‘Every four hours, day in, day out, a jumbo jet crashes, and all the passengers are killed. The 250 passengers are all women, most in their prime of life, some still in their teen. They are all either pregnant or recently delivered of a baby… (WHO, 1986; 175)’
The above quotation captures the global enormity of the problem of maternal mortality in ‗real terms‘. Moreover, Studies by Thaddeus and Main (1994) focused on indirect factors that contribute to maternal deaths rather than direct causes such as haemorrhage. The result of this study showed that maternal mortality is attributable to three forms of delay. These delays include the delay in seeking care (type 1 delay), the delay in identifying and reaching medical facilities (type 2 delay) and the delay in the provision of adequate care (type 3 delay). The rationale for this specific focus may be based on facts that the healthy state of a woman and her high socioeconomic status still predisposed women to deaths during delivery in developing countries.
These barriers associated with delay in seeking care (type 1 delay); include the socio-economic status of a woman, illness factors such as the perception of illness, cost, and quality of care and socio-cultural factors. However, it can be argued that type 1 delay based on cultural beliefs are the major cause of maternal mortality because maternal mortality in Nigeria varies across geographical locations, for example, studies have shown that maternal mortality is higher in the north than in the south of Nigeria and this has been attributed to the adoption of Islamic religion that encourages the practising of ‗’sharia law‘and ‘purdah‘(wife seclusion), in most northern states. Here, most women are disempowered by the emphasis which is put on various traditional beliefs such as squatting during labour, unassisted deliveries by women in order to show modesty during pain, for the sake of delivering a prestigious male child in the Hausa cultural group and also seeking permission from their spouse before a woman can attend a hospital facility for her delivery. In contrast, Stock (1983) and Egunjobi (1983) argued that distance is the major risk factor to the perception of seeking adequate health care in Nigeria. Where Stock (1983) demonstrated for example, that the number of mothers seeking treatment within one week of the onset of illness declined as the proximity to treatment facilities increased.
In addition, Thaddeus and Maine (1994) argue that Type 2 delays were attributable to the inaccessibility to adequate health care services after a decision to seek care. This may be because of travel distance resulting from the uneven distribution of health facilities in rural and urban areas and lack of transportation. However, the transportation may be available but the means of a mother getting to an adequate health care institution may be identified as a barrier for reaching the hospital on time. For example, Stock, 1983 asserts that in some northern parts of Nigeria, Muslim women are forbidden to ride bicycles or donkeys, even though these sources of transportation may be available. additionally, Type 3 delays may be caused by lack of qualified staff, and the unavailability of blood and essential drugs.
However, most top ranked health professionals in Africa may challenge that type 1 and 2 rather than type 3 delay may be the major attributary factor to maternal mortality in Nigeria. This may be because there has been no definitive observational study that have been carried out in hospitals and have been linked to the precise cause of maternal deaths. Therefore, this may insinuate that type 3 delays in actual fact may be a myth in Nigeria. However, one professional argues that based on personal experience type 3 delay is not a myth in its contribution to maternal mortality in Nigeria. This is her story.....
The story......
She strolled into the hospital as cheerful as she could be....this was her first day in her obstetrics and gynaecology posting as a medical student in a Edo state, Nigeria.
Suddenly, she was ignoring the unpleasant odour that filled the obstetric ward, which was the usual antiseptic smell that accompanied most governmental hospitals in Nigeria. This offensive odour may be deduced to be the locally enhanced antiseptic called dettol with a mixture of polluted water and bleach (jik), which is used by most cleaners to wipe the hospital floors. However, the spontaneous lack of recognition of this offensive smell in the supposed ‘hospital’ environment was precipitated by the unusual screams that overwhelmed the labour ward. Furthermore, she realised that the spaces of her footsteps were increasing as she was approaching towards the direction of the abrupt cries of a woman. In addition, she noticed that her heart beat was increasing rapidly as her fingers came in contact with the unknown, which is the doorknob of the ward while Her other fingers were clenching on to her medical books.
In a few seconds, she found herself standing in front of her young colleagues who also appeared to be perplexed as they gazed at one of the naked patients in the wards. She was acknowledged to be a restless woman, in her early twenties, who appeared unkempt, with a gravid abdomen and her opened thighs were covered with ‘show’. ‘Show’ can be described to be a brownish or blood-tinged mucus discharge which accompanies labour in pregnancy. However, the first appearance of the blood stained mucous was not the cause of the apprehension that filled the room but rather it was the appearance of the obstructed head of the pink looking foetus that emerged out of the woman’s cervix. The gluteal region (buttock) and the legs of the fetus were also visible to her and the audience.
Now, she was confused as she studied at her environment. She could not comprehend that the elder doctors, so called registrars’ and senior registrars’, who must had taken the medical oath and sworn to preserve both physical, mental and social health, paid no attention to the helpless mother that laid lifeless in the maternity ward. They attended to other deliveries. She turned towards the nurses and asked the obvious questions, that all her colleagues feared to ask.
’how long has she been here for and why is nothing been done?’
. http://.blogspot.com/2012/02/what-type-of-delay-is-considered-myth.html?spref=tw
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