Maternal health equity refers to ensuring that all individuals regardless of socio-economic status, ethnicity, geographical location, abilities or other determinants of health, have access to the best maternal healthcare that is responsive to their needs.
According to the World Health Organization (WHO), universal health coverage (UHC) implies that “all people have access to the full range of quality health services they need.”However, a person’s health is influenced not just by access to healthcare, but also by other Social Determinants of Health, such as where they live, work and their educational attainment.
In Nigeria, 84.3 per cent of women from the highest wealth quintile give birth with the assistance of a skilled provider, compared to only 13.4 per cent of women from the lowest wealth quintile. Education is a determinant of health and 92 per cent of women with more than secondary education give birth with a skilled provider, while only 16 per cent of women with no education access a skilled provider for their delivery.
Disparities exist as well across geographic locations.81.8 per cent of women from South Eastern Nigeria give birth in a health facility, compared to 15.6 per cent from the North Western Nigeria. Achieving maternal health equity involves recognizing these differences among different populations and addressing these inequalities to improve maternal health outcomes.
What does it take to achieve maternal health equity?
Achieving maternal health equity will include diversified approaches to the design and implementation of solutions to improve maternal and child health outcomes. It is important to understand how age, socio-economic status, abilities and other social determinants of health influence maternal health outcomes.
Interventions have been implemented that focus on improving access to quality maternal healthcare services, meeting the diverse needs of women and addressing the structural barriers to maternal health equity.
Innovations in Technology: Technology and telemedicine continue to play an important role in improving maternal health equity, by providing pregnant women with greater access to information, healthcare services and support throughout their pregnancy journey.
This is true in resource-constrained settings. To address inequalities between rural and urban areas, Life bank is providing access to blood for the management of postpartum haemorrhage. Through an innovative mobile application, health workers are able to order lifesaving blood and blood products and connect potential donors to their local blood banks.
Digital Mom and Mom Care are also two examples of initiatives that use technology to provide platforms for pregnant women to track their maternal health journey and give feedback on healthcare received to enhance quality.
Community Engagement and Capacity Building: Community engagement and capacity building programmes have included communities in the design and implementation of health initiatives enabling tailored and culturally sensitive interventions.
The dissemination of accurate maternal health information through one-to-one and group interpersonal communication sessions, as well as the distribution of low literacy social and behaviour change communication (SBCC) materials, has helped to raise awareness of maternal health issues in communities and improve health-seeking behaviour, empowering community members to overcome specific barriers and gain access maternal health care.
Capacity building has also helped to improve maternal health equity by increasing the knowledge, skills and resources of people, communities and health workers involved in maternal care. Skilled birth attendants and health workers have also been empowered to manage complications, recognise danger signs in pregnancy and establish effective referral systems, thereby averting maternal deaths.
Through community engagement, capacity building and telemedicine RICOM 3, a maternal health programme aimed at reducing indirect causes of maternal mortality and morbidity saw a more than 50 per cent increase in the number of women who were confident in managing indirect causes of maternal morbidity (hypertension, diabetes and anaemia) in order to have a healthy pregnancy and positive maternal outcome.
Leveraging and building the capacity of community structures, The IntegratE project, implemented by a consortium led by Society for family Health (SFH)and championed by the Pharmacy Council of Nigeria (PCN),has proven that community pharmacists and patent proprietary medicine vendors (PPMVs) can provide a wider range of quality family planning and Primary Health Care (PHC) services in hard to reach, undeserved communities.
Financial Support: Providing financial resources to support maternal health programmes and initiatives improves access to quality maternal health care. Financing and Operational Revitalisation for Maternal care – FOR M(om), an initiative supported by MSD for Mothers with the goal of improving maternal care, reducing maternal mortality and ultimately strengthening systems for safer childbirth, seeks to provide financing for facility operations and equipment through Helium Credit, a loan facility.
This funding will support facilities become better equipped and positioned to provide quality maternal health care. This will increase access to high-quality care and promote maternal health equity. The FOR M(om) programme is implemented in Delta, Kano and Lagos states.
Collaboration: Postpartum Haemorrhage (PPH) is a leading cause of maternal death in Nigeria. Through a collaboration with the World Health Organisation, Ferring Pharmaceuticals and MSD for Mothers, women in Nigeria and other LMICs will have access to new innovations to prevent PPH. Smiles for Mothers – a consortium led by Solina Centre for International Development and Research — is providing health systems support in Lagos, Kano and Niger states to strengthen response to PPH, including the adoption of quality-assured uterotonics for the prevention of PPH, in alignment with WHO PPH Prevention recommendations, thereby improving equitable access to high quality uterotonics.
Customised approaches to population groups: Different population groups require a unique approach. Adolescent 360, implemented by the Society for Family Health, and Life Planning for Adolescent and Youth (LPAY) by The Challenge Initiative (TCI)has contributed to maternal health equity by addressing young people’s unique reproductive health needs, preferences and concerns, thereby increasing demand and access to comprehensive, age-appropriate health services for the young population and improving their maternal and reproductive health.
Efforts to sustain these and similar programmes will not only bridge maternal health inequity gaps, but is a step towards improving our maternal health outcomes.
Advancing Efforts for Equitable Maternal Health Outcomes.
The government efforts to provide equity can also be seen through the implementation of the National Health Insurance Authority (NHIA) Act and investment in human resources for health.
The Midwives service scheme (MSS),Community Health Extension Workers-(CHEWs),Community Health Influencers Promoters Services (CHIPS),Community-Based Research, Innovative-Training Services Programme (CRISPs) and periodic maternal and child health programs across PHC facilities are evident efforts to promote health equity.Althoughit is important to recognise these efforts, challenges such as infrastructure limitations, funding constraints and regional disparities persist.
Nigeria’s health budget was about USD70 per capita in 2022, with the majority of individual’s health-care expenditure being covered out-of-pocket. The Government of Nigeria has set out a four-point agenda- a strategic vision for the health sector, which includes improving population health outcomes through an efficient equitable and quality health system.
This commitment to universal health coverage has been quickly backed up by the unveiling of Nigeria’s Health Sector Renewal Investment initiative and the signing of the Sector-wide compact in December, 2023 with multilateral partners and state governors in Nigeria. This will improve harmonisation of resources channelled to the health sector, in order to improve the equitable access to healthcare.
Nigeria’s maternal mortality rate demands urgent attention. Amid these broader health sector efforts, there is a call for increased funding and equitable investments in maternal health to complement prior and ongoing initiatives.
Health sector stakeholders should also establish and execute monitoring and accountability mechanisms for transparency in government and donor investments, commitments and expenditure to ensure that allocated funds are released and used to improve maternal and child health outcomes in particular.
• This publication is supported by funding from MSD, through its MSD for Mothers Initiative and is the sole responsibility of the author. MSD for Mothers is an initiative of Merck & Co., Inc., Kenilworth, NJ, U.S.A.
