Infrastructure, Culture, & Policy in Nigeria

Impact of Healthcare Infrastructure on Maternal Health in Nigeria

Nigeria’s weak healthcare infrastructure is a major factor in the nation’s maternal health crisis. Although Nigeria’s healthcare infrastructure has systemic issues, its flaws create disproportionately detrimental effects for women and children. This is especially true for those with low-income or who live in rural areas.

The first obstacle that women face is the lack of family planning within Nigeria. Many Nigerian women do not have access to education about family planning or access to contraceptives. This leads to a situation where only 38% of Nigerian women say that their family planning needs are met and over one in four Nigerian mothers report that their last pregnancy was unplanned (Akinyemi 3). Once a woman is pregnant, the lack of maternal health clinics, especially in rural Nigeria, is another obstacle. According to one senior official with the Nigerian Ministry of Health, “Right now, there is a doctor covering a whole local government. There are 18 local governments, so we have about 17 doctors… If they come to the health care facilities, sometimes there is nobody there to attend to them,” (Udenigwe et al. 8). With nearly no available maternal health clinics, expecting mothers do not have access to the proper guidance and expertise during their pregnancy. Even when care is available though, cost often acts as a barrier. According to Professor Akanni Ibukun Akinyemi of Obafemi Awolowo University, “Although the country’s national healthcare policy provides a framework for access to basic healthcare, most Nigerians are still faced with out-of-pocket payment for health services,” (Akinyemi 2). Many low-income mothers simply cannot afford maternal health services, meaning that for them maternal health services do not exist. Thus, the lack of available maternal health clinics, out-of-pocket healthcare costs, and lack of family planning services are large contributors to the maternal crisis in Nigeria.

Impact of Political/Cultural Influences

Cultural influences of Nigeria have been shown to affect maternal and child health. Studies have shown that Nigerian women disproportionately experience inequality in education, income and social standing (Bolu-Steve, 2020). Women who experience these factors tend not to give birth at health facilities or in the presence of a skilled doctor. Because they don’t give birth with the help of medical professionals it can lead to birth complications, and worse, the death of the fetus or the mother. These social factors also impact the preparation of birth and prevention of complications related to birth, as well as the male or father’s involvement in maternal care. Being prepared for possible birth complications can prevent birth defects, possible infections, and maternal mortality while having paternal involvement allows for closer bonding between the parents and the baby. In addition, multiple studies that have been conducted show that the cultural influence on maternal and child health practice sis prevalent in rural settings (Ikechukwu,2020). Women who live in a rural setting have a positive cultural disposition to prenatal care. Preparation for newborn care was common among individuals that were indifferently disposed to cultural influences. To add on, studies have shown that female circumcision was more common among individuals that were more culturally disposed to such practice.

Analyzing Current Policies

To understand what steps can be taken to improve maternal mortality rates in Nigeria, it is necessary to examine what current policies have been put in place within the healthcare system. The policies that are present can aid in determining what is not working and what needs to be changed in order to decrease the rate at which expectant mothers are dying in Nigeria. When first looking at the maternal mortality crisis within the country, the inadequacy of the overall healthcare system is seen to play a major role in how care for expecting mothers is delivered. That is, the problems with the overall system directly impact the quality of care pregnant women receive and the rate at which they do. Olawale Olonade discusses the problems that arise within the system in a journal published by the National Center for Biotechnology Information. Within this paper, Olonade expands on the insufficient funding within the healthcare system which has caused pregnant women in need of medical attention to be met with healthcare workers that lack sufficient expertise. This is especially problematic when the situation becomes life threatening and women do not have enough time to be transported to another medical facility. Other issues include a lack of medical supplies and essential drugs. The quality of the actual medical facilities can also be poor as hospitals and clinics have dealt with electricity and water supply shortages. It becomes apparent that the weak infrastructure of the healthcare system delays medical care from reaching women, especially when they need it most.

