Maternal Figures

Blog of the Maternal Figures project, sharing insights of our work.

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Solutions Journalism Fellowship FAQ’s

What is the Maternal Figures Solutions Journalism Fellowship

The Maternal Figures Solutions Journalism Fellowship is a fellowship open to Nigerian reporters and editors (living in Nigeria) who are interested in producing in-depth and rigorous reporting about maternal health interventions implemented in Nigeria and expanding the practice of solutions journalism within their newsrooms. 

How much financial support does the fellowship provide?

The fellowship currently provides a stipend, up to N150,000 to each reporter and editor selected.The stipend can be used to cover reporting costs, including travel, accommodation and the journalist’s time. The stipend is not payment for the production of the story/stories. We expect the publishing outlet to pay the selected journalists and editors for their work. However, in exceptional cases where a publication is willing to assign a story but is unable to pay for it, we may allow the grant to be used to cover the writer’s fee, if a reasonable explanation is provided. The stipend will be provided to the journalist in two installments - one at the beginning of the fellowship and the final installment will be provided after the story is published. 

What other support does the fellowship provide? 

The fellowship also offers editorial support. We can work with the journalist by teaching them how to use our database to access documents or additional information about the selected intervention or similar interventions. We also provide training on how to use solutions journalism to cover endemic issues. 

When is the application deadline for the fellowship? 

We accept applications on a rolling basis. But we do have deadlines to consider applications quarterly. To be considered for the April - June 2021 quarter, journalists must apply by February 26, 2021. 

What kind of stories are you looking for?

We’re looking for stories about the successes and failures of maternal health interventions implemented in Nigeria. Maternal health continues to be an endemic problem in the country, but governments, donors, and communities have come together to address the issue over the last three decades. We’re looking for rigorous stories that can answer the question: is this solution working, if so how? And if it’s not, why? In the past, we’ve funded stories that looked at the successes and shortcomings of Nigeria’s seven-year strategic plan to bring malaria related mortality to zero and a donor organization’s total market approach to saving the lives of pregnant women in Cross River state. 

How can I make my pitch stand out?

Make sure you’ve identified a solution

Make sure you understand what the solution is, how it’s being implemented and what are its goals are

Make sure your pitch includes all of the Solutions Journalism elements 

How can I find maternal health solutions to write about?

Check out our database, we have over 150! 

How can I apply?

Access the application here 

More questions? Email us at [email protected] 

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Maternal Figures partners with Code For Africa to offer solutions journalism fellowships

Maternal Figures will partner with Code For Africa (CfA), Africa’s largest federation of affiliated civic technology and data journalism laboratories, to offer reporting and editorial fellowships to journalists in Nigeria. Over the next year, the two organizations will support Nigerian journalists and editors interested in reporting on maternal health from a solutions journalism perspective.

This partnership will build on Maternal Figures existing reporting grants, which supports journalists reporting on maternal health in underreported communities in Nigeria. Support from Code For Africa will prioritize members of the CfA’s WanaData women data science/storytelling initiative. 

The fellowship will be open to freelance and staff journalists as well as editors looking for support for their newsrooms. In total, the partnership will support 4-5 journalists each quarter with $400 each (payable in Nigerian Naira, of the official value at the time of payment) and the reporting period will be administered in three quarters of three months from January 2021 to September 2021. 

Applications are currently open and interested journalists are invited to apply. 

For more information, reach out to [email protected].

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How to Credit Maternal Figures

Ashley Okwuosa

When creating Maternal Figures, our primary measure of its impact was how journalists will use the site. Were journalists using the site as a starting point to report about the success or failures of maternal health interventions in their state? Were the documents being used to track funding for certain programmes or provide greater context? We would like to hear from you, can you tell us how you’re using the database in your reporting and how we can improve it. 

While the usefulness of the site is our main priority, it is important to us that we are credited appropriately for the work we did. This is why we’re listing a step by step guide showing how to credit us when you use documents from our database in your reporting. 

