WUNRN
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Mothers and children at the Gazouby maternal health
hospital in Niamey. These are the lucky ones - most mothers in Niger will
never see the inside of a health centre or hospital |
NIAMEY, 14 December 2007 (IRIN) - Every two hours in
Niger a woman will die during her pregnancy or while delivering a baby - a
symptom of under-resourced health services, neglected transport and education
infrastructure, and a lack of awareness among women of their rights, health
officials and experts say.
Niger’s 13.5 million people (Nigeriens), spread across a
barren territory roughly the size of Western Europe, have missed out on much of
the development that has happened in other countries on the African continent.
There are just a handful of paved main tarmac
highways, and most people live in remote villages miles from a road, school,
health centre or local government office.
Fatima Trapsida, director of the Gazouby maternal health
hospital in the capital, Niamey, says this is the first obstacle to getting
women to the help they need: “Getting to a doctor can mean taking a horse and
cart, waiting for public transport, or paying for the petrol for one of the
country’s ambulances.”
The health system
Getting to a health centre does not guarantee treatment.
There are just 17 doctors trained to perform Caesarean
operations in the entire country - seven based in Niamey and 10 in the regions.
Health system woes |
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Niger’s health problems are not
restricted to the maternal health sector. |
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Some regional capitals like Diffa and Tillaberi do not
have anyone available to perform birth-related surgery.
“The system is still very insufficient,” said Soumana
Hama, one of the emergency doctors based at the Gazouby maternal health centre
in Niamey.
“It’s a problem of getting the means - maternal
mortality was not a priority until very recently,” he said.
According to the UN annual Human Development Index, a
trained midwife tends to only 16 percent of the 600,000 Nigeriens born every
year.
Education
Another powerful factor driving up the country’s
maternal mortality rate is the impoverished state of girl’s education in Niger,
experts say.
Just 15 percent of girls overall, or less than 10
percent in some areas, can read or write.
Many thousands of the girls that do make it to school drop
out early to marry, often before the age of 15.
“There is still not enough awareness of the importance
of modern healthcare for pregnant women both during pregnancy and during
labour,” Amoul Kinni Ghaichatou, a medical officer at the UN Population Fund
(UNFPA) in Niamey, said. “If women and girls and their families knew what the
consequences of not going to modern health centres would be, they would go to
hospital to have their children.”
Instead, she said, many families - which are usually run
by the man - will turn to local charlatans, religious officials and traditional
healers for help with complicated births, before finally seeking out a doctor.
“The big need is to get people’s children to school,
especially girls, because if she goes a lot of things will improve. That’s the
big challenge - getting all girls to school. Then all health indicators will
improve,” Trapsida said.
Costs
Poverty is another problem. Nigeriens are among the
poorest people in the world, with 85 percent still relying on primitive
rain-fed subsistence agriculture to scrape by.
Although Niger’s government has elaborated national
strategies for free healthcare for under-fives, free Caesarean births, and
pre-natal consultations - in reality many people have had to keep paying for
these services as the central fund to subsidise health centres has not been fully
operational.
Once they have paid for the transport and other costs to
get themselves to a health centre, there’s often nothing left to pay for
treatment at the clinic or hospital, experts say.
“Women are dying five metres from health centres because
they can’t afford to go inside,” Ghaichatou said.
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Nurse at the Gazouby maternal health hospital in Niamey |
Change
Despite the scale of Niger’s problems, officials insist
change is possible.
While getting a functioning education system off the
ground and changing stereotypes about educating girls could take a generation
or more to filter down, targeted information campaigns aimed at women and girls
do help, according to Issa Sadou, a gender programme officer also at UNFPA.
Sadou points to a campaign against female genital
mutilation/cutting, incidences of which decreased by 2 percent in Niger between
1998 and 2006. The turning point in that campaign, Sadou said, was 2001 when a
law was passed banning the practice.
“Making change takes time. It means working to change
laws and sometimes traditions,” he said.
UNFPA’s Ghaichatou sees a link between increasing
people’s awareness of what should be available to them and the rate of
improvements in the system.
“People have the right to access the health service.
When they understand that, they will claim it and demand better treatment,” she
said.
“As things are, we could have the best healthcare
facilities in the world here, but if people don’t understand why it matters,
they won’t go.”
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