By Sola Ogundipe
EVER since she survived a traumatic childbirth several years ago, Mrs Toyin Saraki has been on a crusade to stop stillbirths as well as improve the lot of midwives through boosting midwifery as a career. She had a stillbirth due to a delay in finding an anaesthetist for an emergency Caesarean Section.
Her experience was not uncommon. Nigeria has the world’s highest rate of stillbirths – one in every 23 pregnancies. The nation recorded more than 300,000 stillbirths in 2016, while at least one in 120 women still die during childbirth, according to data from The Lancet and the World Bank.
According to UNICEF, the deaths of newborn babies in Nigeria represent a quarter of the total number of deaths of children under-five. Nigeria is one of six high burden countries for maternal mortality and morbidity.
A Nigerian woman’s chances of dying from pregnancy and childbirth is 1 in 13, and presently, only about 20 per cent of health facilities offer emergency obstetric care and only 35 per cent of deliveries are attended by skilled birth attendants.
Statistics show that 4 per cent of care providers in low- and middle-income countries often attribute stillbirth to a mother’s fault, 12 per cent saying mothers should not talk about their stillborn baby, and only 19 per cent agreeing that a death before birth is the same as a death of a child.
This nasty experience fuelled Toyin Saraki’s desire to stop the ugly trend of maternal, newborn, and child mortality and morbidity.
A lawyer, philanthropist and global advocate for maternal and child health, she founded the Wellbeing Foundation Africa, WBFA, and has gained recognition as a powerful voice of advocacy in the campaign for reduction in the rate of maternal and infant mortality. In her view, investing in an “army of midwives” across Nigeria will cut the number of stillbirths and women dying during or after giving birth.
Africa’s ambassador for midwives
Over the years, midwives have helped to improve the maternal healthcare options available to Nigerian women. Toyin Saraki strongly believes that midwives everywhere need to understand that by working in partnership with women and their families, they can be supported to make better decisions about what they need to have a safe and fulfilling birth.
Widely acknowledged as Africa’s Ambassador of Midwives, Toyin Saraki teamed up with former President of Tanzania, Dr Jakaya Mrisho Kikwete, to press for urgent global policy reform to address the global state of midwifery and recognition of the important role of midwives in maternal, newborn and child health.
Speaking in Toronto, Canada, at a high-level forum of government representatives, heads of agencies and global advocates, hosted by the International Confederation of Midwives, ICM, as part of their 31st Triennial Congress, she avowed: “The impact of skilled and educated midwifery is all around us. Still, the global shortage of midwives amounts to 350,000 and the gap between those who have access to the life-saving care midwives provide and those who do not is enormous. “This needs to change immediately with the provision of increased funding, education and regulation that supports midwives, no matter where they are.
Visit to the Senate
On the 2017 International Day of the Midwife (IDM), with the theme “Midwives, Mothers and Families: Partners for Life!”, she led a delegation to the National Assembly. The visit was not in her capacity as Wife of the Senate President, Senator Bukola Saraki, but as the Global Ambassador for the International Confederation of Midwives (ICM).
The delegation included members of the United Nations Populations Fund (UNFPA) and the National Association of Nigerian Nurses and Midwives (NANNM). Their mission was to present the International Confederation of Midwives (ICM) Midwifery Services Framework to the Senate President.
In March 2007, during a National Conference on Maternal Newborn and Child Health (MNCH), organised by the Federal Ministry of Health in Abuja, Toyin Saraki was an arrowhead in spearheading collaboration between different MNCH stakeholders in the country. The National Nigeria Partnership for Maternal Newborn and Child Health was launched to bring the issue of maternal, newborn and child health to the forefront of the country’s development agenda.
It was also to review the draft integrated maternal newborn and child health (IMNCH) strategy and fit it Nigerian purpose and needs and build a consensus on the IMNCH strategy and its implementation through NGOs, civil societies, professional health associations and relevant stakeholders.
