Gender in niGeria report 2012 - Economic Commission for Africa

More documents

Recommendations

Info

40 Gender in Nigeria Report 2012: Improving the Lives of Girls and Women in Nigeria Reproductive decision-making and social dynamics. The more a woman is educated, the fewer children she is likely to have (table 19). Some analysts highlight the role of Islam as a driver of high fertility and pro-natal attitudes in the North. They cite Koranic inheritance rules as a key influence on women’s desire for more children. In particular, they suggest that women in polygamous households strive to have more children than their co-wives in order to ensure greater security in their marriage and old age. 31 A recent analysis of child deaths in Northern Nigeria highlights the way deaths cluster in households and may affect one rather than all women within a polygamous household. The authors attribute this to the different levels of social support that individual mothers experience (Klouda, 2010). This is an important study because it highlights the way intra-household relations may determine health outcomes, and the importance for health providers of identifying vulnerable individuals who lack social support, if services are to be inclusive. 6.4 Why are women dying in childbirth? High rates of maternal mortality are associated with poor or delayed access to adequate emergency obstetric care (EmOC) and the provision of facilities that are free at the point of delivery. The first delay in seeking life-saving obstetric care may occur in the woman’s household. The ways in which other kin and household members influence such decisions in sub–Saharan Africa continue to be debated (Klouda, 2010). Only 36% of Nigerian women deliver in the presence of a qualified birth attendant or in a health facility. According to the DHS (2008), a woman’s educational status is strongly associated with the uptake of antenatal care and with delivery in a health facility. Nearly 90% of women with higher education deliver in a health facility compared to only 11% of women without any education. Where family resources are scarce and women lack autonomy and mobility, young women may feel unable to make the decision to seek costly treatment. 34% of women cited this as a reason for delaying treatment (FMH, 2011). Husbands, mothers in law or other kin may also play decisive roles. Regardless of who takes the decision to seek treatment, the household’s ability to pay appears to have a key role in influencing what is decided. The economic status of mothers correlates strongly with delivery in either a private or public health facility. 32 This suggests that transport costs, user fees, and charges in public facilities all play a role in excluding poorer women from these essential services. In addition, these facilities are frequently inadequate and thinly spread in Nigeria, and therefore likely to be distant from many women. Mobility and lack of appropriate transport has been identified as a serious issue for poorer Muslim women in some communities (Adamu, 2004). Nigeria spends relatively little on health. It currently spends 6.5% of the budget, well below the 15% threshold that Nigeria pledged to spend when it signed the African Union’s Abuja 2001 Declaration. It has yet to meet its obligation to spend the equivalent of US$31.63 per capita. More recently, on 18 October 2011 at a Conference of Speakers from African Parliaments, Nigeria pledged to increase the budget allocation to 15% by 2015. Funding levels reflect political will. Low State funding means that 75% of total health care costs are borne by individual households. Work by Pitt et al. (2010) shows that user fees are a major factor in maternity care provisioning. It is therefore not surprising that maternal mortality rates are highest amongst the poorest. 31 Izugbara and Ezeh (2010). 32 WHO (2007).
Gender in Nigeria Report 2012: Improving the Lives of Girls and Women in Nigeria 41 The Federal Ministry of Health’s report observes that “[t]he cost of care, particularly in the case of obstetric emergency, is one of the most important barriers to healthcare use” (2011: p. 17). This is backed by evidence from the DHS (2008) which found that 56% of people interviewed declared that cash constraints were a barrier to accessing health care (up from 30% in the survey of 2003). Although the federal government introduced a National Health Insurance decree in 1999, this became operational in 2005 and has benefited those in formal employment most. The DHS data show that it was only accessible to 2% of women and 3% of men. Quite clearly, the issue of access to health care of poor women needs to be addressed urgently if Nigeria’s unacceptably high maternal mortality rates are to fall further. The role of family planning in reducing maternal mortality. Improvements in maternal health are often associated with declines in fertility because women are exposed less often to the risks of childbearing. Fewer births should also imply that more resources are available to provide adequate care to those who need it. Although contraceptive use among married women aged 15-49 doubled between 1990 and 2003 (from 6% to 12%), it is still relatively low compared to peer countries. In 2003 more than half of married women wanted to delay having a child (34%), or stop childbearing altogether (18%). This indicates a considerable unmet need for family planning. One study found that 20% of married women reported having unwanted pregnancies (Okonofua, 1999). Some studies suggest that Southern Nigerian women were increasingly taking charge of reproductive decision-making (Orubuloye et al., 1997). Others reveal that enormous variations in belief and practice currently coexist in different communities across Nigeria. 33 In some Northern states young women have very little knowledge of contraception. According to the DHS (2008), 94% of 15-24 year olds in Kebbi did not know about any contraceptive. If Nigeria is to reduce its maternal mortality rate and capitalise on its “demographic dividend”, one strand in its strategy must be to scale up and improve the provision of family planning facilities, so that more women can exercise reproductive choice. Provision of facilities should be supported by universal education for girls. The evidence gathered by the DHS shows a clear association between a woman’s level of education and her use of family planning methods. In Nigeria women with more education are more likely to use contraception and have smaller families. Table 20 is a composite summary of key issues of women’s health that are highlighted by the inadequacies of the health service. It reveals a system that is failing women at every level, before pregnancy, during delivery, and in the crucial period after childbirth. 33 Sociocultural factors influencing decision-making in the Kanuri tribe in North-Eastern Nigeria. See Abdul Karim et al. (2010).
Page 1 and 2:
Gender in Nigeria Report 2012: Impr
Page 3 and 4: Contents FOREWORD..................
Page 5 and 6: List of tables Table 1. Indicative
Page 7 and 8: Gender in Nigeria Report 2012: Impr
Page 17: Gender in Nigeria Report 2012: Impr
Page 20 and 21: 6 Gender in Nigeria Report 2012: Im
Page 40 and 41: 26 Gender in Nigeria Report 2012: I
Page 99: This study was funded by the UK Dep
show all

Gender in niGeria report 2012 - Economic Commission for Africa

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?