Reducing Maternal Mortality – Everyone has a role to play

Going back in time to precisely ‘1982’, a safe motherhood initiative was launched to reduce maternal mortality at least by half by the year 2000 in developing countries including Nigeria. This initiative collapsed specifically due to a lack of focus on the program. The model that was to be adopted was that of a ‘mass attack’ that aims to combat all cases of maternal deaths, a highly ambitious but difficult task as at then.

Ever since then, the causes of maternal mortality have become very rampant in all parts of Nigeria and in Sub-Saharan Africa at large. During Pregnancy, the mother and the fetus form a non-separable single and functional unit and therefore maternal wellbeing becomes a prerequisite for the development of both part of this unit. Before proceeding, it is noteworthy to pour the differing definitions for what constitutes maternal death and according to the center for disease control (CDC) and the American coverage of obstetricians and gynecologists (ACOG), two main definitions predominate; pregnancy-related maternal death (death of the mother resulting from pregnancy and its complications) and pregnancy-associated maternal death (death that would have occurred even in the absence of pregnancy). The main focus here from all healthcare professionals is the pregnancy-related death and all hands must be on deck to have a lasting and measurable reduction in pregnancy-related deaths in the coming years.

Approximately two-thirds of Nigerian women deliver outside a health facility while treatment and management of post-abortion and post-delivery complications remain elusive to the majority of the population. Access to essential obstetric care is poor and there is a considerable low commitment for maternal health services, so important low-cost pharmaceuticals like misoprostol have made its way to offer promises to women. Although, misoprostol is an essential drug list for treatment of gastric ulcers, for induced abortion (in combination with mifepristone) and induction of labor, some pregnant women have seen this drug as a way out for unplanned and unwanted pregnancy and hereby using it irrationally of which can later cause a number of complications in future pregnancies. Pharmacists and pharmacists in training have a huge role to play in the control of misoprostol misuse.

In addition, pharmacists as the counselors of the healthcare team can possibly counsel women before a planned pregnancy pointing out the risks of some therapeutic agents like herbal medicines and alcohol. The roles pharmacists have to play in reducing maternal and child mortality are somewhat numerous ranging from ensuring that pregnant and lactating women use the lowest possible medications and if absolutely necessary, the best choice of medicines should be dispensed. In fact, all healthcare professionals who prescribe medication for women of childbearing age should consider possible pregnancy before prescribing.

Pregnant and lactating mothers should be prescribed medicines only if the expected benefits of the mother outweigh the risk of the fetus because when there is an infection, it is not only the immune system that is responding to that infection but also the fetal/placental unit and this means that teratogenicity and fetotoxicity can come in as a result of the medication. I believe that the use of medication during pregnancy and lactation should be incorporated into students’ curriculum so as to let the future healthcare providers have a good understanding of the topic at hand.

Studies have shown that eclampsia is the leading cause of death among pregnant mothers in the Northern part of Nigeria while hemorrhage and illegal abortion predominates in the southern parts. With these results, it becomes crucial to study, analyze, and understand the socio-cultural contribution of maternal mortality otherwise; on-going effect to reduce maternal deaths in these societies will be futile. In the North, there is a belief that women affected by eclampsia are possessed by evil spirits and this considerably delays receiving modern obstetric care which could be a predisposing factor in the causation of maternal mortality.

A substantial shortage of professionals with midwifery skills need filling in sub-Saharan Africa to scale up to universal coverage of maternal and child health, the availability of skilled health providers (particularly midwives, nurses, doctors, and obstetricians) is critical in assuring high-quality antenatal delivery, emergency obstetric and postnatal services. In summary, everyone has a role in the causation of maternal mortality and it’s, therefore, everyone’s responsibility to achieve a considerable reduction in maternal death in Nigeria and in Africa at large.