Abuja — No doubt, Nigeria has one of the worst infant and maternal mortality statistics globally. Although Nigeria constitutes only 2 per cent of the world's population, it accounts for 10 per cent of global maternal mortality, contributing the largest number of deaths in Africa.

 

This high rate of maternal death, experts say, is due to poverty, unavailability of healthcare, unavailability and uneven distribution of health personnel in the country.

 

Findings further show that about 47,000 maternal deaths occur annually with almost 284, 000 children dying in the first month of life in Nigeria.

 

There is however, a consensus in the global health community on the three most cost effective interventions to reduce maternal mortality and morbidity. These include universal access to family planning, a trained health professional with midwifery skills at every childbirth and timely access to high quality emergency obstetric and newborn care.

 

Medical experts have also argued that about 62% of pregnant women in Nigeria still deliver their babies without the help of skilled birth attendants and that although there is 97% availability of midwife workforce, it is marred by uneven distribution.

 

Therefore, investment in midwifery, the experts noted, is the best buy in primary healthcare development.

 

In order to correct and reduce the embarrassing infant and maternal health indices through investment and strengthening of the midwifery service services in the country, the United Nations Population Fund (UNFPA) in partnership with the Federal Ministry of Health recently launched the State of the World Midwifery 2014 and strategic plan to strengthen midwifery in Nigeria.

 

The event which was held in Abuja attracted nursing and midwifery professionals and other key development partners in the health sector.

 

The State of the World Midwifery (SoWMy) Report 2014 was co-coordinated by UNFPA and released on June 3, 2014, at the 30th International Confederation of Midwives (ICM) triennial Congress in Prague. It was however, recently launched in Nigeria.

 

The report provides an updated evidence base detailed analysis of the present and future challenges to deliver effective coverage of midwifery services in 73 countries including Nigeria.

 

The SoWMy report highlights four key areas. They include - availability, acceptability, accessibility and quality of midwifery services that countries and health systems must address in order to provide women and newborn with live saving care that they need.

 

The aim of launching the SoWMy report in Nigeria is to share the findings of the report and evidence to all stakeholders; strengthen policy dialogue based on the evidence provided in the SoWMy brief, identifying barriers and opportunities to improve midwifery services for women and newborns and obtain commitments from participants on next steps.

 

Speaking at the launch of the report, the Deputy UNFPA representative in Nigeria, Koffi Koaune, regretted that currently, only half of pregnant women in Nigeria make up to the minimum of 4 or more Antenatal Care (ANC) visits in pregnancy as prescribed by the World Health Organisation (WHO).

 

 

"In spite of the low national average, women who reside in rural areas are less likely to visit ANC clinics than their counterparts in the urban areas as only 38.2% of such women meet up to the minimum number of ANC visits. This low ANC penetration generally, and specifically at the rural communities may not be unconnected with inadequate supply of appropriate health manpower, including qualified midwives.

 

"The underlying factor that contributes to the high mortality figures may not be unconnected to a low Skilled Birth Attendant (SBA) rate as only a third of pregnant women in Nigeria (38.1%) are attended to by a skilled health provider at delivery. This is worse amongst women with no secondary education amongst whom only 11.7% of births are delivered by SBA.

 

"It is worthy of note that 'midwifery' is the only profession in the medical field that dedicates 100% of its manpower hour to the provision of maternal and newborn health care including delivery services," he said.

 

He, however, disclosed that with the current deficit of projections of future needs, Nigeria would require additional 3500 midwives, above current levels annually for the next 15 years to meet the needs of the population in the year 2030. This means that in spite of the current efforts, government and the development partners would need to more than double existing efforts to ensure current gains are neither halted nor reversed.

 

According to him the UNFPA in Nigeria has been a key partner of the federal government initiative to improve skilled attendant at birth: the Midwives Service Scheme; it has provided financial and technical support to the scheme since 2010. He said UNFPA in collaboration with ICM is also supporting Nigeria in strengthening its midwifery workforce through their joint 'Investment in Midwives Programme (IMP), a global initiative that focuses on strategies for capacity building of national midwifery associations, pre-service midwifery education and accreditation as well as strengthening midwifery service provision an regulation.

 

Also speaking, the Permanent Secretary in the Federal Ministry of Health, Linus Awute, said: "Our knowledge of history have shown that midwives have been, right from time the harbinger of God's will for humanity and they have remained a veritable instrument in the hands of God through which he has succeeded in expanding creation to this day.

