CHAPTER ONE

INTRODUCTION

Background of the Study

Maternal mortality remains a constant and major challenge to the healthcare systems in Africa and the resource limited areas of Asia. Worldwide, about 500,000 women die each year from mostly preventable complications related to pregnancy and childbirth, and more than 95 percent of these deaths occur in sub-Saharan Africa and Southern Asia (WHO, 2014). This translates to about 1,000 women dying every day (WHO, 2015). This is of course unacceptably high, and prompted the United Nations into listing ‘Improving Maternal Health’ as the 5th Millennium Development Goal which was adopted by the International Community in the year 2000, 12 years ago. The target was to reduce maternal deaths by three quarters by 2015 (WHO, 2013). It is now 3 years after the end of the time frame and many countries are showing worrying signs of failure to achieve this goal.

Africa bears the highest burden of maternal deaths in the world (WHO and UNICEF, 2013), and Nigeria, where this study was conducted, has a population of about 2% of the world’s population and inappropriately accounts for an estimate of close to 10% of the world’s maternal deaths (WHO, 2010; Hill et. al., 2012; FMOH, 2015). But the question is, why do these women die? Why are there so many maternal deaths?

The direct major causes of maternal death worldwide have long been identified as: severe bleeding mostly after child birth; high blood pressure with fits in pregnancy (eclampsia); maternal infection (sepsis); obstructed labour; and unsafe abortion (Chiwuzie et. al., 2012; WHO, 2014).

The act of giving birth is the most serious labour in the world (Ademowore, 2011). Apart from a small number of privileged and conscientious countries that have succeeded in reducing maternal mortality to close to zero, each pregnancy and birth remains a risky potentially fatal experience for hundreds of millions of women worldwide.

In a case study conducted by Adamson (2012) on maternal mortality, some 600,000 women died in agony every year. Adamson further stated that it is not an exaggeration to say that the issue of maternal mortality, fast in its conspiracy of silence is in scale and severity the most neglected tragedy of  time.

Adewumi (2011) stated that a staggering number of 585,000 women die during pregnancy and childbirth, and these are not deaths like other deaths. They die, hundreds of thousands of women whose lives came to an end in their teens and twenties and thirties, in ways that set them apart from the normal run of human experience.

In the 1990’s and early 2000’s for instance, studies carried out by different researchers such as Adamson (2010), Caffrey (2012) revealed that a lot of young women die in thousands and millions every year. And they continue to die at the rate of 1,600 every yesterday, today and tomorrow. In the worst part, these are deaths not of the ill, the very old and of the very young, but of healthy women in the prime of their lives upon whom both young and old may depend.

Mahmound (2011) opined that, maternal mortality is not about statistics. It is about women; women who have face, faces which we have seen the throes of agony, distress and despair. Faces which continue to hurt our dreams, not simply because  maternal death is one of the most terrible ways to die…. But above all because it could be avoided and should never have been allowed to happen.

Millennium Development Goals (2012) see maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration of the pregnancy or its management but not from accidental or incidental causes. As a result of advances in medical science, economic resources and human welfare, it is possible to avoid mortality almost entirely expect in the most extreme cases or as a result of accidents. MDGs (2012) further stated that children are most vulnerable in the first few months and years of life. Yet, in the advanced countries, the under-five mortality rate fell during the 20th century to extremely low levels, averaging only 6 per thousand live births (1998 UNICEF).

Beazley (2002) showed that the causes of maternal death are similar throughout the world. Globally, around 80 percent of all maternal deaths are the direct result of complications arising during pregnancy, delivery or the puerperium. The most common direct obstetric causes include the following: haemorrhage, sepsis, preeclampsia, anaemia, cephalopelvic disproportion, malaria and abortion.

Women who are at higher risk of maternal mortality need to be identified early, so that appropriate timely measures can be taken. Beazley (2012) showed that these more vulnerable mothers include those who deliver at extremes of maternal age (particularly those under 20 years or over 40 years). The early age at which many women begin childbearing is  therefore a serious cause for concern.

Nigeria Millennium Development Goals (2014) in Nigeria Demographic and Health Survey (NDHS, 2012) reported that 44 percent of women aged 20 – 24 had given birth before they were 20 years old, 27 percent before they were 15 years old. The survey found that 22 percent of teenagers aged 15 – 19 were either already mothers or pregnant with their first child.

The figures were much higher in the rural areas than in the urban areas. Early pregnancy is likened to one of the main reasons for the high rates of maternal mortality among the young women of childbearing age.

