RISING CASES OF STILLBIRTHS
The states should do more in primary health care to contain the scourge
A recent report, ‘Lost Before Their First Breath: The Reality of Stillbirths in Nigeria’, by the Nigeria Health Watch has once again drawn attention to a major health issue that has plagued the country for decades. But that the challenge is hardly ever discussed is the critical point. “Nigeria ranks among the top six countries with the highest number of stillbirths”, according to the report which listed India, Pakistan, DRC, Ethiopia and Bangladesh as accounting for almost half of the estimated global number of stillbirths, and 36% of global live births in 2021. One out of every four stillbirths in sub-Saharan Africa occurs in Nigeria, but discussions on maternal and child health rarely highlight this crisis.
What should even be of greater concern to the health authorities in the country is that two-thirds of those stillbirths happen in rural areas, where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections.
The report is very useful for the relevant authorities because it shows clearly that there is a link between poverty and stillbirths, especially considering that they happen mostly in low-income countries and in the rural areas. But the report has also attributed the huge number of stillbirths in these countries to five main causes including childbirth complications, maternal infections in pregnancy, maternal disorders, especially pre-eclampsia and diabetes, fetal growth restriction and congenital abnormalities.
We believe that this report should spur action on the part of the health authorities in the country. As things stand, many of the rural communities in the 36 states lack cottage hospitals and medical facilities that will address these challenges. Where they exist, there is shortage of manpower, obsolete medical equipment, and skeletal services that are seriously inadequate. For instance, many a time, pregnant women have had to die in the process of commuting from their homes to a medical facility.
It is very much evident that the Universal Health Coverage (UHC) has failed abysmally to tackle the challenge of still birth and other hiccups associated with pregnant women and infants. In a recent case, a woman in Enugu State gave birth to a baby inside a tricycle popularly known as ‘Keke NAPEP’. Were it not for the intervention of some passers-by, the pregnancy would probably have ended in still-birth.
However, we must put the blame on the state governments and the lack of attention by many of them to primary health care system at the grassroots. It is even worse that most of them have rendered prostrate the local government administration in their states, leaving healthcare delivery at that level comatose. The solution goes beyond mere formulation of some policies by the federal government in Abuja. There should be a framework where states and local governments are held accountable for maternal child health care services in their domains.
Going forward, we believe the National Primary Health Care Development Agency (NPHCDA) should be strengthened in such a manner that enables it to effectively collaborate with health authorities in the states. There is also a need to go beyond rhetoric and promises, to actionable plans to address all the existing gaps in the primary health sector. We must end the agony and tears of mothers who carry pregnancy for nine months only for their babies to die during delivery.