If you embed or link to documents from our database in your story, please make sure to indicate the documents original source (USAID, The World Bank, etc) while also mentioning that the documents were obtained by Maternal Figures. For example, “USAID reports obtained by Maternal Figures show that the projected budget for the programme was $500,000,000 USD.” 

If you are a recipient of a Maternal Figures reporting grant, it’s mandatory that we are credited in some format in the final (print, video, broadcast, digital, etc) story. Suggested language for credit is:

This story/series was produced in partnership with Maternal Figures. 

-or-

This story/series was supported by Maternal Figures. 

When applicable, a link to our website should be provided.

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Our second webinar: we explore some data.

Chuma Asuzu

Following our blog post where we explored some of the maternal mortality data sources, we presented our second webinar on March 28, 2020. This time, we wanted to take a step further to understand data, what it means, what to look out for when seeing a survey result, then present the maternal mortality data sources, and show how the different figures were arrived at.

The webinar began with an introduction to statistical terms such as population, sample size, margin of error, confidence level and more. Using examples, the participants were taken through an understanding of these terms and how to evaluate survey results.

Next, the webinar explored the different maternal health data metrics: Skilled Birth Attendance, Antenatal Care Prevalence, Under-5 Mortality and others. Journalists were interested in the difference between the metrics (what is measured) and the units of measurement.

The data metric on focus of the webinar was the Maternal Mortality Ratio (MMR), defined as the number of maternal deaths per 100,000 live births and represented by the simple formula below.

Source: Open.edu

This definition depends on the definition of maternal deaths, which is a careful distinction explained by the WHO (in ICD-10) as: the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or management but not from accidental or incidental causes.

While that definition is debated, it remains the internationally-accepted definition and different sources of the Maternal Mortality Ratio use that expression in their documents. 

Nigeria has experienced some difficulty in calculating its Maternal Mortality Ratio, primarily due to maternal deaths being underreported for a three main reasons: the death does not take place in a hospital, or the reason of death is not determined, or there is no skilled person in attendance at the death. Live births are also underreported, but not at the same scale as maternal deaths.

Also shared at the webinar was the disappointment that Nigeria does not currently have a Civic Registration and Vital Statistics (CRVS) database that tracks maternal deaths and live births. Countries across the world employ these systems to track birth and death certificates for causes of death in order to have an up-to-date database for important metrics like the MMR.

The next section of the webinar explored the different sources of Nigeria’s Maternal Mortality Ratio: 

Trends in Maternal Mortality, published by the WHO, UNFPA, World Bank every few years;

The National Demographic and Health Survey, published by the National Planning Commission and the Ministry of Health usually every five years;

Global Burden of Disease, published by the Institute of Health Metrics and Evaluation every few years.

Each source publishes a different figure, as explained in a previous blog post. Our next task during the webinar was to show why this is the case, and why there is not right or wrong source. The key to understanding this is by exploring the methodology and sharing the pros and cons of each approach.

We ended this section of the webinar by sharing our recommendations for which source is the best fit for which type of story. As usual, it depends on the story being told - see our recommendations below.

The presentation slides are currently available on SpeakerDeck.

To conclude the webinar, we shared other maternal health data sources such as the National Urban Reproductive Health Initiative (NURHI) and Women Health and Action Research Centre (WHARC). 

At the end, the participants were reminded of the important questions to ask when trying to report with data: what metrics matter when it comes to measuring success? Are there any conflicts of interest? Does the data help the story? What does the metric mean and is it composed of any variables?

Stay tuned for our future webinars!

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Our first webinar!

Ashley Okwuosa

Last Wednesday, Maternal Figures hosted its first-ever webinar. We engaged with over a dozen journalists in Nigeria about our work and how to use the database we’re creating to do something called Solutions Journalism. The webinar was divided into four parts: With the first focusing on what Solutions Journalism is and how journalists can do it. 

According to the Solutions Journalism Network, Solutions Journalism (or SoJo as it’s also known) is “is rigorous and compelling reporting about responses to social problems.”