In recent years, MDGs (2015) also indicated that illegally induced abortion has increasingly been recognized as a major cause of mortality in women of childbearing age, particularly among the young women. Maternal mortality has become a threat to families, communities, nations and the world at large. Many families have lost their loved ones through maternal mortality and those gaps which have been created can never be bridged because women are the nation builders. They contribute to a large extent to the development of economic, education, social and health sectors of every community.

Ikedife (2012) stressed that there are complex problems associated with providing good obstetric care for our women of childbearing age. The expected joy from pregnancy and childbirth often eludes our women. Many times, the hope of having a healthy baby and the joy of motherhood have been replaced by bitter bereavement through the loss of a spouse or a caring mother. In the 1990’s and early 2000’s maternal and perinatal mortality have continued to maintain a disproportionately upward trend which is a great threat to our community development. He further stated that conditions of poverty, supervision, poor nutritional status, illiteracy, infections and infestation affect obstetrics on a wide scale. In addition facilities are grossly inadequate in all spheres of medicine.

 Statement of the Problem

Maternal mortality has become a threat to families, communities, nations and the world at large. Maternal mortality is not about statistics, it is about women; women have names, women who have face, faces which we have seen in the throes of agony, distress and despair. Faces which continue to live in our memories and continue to hurt our dreams. Not simply because a maternal death is one of the most terrible ways to die… but above all because it could be avoided and should never have been allowed to happen. Maternal and perinatal mortality have continued to maintain a disproportionately upward trend which is a great threat to development of our communities.

Also compounding the situation is the facts that some clinical conditions, which have apparently been confirmed, are now found in our localities. Harrison (2010) has written that over the years, there has been an unjustifiably poor allocation to the health sector by the government and this has accounted for inadequate and poorly equipped health facilities. The annual health budget has always been far below the minimum five percent recommended by the World Health Organization for developing states and countries.

Margret (2013), regretted that the few maternal health facilities that exist are poorly utilized. It is therefore not surprising that the magnitude of problems that face the practicing obstetrician, as well as women and children are staggering. All these, lead to high rate of maternal mortality in Ogbia Local Government Area of Bayelsa State. This high maternal mortality in Ogbia has direct impact on the development of the communities.

Maternal mortality hinders all these roles women played; hence, the researcher is interested in studying the strategies for reducing maternal death among women of child bearing age in Ogbia Local Government Area of Bayelsa State.

Purpose of the Study

The purpose of this study is to find out the strategies for reducing maternal death among women of child bearing age in Ogbia Local Government Area of Bayelsa State. Specifically, the study is meant to:

1. Find out the causes of maternal death in Ogbia Local Government Area.

2. Determine the effects of maternal death in Ogbia Local Government Area.

3. Ascertain the strategies that could be adopted to curb the problems of maternal

    death in Ogbia Local Government Area.

Significance of the Study

It is hoped that the findings of this study will be of benefit to parents, health workers, community workers, government and non-governmental agencies.

Parents will be able to understand the various ways of minimizing the incidence of maternal mortality in their communities by patronizing adequately health facilities during pregnancy, delivery and after birth. Health workers will be able to know the right steps to take in creating awareness and knowing the appropriate preventive measures of maternal mortality that is good for different women during ante-natal

programme. Community health workers will also be properly informed on the various modern health practices available in the country and the world at large which will, in no small measure, reduce the rate of maternal mortality in the society and Ogbia community in particular. Those they can convey to the people through seminars, workshops and so on.

Government and non-governmental agencies will see the areas of need in order to intensify their efforts in implementing preventive measures geared toward reducing maternal mortality in the rural areas.

It will also expose the male folk to the need for allowing their women receive adequate medical care during pregnancy rather than engaging in the obsolete methods of medication and child delivery which has been the method in most homes in Ogbia Local Government Area.

It is equally hoped that the findings of this will serve as a starting point for both the government, community health workers and other enlightened stakeholders on their roles in reducing maternal mortality in our communities and the society at large through enlightenment campaigns programmes.

Research Questions

The following research questions guided the study:

1. What are the causes of maternal death in Ogbia Local Government Area?

2. What are the effects of maternal death in Ogbia Local Government Area”

3. What strategies could be adopted to curb the problems of maternal death in 

     Ogbia Local Government Area?

Scope of the Study

The study is carried out on the strategies for reducing maternal death among women of child bearing age in Ogbia Local Government Area of Bayelsa State.

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