CHAPTER ONEINTRODUCTIONBackground to the studyPregnancy and childbirth are normal physiological processes that bring joyful experiences to individuals and families. However, in many parts of the world, pregnancy constitutes a perilous journey, a risky and potentially fatal experience for millions of women especially in developing countries. Over 289,000 women die annually from complications during pregnancy, childbirth, or postpartum period (World Fact book, 2014 andWHO,UNICEF, UNFPA &The World Bank 2014). About 70% of these deaths are largely treatable or at least preventable (UNICEF, 2010) and nearly all these deaths (over 90%) occur in developing countries where fertility rates are higher and a woman’s life time risk of dying during pregnancy and childbirth is over 400 timeshigher than in developed countries (Audu, Takai, &Bukar, 2010).The situation in Nigeria is especially grave as maternal mortality rate as high as630 per 100,000 live births is still recorded (World Health Organization, UNICEF & The World Bank, 2014), thus including Nigeria among the nations with the highest number of maternal deaths (WHO, 2010, National Primary Healthcare Development Agency (NPHCDA) 2009). Nigeria makes up only 1% of the total world population but accounts for about 10% of the global estimate for maternal mortality (FMOH & NPHCDA, 2010). The new-born and under-five mortality rates follow the same trend with an estimated infant mortality rate of 74/1,000 (Index Mundi, 2014).This ugly trend has been traced to deliveries being attended to by unskilled birth attendants (N&MCN Newsletter 2011 & NPHCDA, 2009).It is against this backdrop that the Midwives Service Scheme [MSS] was initiated in 2003 by the Nursing and Midwifery Council of Nigeria (N&MCN) though originally as a mandatory service 2 for newly qualified basic midwives (NMCN Newsletter, 2011). Subsequently, the NPHCDA in collaboration with the Nursing and Midwifery Council of Nigeria (N&MCN) and the FMOH in 2009 expanded the programme to include retired but active midwives, unemployed midwives and fresh graduates of basic midwifery as a rescue initiative to provide an emergency stopgap to the human resource shortage of skilled birth attendants at the level of primary health care (PHC) (Nigerian Health Watch, 2011 and N&MCN Newsletter, 2011).The choice of MSS as a remedy for maternal, new-born and under-five mortality was informed by the successes recorded by Egypt through the same means. Egypt witnessed a dramatic reduction in maternal mortality ratio from 174 per 100,000 live births in 1990s to 84 per 100,000 live births in 2000 and further reduction to 68 per 100,000 in 2003 (UNICEF, 2010). In Sierra Leone, the high mortality rates in under-fives of 296 per 1000 live births for boys and 269 per 1000 live births for girls in 2004 was attributed to lack of skilled birth attendants among other factors (Oluwale,2004). In like manner, the outrageous rates of maternal mortality of 2000 per 100,000 live births in Sierra Leone has also been attributed to the lack of skilled birth attendants.

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