In Nigeria, maternal care is organized into three levels of care: primary, secondary, and tertiary. It is mainly delivered through primary healthcare centers where expecting mothers go to receive prenatal and postnatal care along with delivering the child. Should complications arise, women are then told to go to secondary care treatments which are managed by the state government or to tertiary centres which are managed by the federal government (Olonade). However, it has been found that the efficiency of these tiers is not that strong due to a poor referral system. This means that delivering medical care is not as productive because referrals are delayed and women are not being seen as quickly as they should be by medical staff (Osain). Furthermore, actually receiving care in these facilities is not always possible. In Beatrice Wuraola Ope’s article published in the Journal of Global Health Reports, the author brings to light a topic which Olonade also touches on: the importance of addressing socio-cultural factors. These factors include how modern healthcare facilities are viewed by women in Nigeria. For instance, some women believe that modern facilities do not provide the same level of care as more traditional birth settings (such as their home) since traditional birth attendants that aid in childbirth are more compassionate and provide native medicine. Lack of awareness and education play a role in these cultural views which needs to be addressed in order to influence Nigerian women to receive care in medical facilities. Furthermore, due to Nigeria’s patriarchal culture, women’s subordination to men means that even while they are pregnant, they may still have to take care of their homes and their communities. This leaves them with little time to rest, which is dire when it comes to ensuring a healthy pregnancy (Olonade).

The cost of healthcare is also a leading factor of maternal mortality within the nation.

In the article, “Health Care in Nigeria: Challenges and Recommendations,” Aregbeshola Bolaji Thu addresses the high cost of healthcare and provides solutions to the economic barriers of receiving maternal care. Thu states that while women have been declared as a

vulnerable population and are sometimes granted benefits of free services, they still are seen to be having to pay expensive costs for medical care. To combat these high costs, the author suggests three different means of payment coverage: state health insurance, state funded private insurance, and universal health care. While each idea would provide more stability, the latter seems to be the most beneficial towards the nation as a whole. This is due to the fact that there are high poverty rates within Nigeria. If a majority of the population is experiencing the rampant effects of poverty, they are already at higher risks of having medical issues. These individuals are way less likely to be able to afford medical care, therefore making universal healthcare a major method to increasing access to healthcare.

References:

Aregbesholaon, B. (2019). Health Care in nigeria: Challenges and recommendations.

socialprotection.org. Retrieved October 21, 2021, from https://socialprotection.org/discover/blog/health-care-nigeria-challenges-and-recommendations.

Ariyo, O., Ozodiegwu, I. D., & Doctor, H. V. (2017). The influence of the social and cultural environment on Maternal Mortality in nigeria: Evidence from the 2013 Demographic and Health Survey. PLOS ONE, 12(12). https://doi.org/10.1371/journal.pone.0190285

Bolu-Steve, F. N., Adegoke, A. A., & Kim-Ju, G. M. (2020). Cultural beliefs and infant mortality in Nigeria. Education Research International, 2020, 1–10. https://doi.org/10.1155/2020/6900629

Ibukun Akinyemi Professor, A. (2021, July 9). Why Nigeria's weak health system affects women and girls the most. The Conversation. Retrieved October 21, 2021, from https://theconversation.com/why-nigerias-weak-health-system-affects-women-and-girls-the-most-163904.

Ikechukwu, H. U., Ofonime, N. U., Kofoworola, O., & Asukwo, D. E. (2020). Influence of cultural and traditional beliefs on maternal and child health practices in rural and urban communities in Cross River State, Nigeria. Annals of Medical Research and Practice, 1, 4. https://doi.org/10.25259/anmrp_4_2019

Olonade, O., Olawande, T. I., Alabi, O. J., & Imhonopi, D. (2019). Maternal mortality and maternal health care in Nigeria: Implications for socio-economic development. Open Access Macedonian Journal of Medical Sciences, 7(5), 849–855. https://doi.org/10.3889/oamjms.2019.041

Ope, B. W. (2020). Reducing maternal mortality in Nigeria: Addressing maternal health services’ perception and experience. Journal of Global Health Reports. https://doi.org/10.29392/001c.12733

Udenigwe, O., Okonofua, F. E., Ntoimo, L. F., Imongan, W., Igboin, B., & Yaya, S. (2021). Perspectives of policymakers and health providers on barriers and facilitators to skilled pregnancy care: Findings from a qualitative study in rural Nigeria. BMC Pregnancy and Childbirth, 21(1). https://doi.org/10.1186/s12884-020-03493-8

Welcome, M. O. (2011). The Nigerian Health Care System: Need for integrating adequate medical intelligence and surveillance systems. Journal of Pharmacy and Bioallied Sciences, 3(4), 470. https://doi.org/10.4103/0975-7406.90100

World Health Organization. (2019, July 1). Maternal health in Nigeria: Generating information for action. World Health Organization. Retrieved October 21, 2021, from https://www.who.int/reproductivehealth/maternal-health-nigeria/en/.

World Health Organization. (2020, February 3). Female genital mutilation. World Health Organization. Retrieved October 21, 2021, from https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation.