The rate of maternal mortality in Ondo State has been increasing, and the efforts of government to put an end to pregnancy and childbirth related complications in the state, have not yielded any result. In 2009, the state government launched Abiye, a safe-motherhood project, to reverse the intolerable loss of pregnant women in the state. Although the project recorded a significant level of success, it was handicapped; no thanks to the activities of the traditional birth attendants, TBAs, in the state. Pregnant women, who had registered with the state health centres, still visited and delivered at local TBAs places and missions. Majority of the TBAs, who are illiterate and have neither formal nor informal training, always refer their clients to hospitals very late. Many of them do not know their limits and cannot recognise childbirth complications. The TBAs are also ignorant about maternal complications during childbirth and the appropriate treatment required, while the missions solely rely on divine revelation for guidance. Little wonder, the 2013 report by the Confidential Enquiry into Maternal Death in Ondo State, CEMDOS, traced the 50 per cent of the 114 maternal deaths recorded that year to traditional practices and activities of unskilled midwives.
Olawale Oyeneyin, medical doctor and coordinator of CEMDOS committee, cited postpartum haemorrhage (excessive bleeding after birth), septicemia and severe hypertension as some of the major causes of maternal mortality. The situation prompted Governor Olusegun Mimiko to read a riot act to the TBAs in the state last year, “if anything happens resulting in deaths, the birth attendants will take responsibility for it and the law must take its course,” he warned.
However in a bid to further reduce the rate of maternal mortality in the state, the state government has come up with the Agbebiye Initiative, a programme that involves the state government partnering with the TBAs and faith-based organisations, (mission homes), MHBAs. In the programme, the TBAs and MHBAs are expected to refer all pregnant women to the state hospitals or health facilities where skilled birth attendants are available.
At the official commissioning of the initiative, on September 4, 2014, Dayo Adeyanju, commissioner for health, said the state government will pay the TBAs some stipends. The commissioner said the birth attendants will be paid based on each delivery referred to the state health centre. He added that this will be based on the coupon or voucher issued to them at the health centre. The programme also involves training the birth attendants in vocational skills such as hat making, tie and dye as well as catering services; and they will also be provided with micro-credit finance which will serve as start-up capital for businesses that will replace those of the birth attendants. “This is with a view to achieving the goal of making pregnancy safe in Ondo State and to ensure that pregnancy is no longer a death sentence in the state,” the commissioner said.
According to Adeyanju, the Agbebiye Initiative has been successfully piloted in Akure South Local Government area. “The pilot phase took us through a range of processes, which include advocacy and sensitisation meetings, awareness creation, trainings, community visits, evaluation etc,” he said.
While commending the governor for his doggedness in tackling the menace, the commissioner stressed the roles of skilled birth attendants as a major factor in reducing maternal and child mortality. He said delivery under the supervision of skilled birth attendants is vital for monitoring global progress in reducing maternal death and is also capable of reducing maternal death from 13 to 33 per cent and neo-natal mortality from 20 to 30 per cent.
Participants, which included traditional and religious leaders, state health officials, World Health Organisation representatives and other top government functionaries at the epoch-making event, expressed optimism that the Agbebiye Initiative will go a long way in reducing the rate of maternal mortality in Ondo State.
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