Free and quality Maternal Health; Right or Privilege?
Free maternal and child health care in Nigeria, since pronouncement in Kano State in 2001 has been received with utmost privilege and fast becoming a yardstick for judging a performing administration. This report compiled by Ayodele Adesanmi reveals the inter-relationship between maternal health and human rights.
Access to quality and free Maternal and Child Health care in Nigeria is one of the rights of women and children that should be upheld just like any other general diseases affecting men and women like HIV, Ebola, Malaria, Polio and other diseases which have been treated with urgency at one point in time in the country.
Yet, many deaths that occurred as a result of giving birth are preventable with adequate plan and provision of quality care. Prompt accessibility to emergency obstetric care, including referral and ambulance services, drugs that prevent hemorrhage, and presence of skilled health worker at point of delivery can make the difference.
Such is how easy it is to save a woman's life and salvage the society of robbery, hooliganism, rapists, and frustrated beings who lack motherly support.
Maternal health status
According to the WHO estimates of 40,000 deaths in 2013, Nigeria looses about 110 women daily due to child birth because current progress and pace are not much to stem the tide even though the government, in collaboration with development partners, has continued to improve access to quality maternal health services through the Community Health Insurance Scheme, Midwives Service Scheme and other policies and programs.
It is also on record that some state governors have inaugurated free maternal and child health programs in their states to encourage women to access maternal health care. Delta, Kaduna, Jigawa, Kano, Bauchi, Ondo, Lagos and others are among the states where free maternal and child health care has been practiced up to varied degrees.
Where available, they are often devoid of intents, strategies, legal backings and quality. Administrators see it as a way of showing the citizens that they care for their people who they want to enjoy dividends of democracy. Many campaign groups often lay claims to it as the achievements of their members and politicians are beginning to make it a point in their manifestoes.
While, the presence of free maternal and child health care and services are indication of hope for women and children, experts have said that maternal health is a human right issue and not negotiable.
Rights Issues in Maternal health
Speaking at CS-Media Forum organized by Development Communications (DevComs) Network, the Executive Director, Women Advocates and Research Documentation Centre (WARDC), Dr. Abiola Akiyode said "when a woman is denied her right to give birth in a conducive environment or when she is denied because of fees, she has to go to the Traditional Birth Attendants (TBAs) or to a place where she cannot get good quality health care. In a way, what we have done indirectly is denying her 'right to life'."
According to the women and rights activist, maternal health should be conceptualized not only from the medical or public health perspectives, but also from other aspects of life such as right to life. 'We must be able to conceptualize maternal health from a rights-based perspective, in a way it gives us a much better understanding of what maternal health is, so that we are not just seeing it as a medical or public health discussion.' says Dr. Akiyode.
The right to life is fully guaranteed in the 1999 constitution of the federal republic of Nigeria under chapter iv, section 33 (1) that says "every person has a right to life, and no one shall be deprived intentionally of his life, save in execution of the sentence of a court in respect of a criminal offence of which he has been found guilty in Nigeria”.
Quoting article 12 (1) of the International Covenant on Economic Social and Cultural Rights (ICESCR ) which deals with the "…right of everyone to the enjoyment of the highest attainable standard of physical and mental health," Dr. Akiyode said the right to health could be construed as right to health care and right to conditions that promote good health.
Lamenting the discrimination against women, she said many women have failed to access maternal health care on the ground that they were unable to produce their husbands for blood donations. Such act was labeled by Dr. Akiyode as discriminatory against women. "What happens when a woman was raped or her pregnancy rejected? A woman usually appeared tortured in a situation whereby she feels like going to the hospital but the husband wouldn't go because he is afraid that he might be tested for HIV/ AIDS or for Hepatitis B and other screening".
"... this is seen from the perspective of discrimination because it is only the woman that carries baby. In a way you are discriminating against her because a woman is seen as a target by asking her to bring her husband to come and donate blood before you can allow her to access health care".
She noted that unavailability of information that can help a woman secure her health is a violation of the right to information. Information about Family Planning, contraception, and other useful information about the woman are useful in the prevention of unwanted pregnancies and maternal mortality.
Akiyode cited several conventions like the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) which establishes that, “States parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation”
Maternal health and Accountability issues
Discussing the need for accountability in maternal health, participants at Civil Society- Media forum agreed that the government has the mandate to fulfill their obligations and also to respect women's rights as human beings and citizens of Nigeria.
While summarising the role of government in ensuring that the rights of women are protected, Dr. Akiyode said the government should provide access, stability, and enabling environment in terms of adequate and effective policies. She also charged the government and concerned authorities on remedy when there is negligence in government hospitals so that people have a right to compensation. According to her, all these cannot be achieved without increase in health and maternal health budget so that there is enough fund to be able to ensure that people have adequate health care services.
"I think that generally, the government is not willing, it’s a political will issue while I also think that probably if it's a general problem like Ebola they would have taken it much more seriously. In that context I can then say one of the reasons why it has not been done is because it is seen as women’s issue but unfortunately there is a difference between who impregnates and who gives birth and I think it is when we see that connection we will be able to address the issue of maternal health in an appropriate manner".
The secretary of MCH-CS partnership in Kaduna State, Hajiya Amina Kazaure told NOTAGAIN Correspondent in an interview recently that the free maternal and child health policy in the state was laudable but needed to be translated into law. "We know that the State Primary Healthcare Development Agency is in place now and functional, so also the Drug Management Agency. However, something stronger is needed to back the sustainability of the programme - if there is no law in place to back the sustainability of the programme, another Government could come and scrape it completely." She said.
The former Commissioner of Health in Lagos State, Dr. Leke Pitan has also revealed to NOTAGAIN Campaign recently that there was need to declare emergency in maternal health care delivery in Nigeria.
''Making antenatal care as well as delivery, whether natural vaginal delivery or assisted delivery by Cesarean Section or otherwise free will go a long way'. 'They must declare an emergency in obstetric care and put it in the front burner'', he added.