Full Project - SOCIO CULTURAL INDICES AFFECTING PREGNANT WOMEN AND CHILDREN MORTALITY IN RURAL AREAS IN NIGERIA - AZ Research Consult (MBA MSc Dissertation/thesis Project Writer) Nigeria

Full Project – SOCIO CULTURAL INDICES AFFECTING PREGNANT WOMEN AND CHILDREN MORTALITY IN RURAL AREAS IN NIGERIA

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CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Pregnant women and children mortality is currently an issue of much concern on the international health agenda. The number of women dying everyday with pregnancy associated problem has been on the increase despite improvements in primary health care delivery the world over (World Health Organization [WHO], 2006a). WHO (2006b) issued estimates for levels of pregnant women and children mortality world wide which suggest that the numbers of pregnant women and children deaths are even greater than was previously thought: an estimated 600,000 women die each year in pregnancy and childbirth. This calls for the issue to be forced into public consciousness and further into the political agenda (UNICEF, 2010).

For decades, in the field of women‟s health, there has been a focus on fertility regulation, creating a narrow conceptualization of women‟s health as bounded by the ages 15 to 45 and the reproductive system (WHO, 2009). World Health (WHO) and United Nations International Children‟s Emergency Fund [UNICEF] (2010) released estimates indicating that globally, the number of women who die each year in pregnancy and childbirth is around 585,000, almost 20 percent higher than previous estimates. An estimated 300 million women suffer lasting damage to their health due to pregnancy or childbirth (UNICEF, 2010). The gap between developed and developing countries is wider in terms of pregnant women and children mortality than for any other health indicator. In Africa, pregnant women and children mortality ratios are highest with figures of up to 100 per 100,000 reported in rural areas of several countries, and ratios of over 500 in some cities (WHO, 2001). In Western, Central and Eastern Africa, the risk of pregnancy is generally higher than in Northern and Southern Africa (WHO, 2006b). This is due to high fertility rate and poor access to medical services.

According to the Federal Office of Statistics (2002), Nigeria is reported to have one of the highest occurrences of pregnant women and children mortality in the world with figures ranging from 704 to 1,500 pregnant women and children deaths per 100,000 live births. More than 70 percent of pregnant women and children deaths in Nigeria are due to major complications such as; hemorrhage, infection, unsafe abortion, hypertensive disease of pregnancy and obstructed labour (National HIV-AIDS and Reproductive Health Survey, 2003). Also, poor access to and utilization of quality reproductive health services contribute significantly to the high pregnant women and children mortality level in Nigeria. The shocking pregnant women and children mortality rates in Nigeria cannot be explained by poor antenatal care attendance alone. Most pregnant women and children deaths occur during delivery or postpartum period and would be preventable with follow-up and better access to obstetric care. It is not only a matter of long distances and money but also of social and religious factors why women do not have access to healthcare facilities. A majority of women still give birth in a traditional setting, either at home or in a church, instead of hospital. This also explains the disparities in pregnant women and children mortality rates in urban and rural areas.

Religion is a problem, not only due to its effect on women‟s societal position, but also because of harmful beliefs and traditions relating to childbirth. Traditional and religious customs such as Female Genital Mutilation (FGM) for pregnant women also put the mother under a huge risk of serious complications (Harrison, 2010). According to UNICEF (2010), distance as the case may be can become a barrier for seeking medical assistance. In situations where the health care facilities are near-by, their capacity to take care of serious complications is, however, poor. This may be one of the major factors behind such high pregnant women and children morality rate. This research therefore looked into the causes of pregnant women and children mortality in Ngbo Clan. It also identified the socio-cultural and economic factors contributing to pregnant women and children mortality alongside the difficulties involved in the treatment of women with, pregnancy related problems in Ohaukwu, it also suggested measures of reducing pregnant women and children mortality rate in the study area.

