Nigeria’s health indicators, especially in maternal and child health show the disposition of the health sector to issues of gender and child health mainstreaming. Women and children are considered to be the most vulnerable group in the society with limited access to education, employment and quality health care. This necessitates the need for adequate attention to be given to them.
There are several factors identified as leading to the inequality in accessing health care for women, infants and children. Some of those factors include cultural norms and practices, poverty, the poor funding of Maternal Newborn and Child Health (MNCH), poor primary health care facilities, lack of awareness in the society and health policies in the country. MNCH focuses on improving the health and nutrition of mothers-to-be, providing quality ante-natal care, safe delivery and post-natal care after delivery. Many pregnant women often lack access to quality facilities, medical care and resources which affects them before and after their pregnancy. Funding priorities seem to focus on secondary and tertiary health care, whereas most pregnant women and children receive care at the primary health care centres. The neglect of the PHCs by the government has resulted in poor infrastructure, lack of facilities and modern equipments making it undesirable for women to give birth at the PHCs. The poor funding of the PHCs has given rise to the high cost of treatment at the secondary and tertiary health institutions as a result; women find it difficult to afford services at that level of health care. Due to the unaffordable rate at the secondary and tertiary health institution, some women have no option than to deliver at home thereby standing the risk of losing their lives and that of their unborn babies.
Inequality has also been expressed with the type of unfavourable policies towards pregnant and nursing women at the work place. Recently, the debate for extending the maternity leave of women from three to six month came up. Prior to this consideration, what is obtained in most offices is a three month maternity leave and during this period most women are marginalised. Most offices do not retain the services of their pregnant or nursing staff because they consider their state as a distraction to the workplace. This shows gross insensitivity to the biological and reproductive state of women.
There are also certain cultural norms that have enhanced gender inequality. For instance, the inability of many pregnant women to make decisions on how she prefers to receive medical attention affects her rights. In some part of the country, family planning decisions are subject only to the will of husbands and the men also determine where the women should conduct delivery, either at the hospital or at home due to some outdated beliefs. Gender inequality for pregnant and nursing mothers leads to both emotional trauma and depressive biological state of women.
The budget of the federal and state government for health has also failed to make proper allocation for MNCH consumables such as nutrition, vaccines, anti-malaria drugs, mosquito nets etc. Most of these drugs and consumables are to be administered at no cost to the pregnant and nursing mothers. Unfortunately the poor funding of the primary health care sector has made this provision a mirage, thereby promoting gender inequality.
To reduce gender inequality, the following should be taken into consideration; official policies on health care should prioritise MNCH and it should be included as a fundamental right of Nigerians. The consideration to extend the maternity leave of pregnant and nursing women is one of such issues that should be given utmost consideration and this should include the provision of baby friendly offices and work places. Secondly, there should be adequate budgetary provision for immunization, nutrition, upgrade, maintenance of facilities and infrastructures at the primary health centres and recruitment of skilled medical personnel to manage these facilities. In addition, adequate measures should be set up for sound administration of Antiretroviral (ARV) prophylaxis to women pregnant with HIV to prevent HIV transmission from mother to child. Also, special care should be given to mothers before, during and after child birth to reduce the mortality and morbidity rate in the country. Proper sensitization of women, men and the health care workers should be carried out. Traditional rulers and religious leaders must play a key role in the sensitization. The emphasis should be on the need for quality health care for antenatal and postnatal care, including giving women the opportunity to make family planning choices.
Furthermore, the training of healthcare workers of all cadres should be gender sensitive and this should start from the modification of the curriculum. Sensitisation sessions and continued education for health professionals should also respect gender sensibilities. The Midwife Service Scheme should be introduced in rural communities across the country to promote health care in rural communities. In addition, there should be a balance in the employment of medical practitioners, a balance in assigning roles and responsibilities and a gender sensitive structure in the health system. The views of people living with disability should be properly mainstreamed in health policies and budgeting making process for health care.
Finally gender consideration should be mainstreamed in formulating health policies and agenda. All stakeholders should be involved in the policy and decision making process that affects women’s health. Women being the most important stakeholders should be fully involved and have a say in the policy making process. The laws should be gender inclusive and gender equality should be considered before health policies are formulated. Achieving gender equality in health care should be considered a top priority in Nigeria.
– Obidiegwu is of the Centre for Social Justice, Abuja
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