When it was time for Famata Hassan’s pregnant daughter to deliver her baby, violence struck again in the war-torn Borno state, North East Nigeria. The expectant woman had to flee her community for a more protected area in Maiduguri, the state capital. Exhausted after a long walk, she gave birth to twins but died instantly, according to a report by the International Committee of the Red Cross.

Nigeria has a maternal mortality problem and the northeastern region, where Famata’s daughter gave birth, has the largest share. With 1,549 deaths per 100,000 live births, the Northeast has the highest maternal mortality rate compared to other regions of the country, according to the World Health Organization (WHO). The report estimated that Nigeria has approximately 58,000 maternal deaths, accounting for 19 per cent globally, with at least 800 women dying in every 100,000 live births. 

The situation is even worse at displacement camps in the North East. Women who fall pregnant barely have access to quality healthcare, leading to several childbirth complications. In one report, the United Nations Children’s Fund (UNICEF) revealed that in some cases, newborn babies die during night delivery, but their mothers hardly inform concerned authorities. The report stressed that although pregnant women require sanity and peace of mind for safe child delivery, displaced pregnant women rarely get these in conflict zones.

The Clinical Epidemiology and Global Health, an international research think tank, revealed in a study that the scourge of the Boko Haram insurgency aggravated the maternal mortality problem, causing an abnormally low rate of child health service delivery in northeastern Nigeria. 

This is because the crisis has led to the shutdown of health facilities, a shortage of medical personnel, a lack of adequate sanitary facilities, food insecurity, malnutrition, and so on. The conflict has also made it impossible for humanitarian workers and healthcare service providers to access certain communities safely.

According to the Borno state government, within eight years of the insurgency, non-state actors destroyed 19 general hospitals and 248 primary healthcare centres in the state. “Many of our health workers were targets of the Boko Haram insurgents. Innocent health workers were killed in cold blood,” then-health commissioner Haruna Mshellia said in 2017.

Shiktra Steven, a registered nurse and midwife at the Modibbo Adama Teaching Hospital in Yola, told HumAngle that the major causes of maternal mortality are unsafe abortion, postpartum haemorrhage, and preeclampsia.

“These are issues that bring up complications during childbirth,” she explained. “For instance, in the case of unsafe abortion, a woman might die if the process is carried out without proper care during evacuation.”

Shiktra clarified that postpartum haemorrhage is the bleeding that occurs after a woman has given birth. When a woman is in the third stage of labour and is not in a good facility with competent hands, the woman might lose her life, especially in the case where the placenta is retained.

WHO corroborated Shiktra’s view in a report, noting that some of the complications that occur for nearly 75 per cent of all maternal deaths are severe bleeding, mostly after childbirth and infections.

Shiktra stressed that another factor leading to a high maternal mortality rate is pregnancy-induced hypertension.  

“Some women do not have high blood pressure, but when they get pregnant, they end up with high blood pressure and this can lead to death which is preeclampsia.” 

In many northern Nigerian communities, women prefer to have their babies at home or in traditional birth centres where, unfortunately, birth attendants do not have scientific knowledge. Shiktra observed that women who have their babies in these places are more prone to maternal mortality. 

“Some of the birth attendants are not professionals, so a part of the placenta or the whole placenta is retained inside the woman, which causes non-stop bleeding and can lead to death because since the caregivers are not experts, they lack the skills to transfuse the placenta and this leads to death,” she said.

Shiktra advised that to reduce the high rate of maternal mortality, pregnant women must prioritise antenatal care. She noted that antenatal sessions help pregnant women avert complications that might arise during childbirth and grant access to early diagnosis.

But there is a problem: women in remote areas are likely to need more adequate health care,  especially in regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia.

Wondimagegnehu Alemu, the WHO country representative in Nigeria, believes that governments must work with other stakeholders, including community and traditional leaders, to ensure quality maternal services to the people, irrespective of their regions.

Shiktra also added that folic acid is a common medication given to women during antenatal, which prevents anaemia during pregnancy, but women who miss out on antenatal do not have access to these drugs.

“These drugs also prevent certain diseases that babies might have after childbirth. There are cases where babies are born with the back of their brains open. Some babies are born with open spinal cords, so taking these medications helps the babies,” she explained.

The Nigeria Director of the MacArthur Foundation, Kole Shetima, has argued that getting the support of men is imperative to reduce the maternal mortality rate in the country. Kole said some community mobilisation networks have worked effectively towards improving maternal health projects in many localities.

He mentioned that Civil Society Organisations (CSOs) such as Fathers Club, Mothers Club, Peer Educators and the Association of Traditional Birth Attendants have contributed to the improvement of maternal health in Nigeria. He recalled how some members of the Fathers Club, for instance, decided to sell the goat of a husband to pay for transporting his pregnant wife to the hospital. 

Kole believes that since the government can mobilise communities when they are determined to do so for activities such as census and registration of voters, similar strategies could be used to enable women to visit health facilities.

“Making maternal health services free will remove a significant barrier for women and communities,” he said.