On 17 December 2014, the Wilson Center Maternal Health Initiative convened this dialogue, in partnership with the Maternal Health Task Force (MHTF) and the United Nations Population Fund (UNFPA).
“Nigeria’s population is only two percent of the world population, but we contribute about 10 percent of the maternal mortality,” said Oladosu Ojengbede, professor and director of the University of Ibadan’s Center for Population and Reproductive Health.
Despite efforts to achieve Millennium Development Goal 5 – reduce the maternal mortality ratio by three-quarters compared to levels in 1990 and achieve universal access to reproductive health – Nigeria has seen only modest improvements to maternal health, said a panel of experts participating in a live videoconference in both Abuja and Washington, DC, on December 17.
The simulcast event was preceded by a day-long policy workshop in Abuja with 40 participants from a wide array of stakeholders, including the ministry of health, development partners, NGOs, traditional leaders, health organizations, and the media.
Results from Nigeria’s most recent National Demographic and Health Survey indicate the maternal mortality ratio stood at 576 per 100,000 live births in 2013, compared to 800 deaths per 100,000 live births in 2003 – a 52 percent decline since 1990. Through roundtable discussions, participants identified five key factors to Nigeria’s maternal mortality that must be addressed to accelerate progress.
Five Central Challenges
The first roundtable, led by Dr. Chris Agboghoroma, secretary general of the Society of Gynaecology and Obstetrics of Nigeria, identified quality of care as a critical area for improvement. “The quality of care in most public and private facilities varies significantly from poor to near excellence,” he said. This inconsistency causes women to lose confidence in health services and leads some to refuse services altogether. To improve quality, said Agboghoroma, Nigeria needs dedicated departments in the ministries of health with motivated staff to enforce standards in training institutions.
The second roundtable focused on the provision of integrated services. Dr. Hadiza Galadanci, an obstetrician and gynecologist consultant, said the lack of skilled health care providers, poor infrastructure, and lack of commodities, like family planning, makes it difficult to provide integrated services for women at health facilities. She called for the full involvement of traditional and religious leaders and a more comprehensive curriculum for health workers. Workers should not only be trained in reproductive health services, family planning, or maternal health as individual specialties; they should be able to treat any woman that walks into a facility with a need, she said.
Dr. Adesegun Fatusi, provost at Obademi Awolowo University, spoke for the third roundtable. He identified social determinants – such as poverty, child marriage, home delivery without aid or use of a skilled birth attendant, and cultural or religious opposition to family planning – to be consistent contributors to poor maternal health outcomes. There must be macroeconomic, “pro-poor” policies within the health sector that specifically address the poverty rate and provide social protection for the most vulnerable, he said. In addition, stronger legal provisions that protect against child marriage, engaging community leaders, and prioritizing education within households and throughout communities, especially for girls, is required to change social norms, said Fatusi.
The fourth roundtable focused on knowledge gaps and research needs. Efficient data collection, reporting, and funding allows for the interpreting of maternal health trends and translation into policy, said Dr. Oluwadamilola O. Olaogun, a project manager with the White Ribbon Alliance. In Nigeria, an estimated 38 percent of deliveries take place in health facilities, which means over 60 percent take place outside a facility. A mechanism for collecting maternal health data from all delivery points is therefore essential, she said.
Often, there is also a disconnect between research findings and implementation, which delays progress. More government involvement is needed in research projects and the benefits of these findings need to be better articulated to the government, said Olaogun.
Ojengbede spoke for the fifth roundtable, which focused on policy. For maternal health policies in Nigeria to be more successful and sustainable they require political commitment and incorporation into legal frameworks, said Ojengbede. The ministries of justice, health, and civil service organizations working on maternal and child health play an important role. They must support legislation on the state and national levels to ensure accountability and implementation, he said, rather than relying on ad hoc efforts led by third parties.
“Fertilizers to Improve the Fruits of Our Labor”
“It is evident that Nigeria does not lack expertise or insightful discussions,” said John Townsend, vice president and director of reproductive health at Population Council, serving as a discussant in Washington, DC. “However, the issue of moving intervention to scale and getting services to people still needs to be addressed.”
The importance of execution was well noted by workshop participants. Galadanci called for more comparative research that shows which programs are working in different states to determine which should be expanded. Ojengbede pointed out that Nigeria’s response to the Ebola crisis was very efficient; it created a national sense of emergency which spread awareness quickly. Likewise, the perception of maternal health must be changed so improving conditions for women and children is seen as a national duty for all.
Ojengbede expressed optimism about the outcome of the workshop and Nigeria’s ability to tackle these important issues. “The government and fellow participants both 100 percent agree that the recommendations from this dialogue will be applied like fertilizers to improve and increase the fruits of our labor,” he said.
Dr. Wapada Balami, director of the family health department in the Federal Ministry of Health, said the recommendations would be forwarded to the Honorable Minister of Health, who will set up a committee to advise him on the meeting’s results. “This will help in shaping reproductive, maternal, and newborn health policies in the country.”
- Dr. Chris Agboghoroma
Secretary General, Society of Gynaecology and Obstetrics of Nigeria (SOGON)
- Sarah Craven
Chief, Washington Office, United Nations Population Fund
- Dr. Adesegun Fatusi
Provost, College of Health Sciences, Obademi Awolowo University (OAU)
- Dr. Hadiza Galadanci
Obstetrician and Gynecologist Consultant
- Dr. Oluwadamilola O. Olaogun
Project Manager, White Ribbon Alliance for Safe Motherhood (Nigeria); Maternal Health Task Force Young Champion Fellow
- Kole Shettima
Country Director, Africa Office, MacArthur Foundation
- John Townsend
Vice President and Director, Reproductive Health Program, Population Council
- Lauren Herzer Risi
Senior Program Manager, Environmental Change and Security Program