Impact of MDGs on Maternal Mortality in Nigeria by Michael Onjewu Bsc Economics

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study:

In order to address the problem of poverty and promote sustainable development, the United Nations Millennium Declaration was adopted in September 2000 at the largest ever gathering of heads of States committing countries both rich and poor to do all they can to eradicate poverty, promote human dignity and equality and achieve peace, democracy and environmental stability. The goals include those dedicated to eradicating poverty, achieving universal primary education, promoting gender equality and empowering women, reducing child mortality, improving maternal health, combating HIV/AIDS, malaria and other diseases, ensuring environmental sustainability and developing a global partnership for development.

Maternal mortality, also known as maternal death, continues to be the major cause of death among women of reproductive age in many countries and remains a serious public health issue especially in developing countries (WHO, 2007). As explained in Shah and Say (2007), a maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Globally, the estimated number of maternal deaths worldwide in 2005 was 536,000 up from 529,000 in 2000 and 289,000 in 2013.

According to the WHO Factsheet (2008), 1500 women die from pregnancy or pregnancy-related complications every day. Most of these deaths occur in developing countries, and most are avoidable. Of all the health statistics compiled by the World Health Organization, the largest discrepancy between developed and developing countries occurred in maternal mortality. 

Ujah et al. (2005) noted that while 25 percent of females of reproductive age lived in developed countries, they contributed only 1 percent to maternal deaths worldwide. A total of 99 percent of all maternal deaths occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and one third in South Asia. The maternal mortality ratio in developing countries is 450 maternal deaths per 100,000 live births versus 9 in developed countries. Fifteen countries have maternal mortality ratios of at least 1000 per 100,000 live births, of which all but Afghanistan and India are in sub-Saharan Africa: Afghanistan, Angola, Burundi, Cameroon, Chad, the Democratic Republic of the Congo, Guinea-Bissau, India Liberia, Malawi, Niger, Nigeria, Rwanda, Sierra Leone and Somalia (WHO, 2008).

1.2 Statement of the Research Problem:

In spite of all the policies, declarations, conferences and other efforts aimed at reducing the scourge of maternal deaths across the globe, only modest gains in maternal mortality reduction appear to have been achieved in many countries in the past 20 years (Shah and Say, 2013). Countries in Africa may have actually lost ground while many developing countries have fallen far short of the standards set by the World Health Organizations’ initiative on Safe Motherhood. 

In Nigeria, the Federal Ministry of Health had set Year 2006 as the target year that maternal mortality would have been reduced by 50 percent. Unfortunately, not only were these targets not achieved but also the maternal health situation in Nigeria is now much worse than in previous years (Ujah et al, 2005). This is aggravated by a host of problems to include political insensitivity to the importance of women in the society, lack of proper awareness and adequately educating women on the danger of maternal death to both the households and the society at large, inadequate provision of infrastructure, inadequate or substandard medical facilities, acute shortage in health personnel, among numerous others. Although series of efforts had been put in place in the past to reducing maternal deaths in Nigeria, however, these efforts have not involved enough resources to successfully reduce maternal mortality in the country.

In view of this lack of success, Shifftman and Okonofua (2012) noted that the high maternal mortality in the country will have to be tackled by generating sufficient political priority to make governments deploy enough resources to successfully reduce maternal mortality in Nigeria.

This study seeks to investigate whether or not the Millennium Development Goals (MDGs) has helped in the reduction of Maternal Mortality in Nasarawa State. Nigeria has one of the highest maternal mortality rates in the world, second only to India whose population is eight times larger than that of Nigeria. Mairiga et al. (2008) expressed the view that the world's maternal mortality ratio (the number of maternal deaths per 100,000 live births) is declining too slowly to meet Millennium Development Goal (MDG) 5 target, which aimed to reduce the number of women who die in pregnancy and childbirth by three quarters by the year 2015. 

