A critic of maternal mortality reduction efforts in Nigeria

Context: Maternal mortality in Nigeria is high and occurs from direct and indirect medical causes together with non-medical causes which include socio-economic, religious, cultural and legal factors, reproductive healthfactors and health systems/health services factors. Government and Non-Governmental Organizations have over the years expended efforts towards the reversal of Nigerian's unacceptably high maternal mortality trends.Objective: This review examines major polices and programmes targeted at maternal mortality reduction in Nigeria as well as their possible outcome if any, identifies gaps attendant on these efforts, and suggests the wayforward towards a sustainable maternal mortality reduction in Nigeria.Maternal mortality reduction activities in Nigeria: Majority of these activities have been characterized by inherent poor design, lack of co-ordination with existing maternal health services and absence of sustainability mechanism, with an overall poor outcome. Amongst major maternal mortality reduction activities in Nigeria includes: Life Saving Skills (LSS) introduced by the American College of Midwifery in 1980 for emergencyobstetrics care and ultimately supported by UNICEF and WHO; White Ribbon Alliance developed by Centre for Development and Population Activities (CEDPA) in late 1990s; Prevention of Maternal Mortality Project (PMM) introduced by Columbia University in 1987 using funds from Carnegie corporation; The Making Pregnancy Safe Initiative introduced by WHO in 2000; Women and Child Friendly Health Services Initiative established in 2000 by the former Nigerian's First Lady — Late Mrs. Stella Obasanjo; United Nation Millennium Development Goals (MDGs) initiated in 2000; Women Sexual and Reproductive Rights Project initiated in 2002 by the International Federation of Obstetrics and Gynecology (FIGO) in partnership with Society of Obstetrics and Gynecology of Nigeria (SOGON) using funds obtained from Packard Foundation. Others include: Mentoring for Post Abortion Care (PAC) Services Delivery initiated by Ipas in 2007; The Integrated Maternal, New born and Child Health Strategy Initiative of the Federal Ministry of Health also initiated in 2007; and the Midwives Services Scheme (MSS) initiated by the Federal Government in 2009. Gaps identified to militate against maternal mortality reduction efforts include discontinuity and disconnect in government policies and programmes; legislation and other services emanating from change in government or between the executive and legislature within the same government; poor leadership of the health sector by the health ministries; poor coordination of maternal mortality reduction activities; poor development of human resources and health service infrastructure; inadequate funding of the health system, particularly of maternalhealth services; poor record keeping; and insufficient social mobilization activities.Recommendation and conclusion: Improving maternal mortality reduction efforts in Nigeria involves overhauling of the health system and services to render quality and affordable health care; adequate budgetary allocation and fund release for maternal health services; human resources development through recruitments, training and retraining; ensuring prudence in the development and siting of maternal health service infrastructure; ensuring program continuity between governments, and policy/legislative connect within government;developing effective record keeping protocol for maternal health services; establishing effective socialmobilization outfits and harnessing health sector partnership for funding and other health services. Keywords: Critic; Maternal mortality reductionefforts; Nigeri