Why Nigeria is the most dangerous place on Earth to give birth | DW News

Key Concepts:

• Maternal Mortality in Nigeria
• Postpartum Hemorrhage (PPH)
• Preventable Pregnancy-Related Complications
• Early Detection and Intervention
• Objective Blood Loss Assessment
• Treatment Bundles (MOTIVE: Massage, Oxytocin, Tranexamic Acid, IV Fluids)
• Examination and Escalation
• WHO Recommendations
• National Guidelines
• Implementation Challenges
• Gender Dynamics in Obstetrics

1. Maternal Mortality Crisis in Nigeria

• Nigeria is identified as the most dangerous place on earth to give birth for over a decade.
• A significant portion of global maternal mortality deaths (almost a third) occur in Nigeria.
• In 2023, approximately 75,000 women in Nigeria died from pregnancy-related complications, according to the World Health Organization (WHO).
• This translates to one death every 7 minutes, with most deaths resulting from preventable complications.
• Postpartum hemorrhage (PPH), or severe bleeding after childbirth, is the leading cause of maternal death.

2. Community-Based Interventions

• Maternal and reproductive health collectives, NGOs, are working within vulnerable communities to provide antenatal care.
• These programs offer medical checkups, medication, support, and education to pregnant women.
• The goal is to identify and address potential complications early, especially during childbirth.
• Barriers to accessing medical care include lack of money, cultural beliefs, and distrust in the healthcare system.
• Frontline workers emphasize the importance of registering pregnant women early for monitoring and timely referral to hospitals with expert care.

3. Personal Stories and Experiences

• Kadija, 6 months pregnant with her fourth child, shares the experience of losing a friend during childbirth due to delays in transfer to a general hospital.
• Aishhat Okuno, 4 months pregnant, expresses her fear of complications based on her stressful experience during her first delivery.
• These stories highlight the real-life impact of maternal mortality and the need for improved care.

4. Postpartum Hemorrhage (PPH): Causes and Solutions

• Professor Hadisa Galadeni explains that PPH affects approximately 14 million women globally each year, resulting in 70,000 deaths, with Nigeria being a major contributor.
• Researchers identified three key delays contributing to PPH-related deaths:
  • Delay 1: Delayed diagnosis due to subjective estimation of blood loss.
  • Delay 2: Sequential administration of interventions instead of simultaneous treatment.
  • Delay 3: Delayed escalation to surgical intervention when initial treatments fail.

5. The EMOTIVE Intervention

• To address the delays, the EMOTIVE intervention was developed:
  • E (Early Detection): Objective assessment of blood loss using a calibrated drape to measure blood loss accurately.
  • MOTIVE (Bundle): Simultaneous administration of a treatment bundle including massage, oxytocin, tranexamic acid, and IV fluids within 10-15 minutes.
  • E (Examination and Escalation): Prompt escalation to examination and potential surgical intervention if bleeding persists after 15 minutes of the bundle.

6. Research Findings and WHO Recommendations

• A study across five countries (Nigeria, Kenya, Tanzania, South Africa, Pakistan), with half the data from Nigeria, showed a 60% reduction in severe PPH with the EMOTIVE intervention.
• The results were published in the New England Journal of Medicine, leading to updated WHO recommendations within six months.
• The WHO now recommends:
  • Objective assessment of blood loss for every woman after delivery.
  • Triggering the MOTIVE bundle for PPH defined as 500 ml blood loss or 300 ml with abnormal signs.

7. Implementation and National Guidelines

• Nigeria developed its national PPH guideline based on the WHO recommendations.
• Implementation at the national level remains a challenge.

8. Gender Dynamics in Obstetrics

• Professor Galadeni, the first female obstetrician in Kano, Nigeria, emphasizes the positive impact of being a female obstetrician.
• She believes female obstetricians have a better understanding of labor and can be strong advocates for women's health.
• The increasing number of female obstetricians is seen as a positive trend for improving women's healthcare.
• Many women prefer female obstetricians, especially in certain regions.

9. Conclusion

• Maternal mortality in Nigeria is a critical issue, with PPH being a major contributor.
• Early detection, objective assessment of blood loss, and the implementation of treatment bundles like EMOTIVE are crucial for reducing maternal deaths.
• The WHO's updated recommendations and the development of national guidelines are important steps, but effective implementation remains a challenge.
• Female obstetricians play a vital role in advocating for women's health and improving maternal care.