For Nigeria as a whole, the percentage of birth with any of four key risk factors for morbidity and mortality hardly changed between 1990 and 2003, at 66.4% and 63.9% respectively. Over that period all Zones recorded a rate of at least 60%, with little decrease, with the sole exceptions of the Southwest Zone, which decreased from 61.9% to 45.8% respectively, and the North-central from 67.2% to 56.6%, while the Northeast showed a noticeable increase, from 63.7% to 72.1%.
The Yobe state study at Nguru’s Federal Medical Centre, which was done by doctors looking at case notes of mothers, showed a different order of prevalence among causes of maternal mortality when compared with the international data. Eclampsia was the most frequent cause of maternal deaths (46.4% of deaths from 2003-07), indicating antenatal care as a key area for action, followed by sepsis (vaginally transmitted infection to the blood), haemorrhage, “medical disorders” (conditions aggravated by pregnancy), abortion complications, obstructed labour, and ruptured uterus.
Global One 2015’s preliminary research trip in December 2010 to Kaduna, Kano and Katsina states identified cultural norms that cause early marriage and the link to maternal morbidity and mortality, lack of use of professional health care staff with alternative use of traditional birth assistants (TBAs), skills gaps with existing professional health staff, and the disconnect between health policy making at the federal government level and local government decision making, accountability and implementation of those policies. A follow up field assessment by Global One 2015 in 2011 also confirmed these findings.
Note that a distinction must be made between reported medical causes of maternal morbidity and mortality, and underlying causes, such as early age of marriage, and cultural views about pregnancy (for example in the north, that see pregnancy treated as an extremely private condition, with women being secluded, little discussion on the topic even between individuals who know each other well, and birth delivery being performed at home). Hence obstructed birth, due to small pelvis size, as a cause of maternal morbidity and mortality is caused by early marriage, with delays in seeking professional health care assistance when it does occur, mean that it typically happens after a critical delay, resulting in
“advanced pathology” that makes serious illness and/or death much more likely