Goal but Nigeria isn’t making much progress. As at 2016, Nigeria spent $97 per person on healthcare, equivalent to 3.6% of the national GDP, while Southern Africa countries like Zimbabwe and Lesotho spent as much as 9.4% and 8%, respectively.
In situations where resources are scarce, a technique known as task shifting could help. The idea is to “treat, train and retain” to ensure that patients who have received treatment, care and support can be trained on how to efficiently provide support and care to other patients. As a result, the newly trained workers gain employment through the program. This method has been used in Uganda and Ethiopia to combat HIV with notable success.
The Federal Ministry of Health is working on similar moves by raising the awareness and status of nurses and midwives under the newly launched ‘Nursing Now’ Nigeria Scheme. This came after the WHO declared 2020 as the year of nurses and midwives.
Improving maternal health care is not just vital for improving welfare but can also boost the economy. Mayra Buvinic, Sector Director of the Gender and Development Group at the World Bank, states that making investing in women and girls is both the right thing to do and smart economics.
Healthier women are better able to participate in the labour market and at home, Moreover, evidence has shown that women spend a larger share of both their time and money on children than men. Investing in women’s health is also an investment in the future.