Nigeria: The Burden Of Improving Maternal, Infant Health

Before the unexpected arrival of COVID-19, the Nigerian health sector was already reeling under several challenges such as the high burden of maternal mortality, the high infant mortality rate, poor health financing, poor access and application of novel technology and interrupted quality-assured services. However, since the outbreak of the COVID-19 virus, the Nigerian health system is currently facing serious pressure from the COVID-19 pandemic, especially in the area of Reproductive, Maternal, Newborn, and Child Health and Nutrition (RMNCH+N). Dr. Salma Anas-Kolo, the director, Department of Family Health, Ministry of Health, fittingly said, “COVID-19 is an indirect cause of Maternal, New Born and Child morbidity and mortality in Nigeria.”

Anas-Kolo made an example by saying that between January and April 2020, the proportion of facilities providing Family Planning (FP) for instance, dropped by seven per cent while those providing Long Acting Reversible Contraception (LARC) dropped by twice (14 per cent). “The decreasing 2020 numbers could be attributed to several factors including; patients’ reluctance to visit health facilities during the COVID-19 pandemic or the challenges with full commodity supply experienced across multiple states also owing to the pandemic delaying commodity replenishment at the state stores,” she added.

Similarly, consumption of key commodities like condom, injectable, implant Intra-Uterine Contraceptive Device (IUCD) and oral pills which were on an upward trajectory between September and December 2019 are seen to have decreased between January and April 2020, the director said, adding that of these five commodities, injectable recorded the highest percentage decline at 29 per cent, closely followed by oral pills at 24 per cent and implants at 20 per cent.

“New FP acceptors which were on an upward trajectory between September and December 2019 appear to be on the decline between January and April 2020. New FP Acceptors and Current users of FP increased between September and December 2019 by five per cent and three per cent respectively and decreased by 31 per cent and 29 per cent respectively between January and April 2020.”

With these challenges, it is most likely nigh impossible to achieve the Sustainable Development Goal (SDG) global target of reducing the global Maternal Mortality Ratio (MMR) to less than 70 per 100,000 live births by 2030.Nonetheless, family planning experts are optimistic that if government could upscale FP activities, it would help to address the high infant and mortality rates in Nigeria.

Dr. Kayode Afolabi, the Director of Reproductive Health, Federal Ministry of Health (FMOH), at a media workshop, which was organised by Rotary International, said that through effective communication and expansion of young persons’ access to information by leveraging on new media, the low demand and high unmet need for modern family planning, would have been dealt with. Dr. Afolabi said that developing and rolling out national FP training plan, integrating FP into primary healthcare center opportunities, strengthen strategy for introduction of new contraceptives, expand access to rights-based youth friendly FP services and engage federal and state governments to mobilize for procurement, warehousing and distribution of commodities, would help to improve service delivery and supply chain management.

He said that there is a need for the government to develop policies to increase thee indigenous private sector investment for FP in Nigeria, advocate for policy implementation at the state level, increase FP financing through fulfilling the old and creating new financial commitments to FP beyond 2020, improve accountability and tracking of FP, improve the quality and performance of FP programs at sub-national and facility level and strengthen national structures for coordination of FP activities. These strategies will definitely improve the uptake of family planning that can translate to the realization of SDGs in Nigeria, if well harnessed, Afolabi said, adding that government cannot do it alone, hence the need for more partnership and collaboration to enable sustainable domestic financing for family planning, including leveraging private sector networks to deliver FP services and companies that have not traditionally been involved in health.

Anas-Kolo also added in her own two cents when she said, “Attitudes of health workers to patients in public health facilities be improved and RMNCAH+N activities should be implemented without restriction by providing mitigations. I plead with journalists to support more in creating awareness on RMNCH+N activities at all levels of healthcare. There is need to put in place mitigations to avoid prolong interruption to health facility services to prevent very poor health indices especially RMNCAH+N activities.”