The hope is that through SoJo readers gain a better understanding of problems and challenges by learning about what solutions are being offered. 

The second part of the webinar focused on how to apply the practice of Solutions Journalism to reporting about maternal health in Nigeria. Nigeria’s estimated 58,000 maternal deaths account for 19% of the world’s total according to the Trends in Maternal Mortality: 1990 to 2015 report by WHO, UNICEF, World Bank, and United Nations Population Fund. 

Source: Quartz/Atlas

Nigeria’s high maternal mortality ratio is a topic of national importance and has been covered as such, but we believe that by highlighting what maternal health solutions are working, how and why they are working, or alternatively, why they may be failing readers will have a better understanding of the problem itself. 

During the third part of the webinar, we talked about how the maternal figures database can serve as a resource for journalists looking to write SoJo stories about maternal health in Nigeria. The Maternal Figures database currently has over 200 maternal health interventions, the growing list includes everything from state and federal policy, donor-funded projects, community-led interventions, and even technology. We even showed attendees the 70 that we have fact-checked and verified and talked briefly about how the information might be useful in their reporting. 

To end the hour-long webinar, we opened up our Call for Pitches. 

Up until February 14, we will be accepting pitches for SoJo stories about maternal health in Nigeria. We will provide research support to journalists whose pitches are selected, while our publishing partner Nigeria Health Watch will pay journalists to publish the final story on their website. To submit a pitch, email [email protected] or [email protected] if you have any questions.

Our funders, The Brown Institute for Media Innovation published a short post about our work. Read the post and watch the full webinar if you missed it here.

To see the full presentation from our webinar, click here. 

To learn more about Solutions Journalism, visit the Solutions Journalism Network here. And read the selected blog posts below to find out how to pitch, write, and report a SoJo story. 

What is Solutions Journalism?

How to Prepare a Solutions Pitch — 10 Tips from Journalists in our Network

5 Pitches that Became Solutions Stories

Ten Questions to Inform your Solutions Journalism

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What does the maternal mortality ratio data say?

Chuma Asuzu

Background

A multitude of publications and surveys have tracked Nigeria’s maternal mortality ratio (MMR) since 1990. Since that date, the only two have been published on a consistent (yearly) basis have been by the Institute of Health Metrics and Evaluation (IHME) and the World Health Organization (WHO). 

The African Union keeps an aggregate of the figures from the UN, WHO and the World Bank on their Africa Health Stats page and uses those figures.

Also, since 1990 (and in 1999, 2003, 2008, 2013 and 2018) the Nigerian Population Commission has published the National Demographic and Health Survey (NDHS). Of these six surveys, only two - 2008 and 2013 - have maternal mortality ratios for those years. The Nigerian government, as well as health professionals in the country use those figures.

The chart below shows those figures published by the IHME, NDHS and the UN (as culled from Africa Health Stats).

Interestingly the data shows Nigeria made great progress between 2000 and 2010.

Why do the figures differ?

Fundamentally, apart from the NDHS they are all estimations. And depending on the assumptions, they would typically differ. Maternal Mortality Ratio is the ratio of maternal deaths to 100,000 live births. Nigeria does not record maternal deaths nor live births through her civil registration office as most countries do. 

Interestingly, Nigeria’s Ministry of Health developed an interactive webpage recently that displays all the different surveys showing different figures for health metrics.

The problem lies in the estimations being outside the variability of each other. For 2013, the last year all three sources have published figures for, IHME was 243, NDHS was 576, and the AU says 821.

WHO use the GDP per capita, fertility rate and skilled birth attendance as covariates, while IHME use more input sources - up to 25 - for their model. We are looking to speak with representatives of the two bodies about their respective models, and how the covariates are adjusted for.

On the other hand, the NDHS is administered using the sisterhood method - where women are distributed a survey asking about the deaths of their sisters to determine maternal mortality, deaths associated with pregnancy and childbearing. This is the only survey that is carried out by primary research.

However, only 3 out of 6 NDHS results have had any MMR recorded. In 1999, the NDHS report gave the reason for not publishing any MMR as bad data.

Unfortunately, it appears that many interviewers did not understand how to fill in the maternal mortality section of the questionnaire. Many questionnaires contained sibling histories that were not in proper order and/or that erroneously listed information for the respondent as well as her siblings. More damaging to the analysis was the fact that much of the information about siblings was missing. Among respondents' sisters who had died, 68 percent were missing information on the number of years since death, which is necessary for calculating maternal deaths occurring in a particular time period. For most other DHS surveys in Africa, the comparable figure is less than 2 percent missing (Stanton et al., 1997:16). Although it is sometimes possible to impute a value for the number of years since death if siblings are listed in the correct birth order, the ages of other siblings are given and the age at death of the deceased sibling is given, imputation was impossible for 24 percent of female sibling deaths because both the age at death and the years since death were missing. Without knowing age at death, it is impossible to know whether a sister died of maternal causes.

Another indicator of questionable data is the fact that the sex ratio of siblings was reported as 110.4. This ratio is higher than the expected level of about 102 to 105 and could indicate underreporting of female births and/or overreporting of male births by respondents. Finally, the data on the average number of siblings by age of respondents imply that fertility has been increasing over time. A more plausible explanation is that older respondents omitted reporting some of their siblings. The magnitude of the problems with the data render any analysis suspect.

It is possible that this could be the reason more NDHS reports do not report MMR, although no other report even discusses this issue.

State Level Data

Only the Nigerian Health Management Information System keeps track of state-level MMR data. Their figures are however open to various interpretations; for example in 2013, they recorded one State - Ebonyi - as having an MMR of 10599.2, but the next year recorded the state as having an MMR of 76.1. In fact, the director of the agency has said on the record that the figures are inaccurate as they do not include data from the private sector.

It is helpful to note here that many live births are not in hospitals, but the children are delivered at home by a traditional birth attendant - this is usually an informally trained midwife. The figures in the NHMIS survey only cover live births at federal government owned tertiary hospitals.

Moving on, some studies show that the MMR in rural and urban areas vary widely. One study is reported to have put the ratio at an average of 825 deaths per 100000 live births in the rural areas compared with 35 deaths per 100000 live births in urban areas.

Moving forward

For now, journalists reference any of the different sources in their reporting. We see this as quite interesting and are interested in learning why people use one over other and what the perception of the data quality is. Let us know!

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Two Ways we Fact-Check Interventions

Ashley Okwuosa

So far, we’ve documented over 100 interventions for Maternal Figures. The list includes everything from million-dollar USAID projects, community-based non-profits that provide medical kits to traditional birth attendants in high need communities, and nation-wide health policies. 

Finding these interventions isn’t the hardest part of our job, we find them from news articles, academic journals, and state and national budgets. And when we find them, we try to cull as much information as we can from our “first source” (this includes the aforementioned news article, academic journal or policy document.) But that hardly ever provides us all the information we need.

So we need to fact check. In the six months I’ve been working on this, I’ve come across multiple ways to fact check. The first method I tried was reaching out for a simple interview. 

I would email the founder, program manager or policy expert associated with the intervention to see if they were available for an interview and most times they agreed to a phone call. The interviews were anywhere between 20 - 40 minutes long. They were always recorded, dated and transcribed later. 

The interview is often my favorite way to fact check; it’s personal, you get as much clarity as possible. But you also get nuance. By asking question after question, and building a rapport, you get to learn things about not only the intervention but the maternal health landscape in Nigeria that are equal parts fascinating and infuriating. But it’s often hard to fit much of the interview, which is mainly anecdotal in the database. Also, transcribing is tasking and time-consuming. 

So a few months ago, we developed a questionnaire. The questionnaire initially began with only a few questions: the project's name, date of implementation, summary, geographic focus, etc. Ultimately, as our database grew, we started asking more questions: is your project funded by a donor agency? How is your project’s success in preventing maternal deaths measured? 

We began to share the questionnaire with representatives of the implementing organization via email and we've had a good share of success. The questionnaire has been especially helpful when we’ve identified multiple interventions by the same organization. 

