Full Project – ASSESSMENT OF SOCIO-CULTURAL FACTORS AFFECTING MATERNAL HEALTH IN NIGERIA

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CHAPTER ONE

INTRODUCTION

1: 1 BACKGROUND TO THE STUDY

Globally, at least one woman dies every minute from complications related to pregnancy or child birth. That means 500,000 women deaths a year (United Nations Millennium Summit, 2000). Amala, Indra , Jerker, Martins, Lalin , and Prabha (2003) put the figure at 515,000 while WHO (2005b) put it at 529,000. United Nation Millennium Summit (2000) reported that the number – one killer of women in developing countries is not disease whose cure eludes the world or condition which the world lacks resources to treat rather it is pregnancy and childbirth. World Health Organization (2005b) noted that in addition to every woman who dies in child birth, around 20 or more others suffer injury, infection or disease.

During the 1990s, world leaders formed a consensus on agenda to improve human development (of which maternal health is one) during a series of global conferences that included 1994 International Conference on Population and Development in Cairo; the 1995 Conference on Women and Development in Beijing and ;1995 Social Summit in Copenhagen (Arlette, Merrick,and Yazbeck, 2006). The need for better health for women has been recognized and a number of efforts have been made towards that. For instance, the theme of World Health Day 2005 was healthy mothers and children (WHO 2005a). In 2007, key women parliamentarians from 20 developing and developed countries met in London to promote investment and methods that would accelerate progress on maternal health (WHO, 2007). Similarly in 2009, members of parliament from 15 developing and developed countries convened in Kampala, Uganda, for the third Parliamentary Conference for the implementation of evidence based intervention in order to reduce maternal mortality (WHO, 2009c). It is also of note that a number of effort have been made in Nigeria both at the national and state levels towards addressing the health needs of women, for instance, the ongoing Free Maternal and Child Health Care (FMCHC)

initiative by the Enugu State Government. However, despite all these efforts, the UNMS (2000) maintained that achieving the Fifth Millennium Development Goal (MDG) which is to improve maternal health, to reduce the maternal mortality ratio and ensure universal access to reproductive health by 2015 remains perhaps the greatest development challenge.

World Health Organization (2009b) while reporting on the health of women throughout their lives noted that though women look after the health needs of others, whether in the home or the community, their own health needs are often neglected. Maigua (2009) maintained that women are being denied access to health care at key moments of their lives. Newell (1975) argued that even though we must recognize the fact that great changes for the better have occurred during this century, that while we recognize this achievement, we must also be perceptive enough to understand to what point these victories have taken us. The majority of the rural population of the world, he noted, do not have sufficient food to enable them to have normal growth and development. Eighty percent of the rural population of the world according to him has little or no contact with what we call health technology which is often quoted as an example of present day man’s technological progress.

Amala et al. (2003) have observed that, of 515,000 maternal deaths that occur every year, 90% take place in developing countries. According to them, women in developing countries have 1 in 48 chances of dying from pregnancy related causes, while the ratio in developed countries is 1 in 1,800. In addition to this, a reasonable number of women in Africa still suffer from diseases and other related problems. They went further to argue that, of all the human development indicators, the greatest discrepancy between developed and developing countries is maternal and child health.

Kuntala and Gopa (2002) noted that statistically women make up half of the population of many of the developing nations. However, even though WHO (2009a) reports that life expectancy was higher for women than men in most countries, a number of health situation and socio-cultural factors combine to create lower quality of life for women in developing countries. Women from Obollo Eke and Owupka communities are typical of rural Nigerian women as well as women in other rural populations of developing countries. They are low income earners with little or no education, have poor standard of living and are generally constrained by a lot of socio-cultural factors. In other words, despite the emphasis of WHO on better health for all, too many women especially those in rural areas are still dying or suffering from ill health, poor nutrition, violence and inadequate health care.

The choice of the two rural communities that is (Obollo Eke and Owukpa) is to examine disparity in the socio-cultural factors and their implications on maternal health in the two communities.

1:2          STATEMENT OF THE PROBLEM

Many women suffer and die carelessly because they lack access to good health care and clear useful information about their health. According to Abejide, Makanjuola and Okonofua (1992), high maternal mortality rate in sub-Saharan Africa and other developing nations is currently a major source of concern to policy makers throughout the world. Adetokunbo and Gills (2003) noted that poor maternal health leads to maternal mortality. According to the Prevention of Maternal Mortality Network PMMN (1992), 10% of the maternal deaths that occur in the world each year take place in Nigeria.

The conditions that produce poor maternal health in Nigeria are to be found almost everywhere in sub-Saharan Africa and are surely worse in some places. Adetokunbo and Gilles quoted above have observed that the medical and obstetric cause of poor maternal health leading to maternal mortality is now known. WHO (1985) maintained that 75% of maternal death in Africa are attributable to direct obstetric complications such as hemorrhage, obstructed labor, infections, toxemia and unsafe abortions.

