Praying for Divine Intervention: The Reality of “The Three Delays” in Northern Nigeria

Praying for Divine Intervention: The Reality of “The Three Delays” in Northern Nigeria

BM Tukur, U Bawa, K Odogwu, S Adaji, P Passano, I Suleiman




This paper describes how pregnant women in three northern Nigerian communities responded to maternal complications that occurred outside of a hospital setting. The sample consisted of 322 women who had recently delivered, of which 15% had at least one complication. Thirty-seven percent of women described antepartum or postpartum haemorrhage. Over 60% of women went to a health care facility, but 35% first tried herbal remedies and another 20% simply waited for their husband to return. The median interval between recognizing the problem and deciding to seek help was two hours. It took approximately one to two hours to reach the hospital and upon arrival, most respondents got care in one to two hours. Rural communities clearly have their own hierarchy of appropriate actions in the face of a household emergency which need to be understood in order to develop creative intervention strategies to reduce unnecessary risks to the life of a mother (Afr. J. Reprod. Health 2010; 14[3]: 113-119).

Key words: Maternal mortality, obstetric emergency, three delays, obstetric complications, actions taken.

Antenatal Care and Skilled Birth Attendance in Three Communities in Kaduna State, Nigeria

This study assessed antenatal care (ANC) coverage, place of delivery and use of skilled birth assistants in three communities in Kaduna State, Nigeria. The sample included 332 women who had delivered within two years of the survey. ANC attendance rates were high, with 76.2% of women reporting at least one visit, and 63.3% receiving four or more. However, median gestational age at the first visit was four months and only 9.3% received all the recommended components. Health facility deliveries (11.7%) were far lower than ANC attendance. Educational status was found to be statistically significantly associated with all ANC and safe delivery outcomes. To make significant progress towards the fifth MDG in northern Nigeria, effective strategies to encourage women’s education paired with improvements in ANC quality (especially within communities) is essential. Most importantly, safer delivery options that would be acceptable in communities where women traditionally birth at home need to be explored (Afr. J. Reprod. Health 2010; 14[3]: 89-96).

Maternal mortality in developing countries: challenges in scaling-up priority interventions.

Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as Sri Lanka, Malaysia and Honduras, demonstrate that maternal mortality will decline when appropriate strategies are in place. Such achievable strategies need to include redoubled commitments on the part of local, national and global political bodies, concrete investments in high-yield and cost-effective interventions and the delegation of some clinical tasks from higher-level healthcare providers to mid- or lower-level healthcare providers, as well as improved health-management information systems.

Setting priorities for safe motherhood interventions in resource-scarce settings

Objective: Guide policy-makers in prioritizing safe motherhood interventions.

Methods: Three models (LOW, MED, HIGH) were constructed based on 34 sub-Saharan African countries to assess the relative cost-effectiveness of available safe motherhood interventions. Cost and effectiveness data were compiled and inserted into the WHO Mother Baby Package Costing Spreadsheet. For each model we assessed the percentage in maternal mortality reduction after implementing all interventions, and optimal combinations of interventions given restricted budgets of US$ 0.50, US$ 1.00, US$ 1.50 per capital maternal health expenditures respectively for LOW, MED, and HIGH models.

Results: The most cost-effective interventions were family planning and safe abortion (fpsa), antenatal care including misoprostol distribution for postpartum hemorrhage prevention at home deliveries (anc-miso), followed by sepsis treatment (sepsis) and facility-based postpartum hemorrhage management (pph).

Are the population policies of India and China responsible for the fertility decline?

In the 1970s, policy-makers in both India and China, convinced that reducing population growth was critical for ending poverty, instituted coercive population policies. Yet fertility had already been declining in both countries before the population policies were instituted. In China, the total fertility rate (TFR) had already fallen to 2.9 before the institution of the One-Child Policy. In India, fertility continued to decline at roughly the same rate before, during and after ‘The Emergency’. Regardless of government mandates, couples in both countries before the policies and since have shown a desire to reduce their family size and when given access to family planning, have voluntarily limited the number of children they chose to have.

Avoidable maternal deaths: Three ways to help now

The current paper examines the realities of women delivering in resource-poor settings, and recommends cost-effective, scalable strategies for making these deliveries safer. Ninety-five percent of maternal deaths occur in poor settings, and the largest proportion of these deaths are women who deliver at home, far away from health care facilities, and without financial access to skilled providers. This situation will improve only when policymakers and programme planners refocus their attention on service delivery and financing interventions, with the potential to reach the largest portion of women living in places where mortality is the highest. We suggest three feasible interventions that can potentially minimise both demand and supply side problems of safe delivery: (1) misoprostol to treat postpartum haemorrhage, an easy to use and heat stable technology to reduce the leading cause of maternal deaths; (2) alternative providers, such as clinical officers, trained to offer emergency obstetric care services; (3) financing safe delivery through vouchers or other mechanisms that can be implemented in poor settings and made attractive to the donor community through output-based assistance (OBA).

Keywords: postpartum haemorrhage; maternal mortality; safe delivery; vouchers; misoprostol

Published In Global Public Health, Volume 4, Issue 6 November 2009 , pages 575 – 587

Maternal mortality: one death every 7 min

This comment in the explores the role of policy and research in using the prevention of postpartum hemorrhage and suggest a joint meeting by WHO and FIGO to revisit the 2009 statement by WHO which does not recommend the use of misoprostol at the community level.

THE POPULATION FACTOR: How does it relate to climate change?

The human contribution to climate change is driven primarily by high per capita consumption in the North. The poorest 1 billion people living on a dollar or two a day contribute only 3 per cent of the world’s total carbon footprint, yet the loss of healthy life-years resulting from global warming could be as much as 500 times greater in Africa than in Europe (McMichael et al., 2008). It is also true that 99 per cent of the projected 1-4 billion increase in global population that will occur between now and 2050 will take place in the least developed countries with the smallest carbon footprints.  At first sight, the inequity that the nations of the North have caused over 90 per cent of global warming but suffer fewest of its adverse effects, combined with the asymmetry in population growth between the South and the North, seems to create an impossibly difficult background for policy discussions between countries and national groupings. The countries of the North could not ask the 2 billion people of the South living on one or two dollars a day to either slow economic growth or have fewer children in order to slow global warming.

But if we frame the discussion at the level of individual needs rather than national interests, then a totally different picture emerges. Surveys demonstrate that there is a large unmet need for family planning in both developed and developing regions, and analysis shows that meeting the unmet need for family planning and preventing unintended pregnancies – whether women are rich or poor – is one of the most cost- effective ways of slowing global warming. It has the potential to benefit hundreds of millions of individuals, to help the whole planet slow greenhouse gas accumulation and facilitate countries in adapting to climate change. As the failure of the 2009 United Nations Climate Change Conference in Copenhagen demonstrated, people do not want to consume less: they do, however, want fewer children. At the individual level, the link between climate change and family planning is a win-win strategy. But, for reasons just set out, it is also the climate strategy most likely to be misunderstood, corrupted deliberately or rejected out of hand, by those with strong feelings about human sexuality and the autonomy of women, as well as those promoting access to family planning.

Published by the Bixby Center for Population, Health and Sustainability, at the University of California, Berkeley.