“Mame Rie Emion”—Mother of Mine, At Risk
by Osaremen Okolo
Maternal mortality is not an unfathomable concept. It is not only the result of a woman who happens to undergo an unfortunate accident while in the late stages of her pregnancy. It is not only the result of physician neglect. It does not only exist in remote regions of our world. We cannot continue to maintain a Western-centric perspective and classify maternal mortality as solely as only a rare incident. I write to you from the United States, but also write with the mission of speaking to our world at large. In particular, I speak to my fellow people of Nigeria.
Nigerians take pride in our rapidly growing and developing nation. We cite our status as the world’s seventh largest population and boast that in any township, city, or global region you will find a Nigerian. Congruently, we must also address the fact that our motherland maintains the fourth highest maternal mortality ratio worldwide. In a group of twenty-two mothers, sisters, daughters, and wives, one may die of pregnancy related complications over the course of her lifetime. That amounts to almost 60,000 deaths among Nigerian women per year. And though our maternal mortality ratio has significantly decreased over the past thirty years, it still sits at about 810 for every 100,000 live births—a frightening prospect for a country in which the median female sits at the biologically ripe childbearing age of 18.
HIV, AIDS, malaria, tuberculosis and other communicable diseases are all indirect causes of maternal mortality that typically present prior to pregnancy but can greatly increase fatality. Sepsis, hemorrhage, anemia, ectopic pregnancy, or other infection can also indirectly cause maternal mortality, although they typically arise as a result of pregnancy. What these diseases and health conditions all have in common is that they are multilayered, pervasive, and therefore difficult to address with any single solution or idea that I could effectively outline in this medium. Instead, want to focus and speak directly to three key stakeholders in my proposed solutions to combat maternal mortality in Nigeria: mothers, clinicians, and legislators.
To the ever strong, ever mighty women of Nigeria: your home is your safe haven, but the hospital or clinic must be your safe refuge. I urge you to allow the experts to handle the most important moment of your life. Almost two-thirds of us deliver without a skilled birth attendant present, and that number will decrease if we at least elect to deliver in the hospital setting. The complications during labor and delivery that you may have been told are caused by an evil or unkind spirit can be resolved with a doctor by your side during childbirth. We have seen too many babies born silently into the world, and too many children who grow old without ever knowing the women who carried them.
I urge health practitioners across Nigeria to understand that even if expectant mothers choose to come to you, you must increase your capability to care for them—only 20 percent of our health facilities offer emergency obstetric care by skilled or qualified birth attendants. Emergency obstetric care must be available, accessible, and affordable to all women at all Nigerian health facilities; let us work together and form coalitions that can improve obstetric and gynecologic access and save lives. After receiving my own medical degree, I plan to specialize in obstetrics and gynecology, motivated by the millions of people who desire to become parents but struggle with unexplained or untreatable infertility. Similarly, our country’s extraordinary maternal mortality ratio should motivate all of us who love Nigeria and enter this profession with the mission of bettering humanity to seriously consider obstetrical training. In fact, Nigerian providers across all specialties must ensure that if they are attending to a pregnant woman or a woman they suspect to be pregnant, they have the capacity to offer prenatal care or to refer the patient to a provider who can offer pre- and postnatal care, ensuring that the infants being delivered are healthy enough to survive.
Finally, Nigeria’s public servants should consider offering the women they represent a more equitable and comprehensive public service. A pregnant woman cannot legally seek an abortion in Nigeria unless she is determined to be in mortal danger. While this distinction is certainly useful in acute cases of maternal distress during labor, the thousands of women who seek illegal and unsafe abortions unnecessarily account for twenty percent of maternal mortalities. If we truly carry a mission of protecting the female population of Nigeria, legislators and governors must move to completely decriminalize a medical operation that may save their mother’s, sister’s, or wife’s life.
Every day, Nigeria loses 145 women of childbearing age.
Every day, Nigeria loses ~2,300 of children under 5.
Every day, a Nigerian woman’s chance of dying from pregnancy and childbirth is 1 in 13.
These are three sobering statistics in a multilayered and pervasive health issue. And truthfully, those who can effect change owe the women of Nigeria so much more than just the three solutions I have suggested. Together they comprise only a start, but one we must begin. Though mothers are certainly partners in achieving a solution, we cannot leave them to battle their own mortality. Instead, let us all—citizens, leaders, experts—build, grow, and work towards life together.
To learn about maternal mortality and to take action: