Introduction
According to Park (2005), “The test of any utilization is the measure of consideration and care which it gives to its weaker members”. The weaker members in this context are the mothers and children or pregnant mother with her unborn child. He further stated that in any community, mothers and children constitute a priority group. In sheer numbers according to him, they comprise approximately 70 percent of the population of the developing countries.
Mothers and children not only constitute a large group, but also a “vulnerable” or a special-risk group. The risk is connected with child-bearing in the case of women, and growth, development and survival in the case of infants and children (Park, 2005). He asserted that 50 percent of all deaths in the developed world are occurring among people over 70, the same proportion of deaths are occurring among children during the first five years in life in the developing world. Global observations according to him show that in developed regions maternal mortality ratio averages at 30 per 100,000 live births; in the developing regions, the figure is 480 for same number of live births.
From commonly accepted indices, it is evident that infant, child and maternal mortality rates are high in many developing countries. Furthermore, much of the sickness and deaths among mothers and children is largely preventable. By improving the health of mothers and children, we contribute to the health of the general population. These special considerations have led to the formulation of special health services for mothers and children. These largely may be responsible for the free maternal and child health programme by the Delta State Government.
The International Conference on Population and Development (ICPD) (1994) defined maternal and child health as a situation in which going through the physiological process of pregnancy and child-birth suffers any injury or loses her life and that of the baby. The annual global number of maternal deaths is about 525,000 (WHO, 2000). It asserted further that Nigeria’s population constitutes 2% of the world’s population, it accounts for the 10% of worldwide maternal deaths (about 60,000 Nigeria women die each year). Moreover, for each of these deaths, about 25 other women suffer long term and often debilitating illness, Federal Ministry of Health (FMOH, 2002).
Conceptual framework
Maternal and child health is a component of primary health care and its main objective is to reduce maternal and child mortality and morbidity rate. It is important that every health worker involved in the delivery of primary health care services possess knowledge and skill in the management of health and welfare of the target population (Ejebe, 2007).
Akinsola (2006) opined that although the health of the father is also important but the mother and child constitute a special group, known as “the at-risk” or vulnerable group. They are both vulnerable because during pregnancy, both the pregnant mother and the child in-utero have delicate health condition; and even when the child is born both the mother and the child still have very delicate health status, especially the risk of catching infections and dying from it if not given proper preventive and curative services. According to him, the survival of any society depends on the survival of the mother and that of the children because it is only if the mothers survival that more children can be born and it is only when children survive that we can perpetuate the human race.
He further stated that, every society whether developed or developing, recognises the importance of the health needs and problems of women and their children from birth to adolescent and for this reason both the pregnant women and lactating mothers and their children are often given a special status in the society. In African societies according to him when a woman is pregnant, she is often excused from carrying out heavy duties, such as carrying heavy loads or farming activities. She is also given special diet which is more nutritious that that of the rest of the family. The same thing applies to newly delivered and lactating mothers. Children are also treated like “eggs” which can break if handled carelessly. They are often protected from any harm, however slight, and are fed with breast milk which is the most balanced food ever known to man. Therefore one can safely say that the concept of maternal and child health with the context of African tradition is not new. It is only the approach that appears different.
By him, maternal and child health has two areas of concern.
- The biological demands of reproduction, growth and development.
- The special vulnerability (delicate position of mothers and children as a result of the biological factors stated above.
Having identified two areas of concern, maternal and child health services are often provided to meet the needs related to the above-mentioned demands by providing promotive, preventive and curative services. For example, because infection and injury during the period of pregnancy, child birth, growth and development may damage individual child permanently, preventive health measures, such as immunization are often carried out as an integral part of maternal and child health services.
Park (2005) stated that mothers and children not only constitute a large group, but they are also a “vulnerable” or special-risk group. The risk is connected with child bearing in the case of women; and growth, development and survival in the case of infants and children. Whereas, according to him, 50 percent of all deaths in the developed world occurring among people over 70, the same proportion of deaths are occurring among children during the first five years of life in the developing world. He also said that global observations show that in developed regions, maternal mortality ratio averages at 30 per 100,000 live births; in developing regions the figure is 480 for the same numbers of live births.
From the above, commonly accepted indices, it is evident that infant, child and maternal mortality rates are high in many developing countries. Further, much of the sicknesses and deaths among mothers and children are largely preventable. By improving the health of mothers and children, we contribute to the health of the general population. These considerations have led to the formulation of special health services for mothers and children all over the world.