1.2 State of the Problem

Pregnant women and children mortality is a serious problem in less developed countries, with a alarming rate. Majority of victims are women of reproductive age 15 to 45. These women spend most of their life fulfilling their roles in child-bearing, child-rearing and the care of adults (WHO, 2009). The current interest in pregnant women and children health and pregnant women and children mortality marks a widening of this understanding of women‟s health and recognition that, in the contest of pregnant women and children and child health programmes mothers have in the past been neglected in favour of measures to improve infant and child health. A narrow focus on pregnant women and children mortality runs the danger of falling into an old-fashioned welfares approach, seeing women primarily as mothers (Toubia and Sharief, 2003).

According to Freedman and Maine (2003), “a dramatic reduction in pregnant women and children deaths will happen only when there has been the explicit decision to make emergency obstetric care accessible to all women. Yet whether or not a society makes that decision is itself a measure of women‟s status”.

That not withstanding, poverty can be said to be the major cause of pregnant women and children mortality in Nigeria. It has many dimensions among which are poor access to public services and infrastructure, unsanitary environmental surrounding, illiteracy and ignorance, poor health, insecurity, low level of employment, voicelessness and social exclusion, as well as low levels of household income and food insecurity (Hodges, 2001). Other factors which may affect pregnant women and children mortality include the belief system of the people and their attitude toward certain diseases which tend to influence their choice of health services; male dominance in decision-making and idea which tend to influence their choice of health services; male dominance in decision-making and idea which tend to attribute certain disease like asthma, malaria, hypertension etc to witchcraft which also influence their choice to health services. Women of reproductive age in the rural areas are engaged in tedious activities like farming, food processing, trekking long distance to fetch water, firewood and other domestic chores resulting to fatigue and consequently, fatal loss and reduction in childbirth among other complications (Paul, 2003). The issue of power relation with the family has been much studied in different cultures. For most of the language/tribal groups in Nigeria, the husband is assumed to be head of the household. He dictates what gets done in the family including when he will have sex with his wife or wives. It is therefore inconvincible to think of a situation where the wife would refuse to grant sexual favour to her husband on demand. The women can also not insist on the man using condom or any other protective device while having sex with her without incurring the wrath of the man. This powerlessness of the woman to negotiate conditions favouring her is even made worse if she is an illiterate, poor and rural dweller (Oyakanmi, 1995).

The gender inequality has done more harm to women says Dunkle (2004). Erinosho (1998) commented that the Nigerian health care system as a whole has been plagued by problems of no opportunity to receive antenatal care, quality of service, including unfriendly staff attitudes to patients, inadequate skills, decaying infrastructure, chronic shortages of essential drugs and the well-known “out of-stock: syndrome”, as well as the health sector which is in a dismal state and consequently, the high rate of pregnant women and children morality etc.

All these problems motivated the researcher to undertake this study on pregnant women and children mortality in Ngbo. The researcher therefore identified the causes, socio-cultural and economic factors affecting pregnant women and children mortality and proffer suggestions of reducing the rate of pregnant women and children deaths in Ngbo, Ohaukwu LGA of Ebonyi State.

1.3	Research Questions
(1).	Does unemployment of women predispose them to pregnant women and children death in Ngbo?
(2).	Is there a relationship between women‟s level of education and the high level of
	pregnant women and children death in Ngbo?
(3).	Are there cultural factors that predispose women to pregnant women and children complications in Ngbo?
(4).	What difficulties do women experience in seeking health services and care for
	pregnancy and childbirth in Ngbo?
(5).	Is there a relationship between women‟s low level of employment and the high level
	of pregnant women and children death in Ngbo?
(6).	What difficulties are encountered by health providers in the treatment of pregnant
	women in Ngbo?
(7).	What are the policy implications to women having pregnant women and children mortality problems in
	Ngbo?

What are the suggestions for reducing pregnant women and children death in Ngbo?

1.4 Objectives of the Study

The general objective of this study is to examine the socio cultural indices affecting pregnant women and children mortality in rural areas in Nigeria. The specific objectives derived from the general objective are:

(1).	To examine the factors that predisposes women to pregnant women and children death in Ngbo.
(2).	To ascertain the difficulties women experience in seeking health services and care for
	pregnancy and childbirth in Ngbo.
(3).	To examine the relationship between the women level of education and high level of
	pregnant women and children death in Ngbo.
(4).	To ascertain cultural factors those predispose women to pregnant women and children complications.
(5).	To examine the relationship between the women level of unemployment and high
	level of pregnant women and children death in Ngbo.