While an annual decline of 5.5 per cent in maternal mortality ratios between 1990 and 2015 is required to achieve MDG 5, figures released by WHO, UNICEF, UNFPA and the World Bank show an annual decline of less than 1 per cent. Gains in reducing maternal mortality have been modest overall. While average global infant mortality and under five mortality have been reduced by more than half in the past 40 years, and average global life expectancy at birth has increased enormously during the same period there has been no visible progress in maternal mortality (MMR) reduction at the global level. Shah and Say (2007) noted that the trend in developing countries is much worse, as studies from various countries of sub-Saharan Africa indicate that maternal mortality has not only continued to be high, but is indeed increasing after the launch of the Safe Motherhood Initiative (SMI) in Kenya in 1987.

Nigeria has one of the worst records of maternal deaths in the world and this situation is worsening with time. The indicators are as shown in table 1 below.

 

Indicators	%
Average number of children per woman	5.31
Maternal deaths per 100,000 deliveries	560
Antenatal coverage	30%
Institutional delivery	28%
Infant deaths per 1000 births	68
Birth Registration	38%

  Unicef

The problem of poor organization and access to maternal health services has always been a major challenge in Nigeria. Omo-Aghoja et al (2008) asserted that maternity care in Nigeria is organized around three tiers: primary, secondary and tertiary care levels. Primary health centers are located in all the 774 local government councils in the country. Pregnant women are to receive antenatal care, delivery and postnatal care in the primary health centers nearest to them. In case of complications they are referred to secondary care centers, managed by states, or tertiary centers, managed by the federal government.

The Nigerian health system as a whole has been plagued by problems of service quality, including unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, and chronic shortages of essential drugs. Electricity and water supply are irregular and the health sector as a whole is in a dismal state. In 2000, the World Health Organization ranked the performance of Nigeria’s healthcare system 187th among 191 United Nations member states. 

A 2003 study revealed that only 4.2 percent of public facilities met internationally accepted standards for essential obstetric care (Harrison, 2009). Approximately two-thirds of all Nigerian women deliver outside of health facilities and without medically skilled attendants present. The weak performance of the health system must be understood in the context of the country’s long-standing problems with governance. Corruption in the political system is endemic while social development, including the promotion of the health of Nigerian citizens, has been more a rhetorical than a real aim of the state.

This research work seeks to examine the impact if there is of the Millennium Development Goals (MDGs) as a program for the reduction in Maternal Mortality Rate (MMR) in Nigeria, using Nasarawa State as a case study.

Nasarawa state is situated in the north central zone of Nigeria, one of six geopolitical zones of the country. It occupies 27,117 square kilometers of land mass. The state which was created on October 1, 1996 currently has 13 local government areas and is bounded in the north by Kaduna State, in the west by Abuja Federal Capital Territory, in the south by Kogi and Benue States and in the east by Taraba and Plateau States. 

The state is one of Nigeria’s most dynamic states with its rich historical past and a glorious culture coupled with its level of cosmopolitan, Industrious, accommodating and highly receptive populace. Its population of 1, 869,377 people is made up of mainly people from the defunct quararafa kingdom. Major tribes however include Eggon, Alago, Kambari, Hausa Fulani, Mada amongst others. The people are mainly farmers with few venturing into business and civil service. Lafia is the capital of the state. 

Women constitute 925, 576 of the population. The state total fertility rate is 8.1 per woman and the contraceptive prevalence is 2%4. Life is very vigorous for the people of Nasarawa. 61% live below poverty line; life expectancy is 51 years for men and 52.2 years for women. 

The state literacy rate is 35%. Primary school enrollment is 65%; secondary school enrollment is 60% while tertiary institution enrollment is 68%. Women folk school enrollment is at significantly lower level. The female primary school enrollment is 40%; secondary school enrollment is 35% while tertiary institution is at abysmal 42%. 

Maternal Mortality indicators shows that 63.2% women had antenatal care from a skilled provider, while about 51.4% women had their live birth protected against neonatal tetanus. During the period under review, 40.7% women delivered through skilled personnel while 59.3% delivered from unskilled personnel. During this period, about 40.1% delivered at a health facility (Alhassan 2008). The Maternal Mortality Rate of the state is put at 984 /100,000 births (NDHS 2003). 

