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Arquivos de Medicina

versão On-line ISSN 2183-2447

Arq Med vol.28 no.6 Porto dez. 2014



A tale of two countries -safe motherhood in Portugal and Nigeria

Musa Abubakar Kana1,2


1Epiunit – Institute of Public Health, University of Porto (ISPUP), Porto, Portugal

2Department of Community Medicine, Faculty of Medicine, Kaduna State University, Kaduna, Nigeria




Key-words: Safe Motherhood, Maternal Health, Portugal, Nigeria


Dear Editor,

The attainment of the global goal of safe motherhood is a major challenge to health systems.1-3 Nearly every 2 minutes, somewhere in the world, a woman dies because of complications of pregnancy and childbirth.1 A fact that confers maternal mortality as a widely acknowledged general indicator of the overall health of a population, of the status of women in society, and of the functioning of the health system.4 High maternal mortality ratios (MMR) are thus markers of wider problems of health status, gender inequalities, and health services in a country.4 Therefore, an international comparison of maternal health requires taking into account the differences in demographic and socio-economic determinants of health.



Portugal has a small population and the economy is recovering from a period of recession, while Nigeria has a large population and a rapidly developing economy.5 Maternal mortality in Portugal was decreased from 40 to less than 10 deaths per 100,000 live births between 1978 and 1986.6 On the other hand, Nigeria has over the period of 23 years recorded a decline of 52% in maternal deaths from 1200 per 100,000 live births in 1990 to 560 per 100,000 live births in 2013.7,8 The rate of reduction of maternal mortality in the two countries is incongruent due to a host of factors that include the differences in their initial scale of the burden, health system and intervention approaches.

An international comparison based on the concept of “amenable to health care” avoidable mortality (that is, mortality sensitive to health care system initiatives) provides a rating of the improvement in health status attributable to the health system.9 The strength of a health system offers an important and sustainable mechanism to influence key population level indicators of health, including maternal mortality ratio.10 Therefore, coordinating actions across different parts of the health system, initiatives to improve maternal health can increase coverage and reduce barriers to the use of various services.11 Through a holistic understanding of a health system’s building blocks,12 systems thinking identifies where the system succeeds, where it breaks down, and what kinds of integrated approaches will strengthen the overall system and thus assist countries to improve maternal health.13

The comparison of safe motherhood in Portugal and Nigeria illuminates the concerns that underscore the distinctive challenges each faces. Maternal death is a rare event in Portugal, but the consistent increase in the average age at pregnancy may exacerbate the main causes of death, raising concerns for the future and prompting the need for emergency facilities nearby maternities.6 Even though maternal mortality is declining in Nigeria, the country still contributes 14% of global maternal deaths.14 The high maternity rate has been related to inadequate use of maternal healthcare services.15,16 Sustainable improvement of access to maternal health services will require commitment by stakeholders and consistent implementation of health policies; specifically an integrated approach to strengthen the health system should be the strategy of choice.17

Finally, it seems a future without maternal mortality is far from being attained. But for now, the goal of every human society should be ensuring safe motherhood that gives all mothers an opportunity to survive pregnancy and childbirth.



The author wishes to express his gratitude to Professor H. Barros, teachers and colleagues at the Instituto de Saúde Pública da Universidade do Porto (ISPUP) for their contribution towards his understanding of health systems, which inspired this work.



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Musa Abubakar Kana

Instituto de Saúde Pública da Universidade do Porto (ISPUP)

Rua das Taipas, 135 - 4050-600 Porto, Portugal. E-mail:

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