To identify the difficulties health providers encounter in providing treatment to pregnant women.
To proffer suggestions aimed at reducing pregnant women and children mortality in Ngbo.

1.5 Significance of the Study

The study has both theoretical and practical significances. Theoretically, the study will add to the body of existing knowledge on pregnant women and children mortality. It will enhance research for scholars, serving as a reference pregnant women and children and will bring to light the causes of pregnant women and children mortality in Ngbo. Findings from this study will also help health care providers to better understand the difficulties involved in the treatment of women with pregnancy related problems and provide better approaches toward the treatment of such cases.

Practically, findings from this study will serve as an important document for policy formulation on how best to address the problems resulting to higher pregnant women and children mortality rate. It will enlighten government and policy makers on the need to put into consideration the socio-cultural and economic factors influencing the rate of pregnant women and children mortality. The result of this study will help in understanding the socio-cultural and economic factors influencing pregnant women and children mortality and provide suggestions on reducing the rate of pregnant women and children mortality. It will further necessitate research on the advancements in the field of public health, and pregnant women and children mortality in Nigeria and Ngbo in particular.

1.6 Definition/Operationalization of Concepts

Disease: Disease is “some deviation from normal functioning, which has undesirable consequences because it produces personal discomfort or adversely affects the individual‟s future health states” (Mechanic, 1968).

Gender: Gender in this study means a social construction. It refers to a culturally and historically specific concepts of femininity and masculinity. It reflects in this context the power relations between men and women, and refers to the construction of sex roles between men and women.

Gender Roles: They are sets of cultural expectations that define the ways in which the members of each sex should behave.

Health: According to the World Health Organizations, health on the other hand is a “complete state of physical, social, mental well-being and not necessarily the absence of infirmity or disease” (Lewis, 1953). This means that quest for holistic women‟s health should be the priority of any given society. (WHO, 1993).

Influence: Influence in this study means the ability socio-cultural factors have to effect or change negatively the health condition of a woman.

Live Birth: A live brith occurs when a fetus, whatever its gestational age, exits the pregnant women and children body and subsequently shows any sign of life, such as voluntary movement, heart beat or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord and placenta are intact (WHO, 1993). In the context of this work the term “live birth” refers to the situation whereby after the gestation period of nine months, the baby is born alive.

Pregnant women and children Mortality: It is 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 its management but not from accidental or incidental causes (WHO, 1977).

Pregnant women and children Mortality Ration

Pregnant women and children Morality Ration (MMR) is the ration of the number of pregnant women and children deaths per 100,000 live births. The MMR is used as a measure of the quality of a health care system.

Pregnant women and children Mortality Rate

Pregnant women and children Mortality Rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of the population per unit time (UN, 2008). Mortality rate is typically expressed in units of deaths per 1000 individuals per year. For example, a mortality rate of 9.5 in a population of 100,000 would mean 950 deaths per year in that entire population or 0.95% out of the total (UN, 2008).

Primary Health Care (PHC): Primary health care in the context of the proposed study has been identified as the main focus for delivering an effective, efficient, quality, accessible and affordable health services, to a wider proportion of a given population (WHO, 2009). Socio-Cultural Practices: Cultural practices as practiced by the society, the pattern of living as society sees it.

Socio-Economic Status: This is measured by family income, education and occupation. Socio-Cultural Factors: This is referred to as socio-economic situation that imposes great difficulty on individual to raise money in order to maintain a standard of living.

Uneducated Women: In the context of this study refers to the women population with low education or no opportunity to acquire information education.

Pregnant women and children Problem: This means those factors or hindrances that predispose women to pregnant women and children complications.

Young Girls: In this study means those young girls who fall within the age bracket from 15– 35 years, who eventually may suffer pregnant women and children scourge.

Women with no or low income: This means the proportion of women who have no or low income earning at a given time, which may endanger their pregnant women and children health.

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