Maternal and Child Health in Nigeria

Professor Friday Okonofua

Provost, College of Medical Sciences, University of Benin,
Executive Director,
International Federation of Obstetricians and Gynecologists (FIGO), and
Hon Adviser to the President on Health
Background

1. The 1991 national census reported life

expectancy of 52.6 years for males, and 53.8
years for females

2. However, the crude birth declined from 27 to 14

per 1000 in 1991

3. Despite this, the WHO ranked Nigeria low (163rd

out of 191 countries) in terms of Disability
Adjusted Life Expectancy (DALE) with a value of
only 38.3 years
Disability Adjusted Life Expectancy
(DALE)

• DALE adjusts life expectancy for disability, and is a more

robust measure of survival

• In DALE estimation, Nigeria ranked higher than countries

like Sierra Leone and Liberia, but was behind countries
like Ghana and South Africa

• Further analysis showed that the low DALE ranking of

Nigeria was due to the high maternal, neonatal, infant
and under-five mortality in Nigeria
Global Comparison of Score and Ranking of
Disability adjusted life Expectancy

Country DALE (years) DALE ranking

(out of 191 countries)
Sierra Leone 25.9 191
Liberia 34.0 181
Nigeria 38.3 163
South Africa 39.8 160
Ghana 45.5 149
USA 70.0 24
UK 71.7 14
Sweden 73.0 4
Objectives of this Presentation

• Present current statistics relating to maternal and child

mortality in Nigeria

• Identify some of the most important determinants of

maternal and child mortality in Nigeria

• Review the development of the enabling frameworks for

the delivery of MCH services in Nigeria, and

• Make substantive recommendations on ways to improve

maternal and child health in Nigeria
Maternal Deaths in Nigeria
• An estimated 500,000 women die each year
throughout the world from complications of pregnancy
and childbirth

• 55,000 of these deaths occur in Nigeria

• Nigeria is only two percent of the world’s population

but accounts for over 10% of the world’s maternal
deaths in childbirth

• Ranks second globally (to India) in number of

maternal deaths
Maternal Mortality Ratios in Nigeria

NATIONAL 704

RURAL 828

URBAN 351

SOUTH WEST 165

SOUTH EAST 286

NORTH WEST 1025

NORTH EAST 1549

0 500 1000 1500 2000

Maternal Mortality Ratios in some States
(SOGON, 2005)

7,523
Kano State

727
Borno State

783
Enugu State

Cross River State 2,977

846
Plateau State

Lagos State 3,380

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000

MMR /100,000
Other indicators of Maternal Morbidity and
Mortality

• Risk of a woman dying from child birth is 1 in 18

in Nigeria, compared to 1 in 61 for all developing
countries, and 1 in 29, 800 for Sweden

• For every woman who dies from childbirth in

Nigeria, another 30 women suffer long term
chronic ill-health

• The UNFPA estimates that 2 million women suffer

vesico-vaginal fistula globally, 40% of these
(800,000 women) are in Nigeria
Medical Causes of Maternal Mortality in
Nigeria

Hemorrhage - 23%
Infection - 17%
Malaria - 11%
Anaemia - 11%
Abortion - 11%
Eclampsia - 11%
Narrow Pelvis - 11%
Others - 11%
Unsafe Abortion in Nigeria

• An estimated 610, 000 women undergo

clandestine abortion annually in Nigeria

• The FMOH (1991) estimates that 20,000

Nigerian women die from abortion
complications each year

• Abortion complications also predispose

women to infertility and ectopic pregnancy
Child Mortality Statistics in Nigeria

• Infant mortality rate

71 per 1000 live births

• Under -5 mortality rate

140 per 1000 live births

• Perinatal mortality rate

51 per 1000 live births
103 per 1000 live births
Comparative Performance in Reducing U5MR

NIGERIA 10
LIBERIA 18
S.LOME 19
CAMEROON 40
KENYA 42
S.AFRICA 47
GHANA 53
SSA 34
LDC'S 42

0 10 20 30 40 50 60
Indicator of Equality of Child Survival
(ECS), WHO
• Equality of child survival (ECS) measures the extent to
which under–five mortality reflects pure chance of death
(equal to all children) rather than variations in underlying
factors

• A value of 1 represents complete equality of child survival,

unaffected by underlying factors

• The more the value lies below one, the greater the degree
of inequality in child survival, due to these underlying factors
Performance of Nigeria in ECS Ranking

• Nigeria scored 0.336 in the ECS ranking meaning a high

probability of child mortality from underlying factors

• Nigeria ranked 4th lowest out of 191 ranked countries

• Nigeria was only ahead of Central African Republic,

Mozambique and Liberia

• Nigeria ranked worse than war-torn Sierra Leone and

Angola
Factors contributing to Maternal Mortality in
Nigeria
• Lack of antenatal care