 

"It is not by mistake that we have identified the need for them and their importance and by so doing consolidated an arrangement to make sure that the purpose of their establishment is made consistent for the benefit of mankind and to the glory of God."

 

While charging the midwives to sit up to their responsibilities, Awute said: "This is the moment for us to examine ourselves to begin to put ourselves in alignment with our true job demands and that has to be made in consonance with what obtains out there that if we do the right thing, we will succeed in putting ourselves in the overall equivalent with other nations who are also making it.

 

"The federal government recognizes that investment in midwifery is the best buy in primary health care. In 2009, the launch of the Midwifery Service Scheme (MSS), Nigeria made a giant stride in the recruitment and deployment of midwives, particularly, to rural areas. The further scale up of this initiative was made possible in 2012 with the SURE-P MCH programme.

 

"In 2013, Nigeria launched the 'Investing in Midwives programme' with the support of the UNFPA and set out on a course to the repositioning of the midwifery workforce towards accelerating the attainment of the MDGs.

 

"It is also on record that at the just concluded National Council on Health (NCH) meeting, the Council approved the National Task Shifting and Task Sharing policy and health workforce registry for implementation in all the states of the federation including the FCT. This demonstrates the urgency at efforts in prioritizing the human resource for health within the framework of National Strategic Health Development Plan."

 

He, on the other hand, lamented that there is a very high imbalance in doctors to patient ratio which is approximately 28 or 30 doctors to 100,000 patients. "Not only do we have that kind of imbalance, we also have a situation where 83 per cent of the available doctors dwell in the urban areas. In this case not even in all the urban areas where one can say that should constitute the contact of all the rural communities around, but they are mainly in Lagos and commercially lucrative cities. That is the truth and that is what makes the midwives enjoy a very central attention and consideration in all that we do. We are also planning to continually expand their numbers," he stressed.

 

Speaking, the Founder-President of the Wellbeing Foundation Africa and Chair of the White Ribbon Alliance for Safe Motherhood Nigeria, Toyin Saraka, regretted that despite the long standing tradition of midwifery in Nigeria, access to skilled birth attendants remain limited in rural areas and even now that 10 per cent of rural women in Nigeria deliver without anybody present.

 

"It is already a precarious situation for Nigerian women and it is predicted to become harder in the next 15 years with an expected population increase of 60% by 2030, our already stretched maternal and newborn frontline health services may struggle to respond to the 12.8 million estimated pregnant women every year.

 

"So we must act now to improve availability, accessibility, acceptability and quality of midwifery in Nigeria in order to meet this growing demand from our growing population.

 

"We must invest now. By investing in the training and continuous development of midwives, Nigeria can and will save the lives of thousands of women who die each year from preventable causes relating to pregnancy and child birth.

 

"By investing now to the improved access to our midwives, Nigeria will unleash the untold human potential of every single new life that is save by midwives and those fragile first 24 hours after birth and those first 6 months and in that first 1000 days. By investing now in the availability of midwives, Nigeria can improve the health of our community as a whole by 2030.

 

"I have spent weeks and months meeting midwives all over the country and I was part of the process that started the midwives service scheme that has done so much to put midwives right at the front line, but I will like to remind us of one little thing, when we started the midwives service scheme in Nigeria, it was to bring back seasoned midwives who had worked so hard, so tirelessly and so well back into the system to be able to guide both mothers and the younger midwives in accessing the care and delivering this care at the right quality.

 

"Today the MSS is still alive and working very hard, but it has in reality become as a national service scheme to the young midwives. I will want to remind us of the need to connect these young midwives to our groups of older, seasoned and experienced midwives for quality, transparency and accountability," she noted.

 

At the end of a meeting after the launch of the document, stakeholders arrived at the some resolutions which according to them will assist in improving midwifery education, regulation, association and practice in Nigeria.

 

Among the resolutions are improvement of working conditions and incentives for midwives; uniform salary structure for midwives across all levels (tertiary, secondary or primary); development of career pathway in midwifery; compulsory rural postings for midwives that is time bound; retention and appropriate distribution of midwives to all parts of Nigeria.

 

Other resolutions are the need for increase the number, and quality of midwives; nursing and Midwifery Council of Nigeria should put in place mentoring program for midwives; capacity building for midwifery educators; proprietors of midwifery training institutions should improve the learning environment; gap analysis findings expected to serve as a blue print for advancing midwifery education, regulation and association in Nigeria; government need to develop rural areas by providing social amenities; accreditation checklist of school of midwifery need to be made known to all stake holders and strengthen database of midwifery workforce in Nigeria.

 

By Hassan Zaggi