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World Health Organization has identified long-term political will as an indispensable factor for Maternal Mortality (MM) reduction in Nigeria. However, attitudinal disposition and political opinion of Local Government Legislators (LGLs) regarding the burden of MM have not been adequately documented. This study therefore designed to determine attitudinal disposition and political opinion of LGLs in Ibadan relating to MM reduction. A cross-sectional study was conducted in all the eleven Local Government Areas (LGAs) that constitute Ibadan. Eleven legislators who were Chairmen of House Committees on Health were purposively selected and interviewed using an in-depth interview guide while 110 consenting Legislators’ out of 113 were interviewed using a semi-structured questionnaire. Descriptive statistics and Chi-square were used to analyze the quantitative data while qualitative data were subjected to thematic analysis. Age of the respondents ranged from 20-55 years with mean age of 36.5 ± 7.2 years. Majority (90.0%) of the respondents’ were males and 23.6% had First Degree. Respondents mean attitudinal score was 14.1 ± 4.5. Many (64.5%) and 35.5% of the respondents had a positive and negative attitude respectively. In-depth interview also revealed inadequate resources to health is one of the major causes of MM in Nigeria. Proper monitoring of staff and public health education were included on what government should do to reduce MM in Ibadan. The study found that many of the respondents had a positive attitude towards maternal mortality reduction but no adequate political commitment at the local government level toward maternal mortality reduction. Appropriate sensitization programmes should be organized for policymakers to provide them with credible evidence on the magnitude of maternal mortality in Nigeria.
MATERNAL MORTALITY RATE IN NIGERIA
Nigeria constitutes just 2.4 per cent of the global population of seven billions; it counts for 14 per cent of global burden of maternal mortality and under – 5 mortality rates. It is estimated that 40,000 women die annually in Nigeria from pregnancy related complications which is second to India in its contribution to the global burden. In Nigeria, the risk of a pregnant women dying from pregnancy or childbirth related complications is 1 in 13, compared to her counterpart in developed countries who has 1 in 5000.
Nigeria’s health and development indicators have been generally unsatisfactory, especially in the country’s Northern states. Also, previous estimates had shown a significant disparity between MMRs in the Northern states of Nigeria compared to the Southern states. Among the reasons given for this disparity is a lack of skilled birth attendance in these regions, primarily due to a preference for home births, which are conducted mostly by unskilled birth attendants (e.g., self, family members or traditional birth attendants - TBAs). Other reasons for the disparity include ignorance/illiteracy, poverty, a cultural/traditional reluctance to use modern contraceptives partly due to a preference for large families, and the non-availability of contraceptives for those who wish to use them.
The 2013 National Demographic and Health Survey (NDHS) further shows, that 60 per cent of women received ANC from a skilled provider (doctor, nurse/ midwife or auxiliary). The survey also shows that more pregnant women (33 per cent received ANC from a nurse/ midwife. Disparity in even distribution of skilled health workers across both Northern and Southern states is another big cause of maternal mortality.
The Government of Nigeria recognizes that the causes of maternal death are preventable if appropriate intervention is put in place. With these worrisome indicators, the Federal Government has put up a lot of strategies in place which include implementation of relevant National policies for Health to Health Sector Reform Program, Roadmap for accelerating the attainment of the MDGs related to maternal and newborn health in Nigeria, integrated Maternal Newborn and child Health strategy etc.
In 2011 the Government introduced a new cadre of midwifery – Community midwife with shorter training program in states in the North to increase the number of Skilled Birth Attendance at community level and Task shifting policy for Maternal and Neonatal Child Health has also been put in place as a stop gap measure. Strategies have also been put in place to increase the production, absorption and retention of quality workforce to address the poor indices.
Efforts are being made to put in place for wider stakeholder’s engagement and collaboration to address all aspects of the challenges that hinder progress towards attainment of the MGDs 4&5. I strongly believe that with good implementation, effective supportive supervision, monitoring and evaluation these indices will drop.