by Elisa Slattery
Fifty-nine thousand women die every year from pregnancy-related causes in Nigeria, a number second only to that of India. One Nigerian professor equated the frequency of maternal death with a planeload of Nigerians crashing everyday without survivors. If a plane full of pregnant women fell out of the sky every day in Nigeria or anywhere else in the world, there would be outrage and calls for government action. Yet maternal death is frequently ignored, although in most cases it is preventable. Fortunately, maternal mortality is increasingly being recognized as a human rights catastrophe.
A human rights lens looks beyond the medical and socio-cultural factors typically cited as reasons for maternal death, and places the spotlight squarely on the government, a key player in the contributing political and economic factors.
In fact, in a study by the Center for Reproductive Rights in New York and Women Advocates Research and Documentation Center in Lagos, Nigeria, researchers found that the inordinate number of Nigerian women dying from pregnancy-related causes is clearly linked to inept governance and violations of rights guaranteed by international, regional and national laws.
According to the report, Broken Promises: Human Rights, Accountability, and Maternal Death in Nigeria, the Nigerian government has repeatedly identified maternal mortality as a pressing problem and developed policies in response, but at the same time, repeatedly failed to put its money where its mouth is.
Despite its vast oil wealth, the government refuses to adequately implement its policies or commit funding. In 2001, officials willingly pledged 15% of the annual budget to improve the health-care system, but almost eight years later, that pledge remains unfulfilled. Even when resources are directed towards health care, the lack of transparency in government spending and systemic corruption mean that funds dont always reach their intended goals. As the head of one local NGO described it, politicians spend tens of thousands of dollars on jeeps, then drive on pothole ridden roads past deserted primary health-care centers.
These shortcomings result in financial, infrastructure and institutional barriers that devastate the lives and health of women. Facilities demand user fees for maternity care, but 70 percent of the population lives below the poverty line and cant afford to pay them. Services can cost from $130 to $170 in public hospitals or as much as $400 in private hospitals. The fees lead to delays in receiving lifesaving treatment or discourage women from seeking services altogether. Some facilities even detain women until they can pay. One interviewee described women who had recently delivered moving through the hospital wards, begging for money to pay their bills.
Infrastructure weaknesses such as frequent power outages have serious health consequences. One OBGYN interviewed for the report described completing a C-section with a flashlight she kept handy in case the power went out.
Staffing shortages further complicate the quality of care. A local government official explained that clinics were closed nights and weekends in his area. If we had at least two nurses in a clinic, he noted, they could take shifts, but when there is just one person, he is overworked, and if he is not around, there is no access to health care services.
Sadly, high numbers of maternal deaths are not unique to Nigeria. Globally, half a million women die every year from pregnancy-related causes. Governments have an obligation to protect the lives and health of women by enacting the necessary laws and policies and strengthening their health-care systems. As Mary Robinson, the former United Nations High Commissioner for Human Rights, has said of maternal death: The time has come to treat this issue as a human rights violations, no less than torture, disappearances, arbitrary detention and prisoners of conscience.
December 23, 2008
Elisa Slattery is the Regional Manager and Legal Adviser, Africa Program, at the Center for Reproductive Rights in New York.