As Nigeria announces its MMR of 576/100,000

The much awaited 2013 National Demographic Health Survey (NDHS) was officially presented by the National Population Commission on Monday 16^th June 2014 in Abuja, Nigeria. The MMR of 576 maternal deaths per 100,000 live births was announced which wasn’t significantly different from the ratio reported in the 2008 NDHS of 545/100,000. It has even gone up rather than gone down. This is the time to reflect and begin to ask the hard questions of why and what are we doing wrong and what can be done before another NDHS in 2018 to reverse the trend of MMR in Nigeria.

Some weeks back I published an article in this column titled “W.H.O pegs Nigeria’s MMR as 560/100,000”. I observed that the recently released trends in maternal mortality: 1990 to 2013 Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division has reawaken our desire in Nigeria to have a common position as to what is the Nigeria’s MMR. I also mentioned that the 2012 MDG Report which is yet to be presented, published, disseminated or shared to interested stakeholders had put Nigeria’s MMR as 350/100,000. In one of my published articles I termed the survey “Clandestine and midnight survey.  With the MMR of 576 by 2013 NDHS, it has put to rest what is the Nigeria’s MMR? One can see a similarity between the 2013 NDHS MMR and 2013 WHO MMR estimates as the figures are almost the same. One can understand the slight differences which could be due to different methodology each survey adopted.

Another lesson learnt about the release of the MMR by theNational Population Commission on Monday 16^th June 2014 in Abuja, Nigeria was the courage and the boldness of the Nigerian government to release the figures even though it has shown upward trend rather than decline. We expect such courage and boldness in charting a way forward to reverse the trend sooner than later.

In trying to understand the high unaccepted MMR, one need to also know some of the outcome indicators that affect MMR. The antenatal coverage for at least one visit was put at 60.6% and for four or more visits was put at 51.5%. These Percentages signifies that almost half of the women population were disenfranchised and it raises the question of equity in health care. The % of births attended by skilled health personnel was put at 38.1%, it is very poor and a red card for a country that is bless with avalanche of donor funded projects on maternal health and a country boasting of being the largest economy in Africa. We have to work very hard to improve the health workforce by redistribution, more recruitment and motivation for health workers to work in rural areas.

The contraceptive prevalence rate (CPR) was put at 15.1%. This is totally unacceptable.  Nigeria on the 11^th of July 2012 at a London Summit on Family Planning tagged FP2020 pledge to “in addition to our current annual commitment of US$3 million for the procurement of reproductive health commodities, we are now committed to provide an additional US$8,350,000 annually over the next four years, making a total of US$33,400,000 over the next four years. This is an increase of 300 percent.”  We also committed to achieving the goal of a contraceptive prevalence rate (CPR) of 36 percent by 2018. Achieving this goal will mean averting at least 31,000 maternal deaths. Over 700,000 mothers will be prevented from injuries or long-term complications due to childbirth.

For a country that wants to achieve CPR of 36% by 2018 which is barely 4 years now, it leaves much to be desired in relation to the 2013 CPR of about 15%.

Why will Nigerian government do more in the areas of Reproductive Health?

1. Nigeria is one of the 10 worst places in which to be a mother, and has the second highest number of newborn deaths worldwide.
2. One woman out of every 29 Nigerians faces a lifetime risk of death in childbirth. This is in contrast to Ethiopia, where one woman out of 67 faces such a risk.
3. Currently, only 15% of Nigerians married or in-union aged 15-49 use any modern method of contraception. These numbers are shockingly low, and in stark contrast to Ethiopia where the rate is 27%. In Bangladesh 52% of women married or in-union aged 15-49 are using modern methods of contraception.
4. In 2011, 175,514 married adolescents did not have access to modern family planning information and services.

Also from W.H.O 2013 MMR estimates, Nigeria should do more as shown below;

1. Nigeria is estimated to have an MMR of 560 maternal deaths per 100,000 live births.
2. MMR in Nigeria has declined by 52% between 1990 and 2013.
3. The average annual % change in MMR between 1990 and 2013 was -3.1%.
4. The estimated number of maternal deaths for 2013 is 40,000.
5. The lifetime risk of maternal death is 1 in 41.
6. Nigeria is classified as ‘making progress’ towards maternal health, rather than ‘on track’ or ‘insufficient progress’.

In conclusion, having observed all the above, our 36 states + FCT  should be interested of knowing all the relevant health indicators reported in the NDHS survey and develop scorecards by comparing  2008 and 2013 and institute measures and strategies to improve the health outcomes. At the national level, it also calls for improved accountability and transparency in the way and manner we allocate and spend our own resources and donor funded resources.

This article was 1^st published in Daily Trust Newspaper of 24^th June 2014 by Dr Aminu Magashi ( healthweekly@yahoo.com)