Saving mothers’ lives in Northern Nigeria
09 May 2007
Related pages:
Nigeria country profile
| Millennium
Development Goal 5: Maternal Health
In
Nigeria, child and maternal mortality rates are extremely high, with the
situation especially serious in rural areas. In the northern state of Jigawa,
where many women still give birth at home, around 2,000 out of every 100,000 live
deliveries result in death for
the mother, which is one of the highest rates in the world. About one in every
ten women in the state is likely to die of maternity-related causes.
However, in Jigawa a unique approach to maternal health,
supported by DFID’s
 PATHS project,
is making some real breakthroughs in getting more pregnant women into hospital.
The Safe Motherhood Initiative works with local communities to build demand for
maternity services, encouraging local women to opt for hospital over home births and providing quality nursing care, medical equipment and all-important
transport to the hospitals.
Breaking down barriers to maternal care
 Selatu Saji was rushed to hospital in the late stages of labour. She was giving
birth to twins and complications had ensued. One of the twins was breech
(delivered buttocks-first), and although the second was less troublesome Selatu
had retained placenta and a manual removal was necessary. Over the course of
several hours Selatu lost ten pints of blood and had to have eight pints
transfused. “If I had had my emergency a few years ago, it is certain I wouldn’t
have survived,” she says.
Prior to the Safe Motherhood Initiative, traditional beliefs in Jigawa meant
that there was a great deal of resistance to the idea of giving birth in
hospital. Girls in the region tended to marry very young, and were expected to give
birth unattended. With local medical facilities long being the subject of
suspicion, most pregnant women required permission from their husbands to make
use of them. Added to this were the difficulties of getting to hospital and paying
for treatment when there. Badly-equipped facilities and poor staff attitudes made the prospect
of going even less inviting.
However, in under a year, the number of women attending hospital for
emergency obstetric care has risen by 50% in the areas of Jigawa where the
initiative operated. And, while in 2005 the average facility in these areas managed 100 deliveries a month, by the end of
2006 the figure was over 150, with the quality of care greatly improved. These
figures include women like Selatu - women who may not have survived a home
birth.
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Partnerships: the key to success
One
of the keys to the success of the initiative is the
partnership that has been formed with local religious leaders, whose
support is essential in breaking down the barriers to women attending hospital.
In this predominantly Muslim part of Nigeria, Imams have been instrumental in
making the case to husbands of the benefits of a hospital delivery. They have
also publicised the good news when lives have been saved.
Close cooperation with local communities generally has proved instrumental to
developing solutions that work on the ground. It is this approach
which has strengthened transportation systems, with local vehicle
owners being hand-picked as emergency transport drivers. The involvement of Jigawa’s
Road Transport Workers Association, too, means that transport is now free to
anyone who needs it, while talks with the police have resulted in drivers being
issued with special IDs, helping to avoid delays during emergencies.
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Safe Motherhood: A model that works
The success of the scheme so far has convinced the State Ministry of Health in Jigawa
that many more mothers' lives could be saved by following its example. Now, the
initiative is being expanded to the rest of the state, so that even more rural
dwellers can benefit.
In another positive development, after seeing the successes in Jigawa the neighbouring states of Kano and Kaduna (which have a combined population of 15 million) asked PATHS to
support similar initiatives, which have already begun.
Kubli Danmaraya, the initiative's chief trainer, has reason to congratulate
herself for the achievements she has helped bring about in Jigawa. "When communities see people benefiting and lives being saved, the message
spreads," she says. "We are now reducing maternal mortality here and that makes me very
proud."
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Key Facts
- PATHS is the DFID-funded "Partnership for Transforming Health
Systems", which works in five of Nigeria’s states and with the Federal Ministry of Health.
The project runs from 2002 to 2008 and its budget is £55 million.
- PATHS provided funds through the Ministry of Health to improve equipment for
maternity services, delivery, laboratory services and theatre equipment for
eight facilities.
- The Ministry and PATHS identified needs for training in "Life Saving Skills".
Fifteen midwives were trained as trainers of additional midwives.
- PATHS established a network of "Community Identifiers" to link emergency cases
to Safe Motherhood Centres. These spot the danger signs in pregnancy so that
action can be taken quickly.
- The Jigawa initiative is part of DFID’s global push to do more on
saving
mothers' lives
 (135
KB). The initiative demonstrates how strategies and tactics to
achieving this must be adapted to local conditions if they are to succeed. The
initiative is unusual internationally in having achieved such rapid results in a
short period in a very conservative area.
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