Gynecologists and Obstetricians rose from its annual conference in Benin City, Edo State last week with a strong resolve to put an immediate end to the increasing rate of maternal deaths in the country. Presently, about 529,000 women die annually globally, while Nigeria is said to account for 10 per cent of the annual maternal deaths. Eugene Agha writes

Hawatu as she was identified is a mother of four. She had only been to the hospital once in her life and that was many years ago when she had her first baby. Even at that, she could not complete her antenatal dates in the hospital where she had registered so when it was time for delivery, she did it alone quietly but painfully and riskily too in a corner of her hut without the presence of any health worker.

The second, third and forth time she didn't even border to register for antenatal as she did the first time. She took herbs that were given to her by one of the local traditional birth attendance who practice his trade in the far corner of her village.

Hawatu took all what the local birth attendant told her religiously. Daily, in her little hut she brews the herbs that were given to her. And when it is her delivery date, she is left on her own, screaming and cursing at the same time. She is quick to forget the pains after her baby had arrived. She was however lucky as she was later made to understand. Not every woman can go through this process and still stay alive, said a gynaecologist at the SOGON conference,

Many young women, particularly those from the northern parts of the country go through this process for one reason or the other. Some may be that she would not allow a male doctor to attend to her during delivery.

This attitude and belief may have accounted for a good number of maternal and newborn deaths in Nigeria. Though, other factors too can also account for the high rate of maternal and newborn deaths in the country. Some of those factors may include, bad road, absence of health facilities in the rural communities while the persistent electricity failure could also be said to have contributed to the death of mothers in Nigeria.

For these reasons, Nigeria is said to be the second highest, next to India, with an unimaginable rate of maternal and infant death in the whole world. A record which members of the society agreed was alarming. About 529,000 women die annually globally, while Nigeria contributes 1.7 percent of the global population yet it accounts for 10 percent of maternal deaths annually.

SOGON President, Dr. John Okaro, who made this known at the conference he pledged that the important task before the new SOGON Council was an uncompromising and unrelenting war against the shame3ful high figures of mate4rnal and newborn death in Nigeria.

According to him, at that time it was clear to SOGON that thoughtful preparations had to be made to get the army in a fit state to under take the war.

"Since then we have been interacting with Government, International and National donor agencies, the private sector and faith groups as we discussed to find out why up to now Nigeria has not been able to fashion out a way to deal with the high mortality in the country" he added.

The SOGON President further stated that as stakeholders in the field of maternal health, they have now agreed that their uncoordinated work efforts since the first motherhood conference in Abuja, in 1999, has been entirely responsible for the rising figures of maternal and newborn death in Nigeria.

While blaming members of the society for the continuous increase, Dr. Okaro said that members have not applied, in a sustained manner, the result of their various research projects which, according to him, still stood stagnated and even disintegrated as soon as the supporting personnel withdraws.

He added that it was now clear that the only way they can impact on the monstrous figures was for the stakeholders to work together in a structure that will cover the whole country with their bases rooted in the existing health structure of the states, federal government and private health institutions.

He revealed that after considerable time in a long dark tunnel, SOGON has emerged into light, with an embracing National partnership plan and structure which have integrated all levels of Local State, Federal, Faith and Private health structures into a system that will be able to handle and overcome the high maternal and newborn death rates in the country. Dr. Okaro also revealed that SOGON has dedicated and committed members who are prepared to take the war to the field.

On how the programme will be funded, SOGON President said the society has put together a proposal with which to seek fund from the private sector to run a nation wide advocacy of the plan.

He explained that telecommunication companies such as MTN, Globacom, Celtel and others are willing to listen to the horrible tales of the death of Nigerian women during child birth and will be moved to providing financial support for something to be done to prevent the maternal death.

Presenting a paper title "Education and Women empowerment as strategies for reducing maternal child mortality" Dr Mairo Mandara, Senior Country Advisor, stated that maternal and less than five mortality was one of the tragedies of developing countries in the 21st Century. This, he noted, was most worrisome because most of the causes of death can actually be prevented.

