—– The Millennium Development Goals (MDGs) probably constitute the most audacious plan ever made by man to address the most pressing problems of the human race which, over the years, have condemned mankind to circles of poverty, ignorance, hunger and disease. Acting in concert and driven by a yearning to make the world a better place for all in this millennium, 189 Heads of States and Governments assembled in New York, United States of America, in September 2000, and ratified as well as committed themselves to 8 development goals with 21 quantifiable targets that were to be measured by 60 clearly defined indicators for their achievements by 2015, as being the pillars of progress on which substantial improvement in the quality of life and well-being of the human race was to be predicated (1). While the goals address topics as divergent as information technology and the provision of essential drugs to developing countries, the eradication of poverty and its devastating effects on mankind, is recognized as the core issue and major object of the MDGs. Accordingly, although MDG 1 addresses the issue of poverty eradication and hunger specifically, references are made in many of the others, if obliquely, to the centrality of poverty in robbing mankind of his full potentials and in denying him a good quality of life.
Unfortunately, executing and meeting the targets set for the nations of the world to achieve the MDGs have proved to be far more difficult than the process of articulating them, especially for countries in Sub-Saharan Africa, due to a variety of reasons. The MDG Progress Report of April 2008 indicates that despite the impressive annual economic growth in excess of 5% in recent times, attributable mainly to its position as the world’s 8th largest exporter of oil, Nigeria, with a population of about 140 million people, the largest in Africa, has been unable to reflect this growth in the quality of life of its ordinary citizens. The country has remained in the bottom quartile of the Human Development Index with over 60% of its population still living on less than one US dollar a day.
Implementing the MDGs with respect to Women’s Health, the subject of today’s lecture, is an important overall strategy by which the MDGs could be achieved as the health of its people represents one of a nation’s greatest assets. For it is only a roundly healthy people that can institute the good governance on which development thrives, engage in robust mechanized agriculture that will provide sufficient food, build the schools where the people will be educated, and construct the dams and carry out the purification processes that would provide clean water, as was envisaged in the MDGs. As for the specific reference to women, we agree with the organizers of the summit that this is as it should be. For, on account of the many ways by which women impact our lives as mothers, care providers, teachers, home builders, nation builders and growers of the economy, despite the subtle and sometimes open discriminations that they suffer, ensuring the health of the woman, is an important step in ensuring the health of the family – the building block of society.
With this as introduction, the lecture will go on to throw some light on the issue of women and poverty before examining the MDGs that have to do with Women’s Health (MDGs 4, 5 and 6) in order to define their true significance. Next it will review the major causes of ill health in women which cause mortality and morbidity. Furthermore, on the understanding that good health is not merely the absence of disease, but also the presence of a state of physical and mental well-being, the lecture will touch on some other issues which though not having a direct bearing on health, debase the status of women and so compromise their physical and mental well being. The concluding part will draw attention to what roles governments can play in enhancing these processes and thereby respond to the needs of women.
Women and Poverty
Because poverty is central in the MDGs, its eradication in vulnerable groups must be seen as the plank on which implementing most of the development goals should be rationally based. Unfortunately, a number of circumstances have brought about a situation where women are the poorer of the two genders globally but especially so in those societies whose economies are in a state of transition, and with special reference to countries in sub Saharan Africa.
Women carry the burden of two thirds of the total hours of the work performed. For this they earn 10% of the world’s income, slightly more than 50% of what men earn in comparable positions, and own but 1% of global property. (2,3) Women, especially those in developing countries, Nigeria inclusive, constitute the vast majority of the over 1.2 billion people who live on less that one dollar a day, making poverty to “carry a woman face” ( 4).
Although poverty affects households as a whole, women bear a disproportionate load of the problem as they attempt to manage household consumption and production under conditions of increasing scarcity (5) – a situation which no doubt will be aggravated by the current global food crisis. Such poverty badly affects Women’s Health especially their reproductive and sexual health.
This unequal weight of poverty that is borne by women, has been discussed in many world fora, conferences and commissions with a view to seeking avenues for its eradication (Beijing+5 in 2000, forty-ninth session of the Commission on the Status of Women in 2005); the Platform For Action described as the Action For Equality, Development and Peace, which was announced at the United Nations Fourth World Conference on Women, held in Beijing, China, in September 1995, is instructive:
development strategies that address the needs and efforts
of women in poverty.
equal rights and access to economic resources.
and institutions.
Address the feminization of poverty. (5)
What becomes clear is that the elimination of female gender-based poverty is an important precursor for the attainment of the MDGs including those that pertain to Women’s Health.
MDGs and Women’s Health (MDGs 4, 5 and 6)
A good number of the MDGs address women’s issues and the matter of their health as a fundamental area of global concern; directly in some, indirectly in others. For instance, Goal 3 requests for the elimination of gender disparity in primary and secondary school education, while in Goal 7, subjects on access to safe water and slum dwellers, among others, are ventilated. These matters concern women mostly and in some way impact on their health. Elaborating on MDGs 4, 5 and 6 as those that have bearing on women’s health should therefore be seen as an expediency imposed by time constrain.
MDG 4 requests for the reduction by two thirds, the mortality rate among children under five years of age.
Although these deaths have declined by an average of 11% worldwide, they have not changed appreciably in most countries of sub Saharan Africa, Nigeria inclusive, where malaria, diaorrhoeal diseases, vaccine preventable diseases and acute respiratory tract infections constitute the major causes of death. While poor environmental sanitation and hygiene, inadequate immunization coverage, malnutrition and deprivation are some of the root causes of these under five mortalities, the child wastage they result in, drive women to repeated pregnancies and higher parities with all their attendant ills. Furthermore, high parity saps women of their resources – financial and otherwise – especially in areas with poor social infrastructure to support the needs of mothers and children. In addition, high parity constrains women to spend a disproportionate part of their lives rearing children instead of engaging themselves on other issues that improve the quality of their lives, particularly education, skills acquisition and building their personal capacities. By seeking to reduce child mortality rates therefore, MDG 4 can also be said to be seeking to improve women’s health.
In MDG 5 the issue of maternal health is directly addressed with a request to reduce maternal mortality ratio (number of women who die per 100,000 births) by three quarters by 2015.
A large number of women become pregnant at one time or the other during the course of their lives. Their expectation is that pregnancy and childbirth would be normal physiological processes from which they would neither die nor sustain serious disabilities. Unfortunately this is not so for a good number of women especially the poor, illiterate and deprived women in underdeveloped countries, where over one half of a million deaths occur annually in circumstances surrounding pregnancy and childbirth, mainly as a result of inadequate care and complications, akin to the crashing of a jumbo jet every day with full complement of passengers and with no survival. Some who escape death end up with serious injuries to their reproductive tracts and other parts of their bodies which deny them good health, sometimes for the balance of their lives. Ensuring safe motherhood thus becomes an important pathway for ensuring women’s health.
MDG 6 specifically mentions some diseases – HIV/AIDS and Malaria and also makes reference to “other major diseases”. It demands that the nations of the world should “half and begin to reverse the spread of HIV/AIDS” and also “half and begin to reverse the incidence of malaria and other major diseases” all by 2015.
Even though HIV/AIDS was first discovered as a new disease among young homosexual men in the United States of America in 1981, the disease is now commoner amongst females in sub Saharan Africa. Caused by infection by a retrovirus which attacks the natural immune system of the body, thereby making it possible for many different infectious diseases, including those called opportunistic infections that are usually only able to strike when the body’s defenses are weakened, the disease causes severe ill health, desolation and death. Halting and reversing the spread of HIV/AIDS therefore would serve as a major boost to women’s health globally but especially so, for women in sub Saharan Africa. As for malaria, although women who live in holoendemic areas like most parts of sub Saharan Africa would probably have acquired sufficient immunity to ward off frequent attacks of the disease, the disease has its most deleterious effects on children and new-born babies as well as pregnant women – especially those having their first and second pregnancies, where it causes febrile episodes, spontaneous abortions and intrauterine growth retardation. Reducing malaria attacks in an environment will benefit women’s health especially those that are pregnant.
Mortality/Morbidity in Women
1. Pregnancy related
In many instances, society behaves as if women do not matter. This is reflected in the widely shared preference for male children, the number of women that are allowed to attain top decision-making positions and the various forms of violence that women suffer, among others, all of which, in some way, impact on the overall quality of their health. But perhaps nothing is more revealing of society’s nonchalant and indifferent attitude to Women’s Health than the number of women that are allowed to die or to sustain serious disabilities, most times needlessly, in the course of pregnancy and childbirth. And it is possible that this dreadful neglect prompted the inclusion of Maternal Health in the MDGs for indeed, maternal mortality, the death of a woman while pregnant or within 42 days thereafter, is a developmental matter.
