Professor of Obstetrics and Gynecology, Prof. Oluwarotimi Akinolahas declared that it is unlikely that Nigeria will attain the SDG target of maternal mortality ratio of 70 maternal deaths per 100,000 live births by 2030 if she remains trapped in a mesh of high fertility rate that far outstrips the gross domestic product with worsening poverty level, and more importantly the massive hemorrhage of skilled man power in the health sector.
According to him, only a proclamation of a state of emergency in the sector with all it portends will focus the needed attention to reverse the trend.
He stated this while delivering the 74th inaugural lecture of Lagos State University, LASU, Ojo on Tuesday entitled “God’s will: That in Reproduction, There Might be Health”.
He also added that improvement in the socio-economic status of women through investment in education would modulate the health seeking behaviour, facilitate women empowerment and minimize the first level delay.
“Raising the socio-economic status of women, starting with universal basic education would undoubtedly delay age of marriage, reduce the quantum of teenage pregnancy and deliver quality decision taking with regards to fertility and health seeking behaviour.
“Invariably the next exit arising from the first is enhancement of the update of family planning, thereby reducing the number of unwanted pregnancies and consequent unsafe abortion.
“The society must decide that the lives of the women are worth saving and take fundamental steps to open the closed exits from the maternal death road.”
Akinola also recommended that political commitment by providing the necessary infrastructure particularly primary health centres and reevaluation of the universal health model to increase coverage of maternal health is also needed to meet the SDG.
The health practitioner also stated that practitioners must rise up to interrogate every maternal death with a view to identifying direct and indirect contributors, strengthen capacity and improve the quality of care obtainable in the institutions.
“As academicians, we need to exit from our comfort zones in the universities and really serve our communities with positive advocacy,” he added.
Saying the fertility rate in Nigeria is 5.5 per average woman, the don listed the causes of maternal mortality, to include hemorrhage (24.8%), followed by infection (14.9%), Eclampia (12.9%), unsafe abortion (12.9%), obstructed labor (6.9%) and indirect causes account for (19.8%).
Also disclosing that more than half of maternal deaths occur within 24 hours after delivery, the inaugural lecturersaidthis promptedhis research team under the auspices of the WHO to review and implemented the national curriculum for Life Saving Skills and taught the various cadres in health care in various states across Nigeria.
“I was also privileged to have facilitated FMOH/WHO update training in Life Saving Skills for Midwifery in the South Western Zone of Nigeria.
“We also participated in the largest multicenter WOMAN study with 20,060 parturient across the 6 continents over 6 years with colleagues from the London School of Hygiene and Tropical Medicine on the efficacy of early use of Tranexamic acid in the management of primary postpartum hemorrhage.
“Prevention, it is said, is often better than cure; prevention of postpartum hemorrhage is firmly rooted in the active management of third labour. Together with my team we formed a Nigerian active management of 3rd stage of labour group and conducted studies across 7 centres in the south west of Nigeria.”
He said the team found out substantial definition dependent variation in the providers’ adherence to recommended AMTSL practices. “We also found out that AMTSL though familiar, was poorly understood intervention among obstetric care providers in the region.”
“Amongst other things we found out that labours primarily conducted by doctors were more likely to result in the placenta being manually removed compared to those conducted by midwives, we also attempted to define predictive factors for caesarean section in our center to serve as guide for birth preparedness, complication readiness and mitigate the alarming increase in caesarian section rate.
“Other findings were that, though health workers were judged competent, they appeared insufficient, overworked and left poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained common place,” he explained.
Thanking the Lagos State University for given him the opportunity to contribute to medical education in Nigeria, he revealed that as pioneer head of department of O&G, he was privileged to have drawn up the O&G curriculum and superintend the first accreditation of the National University Comission and Medical and Dental Council of Nigeria of the College of Medicine and also serve as external examiner to medical schools in all the zones of the country.