The Edge of Joy


In 2010, The Lancet published a new worldwide study on maternal mortality showing that for the first time in decades, we are experiencing a significant drop in the number of women dying each year from pregnancy and childbirth globally. The new findings from 181 countries also shows an annual decrease of 1.3% in the maternal mortality ratio (MMR), the ratio of the number of maternal deaths per 100,000 live births.  However, Nigeria moved in the opposite direction of this global trend, with a 1.4% increase each year, from 473/100,000 in 1990 to 608/100,000 by 2008.

But I doubt that the results of yet another study, even if it is published in the pre-eminent medical journal will ruffle any feathers in Nigeria. We are engrossed in our political challenges, and search for daily bread; engrossed in our search for electricity and air time for our phones. We hear these terms “maternal mortality” and “MDG5” so often that they mean very little. They sound technical and complicated and arouse very little emotion in us. Without emotion there is little chance of action. The problem appears too big, too overwhelming.

We must deconstruct this term to enable access to our emotions. When the term “maternal mortality” is used to describe the death of mothers during child birth, we often visualise this as a complication of the birthing process; a medical process that we cannot understand. In reality, this accounts for a small proportion of these deaths. In order to understand the circumstances around maternal mortality we need to understand the challenges we face in our society in a bit more detail.

Imagine a woman in labour. In parts of our country, it is not accepted by society that women should travel alone without being accompanied by her husband. So, she waits for her husband to return to take her to the maternity suite at the local primary care facility. She begins to bleed and deteriorates…

Imagine a woman in labour; and her husband does manage to get her to a hospital. She gives birth, but begins to bleed….it is 8pm. He has to find blood….he has run out of money, the town is dark as there is no electricity….the private laboratories are all closed…

Imagine a woman pregnant with her 8th chid, carrying her 7th on her back. Her husband hardly makes enough money to feed his family; they live together in a two room apartment with shared facilities. She goes into labour, there is no one to look after her other children, her husband is not back from work…

None of the scenarios above are rare in our beloved country. Every doctor and nurse in Nigeria would have learnt to assist surgeries with torch lamps and to do episiotomies with kerosene lamps. We learn to deliver babies with no fall back plan, trusting and praying for the best case scenario. Very often it does not go according to plan A, and one more of our mothers is added to the statistics of our “maternal mortality”.

These are the difficult issues explored in the brilliant documentary “The Edge of Joy”.

The film follows Nigerian doctors, midwives and families to the frontlines of maternal care. Inside a maternity ward, the film chronicles distressed labours, deaths, and miraculous survival.  Outside, lack of blood supply transportation and family planning are examined as causes of the cycle that kills more than 36,000 Nigerian women each year. The documentary explores the nuances and complexities of the risks of child birth in Nigeria in a way that no publication could possibly do so. See a trailer here.

In an interview, the director and producer Dawn Shapiro says;

“I encountered many of the heartbreaking and hopeful stories that underpin this global tragedy, but it was only through the people, the doctors and nurses of Nigeria that I was able to tell them. The roughly one dozen Nigerian doctors and midwives I worked with closely over the course of making the film, didn’t push agendas, or act as obstructionists when I asked tough questions, or wanted to follow story lines to their natural conclusions”

Watching this film, the overwhelming emotion was not one of a doctor, or a public health professional, but as a father and a Nigerian. Most of the challenges are mothers who are dying from childbirth complications, and are not those that need great expertise to solve. They are those that require a bit of humanity, political will and resolve. And it is the example of Dr Dikko in the documentary that found an innovative solution to get a blood bank functioning for his busy maternity ward that gives me hope in our country.

Read more about the file here and here.

In the next few weeks, we will bring you some more stories on projects confronting the challenge of maternal mortality in Nigeria.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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