Dr. Babatunde Ahonsi is the Country Director of Population Council and Board Member of the Women Health Action Research Centre, (WHARC) , located in Benin City. In this interview with JOSEPH OKOGHENUN and GLORIA MAMUZO, Ahonsi blamed high maternal deaths on government's lackadaisical attitude towards women issues.MATERNAL mortality seems to have defied all solutions in Nigeria. In spite of global outcry about the trend, why are women still dying in high numbers'THE main reason women die, aside from pregnancy- related complications, is delay in reaching the point where they can get care.There is what we call the three-delays in maternal health field. There is a delay that happens in the household in taking decision. In many parts of this country, a woman can't leave her house without the permission of her husband. Meanwhile, the husband may be in the farm and the woman is in labour pains at home. There are many parts of this country where a woman can't be delivered by a male birth attendant. Meanwhile most of the nurses available in Northern Nigeria are men. These are social issues that cause delay in maternal health.The second delay is transportation. I have been in a place in Kastina State where a pregnant woman with complications was being rushed to hospital in a wheelbarrow. We had to move her from the wheelbarrow to my car to get to a hospital.When the first delay has been overcome, the second comes in -' how do you transport her' This often affects poor people. Most Lagos residents do not know poverty, that is why when we quote statistics, people think we are making them up. But Nigerians are desperately poor. When you tell somebody that 60 million of Nigerians are living below two dollars per day, he will tell you it is not true. But there are many Nigerians who throughout this week did not hold N500. So transportation is the second delay because roads are bad. In riverine communities, boats are not available to take pregnant women to hospital after decision has been taken. These two delays contribute a lot, in my view, more than 70 percent to maternal deaths. That is why some people describe the Lagos State Teaching Hospital (LUTH) as a mortuary because patients are dying there. But the reason why a lot of patients are dying in LUTH is that they are getting to LUTH too late. A doctor is neither God nor magician. If you get to a doctor when it is too late, the doctor just presides over your death.So by the time most women get to hospital, it is too late. When a woman is experiencing eclampsia (hypertension disorder associated with pregnancy) or has experienced three or four episodes of it, what can a doctor in the hospital do' It is too late.The third delay occurs at the hospital or clinic. If a woman gets to hospital and the receptionist is delaying and asking for her card, it may be too late when she finally gets to the doctor. May be at the hospital she needs oxygen, but there is no oxygen. By the time everything is ready and she is wheeled down to the theatre for evacuation of the foetus, there may be no electricity supply.What do we need to tackle this menace of maternal deaths'If you look at each of those three delays, there are social issues involved: economic, cultural, human capacity. So there are things we can do through structural intervention. The most important structural intervention is female education.Globally, educated women are not dying because an educated woman would have the information, orientation and motivation to keep herself alive for the sake of her children and husband. So, if you want to improve maternal health within 20 years, educate all the girls so that by the time they become women, maternal mortality will not be an issue again.But before we educate all the girls in the next 10 to 15 years, what can we do now to save the lives of our women that are not educated' There are low-cost proven portent interventions. We know the three main killers of our women. Postpartum haemorrhage is number one. There is a drug called Misoprostol; once a woman notices that she is bleeding, she takes the drug to stop it. The drug is as cheap as Panadol. She does not need a nurse or doctor to administer the drug. Once the women and the community are educated, and there are signs that the woman will bleed, she would swallow her tablet.Eclampsia is another. But we also know that magnesium sulfate is cheap to manage the condition. Once it is administered on the woman through injection, the woman's blood pressure would stabilise and the doctor can bring out the baby safely.There is abortion-related deaths with young people; malaria in pregnancy among others. We know what to do to correct these things. And the means to them are available. But our women are dying because of failure of governance. Government is not attaching the right values to the lives of women. If it were men and boys that were dying the way women are dying from pregnancy, government would have solved the problem long ago. This leads us to the gender question. What value do we attach to the life of a girl or woman as compared to the life of a boy or man. We have the knowledge; we know the solution, which is not expensive, yet we are not doing them.We should remember that pregnancy is not a disease. Medical experts would tell you with confidence that pregnancy is a natural process, and that most pregnancies can even be delivered at home. There are some parts of the world where home delivery is being encouraged. But usually there is about three to five percent of pregnancy that would develop complications. That is why we say all women should be delivered in the hospital to save lives of these five percent. And it is during those complications that we need skilled birth attendants -'doctors, midwives or nurses -' to manage the complications.We can prevent complication by promptly identifying the danger signals which is why we recommend that all pregnant women attend antenatal clinics three or four times before delivery. During antenatal, when medical experts are taking vital signs, it would be clear whether the woman is likely to have a complicated pregnancy.One of the things we know for sure is that medically, the most significant predictors of safe delivery is skilled birth attendants. The evidence is very clear globally. But a lot of our women do not have access to hospitals or healthcare centres are in such bad shapes that women are not motivated and enthusiastic about having their deliveries in hospitals. So, we need to make sure skilled birth attendants deliver all births. And that means taking them to hospitals. But as we have discovered in Northern Nigeria, a lot of women attend antenatal clinics more than showing up for delivery in hospitals. In other words, we are seeing a lot of women who go for antenatal, but when it comes to the day of delivery, it is done at home because of the experiences of their friends and relatives; when they go to hospitals to deliver. Their experiences are not pleasant. Hospital in communities are in such a bad shape that all hospital managers can give is Panadol. Panadol is not what a pregnant woman needs but skilled birth attendants.Due to the nature of our country, a lot of women would not get to hospital, so what do we do' You reduce the risk of pregnancy complications and delivery complications by ensuring that women have the necessary information not to be in situations where their pregnancies would be at higher risk. That means girls should not be giving birth because their bodies are not ready. And we can only achieve that by education for communities and individuals to ensure that kids are not getting pregnant and having kids. We know that women should not have too many pregnancies too quickly'There is what is called maternal depletion syndrome, which means that the body just 'depletes' with too many pregnancies. So child spacing is healthy for the woman to control maternal deaths.
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