Strategy and partnership
Along with members of professional associations, training institutions, non-governmental organizations, representatives of the bilateral and international partners and the Global PMNCH secretariat, Toyin Saraki brought together stakeholders from across the six geographical zones to review the National MNCH strategy. Following this national conference, the WBFA became a global partner to the Partnership for Maternal, Newborn and Child Health (PMNCH), and a member of the Core Technical Committee which was formed to actualize the recommendations of the Nigerian PMNCH.
Further, the WBFA designed the Personal Health Record (PHR) a book where all medical records of each mother and child is recorded and stored for future reference and analysis. It is a book that records all immunizations of a woman/mother (especially the pregnant women) from day of first presentation at the hospital/clinic till she delivers and the child is 5 years old.
The PHR is a ground breaking health resource developed for the purpose of ensuring effective delivery, evaluation and monitoring of sustainable, effective public health strategies in maternal newborn and child health with the aim of providing a suitable framework for the delivery of primary health care in Nigeria.
Toyin Saraki explained that the PHR is to promote need for increased access to the holistic health of women, throughout the pregnancy and delivery continuum of care, but also to create a more subtle, pervasive emphasis on immunisation with vaccines as a crucial determinant of health for both mother and infant.
“Without a centralised health database for many families to rely upon to keep them informed of the necessary health processes in a child’s first thousand days of life, the PHR came as an innovation that placed this knowledge directly into the mothers’ hands, and empowered her to provide, analyze and follow-up on her own data, not just for health, but also civil registrations and vital statistics, or in a nutshell, holistic accountability.
Support for community midwifery
Recently, the Canadian government announced funding for midwifery services in indigenous communities, saying it would launch new funding initiatives to improve access to midwifery services in two communities
Canadian Health Minister Jane Philpott who disclosed this at the ICM Congress, revealed that Ottawa allocated $6 million over five years to fund the two community-based midwifery projects, which was part of the $828 million promised in the 2017 budget to improve the health outcomes of Indigenous people.
In a response to the development on her Instagram handle, Toyin Saraki stated: “Delighted by the uplifting news, so soon after the International Confederation of Midwives 31st Triennial Congress held at Toronto Canada, that the Federal Government of Canada has announced funding for midwifery services in Indigenous communities.
“Very encouraging news indeed! I was very happy to have the opportunity to meet with Canadian Minister Jane Philpott, to meet with indigenous midwives, and to be able to advocate for more and better investments for midwifery deployment in community health”.
Toyin Saraki contributed to The Lancet’s 3rd report on “Ending Preventable Stillbirths”’ Series launched on 19th January 2015, titled Stillbirths: Economic and Psychosocial Consequences.
In a chat with the BBC, the WBFA Founder-President expressed concern that stillbirths often go unrecorded and how the WBFA is aimed towards improving reproductive, maternal, newborn, child and adolescent health across the continent. She discussed the stigma tied to stillbirth, speaking of the need to bring awareness to the issue and share stories.
Investing in midwives
Toyin Saraki champions the cause of midwives and how they learn how to save a mother and child’s life and also how to detect women at risk of domestic violence and female genital mutilation (FGM).
To her, the value of midwives in Nigeria is being shown in the unlikeliest of places – camps for internally displaced people (IDP) uprooted by Boko Haram militants. “Around one in five babies are dying during childbirth in northeast Nigeria, where the Islamist group has waged a six-year insurgency, yet the survival rate of pregnancies delivered in IDP camps in the region is almost 100 percent”, she said.
“A woman there is only footsteps away from a midwife and clinic, with her family around her, and a doctor on standby. If ever there was an argument for having midwives present at delivery and a doctor on call if needed, this is surely it.”
“Midwives will be the army to change dire health outcomes, if we invest in them and provide them with skills. I want Nigerian midwives to be able to stand on an equal footing with midwives from around the world.
“While Nigeria has started training midwives in life-saving emergency obstetric care in recent years, it still lacks enough midwives or an even distribution across the nation. Midwives can provide the majority of the services needed for newborns and pregnant women and women cared for by midwives are less likely to have complicated births or go into labour early.”
