In 2023, a World Health Organization (WHO) report titled “Maternal Mortality: The Urgency of a Systemic and Multisectoral Approach in mitigating maternal deaths in Africa”gave a morbid analysis of the landscape of maternal health and revealed that maternal mortality remains a significant public health issue worldwide. It is even more problematic that there is an increasing trend in many African countries. Nigeria, Africa’s most populous nation, bears the brunt of this crisis, with one of the highest maternal mortality rates globally. However, amidst the numerous contributing factors discussed in WHO’s reports, a critical issue was remarkably absent – obesity.
The maternal mortality rate in Nigeria in 2017 was about 917 per 100,000 live births. This discouraging figure increased by 14% to 1047 per 100,000 live births in 2020. The WHO attributes these high rates to many factors, including poor access to healthcare, inadequate infrastructure, and socioeconomic challenges. However, the report fails to highlight obesity, which is a significant contributor to maternal mortality. The omission of obesity from such critical discussions is common as it’s often viewed as a problem in developed countries.
The report highlights key factors that can serve as determinants to develop a strategy to combat high maternal mortality and morbidity.But its omission of obesity is a pointer to the failure of most institutions to recognise its growing trend in low and middle-income countries like Nigeria. Advocacy for improved healthcare services, better access to skilled birth attendants, and enhanced emergency obstetric care are important proponents of a health system tackling the poor health indices we currently have. However, the rising prevalence of obesity has been proven to bea critical risk factor for maternal mortality and other adverse pregnancy outcomes. As Nigeria and other low to middle-income countries have observed a rise in the prevalence of obesity, a more holistic approach is needed if we were to succeed in this herculean task.
Obesity complicates pregnancy in numerous ways. It increases the risk of pre-eclampsia, gestational diabetes, and caesarean delivery, all of which contribute to higher maternal mortality rates. Moreover, obesity is a risk factor for other cardiovascular diseasesand a leading cause of maternal deaths globally. Obesity often is a difficult topic to tackle as there are health conditions that predispose people to obesity and it has been associated with stigmatisation, which leads to poor outcomes in the management of people living with it. It’s important then that leading global healthcare organisations take the lead in education regarding the complications of obesity, as the current void in knowledge has created room for a lot of pseudoscience and harm to these individuals.
While exploring the potential contribution of obesity to high maternal mortality and morbidity, I came acrossChigolumOyeka, a research fellow at the Johns Hopkins University Division of Medicine. Her research is primarily targeted at cardiovascular diseases in understudied populations. She had worked with a team in a research publication titled“Preventing Adverse Cardiovascular Outcomes in Pregnancy Complicated by Obesity.”This study highlighted the pivotal role that obesity plays in maternal mortality. The study posits that obesity is a significant health concern that exacerbates the risk of adverse cardiovascular outcomes during pregnancy, amongst other poor pregnancy outcomes like fetal anomalies, pre-term birth etc.There is also an increased risk of cardiovascular diseases in future pregnancies.
Chigolum’s insights are particularly relevant in the Nigerian context, where different cultural and socioeconomic changes have contributed to the increasing rates of obesity among women of reproductive age. Malnutrition remains prevalent in the country and has gotten worse during this recent economic decline. Some traditional beliefs that equate larger body size with wealth and prosperity have also led to the normalisation of obesity in these communities. Moreover, the lack of awareness about the health risks associated with obesity means that many women do not seek help until complications arise during pregnancy.
The study proposes the need for targeted interventions to address obesity as part of Nigeria’s broader strategy to reduce maternal mortality. It calls for increased awareness campaigns to educate women about the risks of obesity, as well as the need for healthcare providers to integrate obesity management into routine maternal care before, during and after pregnancy. These interventions are crucial in a country like Nigeria, where the healthcare system is under-resourced and struggling to cope with the high burden of maternal mortality.
One potential solution is integrating obesity screening and management into antenatal care services. Obesity screening is commonly done in routine antenatal appointments, however its management during pregnancy is often understated. Early identification and management of obesity in pregnancy can reduce the risk of complications and improve outcomes for both mother and child. Additionally, public health campaigns should focus on promoting healthy lifestyles, particularly among women of reproductive age. These campaigns could emphasize the importance of balanced diets, regular physical activity, and the risks associated with obesity during pregnancy.
The high maternal mortality rate in Nigeria is a complex issue that requires a comprehensive and multifaceted approach. While the WHO report provides valuable insights into the broader factors contributing to maternal mortality, its omission of obesity is a significant oversight. Obesity is a critical risk factor that exacerbates the already high maternal mortality rates in Nigeria and must be addressed as part of the country’s maternal health strategy.
Integrating obesity management with the recommendations of the WHO report can aid Nigeria in making significant strides in improving the high maternal mortality and morbidity. This cohesive approach will not just improve primary pregnancy outcomes, but also future pregnancies and offspring cardiovascular health. This, in combination with improving access to healthcare services,strengthening healthcare infrastructure, and ensuring that women have access to quality maternal care is essential in reducing the burden of obesity on maternal mortality.
In the fight against maternal mortality, obesity should not be the Trojan horse that slips through unnoticed. Instead, it must be recognized as a key factor and addressed with the urgency it deserves. Only then can Nigeria hope to achieve the reductions in maternal mortality that are so desperately needed.
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