This post is part of the Maternal and Newborn Integration Blog Series, which shares themes of and reactions to the “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting.
The main causes of newborn mortality are birth asphyxia, birth trauma, low birth weight, prematurity and infections. These accounts for 80% of deaths in the age group. While prematurity can spontaneously occur without any obvious predisposition or previous warning, a lack of obstetric and newborn care is often implicated in birth asphyxia, birth trauma and low birth weight – more especially in the developing countries.
This lack of care—which may occur at any stage of pregnancy, labor or delivery—may manifest as the absence of vital “skills” on the part of the birth attendant or lack of low cost equipment/material such as a mucous extractor. This is why a significant amount of deaths resulting from such causes are labeled as “preventable.” Furthermore, the lack of skill may be manifested by the failure of the birth attendant to recognize the need for an emergency Caesarean.
It becomes evident that if we can ensure antenatal care and the occurrence of delivery in a hospital—where there is likely to be ‘skill’ and low cost equipment—there may be an opportunity or greater possibility of preventing some of these avoidable deaths.
When we consider the commonest causes of maternal mortality—bleeding, obstructed labor, eclampsia, unsafe abortions and infection—obstetric care plays a major role in preventing deaths due to these causes.
In a developing country like Nigeria—where only 38% of deliveries are attended by a SBA and only 35.8% of deliveries occur in a health facility—interventions that will increase facility delivery and consequently newborn care are likely to reduce newborn death. While I agree that effort should be directed at improving facilities in the hospital, a greater problem is lack of demand for the utilization of these facilities. You will frequently find pregnant women registering in a hospital but not delivering there.
Why do majority of Nigerian women fail to use the services of a SBA? Why are Nigerian women not delivering in the hospital?
In my experience as a medical doctor practicing in rural Nigeria, I found out that ignorance was a major factor. I found out that ignorance often times played a greater role than poverty. You would find a patient that had visited a traditional birth attendant and probably spent three times what she would ordinarily spend in the hospital.
So how do we remove ignorance and enable a pregnant woman to make the decision to deliver in a hospital and thus increase the possibility of maternal and newborn survival? How do we deliver critical and relevant information that will lead to education? We can achieve this by delivering relevant and culturally appropriate information through an existing channel that pervades across the rural and urban landscape. This channel is the mobile phone. In our yet to be published work in delivering health education to expectant mothers via Short Message Service (SMS) in Nigeria, we found that greater than 95% of them had mobile phones. Those that didn’t have claimed it was missing or damaged.
I need to highlight that our work is not really about SMS or mobile technology; it is about the education of expectant mothers. Mobile just happens to be the route considering our environment.
In summary, education via SMS will lead to increased education, antenatal attendance and increased hospital delivery. When delivery occurs in a hospital, there is a greater chance of both the mother and newborn surviving.