However, it is now clear that complications are not necessarily fatal, they cause death simply because they occur within the context of the socioeconomic deprivation that is prevalent in these countries. For instance, PMMN (1992) noted that unavailable, inaccessible, unaffordable or poor care is fundamentally responsible. In addition, poor maternal health is detrimental to social development and wellbeing as some one million children are rendered motherless each year. These children according to (WHO 2005a) are ten times more likely to die within two years of their mother’s death. Most maternal death in Africa and Nigeria in particular take place outside the medical system. For millions of women in rural areas as Burns, Lovich, Maxwell, and Shapiro (1997) has noted, barriers to care are so great that they do not benefit at all from the health care system. While for millions of others according to them, there is evidence that the facilities that exist are not being used effectively. Many of the deaths that occur in the hospital are among women who arrive in desperately poor condition too late to benefit from treatment. In other cases it appears that there are serious delays within the hospitals. It has also been observed that in many rural communities such as Obollo Eke and Owukpa, there are shortages of medical facilities, well trained personnel, supplies and equipments.

Moreover, in Nigeria several studies ( Adetoro,1987; Chukwudebelu and Ozumba,1988; Oguniyi and Faleyemu,1988) have shown that poor maternal health is more common among women in lower socioeconomic class when indices such as education, income level and types of housing are used. Adetokunbo and Gills (2003) demonstrated that the quality of maternal health could be improved if resources and services were available. Indeed, Harrison (1985) showed in his studies of 22, 774 consecutive births in Zaria that education was a strong determinant of maternal health.

Ineffective or non use of family planning due to lack of knowledge is also said to be partially responsible for poor maternal health in most rural communities. WHO (2002) has noted that lack of family planning (contraceptive use) cause about 149,000 deaths in the world. Africa has been identified as one of the continents that have the highest disease burden attributable to lack of contraception ranging from 0.6% to 1.5% of deaths.

In addition to these socioeconomic factors, some scholars have attributed poor maternal health in Nigeria and other African countries to certain cultural practices. For instance, WHO (2009c) opined that a number of socio-cultural factors affect the health of women in Africa. Also PMMN (1992) noted that what women in West Africa know about pregnancy and delivery, the preparations they should make, the complications that occur, what they should do about life threatening complications and whether they can decide to take necessary action are all determined by a complex of socio-cultural factors that vary widely within a country and between countries.

One cultural practice that holds serious health implication for women in Nigeria and other places in Africa is Female Genital Mutilation (FGM).Okonofua, Slanger and Snow (2002) noted that regardless of type, female genital mutilation invariably leads to sever morbidity. Kun (1997) also reported that mutilated women are shown to be at greater risk of hemorrhage in childbirth because of obstructed labor. Morgan and Steinen (1980) have opined that it is ironic that female genital cutting which emphasizes fertility at a cultural level can be so destructive of it physiologically. Another cultural practice that holds health implication for women especially in rural areas in Nigeria is desire for many Children and sex preference. Obikeze (1988) noted that son preference among Nigerian mothers has implications not only on the desired fertility but also on other aspect of social life. Alaka (1984) also observed that literature abound with analysis demonstrating the need and desire for several children in Africa. Paternity pattern has also been identified as one of the cultural practices that engender the health of women. Paternity, though an anthropological term, has been identified in this study as having some demographic implications.

Poor nutrition according to Burns et al. (1997) is another factor that is responsible for the most common health problems among women in poor countries. According to them, women, often get less food than they need, thus they are more likely to get sick. This can cause exhaustion, weakness, disability and generally poor health.

World Health Organization (1986) has recognized that health is more than the absence of disease, a state of complete physical and mental well being which results when disease free people live in harmony with their environment and with one another. Burns et al. (1997) also maintained that good health involves well being of a woman’s body, mind and spirit. In addition to these, it has been noted by the same authors and even other scholars that violence against women is on the increase. Violence however is often overlooked as a health problem but it can lead to serious injuries, mental, physical disabilities and even death. Unequal access to information, care and basic health practices further increases the health risk of these rural women. Discrimination on the basis of their sex, physical and sexual violence, sexually transmitted diseases, HIV/AIDS, Malaria and other diseases leads to many health hazards.

1.3          Research Questions

1. What is the situation of maternal health in Obollo Eke and Owukpa communities?
2. What are the socio-cultural factors affecting maternal health in Obollo Eke and Owukpa communities?
3. What are the consequences of poor maternal health in Obollo-eke and Owukpa communities?
4. What are the health implications of paternity pattern on women in Obollo-eke and Owukpa?
5. What are the possible measures that could be adopted to address the problem of poor maternal health in Obollo Eke and Owukpa communities?

1.4   Objectives of the study.

This research seeks to achieve a general objective of examining the effect of socio-cultural factors on maternal health in these two communities.

Specific objectives are:

1. To examine the health situation of women in Obollo Eke and Owukpa communities
2. To identify the socio-cultural factors affecting maternal health in both communities.
3. To find out the consequences of poor maternal health in both communities.
4. To examine the health implications of paternity pattern on women in the communities.
5. To suggest the possible means of addressing the problem of poor maternal heath in both communities.

