Maternal and child mortality in Nigeria has remained very high despite several efforts that have been put in place aimed at reducing the incidences.
It is for this reason that the Nigerian government has desperately recalled more than 2,000 retired and unemployed midwives to rural areas to tackle the problem.
Dr Muhammed J. Abdullahi, director of Nigeria’s National Primary Health Care Development Agency, describes himself as “sad” that, despite all the previous efforts, maternal deaths have not reduced and the country is still losing 52,000 women every year from pregnancy-related complications.
A woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. The country has the highest maternal mortality ratio (MMR) in Africa, which counts how many women die while pregnant or within 42 days of a terminated pregnancy for every 100,000 live births. Only 40% of deliveries are attended by skilled birth attendances, making the Millennium Development Goals on maternal health clearly unachievable by 2015 if the current strategies continue.
“With our current MMR these women are subjected to a lifetime risk of dying from pregnancy related complications,” Dr Abdullahi said. This stark fact has compelled the government to introduce the midwives scheme service (MSS), which is also intended to increase skilled labour.
“In the light of the foregoing development, the government of Nigeria, under the 2009 Federal Appropriation Act, established MSS to mobilise unemployed and retired midwives for deployment to selected primary healthcare facilitate in rural communities in order to facilitate increase attendance at birth and reduction of maternal, new born and child mortality,” he said.
Speaking to journalists in the middle of this month (14 August 2012) at his office in Abuja, Dr Abdullahi said the MSS scheme was designed following wide consultation, networking and consensus-building among stakeholders.
A total of 2,323 midwives have been deployed to 652 primary healthcare facilities in the 36 states of Nigeria so far. It is estimated that the MSS will serve around 10,711,500 people.
Dr Abdullahi said that they have also trained doctors on emergency obstetric care as one way of expanding lifesaving skills. He disclosed that more than 70% of maternal deaths in Nigeria are due to haemorrhage, infections, hypertension, Malaria, obstructed labour and unsafe abortion.
Nigerian mothers speak out
Jolly Jigba, 20, one of the beneficiaries of MSS, said she has confidence in the system. She describes the midwives as “friendly and willing to help at any time.”
“I attended all my antenatal visits because I knew that the staff are there and I will get all the attention. It’s the reason why I came back to give back from here,” Jigba said
Another women Grace and her husband Ben say they did not want to risk the life of their first baby by giving birth around unskilled people. “The life of my wife and my unborn baby is too important to me, and I would risk their lives,” said Ben, who accompanied his wife to Bwari health center in Abuja.
He called upon men to always be supportive to their expectant wives, urging that the responsibility of bearing children should be on both man and woman.
“Some men act irresponsible and take it for granted that after they have impregnated a woman the rest is her burden; to carry the baby, go through the labour pain alone, breast feed and nurture the children. My fellow men – be responsible fathers and husbands and support your wives,” he said.
Nigerian midwives are grateful
Rose Chinyam, one of the nurses who was unemployed but was called back under MSS, said that whenever a mother develops complications they refer her to the high level of health care because at primary health care facilities they don’t have the capacity to handle complicated matters.
Rose’s colleague, Juliana Yori, said she came to serve her people. “We go to communities and beg mothers to come to the health facilities and we are now seeing an increase in number of antenatal attendance and deliveries.”
Lack of skilled birth attendants in Nigeria
Dr Abdullahi acknowledged that the country has a shortage of skilled birth attendants which has impacted negatively on the sector. He said that six million women deliver annually and a midwife should take care of 120 women per year but the current number of staff is insufficient to meet this target.
He also said that retention of midwives is the biggest challenge in rural areas. In reality, skilled staff are rarely present at these center and 90% of primary care units have no midwife.
“Many midwives don’t want to go to rural areas, which makes it hard to retain them. You hardly see doctors and midwives at primary health care, a reason why we have called the retired and unemployed to serve the communities in dire need of services.”
The Nigerian health system is managed under a federal system, which leaves a big gap in distribution of health services especially in the North.
According to Mrs V.O Akinrolabu , the welfare officer of MSS, there is a disconnect in the number in of women who attend antenatal care and those that come to give birth in a health facility.
She said that the MSS intends to increase outreach services so that health workers can visit women in their homes and carry out door-to-door sensitisation on the important of having professional delivery. She added that the scheme also gives out Mama kits to mothers in order to attract them into health units.
“Many women attend antenatal care but do not come for delivery. We are still asking ourselves what we are doing wrong and we will soon get a solution to this problem. We are willing to do what it takes to bring mothers closer to the health facilities,” she said.
Ward Development Committees have also been put in place in communities. These sit once in a month to encourage women to have professional deliveries.
Challenges of maternal health in Nigeria
Dr Abdullahi said dependency on donor and private partnerships is one of the major challenge MSS faces. He urged the government to “own the problem and put her house in order.”
He added that the maternal healthcare budget is too small, that the government has not been giving money for tackling maternal health directly, while the little that is available is often diverted. He also said there appears little political will to solve the problem yet many communities’ attitudes is that it is up to the government and to donors to sort out their health problems and needs.
The nurses who were called back to serve in health centers 
A nurse examines a mother
Men involvement has been key to reduce maternal mortality in Nigeria.