1.3 Objectives of the Study:

The study seeks to achieve the following objectives.

i. Examine the impact of the Millennium Development Goals (MDGs) on Maternal Mortality in Nasarawa State of Nigeria. 

ii. To identify measures to reverse the trends through reforms.

iii. To identify the factors necessitating high rate of maternal deaths in Nasarawa state.

iv. To examine the role women play in reducing maternal mortality in the study area.

v. To proffer possible and practicable solutions to the problems observed.

1.4 Significance of the Study:

Whilst acknowledging the fact that this study is not the first of its kind using Nigerian data, however, it shall go a little further than earlier work as it is restricted to maternal mortality issues in Nasarawa State of Nigeria. The research study is significant because the data gathered will provide for the government, health personnel and expectant mothers information on health risk factors in the bid to identify and bridge the areas of deficiency. The findings of the study will also go a long way to enlightening women on danger of not maintaining good attitudes toward their health status and subsequently have a firm control of their reproductive right. The study will also contribute to existing knowledge in the discipline and other related studies as researchers, students, women and the academics will find it as a reference point in their respective endeavors. Accordingly, this study will enable policy makers to promote legislatures that will in both the short and long run harness quality maternal health through appropriate policy recommendations.

1.5 Scope and Limitations of the Study: 

The study will examine the impact of the Millennium Development Goals (MDGs) in reducing maternal mortality rate in Nasarawa State. Due to the complexity and nature of the study area, and given the time constraints, the scope of the study is however, narrowed down to some selected local government areas in the state. Also, the study is limited to available data gathered from the Nasarawa State ministry of health, UNICEF and WHO Journals and other related sources. 

1.6 Research Questions:

In order to elicit the desired data, the researcher raised the following research questions:

• How has the Millennium Development Goals (MDGs) helped in reducing Maternal Mortality Rate in Nasarawa State?

• Do ignorant and inadequate enlightenment programs contribute to high rate of maternal deaths in Nasarawa state?

• Is shortage of skilled personnel in the health sector contributing to high rate of maternal mortality in Nasarawa state?

• Are the socio-economic and cultural factors contributing to high rate of maternal mortality in the state?

• Does inadequate medical facilities/lack of accessibility to hospitals/primary health care clinic contributes to maternal mortality rate in Nasarawa state?

• How can the problem of Maternal Mortality be solved?

1.7 Research Hypothesis:

Ho: Millennium Development Goals (MDGs) has no significant impact on the reduction of maternal mortality rate in Nasarawa State.

Hi: Millennium Development Goals (MDGs) has a significant impact on the reduction of maternal mortality rate in Nasarawa State.

1.8 Study Report Outline:

This study report is presented in five chapters. The first chapter shall contain the introduction. Chapter two would present the literature review on the subject matter. The methodology to be adopted in the study would be stated in chapter three. Chapter four shall focus on the presentation and interpretation of results. Chapter five presents the summary of the findings, conclusion and appropriate recommendations.

1.9 Definition of Terms:

For the proper understanding of the subject matter of this study, the following key words are defined to enhance proper understanding.

• Maternal Death: The death of women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

• Ante-natal: Medical care given to pregnant women before delivery.

• Post-natal: Medical care given to women after delivery.

• Maternal Mortality Ratio (MMR): The ratio of the number of maternal death during a given time period per 100,000 live birth during the same period. MMR = (MD/LB)*100000. Where MD is the number of maternal deaths in a period, and LB is the number of live births occurring in the same period.

• Maternal Mortality Rate (MMR): the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women. MMR = (MD/PYL)*1000.  Where MD is the number of maternal deaths in a period, and PYL is the person years lived by women of reproductive age (normally 15 to 49) in the same period.

• Millennium Development Goals (MDGs): These are eight international development goals that were established following the millennium summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration. These goals are expected to be achieved by 2015.

*Call 07032879723 or send a mail to michaelonjewu@yahoo.com for the complete project