So tell us, what ways do you fact-check information about maternal health in Nigeria? Anything else you would like to know about how we fact-check interventions? Let us know in the comments!

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What is Maternal Figures and how are you building it?

Ashley Okwuosa

As a journalist, researching and reporting go hand in hand. For me, the process goes a little something like this:

I have an idea for a story, so I start by looking into it. I find news articles, studies, reports, financial documents, video clips, audio recordings, and anything else that might help confirm or disprove my idea of what I think the story is.

After reading and taking notes, I find people - experts who can help me further understand some of the aforementioned reports and studies, individuals who have had a personal experience with the issue or topic I’m reporting on, and officials who can help explain the policy that ties into the issue.

As I do this, I am slowly building some kind of informal database, which includes pertinent information, the right people and resources to help further my research. And only after all that do I really start writing, this is because I know that almost all of what I will need to write a good news story I have sourced.

I have come to realize that this process is the most integral part, for me, when working on a story. It is not the writing, or the interviewing, or even the editing (although that is crucial) it is the foundation I build while reporting and researching that determines how well my story will turn out.

What we are trying to build with Maternal Figures is a large scale version of what I’ve come to rely on personally as a reporter, but there are a few differences. With Maternal Figures, the story is a big, all-encompassing one - maternal health in Nigeria - and I am not the only journalist involved.

Despite this, the key elements still remain the same.

Maternal Figures will be made up of a list of maternal health interventions that have been implemented in Nigeria since 2000, this includes government policies, donor-funded projects, and community-based programs.

The hope is that the website will be a resource for journalists interested in reporting thoroughly on maternal mortality in Nigeria ahead of the 2030 SDG deadline. For each intervention, we are collecting information about funding partners, evaluations of the intervention’s success, project reports, and contact information.

Each intervention included in the database will be fact-checked, and we will do that by reaching out to funding organizations to clarify whatever information we find through our own research.

We also s​urvey journalists​ who report on these interventions and ​individuals​ who use them to help us identify things that might be missing from our database.

We are also collecting other important pieces of information, like all of the available National Demographic Health Surveys, which indicate Nigeria’s maternal mortality ratio in 5-year intervals between 1990 and 2018. We have the UNICEF Multiple Indicator Cluster Surveys, a household survey used to measure a country’s progress towards the global development goals. As well as the Institute of Health Metrics datasets on Nigeria’s maternal mortality ratio from as far back as 1990.

What do you hope to do with Maternal Figures?

Our main goal for Maternal Figures is to encourage journalists to report on a persistent problem from a solutions-approach. To meet the global goal that no country should have more than 70 deaths per 100,000 live births by 2030, Nigeria will need to lower its most recent estimate (512) drastically.

Our hope is that by focusing on the proposed solutions to maternal mortality in Nigeria, people will have a better understanding of what’s working, what’s not, and why? With support from the ​Solutions Journalism Network​ (SJN), we are training journalists to use a solutions approach to report on maternal mortality, one of Nigeria’s most persistent health issues.

Why solutions journalism, you ask?

Solutions journalism heightens accountability by reporting on where and how people are doing better against a problem — removing excuses and setting a bar for what citizens should expect from institutions or governments. It offers a more comprehensive and representative view of the world. And it circulates timely knowledge to help society self-correct, spotlighting adaptive responses that people and communities can learn from. - Solutions Journalism Network.

Solutions Journalism is not advocacy or simply highlighting a solution, it is thorough reporting that encourages journalists to ask better questions about the problem, highlight solutions that could be replicated and investigate solutions that have fallen short of their promise.

We hope that through the Maternal Figures database, journalists will find solutions or programs in different states across Nigeria that have been successful, help readers understand them, and prompt policymakers to see if they can be replicated.

We hope that journalists will use the database to expose programs that have failed and help readers understand why it happened and what can be done about it.

Finally, we hope that journalists will use the database to help readers envision what the next ten years could look like for pregnant women all over Nigeria.