Causes of maternal mortality and contributory causes
Ejebe (2007) stated various cases of maternal mortality and contributory causes as direct and indirect.
Direct Causes are;
- Haemorrhage
- Sepsis
- Unsafe abortions
- Obstructed labour
- Pregnancy induced abortion (Pre-eclampsia and eclampsia)
Indirect Causes are;
- Malaria
- Diabetes mellitus
- Sickle cell
- Renal disease
- Cardiac disease
Contributory Causes are;
- Poverty
- Low status of women
- Low literacy level
- Unemployment (gainful)
- Harmful traditional practices
- Poor maternal and child health services
- Uneven distribution of skilled birth attendance
- Unavailability of emergency obstetric care
- Ignorance – taboo and beliefs
- Poor nutrition
- Poor transportation
Cultural and socio-economic factors affecting pregnancy, labour and puerparium
Ejebe (2002) opined that there are visible culture and economic factors affecting pregnancy, labour and puerparium. They are;
- Harmful practices such as female genital mutilation and cutting
- Nutritional taboos, prohibiting women from eating food rich in protein such as eggs, snails, chicken, etc.
- Poverty, reduced affordability of food, health care which consequently affect health adversely,
- Illiteracy, the higher the level of education the better the utilization of health care services.
- Religion, influences health seeking behaviour
- Value for many children and sons preference leading to high parity.
- Lack of enforcement of health policy and inadequate fund of health care services.
Harmful practices against women and children
In all societies there are practices affecting women and children. Some are beneficial, some indifferent and others harmful. Most, but not all such practices are cultural in origin. However, various practices cut across different communities and ethnic groups.
Harmful practices have both immediate and long term complications. Effects on these groups can be physical, psychological or both. These practices often have a socio-cultural, economic and political context. It is becoming increasingly obvious that patriarchy (male dominance) exist to control women’s reproduction not just as end itself but to ensure male control of resources hence the work and contributions of women to production becomes invisible. The common harmful practices in Nigeria which are related to reproductive health of women include;
Female genital mutilation (FGM/FGC)
Harmful delivery practices, food taboo (in pregnancy, at birth and during breast feeding), early marriages, widowhood practices, skewed intra house division of labour and responsibility and wife battering.
Harmful practices are defined as practices relating to a specific population or groups within the community especially women. Most harmful practices have their roots in ancient tradition, culture and religious practices. They are handed down through successive generations and are generally detrimental to health, psychological and social well-being of women and girls whose fundamental human rights are also violated by these practices.
Objectives of maternal and child health services
Akinsola (2006)stated that the objectives of maternal and child health services generally begins with solving the health problems of individual mothers and their children and extend to solving the problem of all the individual members of a family within the larger community. Therefore, it generally covers the problems of mothering and parenthood. The programme is meant to ensure that every pregnant woman and nursing mother maintain good health, learn the art of child care, have normal delivery and bear healthy children who should grow up in a family unit, with love and security, in a healthy environment, well nourished, with adequate medical attention and socialization.
Components of maternal and child health services
Except for the sake of learning, the field of maternal and child health is a continuous cycle and therefore any separation made within the different services is just artificial. Nevertheless, to facilitate students understanding of topic, the field of maternal and child health will be divided into the following components; (Akinsola, 2006).
- Pre-conception care
- Conception care
- Post conception care
This can further be divided as follows
- Maternal Care: Care of pregnant and lactating mothers, including intra-conceptual care and family planning.
- Care of neonate (1 – 28)
- Care of infants (0 – 12 )
- Care of pre-school children (1 – 5)
- Care of primary school children (6 – 12)
- Care of adolescents secondary school children, including prevention care and family planning (13 – 18 years)
Factors influencing the health of the mother and child
Akinsola (2006) stated that there are various factors (physical, biological and social), which can affect the health of mothers and children. They are summarized as follows;
- Family size: The larger the size of the family, the more likely the health of the mother and child will be poor due to poverty.
- Age of mother: Women who marry too young (under the age of 20 years) often stand the risk of having complications during pregnancy, labour and delivery, teenagers lack the experience to take care of themselves and the newly born babies. Pregnancy by women aged 33 years and above can also lead to congenital abnormalities and complications such as excessive bleeding and death.
- Educational level of mothers: Illiterate mother lack the knowledge to take care of themselves during pregnancy as well as the child.
- Parity: Mothers who are just having their baby lack the experience to take proper care of themselves during and after pregnancy, as well as the child.
- Child spacing: The more the gap between two pregnancies/child birth, the better for the health status of the mothers and the child.
