Nigeria has one of the highest maternal mortality rates in the world with 560 women dying for every 100,000 live births. Although there has been an improvement in the past decade, it still remains unacceptably high. The North East geopolitical zone has the highest maternal mortality rate of 1,549/100,000 live births, compared to 165/100,000 live births in the South West Zone — an almost 10-fold difference.
A study by researchers from Columbia University carried out in Northern Nigeria in 2012 found that most pregnant women had “little or no contact with the health care system for reasons of custom, lack of perceived need, distance, lack of transport, lack of permission, cost and/or unwillingness to see a male doctor.”
It is easy to shrug away this statistic and wonder what to do – but there are many innovative ways out there on how to confront this, and some of these are beginning to be deployed and show results. Tackling this monumental problem requires a knowledge and understanding of local contexts, and there are some individuals and organizations who are engaging passionately in this work. This week, we want to highlight the work of one of these individuals.
Last year, in December 2014 in London, we were privileged to hear from Hajia Fatima B Muhammad, a midwife and midwife educator with over 20 years working experience in Maternal and Child care in Northern Nigeria, as she gave a talk at TEDxEuston’s 2014 conference with the theme “Facing Forward”. In her talk, Fatima spoke on behalf of her sisters, her daughters, her nieces and her cousins in parts of Northern Nigeria, who don’t have access to healthcare. But, as she makes clear, it is not just access to healthcare that matters but the ability to negotiate their own destinies and fulfil their full potential as productive members of society.
Watch her fascinating talk here.
Fatima held the audience spellbound telling her own story, which challenges conventional wisdom. Her story was one of a childhood filled with joy and play, learning and discovery. She was born between two boys and learnt to stand her ground in her interactions with her brothers. Mixing both western and Islamic education, as was the norm for many other children in that area, she grew up aspiring to be a nurse.
While Fatima’s parents were very supportive of her ambitions, a childhood friend of hers was not so fortunate and had a completely different trajectory. As Fatima was expecting her first child, her childhood friend was expecting her eighth. This came at a price as her friend had to give up many phases of development and experienced challenges as a result. The friend is sadly not unique in Nigeria as many girls, especially in Northern Nigeria, are married off at the young age of 14 and younger. At that age, they are still children …and suddenly they are thrown into motherhood. Moved by her friend’s story Fatima developed an interest in family planning and eventually joined the Society for Family Health (SFH), one of the leading organizations in this area in Nigeria.
In her talk, Fatima described one of the interesting interventions being used to tackle the problem of poor access to healthcare facilities for pregnant women in Northern Nigeria. The scheme, supported by the Bill and Melinda Gates Foundation, is an emergency transport scheme for pregnant women in Gombe State. In the scheme, commercial drivers were offered non-cash incentives such as priority loading in the motor parks and peer recognition by the community to transport women on their way to delivery to health care centres for free. The success of this project has spurred several other approaches to reducing maternal mortality in Nigeria.
As identified in the research study mentioned earlier and in the 2013 Nigeria Demographic and Health Survey, distance to the health facility was as a significant barrier to accessing healthcare with 30 percent of the women responding in the 2013 survey reporting it as a barrier.
These and other challenges that lead to the poor maternal health outcomes for Nigeria cannot be solved by simply continuing to do things the way that they have been done in the past. We need individuals like Hajia Muhammad and organizations with an in-depth understanding of the problems and the ability to come up with innovative solutions to continue the good work. We also need, as individual Nigerians, to be engaged with this problem, to demand that our political, religious and traditional leaders tackle these issues, and we must hold them to account. We must ask the aspirants for various offices – local government chairs, the councillors, the governorship candidates, the presidential candidates – what they intend to do to improve maternal and child health, and we must support the individuals and organizations working to tackle this challenge. Dying in childbirth is not normal, and we must all work for a Nigeria where this becomes the reality.
Hajia Muhammad, beyond sharing the story of her life and work, eloquently and passionately made the case for all women to be given a fair chance in life. Her story resonated with the over 600 people in the live audience, and deservedly, at the end of the talk, she received a standing ovation. As she ended her talk, she said “The clouds are dark, but there is a silver lining and I hope that one day these girls will sing in the words of Jimmy Cliff: I can see clearly now the rain is gone …” – Watch her talk here and be inspired.