If only…!

The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year. As at 2010, the average MMR in Nigeria stood at 630 deaths/100,000 live births and has continued to rise due to the lack luster considerations given to the issue of maternal in most parts of the country. As lamented by International health experts and speakers at an event held at the prestigious Centre for Strategic and International Studies (CSIS) in January, 2013, Nigeria, today, remains one of the most dangerous countries in the world for a woman to give birth. While reflecting on this statement, I came to terms with the very hard and harsh reality that the most grievous injustice women and girls face in the world is maternal mortality.

Back in 2009, while in Akure, Ondo State, Nigeria, I got a call from a childhood friend’s elder brother. It was exciting to hear his voice at the other end. Eager to catch up on the long-drawn-out break in communication, I chattered on bombarding him with questions and barely gave him room to speak. My nineteen to the dozen talks was unexpectedly stalled when he said “We lost Fidelia”. A feeling of numbness took me over and I tried really hard to convince myself that I didn’t get his last lines right. Are you there Nike….? Sure you there? Finding my voice again, I said “Yes, I am here, how’s Fidelia?” I answered you already, we lost her in the course of child birth but one of the two baby girls made it. I am sure you are aware it was her first. Are you there he asked again? By this time I was already crying and all I could mutter was “I wish you never told me this, I am not sure I can go on with this conversation. His attempt to put me back in high spirits was greeted with “Please, I’ll talk to you some other time”. Days later, I couldn’t help but get back to him to enquire about the details surrounding his sister’s death. My childhood friend had gone into labour and was rushed to the hospital where she had been attending her antenatal care. She was later wheeled into the delivery room, shortly after which delivered the first baby, a girl. Complications set in, and so began the battle to save Fidelia’s life and that of the other baby who had not been delivered. The decision to carry out the Caesarian Section came a bit too late as she was said to have tired out while trying to push out the second baby.

Barely 6 months after Fidelia’s death, I lost another friend Victoria, a fellow post graduate student and staff of the institution where were both studying for our Masters degree. On campus, we were often around each other and by the time she became pregnant (it was her fourth), I never fell short of teasing her that she was going to have quadruplets, and she would always joke back that she would hand over two of the foursome to me. Months later, I received a text message that she had put to bed a bouncing baby boy and had been discharged from the hospital. I immediately called back to express my ecstasy with a promise to visit her at home. By the next day, I went to school with the plan to proceed to visit my friend’s house thereafter. Unsuspecting that anything was amiss, I leisurely walked into the departmental secretary’s office, only to be greeted with forlorn faces and an eerie silence. It was Mrs. O who summoned courage to say in somewhat out of earshot tone “Mrs. T is dead, your friend Victoria passed on this morning”! With shrill sobs I retorted, “It can’t be true…………….., I still spoke to her yesterday with a promise that I will visit her today, please……….someone tell me it is not true…………”!. It was only after her burial that I found out that a day after her discharge from the hospital she started experiencing sporadic blood discharge. Her husband took her back to the hospital but they were both assured that the bleeding would stop. Sadly however, the bleeding got worse overnight and she gave up the ghost while being rushed back to the hospital by morning.

On a personal note, I had heard a lot of good testimonies about the Abiye (Safe motherhood) programme, particularly the movement of women and children into Ondo State from surrounding States; to access healthcare under the project. While reading about the Abiye (Safe-motherhood) programme, I came across the story of Justinah and Godwin, a couple who both eked a living and barely had enough to survive. When Justinah got pregnant and began experiencing unusual signs and symptoms, she went for diagnosis and scanning and it was discovered that she was with triplets. The registration done under the Abiye programme alongside the pilot scheme of kaadi Igbe-ayo known as Ondo State Residency Card Ondo State Smart Card, however, ensured that Justina was kept under a close watch. She was given a toll-free mobile set and assigned to a cluster of health rangers, who made it possible for her pregnancy and her health situation to be monitored. When she was close to term, Justinah developed complications again and came close to death. The Abiye Basic health centre at Ibulesoro could not cope with her situation, so she was promptly moved to the apex hospital, the Mother and Child Hospital in Akure where her life was saved and the triplets delivered at government’s expense; at no single cost to her or her husband.

Bolanle’s story is another celebrated story under the Abiye programme. Bolanle was not totally happy until she had encounter with personnel of the Abiye Project. She couldn’t make her husband happy enough because whenever she was pregnant, she would have miscarriage after 3 months. Her husband thought it was spiritual problem and they sought spiritual solution to her problem. The problem persisted for years but they never gave up. All through this period, she was being attended to by ‘iyaeleweomo’ a Traditional Birth Attendant. She got frustrated at a time that she advised her husband to get another young lady that will make him a father. However, sometime in 2009, upon paying a visit to one of her friends, she observed a group of people in Nurse’s uniform and others in lemon and blue colour uniform. She found out from her friend that the people were from Akure, the State Capital and that they were registering people for ‘Kaadi Igbe Ayo’ and pregnant women for 'Abiye project'.

Jokingly, one of the Nurses invited her for the registration and with doubt in mind, she succumbed. Later on, she was followed up with calls from the health personnel and was persuaded to register with the Abiye center closest to her; after which she was given phone and was assigned to a health ranger who would regularly check on her. Four months after, by which time the pregnancy had reached 8 months, she had another threat to her pregnancy. Her husband, who had become accustomed to the support of the health ranger assigned to his wife, did not think of any other person to call but the health ranger. Few minutes after the call the health ranger arrived with a motor cycle and she was rushed to the Abiye Center at Ilara-Mokin. The doctor attended to her and she felt better. A month later she delivered a bouncing baby boy and the story of childlessness and miscarriage became a thing of the past as she became pregnant again a year after under proper medical monitoring of the Health rangers.