1.5         Significance of the study

Maternal health is a serious issue all over the globe hence the significance of this study cannot be over stated. The study can be seen as having both theoretical and practical significance. Theoretically, the study will add to the body of existing literature on the maternal health issues in Nigeria and other developing countries with particular reference to rural communities. The research will serve as a reference point for future research work on the subject and also stimulate further research on maternal health especially in rural communities where little or no research has been done on maternal health. Such studies and the present effort will help to unravel the various factors jeopardizing the health of women and provide a systematic body of information about these factors. The study will in addition provide invaluable opportunity for testing the validity and the explanatory powers of the existing theories on maternal health in rural Nigeria.

Practically, the study hopes to generate findings on the socio-cultural factors affecting maternal health in rural Nigeria. This may form the basis of a policy response to the problem. In other words, the findings of this research will provide vital information for policy makers on maternal health issues especially as it relates to rural communities. It will draw the attention of the government, professional and international bodies, non governmental organizations who are interested in health issues to the health situation of women not only in Obollo Eke and Owukpa communities but also other rural communities in Nigeria. Finally, the findings will serve as an eye opener to the general public on the various socio-cultural factors affecting the health of women in rural communities in Nigeria and their implications.

!.6     Operationalization of concepts

Maternal health: This refers to the health of women during pregnancy, childbirth and postpartum period (Wikipedia, 2007). Maternal health according to WHO s’ definition of Health involves the physical, mental and social well being of women and not only the absence of disease or infirmities (WHO, 1986). Most women do not have access to health care and sexual health education services that they need.

Maternal death or maternal mortality (obstetric death): This is the death of a woman during or shortly after childbirth. WHO (2005b) estimated global maternal mortality at 529,000 a year, of which less than one percent occur in the developed countries. World Health Assembly (1990) defined maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and the site of the pregnancy from any cause related to or aggravated by the pregnancy.

Health behavior: This refers to preventive orientation and positive steps people take to enhance their well being. It refers to behavior expressed by individuals to protect, maintain, and promote their health status. For example, proper diet, appropriate exercise is activities perceived to influence health status (Mondofacto, 2010).

Safe motherhood: This refers to a woman‘s ability to have a safe and healthy pregnancy and delivery. This equally means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and child birth. The goal of safe motherhood is to ensure that every woman has access to a full range of high quality and affordable sexual and reproductive health services especially maternal care and treatment of obstetric emergencies to reduce deaths and disabilities (Maternal Health Supplement, n.d).

Abortion: This refers to the termination of pregnancy by the removal or expulsion from the uterus or embryo resulting in or caused by its death. It is the expulsion of a fetus from a woman‘s body before the fetus is viable usually within the first 28 weeks of pregnancy (Minahan, 1987). Abortion may occur spontaneously or it may be induced.

Family planning: This refers to “babies by choice not by chance” it as well means planned parenthood, conception control (Iffih and Ezeah, 2004). It involves planning when and how many children to have and how to prevent unwanted pregnancies. .

Hemorrhage: This refers to heavy bleeding after childbirth. It is the lose of blood or blood escape from the circulatory system (Wikipedia, 2007).Bleeding can occur internally where blood leaks such as the vagina, mouth, nose, ear, anus or through a break in the skin.

Toxemia: This is a serious medical condition that affects women after 20 weeks of pregnancy. It is also known as preeclampsia or pregnancy induced hypertension (PIH). Toxemia is characterized by sudden elevated blood pressure and the presence of excess protein in the urine. If toxemia is left undiagnosed and untreated, the continuous increase in blood pressure can lead to deadly complication for both mother and baby. WHO (2005b) has noted that toxemia and other disease associated with high blood pressure are leading causes of maternal and infant mortality.

Rural Community: This refers to a nature community. It is places outside the cities. Characteristics of rural community may include; homogeneity, primordial behaviour, high dependency on nature etc.

Socio-cultural factors: It is the combination of social and cultural factors. It refers to the various social situations and cultural practices that affect the health of women, for example education, poverty, lack of basic social amenities, female gentile mutilation, sex preferences and desire for many children etc.

Population: This comprises the totality of a person living in a particular territory (Scott and Marshal, 1994). It equally refers to the number and composition of various social groupings and the dynamics of change in these characteristics. In this study, population will equally refer to the aggregate of individuals or units from which a sample will be drawn and to which the result of the analysis are to apply. In the other words the aggregate of persons under investigation.

Paternity pattern: This is one of the structural arrangements of the society which stipulate men’s ownership of children. Paternity pattern varies from culture to culture, however the two predominant types in Nigeria are “genitor” cum “genitrix” and “pater” cum “mater”. This are anthropological term referring to someone’s biological father and mother and culturally created father and mother respectively.

Exclusive paternity: Exclusive biological fatherhood refers to a form of parenting which results from a biological relationship between a father and a child.

Social paternity: This refers to a form of parenting which result from culturally created father-child relationship,that is a father-child relationship that is based on culture instead of biology.

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