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MATERNAL DEATH: ISSUES, ANALYSIS AND SOLUTONS

MATERNAL DEATH: ISSUES, ANALYSIS AND SOLUTIONS
According to the World Health Organization (WHO), maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
Generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or management of the two, and an indirect maternal death that is a pregnancy-related death in a patient with a preexisting or newly developed health problem unrelated to pregnancy. Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths.
The U.S. Joint Commission on Accreditation of Healthcare Organizations calls maternal mortality a "sentinel event", and uses it to assess the quality of a health care system.
However, a number of issues need to be recognized. First of all, the WHO definition is only one of many; other definitions may also include accidental and incidental causes. Cases with "incidental causes" include deaths secondary to violence against women that may be related to the pregnancy and be affected by the socioeconomic and cultural environment. Also, it has been reported that about 10% of maternal deaths may occur late, that is after 42 days after a termination or delivery, thus, some definitions extend the time period of observation to one year after the end of the gestation.

Country 2008 2010
Nigeria
840 630

When it comes to achieving Millennium Development Goal 5 – reducing maternal mortality ratio by 75 percent and granting universal access to reproductive health by 2015 – Nigeria is fighting an uphill battle. Here are some quick facts to illustrate just how staggering maternal healthcare (or lack thereof) is in Nigeria:

1. Nigeria is currently ranked among the top ten most dangerous countries for a woman to give birth, placed alongside Afghanistan, Haiti, Liberia and Sudan.
2. In 2010, approximately 40,000 women passed away giving birth and another 1 to 1.6 million suffered serious disabilities related to their pregnancy and/or childbirth.
3. Data from The World Health Organization suggests that 630 of every 100,000 childbirths result in a maternal death.
4. Nigerian women face a 1 in 29 chance of dying from childbirth whereas the average risk throughout Sub-Saharan Africa is 1 in 39. (The risk in developed countries is as low as 1 in 3,800.)
To clarify: 14 percent of all maternal deaths in the world occur in Nigeria.

It is now necessary to clarifying why Nigeria suffered from such a high maternal mortality rate with facts. In the investigation, it was discovered that four major “delays” contributed to maternal deaths:
1) The delay in deciding to seek care (due to education, mistrust of health facilities, or family constraints);
2) The delay in reaching care (due to distance, infrastructure, or communication);
3) The delay in receiving appropriate care upon arrival (due to inadequate manpower, supplies, drugs, or health infrastructure);
4) The delay in referral (when complications beyond local facility capacities arise).

How can women’s lives be saved?
Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death.
Severe bleeding after birth can kill a healthy woman within two hours if she is unattended. Injecting oxytocin immediately after childbirth effectively reduces the risk of bleeding.
Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner.
Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia.
To avoid maternal deaths, it is also vital to prevent unwanted and too-early pregnancies. All women, including adolescents, need access to family planning, safe abortion services to the full extent of the law, and quality post-abortion care.
Why do women not get the care they need?
Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. While levels of antenatal care have increased in many parts of the world during the past decade, only 46% of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse.

In high-income countries, virtually all women have at least four antenatal care visits, are attended by a skilled health worker during childbirth and receive postpartum care. In low-income countries, just over a third of all pregnant women have the recommended four antenatal care visits.
Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are:
• poverty
• distance
• lack of information
• inadequate services
• cultural practices.
To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system.

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