In 2010 I heard, a firsthand testimony from a beneficiary of the Abiye program. A friend and I had learnt that Mr. F.K’s wife had put to bed and returned home. We were delighted at the news and so decided to pay them a visit at their home. It was really comforting to meet mother and child in very stable and healthy state. Relishing the joy of the safe delivery of his first baby, F.K narrated his wife’s experience at one of the newly established Mother and Child Hospitals (MCH) in Akure, Ondo State. The overly elated father applauded the class of care his wife enjoyed at the maternity center from day one of her ante natal care up to the point of delivery. He said he could readily compare the facility and service to what he observed when he had the opportunity to visit the maternity unit of a hospital in London; and that the difference was that the MCH wards had more number of patients per ward. Imagine that this cheering story is coming from a state that was in 2008 declared by the World Bank to be the state which had the worst maternal and child health indices in the South West Zone, of Nigeria. As I continue to read, hear and reflect on the many celebrated testimonies and success stories about the Abiye (Safe motherhood) program, a brainchild of the Dr. Olusegun Mimiko led Ondo State Government, I am given to say “If only Fidelia and Victoria had access to such safe care……….

The Abiye Programme’s tripartite structure involves pregnant mothers and young children up to age 5; health centers or clinics near them and the Mother and Child Hospital (MCH) initiatives, all linked via the Health Rangers, communication tools, and various types of transportation. There is also a high degree of professionalism and comprehensiveness in project design and execution. Abiye programme involves fully kitted and trained health personnel and the programme goes as far as recruiting and training of health rangers, who visit homes of the mothers, encourage, sensitize and liaise at will. Each health ranger is attached to maximum of 20 mothers and given kitted motorcycle to enhance free access to the mothers. Tricycles are given to the 10 basic Health centers according to the political wards in the Local government. Four wheel ambulances were also given to the Abiye centers to aid transportation of the women during emergencies. The mothers were not left out in the incentive measures attached to the project. Toll free mobile phones to communicate the health rangers are given to them during antenatal and delivery stage, incentives like baby towel and so on are given to them. Regular training is given to the health personnel at all levels to enhance good service delivery as well as meetings every fortnight at the local government level for monitoring aid and assessment of the situation and to fashion a way out if there is any problem at hand.

The Abiye programme is summed up as essentially focusing on four major factors which predispose pregnant mothers and infants to death. “These include the three delays (in seeking care when complications arise, reaching care when decisions are taken to seek care, accessing care on arrival at a healthcare facility; and in referring care from where it is initiated to where it can be completed.” “As of June 12, 2011, barely 15 months into its operation, 26,150 patients had been treated and 5,879 babies had been safely delivered, 905 by Caesarian Sections. Abiye Programme had the lowest maternal mortality ratio during its first year of operation and the innovative mother and child health model has received world acclaim and has been hailed as a benchmark for Nigeria and a template for Africa by international organizations such as the World Health Organisation (WHO) and the World Bank. The World Bank specifically recommended the Abiye Programme’s adoption as a model for achieving MDG-5 throughout Africa. Experts in maternal health, who were enthralled by Governor Mimiko’s achievements in the health sector through which he had reversed the hitherto high rate of maternal and child mortality in the state, also recommended it for Nigeria if the country must achieve the millennium health goal and be deemed serious about the health sector.

The amiable, maternal sensitive and friendly governor of Ondo state said “The peculiarity for a pregnant woman is that when she needs help, she needs it and it is critical as a mere three to ten minutes might make difference whether she lives or die. So there must be a framework, a policy in place. There must be a service machinery in motion that would address the emergency needs of pregnant women and that is why we have in the last four years invested a lot of thought and resources on safe motherhood in Ondo State.” According to Dr. Omololu, the co-coordinator of Abiye Project under Primary Health Care Unit in Ifedore Local Government Area, the bookings for antenatal care between January and November 2009 was 240 and total delivery of 98 was recorded at the health facilities, showing that the traditional birth centers have almost double the number of deliveries recorded. It also indicated that the people preferred to utilize the traditional birth centers. However, since the implementation in November 2009, the reverse in trends has been meticulous. As the implementation of Abiye project started with conversion of 14 health facilities out of 25 to Abiye centers and equipped with modern medical facilities”. No wonder, the bookings have increased drastically from 240 to 3,860 and deliveries from 98 to 1,861 at Abiye centers, 1,986 at other health facilities while Traditional Birth Centers records a paltry 13. “This was achieved as a result of gross awareness and massive sensitization which cut across all the nooks and crannies of Ondo State and beyond and of course attracted the patronage of people from neighbouring states like Osun and Ekiti”.

This memoir is dedicated to the memory of the many known and unknown Nigerian women and girls who have lost their lives in the course of child birth. It is also a call on local, national and global leaders to fully rise up the responsibility of holistically improving maternal health, by making spirited efforts towards reversing the prevalent high mortality rate among mother and child. How much more evidence do we need as a people to know that the Abiye programme is working and is an answer to achieving MDG 5 of improving maternal health? What are we still waiting for?