To him, in discussing the issues of maternal and infant mortality in Nigeria, it was important to look at the socio-cultural milieu within which the people live. This, in no doubt heavily influences not only the health of the population but also more importantly the ability of people to take decisions including decisions on health matters.

"The Nigerian woman, like all African women, is primarily responsible for the health of children and of course she takes the pregnancy even before the child is born. This status of the woman is central to both maternal and infant health and mortality. Thus gender roles from conception, through childhood and adolescence affect this biologic responsibility" he added.

He explained that in Nigeria 44 percent of females are illiterates compared to 22 percent of males and only 3.4 percent hold any political office. Adding that, girls generally do not have same opportunities for education, good food and societal respect for daring to make decisions as boys. To him, maternal mortality was therefore the end result of a series of intricate social dynamics that starts way before pregnancy

About 529,000 women die annually globally, while Nigeria contributes 1.7 percent of the global population yet it accounts for 10 percent of maternal deaths annually.

"This translates to at least 52,000 women dying annually, which is the equivalent of 10 jumbo jets crashing every month and one 737 jet every day or one woman dying every 10-15 minutes

In Nigeria, infant mortality rate was about 100 deaths per 1000 live births. This he explained was even higher than that of Congo which was about 81 per 1000 live births, and Ghana's 50 death per 1000 live births, which is almost half that of Nigeria even though they have same $320 gross national income (GNI) per capital. Equally abysmally low is the immunization coverage rates when compared with these and other countries.

Why this has become worrisome, he explained further that majority of the births in Nigeria occur at home which account for about 66 percent, even though 63 percent of these women attend antenatal care during pregnancy.

"Why do women attend antenatal care but prefer to deliver at home with all the attending risks? In a study conducted by Mandara and Renne in parts of Northern Nigeria (Zaria), the main reasons were cost of hospital services and poor attitude of health care providers to patients. Nigeria is a complex society with many variables confounding any issue particularly issues that border on the ability of women to take decisions and their purchasing power. I am taking time to give you this background information so that we can appreciate the complexity of the issues we are addressing" he added.

The health of any population, according to him, is not only a product of the health care system but also of the socio-cultural norms and desires of the people. This is even more in maternal and child health.

"Thus, maternal mortality is dependant on the age at which a woman gets pregnant, the number of wanted pregnancies as compared to unwanted pregnancies which are associated with high level of abortions, the financial situation of the woman and her ability and level of decision making about her health and those of her children. The most critical determinant of translating knowledge into action is the decision making powers of a women. This is further enhanced by the ability to follow through the decision into actual action. This, more than ever before in the history of Nigeria, is determined by economic power" he added.

Worried by all these factors, he explained that the ability of a woman to take decisions on issues affecting her and her children was determined by her educational status. And that her ability to actualize her decision was also determined to a large extent by her economic empowerment

Thus, the educational and economic status and the societal willingness to recognise women as humans are major determinants of MMR and CMR. These women who die in the prime period of their lives, he reasoned, are not dying from unknown causes or conditions members of SOGON cannot treat, but they are dying because of conditions they can detect, diagnose and treat.

Nigerian doctors, according to him, have the knowledge and the tools to make maternal mortality something of the past. Since Maternity was not a disease.

"Maternity is a privilege. Women are entrusted with the survival and propagation of our species. Women have a basic right to be protected when they risk their health or life in the process of giving us life" he added.

To him, the magnitude of maternal mortality and morbidity represents perhaps the greatest social injustice of our time. He added that SOGON inability to address the preventable causes of maternal and child mortality was but a symptom, a tragic symptom, of a larger social injustice of discrimination against women and the denial of women's human rights from infancy through adulthood which manifests in the societies' unwillingness to prevent women from dying.

It highlights the failure and even refusal of political, religious, health and legal institutions to address the most fundamental way in which women are different from men.