**22. Safe motherhood**

World health organization (WHO) has estimated in a 2007 report that 536, 000 maternal deaths occur annually the world over from causes related to pregnancy and childbirth (WHO, 2007). As high as 99% of these deaths occur in developing countries (WHO, 2001). Maternal and Perinatal mortality statistics are the most important measure of safe motherhood, and their reduction has been recognized in the 5th and 4th component respectively, of the United Nations Millennium Development Goals (UNDP, 2003; UNO, 2003).

Maternal mortality can occur from direct medical causes – obstetrics haemorrhage, sepsis, complications of unsafe abortion, hypertensive disorders in pregnancy and obstructed labour; from indirect medical causes – factors pre –existing or co –existing with pregnancy e:g cardiac diseases and gender based violence; and from non –medical factors – underlying social-cultural, legal, religious, and economic factors, reproductive health factors, health systems and health services factors and delays to access to emergency obstetrics care (Fatusi and Ijadunola, 2003; WHO, 1994; Maine and Wray, 1984).

Most causes of maternal deaths are preventable, such deaths therefore represents a violation of ethical principles and human right of the woman – a situation more marked in the developing countries, lack of access to family planning, abortion services, good antenatal care, delivery by skilled birth attendant, emergency obstetrics care, good neonatal care and postnatal services – all constitute a violation of woman's ethical principles of respect for persons, beneficence, non – maleficence, and justice which may occur both at microethical or macroethical level. Physicians have an ethical responsibility to protect the sexual and reproductive rights of women in other to promote their rights to life, information and education, to decide on whether and when to get married and found a family, to healthcare and protection, to benefit of scientific progress and to be free from ill treatment and torture.

Physicians also have an important role to play in publicity and campaign towards the development of policies and programs that will strengthen the health systems and health service to promote safe motherhood and reduce maternal mortality to the barest minimum.

Governments should work in partnership with non – governmental organizations and communities to provide good roads, acceptable and affordable maternal health services with good health facilities equipped and manned by skilled birth attendants adequately trained on emergency obstetrics care.

Bioethics in Obstetrics 313

for application by health professionals already in obstetrics practice. These health professionals will also benefit from periodic workshops and seminars on bioethics as part of their continuing medical education. Health professionals also have an obligation to guide governments and policy makers towards the development of human rights and ethics – friendly policies and

American College of Obstetricians and Gynecologists. Cesarean delivery on maternal request. ACOG Committee Opinion No. 394. Obstet Gynecol 2007; 110:1501–1504. Adinma JIB, Adinma ED. Ethical Considerations in Women's Sexual and Reproductive

Adinma JIB, Adinma ED: Impact of Reproductive Health on Socio-economic Development: A Case Study of Nigeria. African Journal of Reproductive health 2011; 15(1): 7 Adinma JIB. International Federation of Gynaecology and Obstetrics / Society of Gynaecology

American Civil Liberty Union (ACLU) Coercive and Punitive Governmental Responses to

Beauchamp TL, Childress JF. Principles of Biomedical Ethics. Oxford University Press. New

Cook RJ, Dickens B, Fathala MF. Reproductive Health and Human Rights. Oxford

Council for International Organizations of Medical Sciences (CIOMS). International ethical

Donation of genetic material for human reproduction, Int. J. Gynecol. Obstet, 1994, 44:185. Elkins TE, Strong C, Dilts PV Jr. Teaching of Bioethics within a Residency Program in

Ethical Issues in Obstetrics and Gynecology by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women's Health. November 2006. Ezeani CO. Evolving a human rights based code of ethics for medical practitioners caring for

Fatusi AO, Ijadunola KT. (2003) National study on Emergency obstetrics care facilities in

FIGO Professional and Ethical Responsibilities Concerning Sexual and Reproductive Rights.

James HJ, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1993); Carol

A. Heintzelman, "The Tuskegee Syphilis Study and its Implications for the 21st

women in Nigeria. Trop J Obst Gynae 2002; 19 (Suppl.1): S 26–28.

Gillon R (Ed). Principles of health care ethics. John Wiley and Sons. Chichester. 1994.

Century" at http/www.socialworker.com/Tuskegee.htm. Jonsen A. The birth of Bioethics. Oxford University Press. New York. 1998.

Callahan D. The Social Sciences and the task of bioethics. Daedalus. 1999; 128: 275–294. Commonwealth Medical Association Trust (COMMAT). Consultation on Medical Ethics

and Obstetrics of Nigeria (FIGO/SOGON) Human Rights Code of Ethics on Women's Sexual and Reproductive Healthcare for health professionals in Nigeria. FIGO/SOGON

and Women's Health, including Sexual and Reproductive Health, as a Human

guidelines for biomedical research involving human subjects. Prepared by CIOMS

Obstetrics and Gynecology. Obstet Gynecol. 1986 Mar; 67 (3):339-43. Website:

programmes that will invariably promote obstetrics care and overall safe motherhood.

Healthcare: Nigerian Journal of Clinical Practice. 2009; 12(1):92-98.

Women's Sexual and Reproductive Rights Project (WOSRRIP) 2003.

Women's Conduct during Pregnancy September 30, 1997.

http://www.aclu.org/reproductive-freedom.

Right. NY, USA, 23–26 January 1997.

Nigeria, UNFPA/FMOH Abuja.

Dec. 2004. www.figo.org/Codeofethics

in collaboration with WHO, Geneva, 1993.

http://www.ncbi.nlm.nih.gov/pubmed/3945445

University Press, 2003.

**25. References** 

York. 2001.