- Climate: children and mothers in tropical climates stand the risk of infection and poor health due to poor environmental condition and hot humid tropical climate.
- Customs: Some African cultures/traditions are detrimental to the health of the mother and the child, e.g. food taboos. Nevertheless, some help to promote health, e.g. prolonged breastfeeding by mothers who are not HIV positive, and the custom of carrying children at the mother’s back.
- Inherited and other congenital diseases: Diseases which are inherited/congenital can lead to chronic disability in the child and this can affect the socio-economic status of the mother and other members of the family as well e.g. sickle cell disease.
- Social class: The social class of the family will greatly influence the health of the mother and the child. The lower the social class, the more the chances that the family will be ignorant of health issues, br poor, unhygienic and have nutritional status. In regard, even the father is well educated, if the mother is uneducated, the chances are high that the mother and the child will still suffer from social deprivation and nutritional problems and therefore have poor health status.
The maternal and child health components
Akinsola (2006) also opined that maternal and child health components includes the following
Maternity care: Maternity care as a component of maternal and child health is very broad. It covers both the health of the mother and the newly born child. Maternity care consists of the care of a pregnant woman to ensure safe delivery, her postnatal care, the care of her newly born infant, and the maintenance of lactation. It can thus be divided as follows;
- Antenatal care
- Natal care
- Postnatal care
- Neonatal care
- Neonatal feeding, etc.
Safe motherhood
Safe motherhood as a concept refers to a situation in which no woman going through the physiological process of pregnancy and child birth suffers any injury or loses her life or that of the baby. The annual global number of maternal deaths is about 525,000 (WHO; 2000). Whereas Nigeria’s population constitutes 2% of the world’s population, it accounts for 10% of world wise maternal deaths (about 60,000 Nigerian women die each year.)
Moreover, for each of these deaths, about 25 other women suffer long term and often debilitating illness. Incidentally, most of these deaths are caused by preventable conditions of haemorrhage, obstructed labour, unsafe abortions, pregnancy-induced hypertension, sepsis and malaria. In Nigeria the principal contributory factors to high maternal mortality are;
- Poor availability and quality of maternal and child health services
- Uneven (especially urban/rural) and inadequate access to emergency obstetric care
- Weak community support and lack of male involvement for safe motherhood initiative due to ignorance as a result of poor knowledge and mobilization
- High fertility
- Low status of women and
- Poverty and low literacy
Maternal mortality and morbidity occurs mostly among women under 15 years and over 30 years of age and among women with more than four children, (WHO, 2000). Often access to obstetric services is inadequate. Hence only 64% of all births received antenatal care from a skilled birth attendant; furthermore, skilled birth attendants supervise only 42% of deliveries. The contraceptive prevalence rate remains very low at 9% whereas the unmet need for contraception is 18%.
WHO, further said that in response to the challenge of high maternal and neonatal mortality and morbidity, several proactive interventions have been instituted, including the training of large number of traditional birth attendants (TBAS), scaling-up the skills of midwives in Life Saving Skills (LSS) and, more recently, those of Medical Officers (in local areas) on Expanded Life Saving Skills (ELSS).
In more recent times, contemporary initiatives and strategies, such as the baby friendly initiative, safe motherhood initiative, the mother baby package, and making pregnancy safer have been introduced. However, emerging data depicts a worsening situation due to essentially to the following
- Inefficient implementation and integration of initiatives
- Weak co-ordination of activities
- Poor community sensitization and mobilization for safe motherhood
- Poor access and low quality of services (low Staffing, inadequate equipment and supplies);
- Worsening HIV/AIDS epidemic and
- Collapse of the referral system, poor supervision and weak monitoring and evaluation of activities.
References
Akinsola, H.A. (2006). A-Z of Community Health in Medical, Nursing and Health Education Practice.
Federal Ministry of Health (1996). National Health Plan.
Federal Ministry of Health (2001). National Reproductive Health Policy and Strategy, Nigeria.
Ejebe, A. (2007). Maternal and Child Health Care in the Primary Health Care Setting, Warri, Eregha Publishers.
Okereke, P. (2005). Principles and Practices of maternal and Child Health. A guide for Community Health Officers, Warri, Noble Publishers.
Park, K. (2005). Preventive and Social Medicine, Jabalpur M/s Banarsida Bhanot Publishers
World Health Organization (2000). Report of the International Conference on Primary Health Care, Alma Ata, USSR. WHO for All Series No. 1
