After a series of long and difficult home births, Maryam Abubakar found herself pregnant again. This time, however, she decided to seek prenatal care and give birth in a health facility near her home in northern Nigeria.
Like millions of other women in sub-Saharan Africa, Abubakar had married young—at age 13—and knew little about family planning. Over the years, the babies arrived despite her desire to let more time go by between pregnancies. At the antenatal care clinic at Sir Muhammad Sanusi Specialist Hospital in Kano, Abubakar received information and help that she previously lacked.
As part of her care during pregnancy, Abubakar and her husband were counseled about family planning methods and options. The couple—parents of seven children—decided the best course for them would be a long-acting or permanent contraceptive method. After undergoing an emergency cesarean section, Abubakar received a tubal ligation. She went home with a healthy baby girl named Amina, free from worry that she would be pregnant soon again.
“If I had known about this method of family planning, I would have stopped delivering long ago because I believe quality of life for my children is more important than number of children,” said Maryam, a 35-year-old tailor.
The Abubakars are just one of thousands of couples who have received potentially lifesaving family planning information and counseling through the U.S. Agency for International Development (USAID) flagship Maternal and Child Health Integrated Program (MCHIP). An estimated 30,000 women die annually from complications of childbirth in Nigeria.
Jhpiego, through MCHIP and partners, has helped strengthen reproductive and maternal health and family planning services in three states in northern Nigeria over the past four years.This is part of Jhpiego’s ongoing efforts to partner with countries in building the capacity of health care workers and strengthening health systems to prevent the needless deaths of women and families. The organization develops innovative, low-cost technologies to address today’s global health challenges and works with communities to increase frontline health workers’ ability to deliver lifesaving care.
“I would recommend that all nurse-midwives should be trained in family planning by MCHIP so that they can have the knowledge and skill to counsel and provide better services to clients,” says Iyah Halliru, the nurse in charge of the maternity unit at Sir Muhammad Sanusi Specialist Hospital. “I am really thankful to USAID/MCHIP for updating my knowledge on modern techniques of family planning.”
Jhpiego’s work in Nigeria dates to the 1970s when it first helped to strengthen pre-service education in medical and nursing colleges and to update knowledge and skills of health workers. Since 2006, Jhpiego, initially through the USAID-funded Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS) Program, focused on increasing the use of high-quality emergency obstetric and newborn care and reproductive health services, including family planning.
Today, in many places around the world, family planning during the first year following the birth of a child has been largely neglected, even though this is the period of highest risk for mother and baby. Recent findings show that postpartum family planning (PPFP) can help reduce the number of deaths in mothers and children. In countries with high birth rates—if family planning had been better promoted and women were able to access family planning and pregnancy spacing services—32 percent of all maternal deaths could have been avoided.
Through its recent work with the Nigerian Ministry of Health, Jhpiego and partners have achieved steady and significant gains in women’s visits to antenatal care clinics, skilled birth attendance, active management of the third stage of labor, essential newborn care and use of long-term family planning in three states.
Jhpiego has achieved these gains through a variety of innovative strategies that included: establishing community mobilization teams to engage women and their families in healthy behaviors, using male volunteers to increase male involvement in family planning, employing household counselors to educate pregnant women and their families on danger signs (in pregnancy, during and after childbirth and in their newborns), and developing an emergency transport system.
“The implementation of the household-to-hospital continuum of care framework in Nigeria was like a balancing act between demand creation and service supply. It also demonstrated that pregnant women and their families will recognize a quality service when they see it and will embrace it when they need it,” said Professor Emmanuel “Dipo” Otolorin, Jhpiego Country Director for Nigeria.
As part of these efforts, Jhpiego, through ACCESS and MCHIP, identified and trained 449 male pregnancy spacing motivators who visited and counseled 11,371 men on the benefits of healthy timing and spacing of pregnancies and the use of modern contraceptive methods. Of those counseled, 3,222 (28.3 percent) accepted a family planning method for themselves or their spouses; 1,789 accepted injectable contraceptives; 730 decided on oral pills; 450 opted for condoms; and 253 chose an IUD.
A network of 477 household counselors, women often seen walking to and from women’s homes in their signature blue hijabs (traditional Muslim head coverings), educated 7,302 pregnant women and their families about the danger signs in pregnancy and risks for complications. They also referred 5,179 women for a range of services including focused antenatal care, family planning and giving birth in a health facility.
To help improve the quality and delivery of emergency obstetric and newborn care services at health facilities, the programs introduced a Jhpiego-developed quality improvement approach called Standards-Based Management and Recognition (SBM-R®) to providers in the three states. The approach engages health workers in leading the changes at their workplace and recognizes them when change occurs.
At the ACCESS/MCHIP training center, the Murtala Mohammed Specialist Hospital, while the mean SBM-R score for emergency obstetric and newborn care increased from 25.1 percent at baseline to 91 percent after two follow-up assessments, the maternal mortality ratio in the hospital fell from 2,678 to 836 per 100,000 live births.