NOT many families are prepared when a baby dies prior to delivery. The unusually high incidence of stillbirth cases in Nigeria every year is an indictment of the quality of antenatal care on offer. At a time when medical advances have drastically reduced the number of avoidable deaths and increasing life expectancy globally, Nigeria still grapples with fundamental health challenges, often with fatal consequences.
According to a recent report by the respected international medical journal, The Lancet, Nigeria, with an estimated population of 170 million people, is responsible for the second highest number of stillbirth cases in the world, next only to India, whose population is over 1.25 billion. Jointly sponsored by the World Health Organisation, United Nations Children’s Fund and the London School of Hygiene and Tropical Medicine, the report puts the annual record of stillbirth cases at 2.6 million, with Nigeria accounting for 314,000 cases.
Stillbirth is defined by WHO as “a baby born with no signs of life at or after 28 weeks’ gestation.” Another definition by the United States Centres for Disease Control and Prevention says, “Stillbirth is not a cause of death but rather, a term that means a baby’s death during the pregnancy.” It is different from neonatal death which occurs within the first 28 days of birth.
Although stillbirth is a universal affliction, the report says 98 per cent of cases occur in low- and middle-income countries, 75 per cent of them in Asia and sub-Saharan Africa. Notably, 60 per cent of stillbirth cases are recorded in rural areas, a function of the paucity of standard health centres and qualified professionals to cope with the growing cases of childbirth. While India, with 592,090 cases, leads the world, Pakistan is however credited with the highest rate of stillbirths in the world, closely followed by Nigeria.
tillbirths happen for many different reasons and not all can be prevented. However, experts say there are some things a woman can do to reduce the risk, such as stopping smoking and avoiding alcohol or drugs during pregnancy. For preventable cases, adequate and timely medical intervention is critical. Almost half of the stillbirth incidents occur during childbirth, which reinforces the vital role played by skilled health care professionals in caring for mother and child at that critical period of their needs. It was reported that women who suffer stillbirths are four times more likely to suffer the tragedy again.
In Nigeria, child delivery in rural areas could be an ordeal. Left largely to poorly-trained and ill-equipped traditional health attendants, the outcome is often unpredictable. Health centres, in the few places where they exist, lack the right calibre of manpower needed for such delicate health matters. Some mothers do not even know what antenatal care means and could go into labour while on their way to the farm or market, relying only on providence for safe delivery; doubtlessly a game of chance.
Nigeria’s abysmal standing in stillbirth is just a reminder of such other appalling records of mother-and-child health-related issues. For instance, Nigeria has one of the worst infant and maternal mortality rates in the world. It is believed that about 2,300 children under the age of five years die in the country every day due to preventable causes, such as malnutrition and malaria.
Until last year, Nigeria was one of only three polio-endemic countries in the world. In 2013, the United Kingdom-based Economist Intelligence Unit, a sister company of The Economist, rated the country as the worst place on earth for a child to be born. These are some of the reasons why the country has to invest heavily in her health care delivery system which, in its current form, can best be described as dysfunctional.
Concerned about the high incidence of stillbirth, the World Health Assembly has set a target of 12 stillbirth cases per 1,000 births by 2030. The average rate currently stands at 18.4 per 1,000 births, down from 24.7 before 2000. But LSHTM’s studies still found that little or no progress was made in the reduction of these preventable deaths between 2011 and 2015, which is unacceptable.
While a country such as Iceland has a stillbirth rate of 1.3 per 1,000 births, Finland and Singapore, two per 1,000, and Denmark and Norway, 2.2 per 1,000, Nigeria posts a very disturbing 42.9, barely ahead of Pakistan’s worst case of 43.1. In fact, new research claims confirm that, at the current rate of progress, it will take more than 160 years for an average African woman to have the same chance of her baby being born alive as a mother from a rich, developed country. This should be a serious cause for concern to Nigeria’s health authorities.
Since most of the cases are largely preventable, tackling the causes of stillbirth will go a long way in reducing the incidence. According to the CDC, stillbirth could occur as a result of birth defects or genetic problems. It could also take place if the pregnant woman has some medical conditions, such as high blood pressure, diabetes and malaria, among others. Such risk factors as obesity, teenage pregnancy, getting pregnant from age 35 and above and smoking during pregnancy should also be identified and dealt with. This is why Hannah Blencowe, an expert from the LSHTM, said, “And women need to be closely monitored throughout labour.”
It is also why the Abiye (Safe Motherhood) Programme of the Ondo State Government should be commended and emulated. Drawing from his experience as a medical doctor, the state governor, Olusegun Mimiko, has put up a state-of-the-art medical facility to ensure that pregnant women get the best of medical care at little cost to themselves. A registered pregnant woman, under the programme, is attached to a team of doctors and given a mobile phone, loaded with call credit, to contact the doctors whenever in need of medical help.
Other state governors should adopt such progressive measures. The Lancet advises governments to incorporate standardised stillbirth measurement and monitoring into national strategic plans, and “invest strategically in antenatal care, particularly for the most disadvantaged women, including the very young, unmarried and illiterate”. This is the way to go. Not only should they be concerned about the antenatal care of women, but they should also ensure the overall health of the citizens, including that of young children, in an integrated health care system.
