Abstract
The Federal Government of Nigeria in December 2009 launched midwives service scheme to address the shortage of skilled healthcare workforce needed to drive the efforts at improving maternal and infant health, towards the attainment of MDGS 4 and 5. This was in response to the unrelenting increase in maternal mortality in Nigeria. This review explores the implementation of the scheme and the extent to which its set-goals are achieved vis-a-vis many challenges confronting it. The review first explores the ecologic perspective on maternal mortality to identify factors responsible for high mortality among Nigerian women and the inequality gaps in maternal mortality. The review identifies the need to scale up midwives service scheme to areas in dire health needs, identifies the need for health needs assessment, and recognizes community participation as an essential ingredient in ensuring the sustainability of midwives service scheme. Routine evaluation of midwives service scheme is identified as an important tool for assessing the effectiveness of the scheme in achieving its objectives towards improvement in maternal health and reduction in inequality gaps in maternal mortality. The review proposes multi-sectoral interventions in tackling inequality gaps in maternal mortality with strategic focus on addressing inequalities in health and social determinants of health.
Highlights
IntroductionMaternal mortality (MM) is a major health issue in Nigeria which has one of the highest numbers of deaths per 100,000 live births in the world, with 545 deaths
Maternal deaths are caused by unsafe abortion, prolonged labour, postpartum hemorrhage, obstructed labour, infections and eclampsia [7], with 62% of these deaths caused by infections, toxemia of pregnancy and abortion complications [8]
About 44% of maternal deaths in the North of the country are caused by postpartum hemorrhage, with 1 out of every 6 women dying in the North East and North West while 1 out of 18 die in the South West and South East [6]
Summary
Maternal mortality (MM) is a major health issue in Nigeria which has one of the highest numbers of deaths per 100,000 live births in the world, with 545 deaths. About 1 out of 15 Nigerian women die due to pregnancy complications and child birth, as against one death out of 5000 women in the developed world [4]. It starts by discussing the ecologic perspective on high maternal mortality in Nigeria, the health needs assessment of communities being considered for MSS, the challenges facing MSS in addressing inequality gaps in MM, evaluation of MSS services and the strategies to scaling up MSS and reducing the identified inequality gaps
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