Toyin Saraki has not for a moment stopped acknowledging the role of midwives around the world in saving lives of mothers and babies and tells whoever cares to listen that she was only able to survive child birth because of the role of midwives.
“Having benefitted from midwives, I have decided to dedicate the rest of my life to supporting midwives so that other women can benefit. Many women and children have died because of lack of access to midwives and there is need for more investment in the partnership between midwives, mothers and families in order to save more lives.
The power of three
“Truly in harnessing the power of midwives within health systems, we are investing to the power of three; of midwives, mothers and families as partners for life, from birth to age. At the Wellbeing Foundation Africa, we believe that it is the power of three that would change and revolutionise communities, countries and continents.
“The power of three is- a well-equipped, respected and trained midwife, a healthy and informed mother and a protected and safe baby. As essential as a midwife is, we must, as nations, policy makers and citizens respect the midwife.
“Midwives need to be paid their correct salaries, they need to be respected by other healthcare professionals and the community at large. It is important we look after our midwives as they are the first hands to hold and the first eyes to see our babies.
“When the journey to improve maternal, newborn, and child health (MNCH) began in 2004, midwives were placed at the centre of WBFA policies. In 2010, we lobbied for the passage of the Kwara State Safe Maternity Services bill – the first of its kind – that guaranteed funding for midwives. We did this because Nigeria has a long tradition of midwifery, with a vibrant, active community of dedicated midwives that have an unparalleled understanding of community needs and community sensitivities, and we worked closely with them to develop our interventions. I learnt so much from Nigeria’s midwives, and we are grateful for their continued insight and support.
“In this role, I have been lucky enough to meet midwives from all over the world — from Suriname to Lesotho, from the United States to the Czech Republic — and I look forward to meeting many more as I continue in my capacity as their Ambassador, advocate, and grateful friend.
“Hearing the stories of midwives from around the world has been an inspirational experience for me because they are on the very frontlines of preventing maternal and infant mortality. It has also been a learning opportunity. By engaging with midwives around the world, WBFA and I have been able to identify the challenges facing the profession and the help they need to save the lives of more mothers and babies. This insight has informed our frontline programmes, which have been designed to enable midwives to overcome key challenges.
“Crucially, midwives play a significant role in combating the major social determinants of health, which affect the survival rate of mothers and infants. Socio-economic status continues to impact the likelihood of women receiving skilled care during childbirth, as globally the richest 20 per cent of women are 2.7 times more likely than the poorest 20 per cent to have a skilled birth attendant during childbirth.
“As I found when I spoke to midwives in Suriname, 84 per cent of the poorest people have access to a skilled birth attendant compared to 95 per cent of the richest people. Access to a skilled birth attendant varies considerably across sub-Saharan Africa, with rural communities bearing the brunt of the inequity of access.
“In Nigeria, 27 per cent of pregnant women give birth completely alone, without even a family member present. And this is a trend that is actually getting worse in rural and poverty stricken areas, as in the case of the North West of Nigeria, where there was a 27 per cent increase in the number of women giving birth completely alone.
“Considering that northern Nigeria suffers from the highest maternal mortality rates in the country, scaling up access to skilled birth attendants, like midwives in rural and poverty-affected areas must be a priority to ensure that mothers are no longer giving birth by themselves.
“We must prioritise access to midwives within the poorest communities across the world and ensure that young mothers no longer feel alone and alienated whilst giving birth – regardless of their socio-economic status.
“Ensuring that mothers no longer feel alone and alienated whilst pregnant requires open communication and Respectful Maternity Care from a skilled midwife. Nonetheless, the profession faces a number of issues including a severe shortage of staff, poor working conditions, poor remuneration, limited support and supervision. However, I know that we can overcome them, together, in the years to come.
“I pledge to continue my work in my role as Global Goodwill Ambassador for the ICM and advocate on behalf of midwives during the new era of Sustainable Development. I commit to this pledge because I know that investing in more midwives, and more access to midwives, means an end to the needless and preventable deaths of women, newborns, and children by 2030. This is my vision for every woman and every child by 2030”.
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