Wednesday, 6 November 2019

Reason women die in hands of traditional birth attendants is bleeding, says Prof Akinola


Cyriacus Nnaji
Vice Chancellor, Lasu, Prof. Fagbohun introducing the 74th Inaugural Lecturer, Prof Akinola
Professor Oluwarotim Ireti Akinola of the Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, Lagos State University (LASU), has attributed the incessant loss of lives in the hands of traditional birth attendants to bleeding.

Akinola made the disclosure in his capacity as the lecturer at the institution’s 74th Inaugural Lecture at the university’s main Campus in Ojo on Tuesday.

“One of the major reasons pregnant women die in the hand of traditional birth attendants is bleeding. We need to educate women, there is no doubt about it, that some people are visiting traditional birth attendants, but we should also realize that some people are dying because of that, and most of the women die before 24 hours and the major reason why they die is bleeding, so what can a traditional birth attendant do?”

Speaking on the theme of the lecture: ‘God’s Will: That in Reproduction There Might Be Health’ Akinola said Reproduction supposed to be a natural thing and if it is natural it should be healthy and averred that all concerned should strive to bring health into reproduction.

He said it is unfortunately to see women die in the process of giving birth, “It is unfair to women to die while trying to give birth, so every effort that is taken to make sure that we return health into reproduction is what the lecture is all about,” Akinola stated.

Earlier in his lecture, Prof. Akinola said in 1987, the World Bank, in collaboration with the World Health Organization (WHO) and the United Nations Population Fund (UNFPA), sponsored the Safe Motherhood Conference in Nairobi. The Safe Motherhood Initiative which aimed to reduce maternal mortality and morbidity by one half by the year 2000 worldwide was born. Ten years later, the follow up technical consultation on the Safe Motherhood initiative in Colombo, Sri Lanka reported an abysmal failure as only 2 -3 countries had made any significant progress.

The millennium development agenda featured reduction in maternal mortality as its goal five, just as the Sustainable Development Goals (SDGs) also set targets for 2030. Yet, though progress has been achieved in several countries, our country Nigeria has not had much headway,” he said.

He stated that specific interventions that constitute components of reproductive health will vary from country to country depending on their level of development and perceived priority areas. These are prevention of maternal and perinatal mortality and morbidity (Safe motherhood), Prevention of Unwanted Pregnancy (family planning), Adolescent Sexual Health and Reproductive rights, Prevention of Reproductive tract infections including Sexually Transmitted Infections / HIV / AIDS, Prevention of harmful practices (FGM), gender-based violence, infertility, malnutrition and anaemia, reproductive tract cancers, among othes.

He also said “That reproduction has not always been healthy or safe is evidenced by the cases of several biblical matriarchs such as Sarah, Rebecca, Rachel, Hannah and Elizabeth who suffered from infertility and were exposed to the stress, anxiety and particularly with regards to Hannah, shame and ridicule _(1 Samuel 1:8)_ Women, at the threshold of fulfilling divine injunction to procreate, should not lose their lives in order to perpetuate our specie. Unfortunately, they do and do so in large numbers too, especially in the developing world.”

Akinola added that in 2007, it was reported that 36.59 million women aged 15 years and above in Nigeria were at risk of developing cervical cancer. Cervical cancer can be prevented through vaccination, screening and treatment of pre-cancerous lesions and treatment of invasive cancer with palliative care.

Raising the socioeconomic 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 behavior. Invariably the next exit arising from the first is enhancement of the uptake of family planning, thereby reducing the number of unwanted pregnancies and consequent unsafe abortion

He further stated that  Fertility rate in Nigeria is 5.5. per average woman. (NDHS 2013) Unbridled fertility is a proven risk factor for most complications that arise in pregnancy like Obstetric hemorrhage, anaemia, miscarriage, obstructed labour, ruptured uterus etc. These complications can be anticipated, sometimes pre-empted and often moderated by the provision of essential obstetric care. Several women, he said, however meet this exit blocked because of lack of access and continue further on the maternal death road.

In his recommendation Akinola said, 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 haemorhage of skilled man power in the health sector. Only a Proclamation of a state of emergency in the sector with all it portends will focus the needed attention to reverse the trend.

Improvement in the socio-economic status of women through investment in education would modulate the health seeking behavior, facilitate women empowerment and minimize the 1st level delay.

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. Political commitment by providing the necessary infrastructure particularly primary health centres and reevaluation of the Universal Healthcare model to increase coverage of maternal health services will reduce the 2nd level delays which are barriers to access,” he said.

Akinola further suggested 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 our institutions and improve on the 3rd level delay.

As academicians, we need to exit from out comfort zones in the Universities and really serve our communities with positive advocacy.

Above all, we need to rejig the health system in a manner that the referral system becomes seamless to enhance continuity of care,” He reiterated.


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