• Low proportion of women attended to by skilled birth

attendants

• Delays in the treatment of complications of pregnancy

• Poverty

• Harmful traditional practices

• Low status of women

Utilisation of MCH Services in Nigeria
• Contraceptive prevalence rate 8%

• Unwanted pregnancy rate

among adolescents 60%

• Use of antenatal care by a

trained provider 64%

• Proportion of pregnant women

delivered by a trained provider 37%

• Proportion of pregnant women

who deliver at home 57%
Delays in Treatment of Pregnancy
Complications
Type I Delay - when a woman with a
pregnancy complication
fails to get to a hospital
in time
Type II Delay - when the delay is due to
difficulty with
transportation

Type III Delay - when there is delay in

treatment after the patient
has reached the hospital
Contribution of “Delays” to Maternal
Mortality in Nigeria
• No delay 10%

• Type I Delay 30%

• Type II Delay 20%

• Type III Delay 40%

Causes of Type III Delay
• Non-affordability of antenatal costs, delivery costs
and post-natal costs
• Delays in seeing staff in health facilities
• Incessant strikes and lockouts
• Delays due to poor supplies and consumables
• Delay in referral of patients
• Basic essential obstetrics care not available in most
facilities
• Systemic problems – doctors and midwives refusing
rural postings
• External brain drain
Characteristics of Nigeria’s Health
System
• Weak and inefficient

• Under-capitalized

• Poor motivated health units

• Costly

• inaccessible
Comparative Performance of Nigeria’s Health
System, out of 191 Countries

Responsiveness 149

Fairness in financial
180
contributions

Overall goal
184
attainment

Health expenditure
176
per capita

Impact on level of
175
health

Overall health system

187
performance

0 50 100 150 200

MCH service delivery in Nigeria:
Historical milestones
• 1980s - Emphasis on family planning/MCH services

• 1989 - International Safe Motherhood Conference in Nairobi,

Kenya

• 1990 - National Safe Motherhood conference, Abuja

• 1994 - International Conference on Population and

Development (ICPD), Cairo, Egypt

• 1995 - Fourth World Conference on Women

Beijing, China

• 1995 – 2005 - ICPD + 5, Beijing + 5, ICPD + 10, Beijing

+10

• 2000 - UN Millennium Development Goals

Millennium Development Goals, UN (2000) –
how far?
• Goal 4: Reduced child mortality - To reduce
mortality rate among children under 5 by two
thirds by the year 2015
• Goal 5: Improved maternal health - To
reduce by 75%, the maternal mortality rate by
the year 2015
• Six years into the 15 years deadline for achieving
these goals, there is no clear evidence that
Nigeria has yet achieved any remarkable
achievements.
Recommendations
1. Political leadership is needed.
The Presidency should personally speak to the problem
of the high rate of maternal and infant mortality in
Nigeria, just like he has done for HIV/AIDS
Executive Governors and Local Government Council
chairmen should do the same in their States and LGAs
2. A multi-sectorial approach should be adopted whereby
all sectors (Legislative Assemblies, Information,
Education, Women Affairs etc) should include MCH
programming in their portfolios
3. Costs alleviation for women seeking antenatal care
and delivery services. Such a policy has been
successful in reducing maternal mortality in Kano
State
4. The creation of a National Institute for maternal and
child health
National Institute of Maternal and Child
Health
• Will provide an avenue through which government
will providing funding for MCH
• Will reduce donor dependency on MCH
programming
• Will provide an avenue for research and data
collation on matters related to MCH
• Will develop guidelines, policies and strategies for
reducing maternal and child mortality in Nigeria
• Will provide a forum for capacity building and
resource mobilisation for MCH
Programs to reduce Maternal and Perinatal
Mortality in Nigeria

1. Provision of information and services about family

planning and contraception

2. Programs to encourage all pregnant women to receive

antenatal care and to be delivered by skill birth attendant

3. Improvement of antenatal and delivery services in

hospitals, especially emergency obstetrics care

4. Government should address the problem of women dying

from poorly performed abortions
Recommendation Contd.
1. The government should make
compulsory the registration of all
maternal deaths in the country, as
recently legislated in Edo State
2. Disease – specific preventive
measures for child mortality
3. Promotion and scaling up of
childhood immunization
Conclusions
1. There can be no doubt that maternal and child
morbidity contribute significantly to the low life
expectancy in Nigeria

2. The disease conditions that lead to maternal and child

mortality in Nigeria are the same as in most parts of
the developing world

3. However, it is the adverse socio-economic and cultural

circumstances under which these diseases occur that
increase the risks of these deaths in Nigeria
Conclusions

4. A case is being made for a purposeful, multi-

disciplinary and multi-sectorial approach for
addressing the problem

5. An increased prioritization of the problem and

impetus from the Presidency, the State
Governors and Local Government Councils will
greatly accelerate the pace of attainment of
the MCH aspects of the MDGs in Nigeria

6. Indeed, addressing the high rate of maternal

and child mortality will be a visible
contribution to socio-economic development
and transformation, and a major legacy of this
administration
THANK
YOU