Maternal death has thus become a yardstick by which the quality of Women’s Health is appraised – the death rates being highest in areas of the world where women are accorded a low status by the society and their health issues not considered with any measure of priority. Improving maternal heath and by extension Women’s Health, by drastically reducing the maternal mortality ratio as is requested in the MDGs will therefore involve grappling with the wider issues of female poverty and dependency, female illiteracy and ignorance and harmful cultural practices and taboos that affect them, among many others, which in several instances pave the path to maternal death. In addition, the actual medical causes of death and disability which arise in most instances from complications of pregnancy and labour must be vigorously treated (6).
Globally, 99% of all maternal deaths occur in underdeveloped countries. Of the 430 estimated maternal deaths per 100,000 births that occur worldwide, the estimated ratios are 480 for underdeveloped countries and 27 for the developed countries. These ratios can be translated into women’s lifetime risks of dying from pregnancy/pregnancy-related causes as follows: 1 chance in 48 in the underdeveloped countries contrasted with 1 chance in 1,800 in developed ones. The highest maternal mortality levels are found in parts of India, eastern and western Africa with some of the least developed countries of the world (800-1,000 per 100,000 births in Nigeria); the lowest levels occur in northern Europe with some of the best developed countries of the world (<4 per 100,000 births in Finland).
Our country, Nigeria, has some of the worse statistics relating to maternal mortality in the developing world. Worldwide, an estimated 529,000 women die each year from the complications of pregnancy and childbirth, essentially from 13 underdeveloped countries. Of these, an estimated 55,000 deaths occur in Nigeria alone. Thus, although Nigeria accounts for only 2% of the world’s population, it produces 10% of the global estimates of maternal deaths. The only country that has a higher absolute number of maternal deaths is India with 136,000 maternal deaths each year (7, 8 and 9).
More than 70% of all maternal deaths in Nigeria are due to five major complications of pregnancies: profuse blood loss from the genital pathway that occurs before, during or after delivery causing insufficiency of available blood for the functions of the body, severe genital tract infections during or after parturition leading to generalized body infection, obstructed labour and the problems that follow it, disorders of high blood pressure in pregnancy, and complications of unsafe abortion. In most instances these conditions are preventable and treatable but mothers still die on account of a number of factors: widespread poverty resulting in inability of some to access or pay for medical services; ignorance which precludes those affected from utilizing existing medical services and weak health infrastructure with a very poor referral system which is unable to respond satisfactorily and swiftly to the demands of critically ill patients (10).
Even in the face of severe complications in pregnancy and labour, not all women die; some escape, but, not infrequently, with some serious debilities. Although these are many, mention will be made only of two here, again, as a result of time constrains: obstetric fistulae and blockage of the fallopian tube.
Obstetric fistulae are abnormal communications between the vagina and adjacent soft tissues – commonly the bladder (Vesico Vaginal fistula, VVF) and/or the rectum (Recto Vaginal Fistula, RVF). They arise as a result of prolonged and neglected unrelieved obstructed labour from cephalo pelvic disproportion causing devitlization and pressure necrosis of adjacent tissues (bladder and/or rectum) which then slough off leaving a hole between that soft tissue and the vagina, as the abnormal communication. The disease is found mostly in illiterate, poor and deprived women with contracted pelves, either from having married too early when they had not attained their full growth potentials, or from a generalized stunting associated with chronic malnutrition. Labour in such circumstances will be seen to have commenced usually from home or similar environments where informed and specialized care was absent.
The magnitude of the disease world wide is unknown but the WHO estimates that there are about 2 million untreated cases and that 100,000 new cases get formed each year mainly in sub Saharan Africa but also in parts of South and Central Asia, Latin America, the Middle East and isolated parts of the former Soviet Union and Soviet dominated Eastern Europe. The incidence in one Nigerian hospital was given as 350 per 100,000 deliveries.
Obstetric fistulae result in continuous and uncontrollable leakage of urine and/or faeces from the vagina and they constitute some of the most dehumanizing diseases anyone can ever suffer as those affected get ostracized as a result of the strong, pungent and offensive smell of urine and/or faeces.
As for fallopian tubal occlusion, the condition arises from tubal infection commonly as a result of botched abortions or infections from the genital track during poorly managed labours and puerperia. Such infections, giving rise to tubal blockage, are responsible for the vast majority of cases of secondary infertility which are often found in many Gynaecology clinics in several parts of Africa.
2. Not-pregnancy related
Only very few of the large gamut of diseases which cause death and ill health in women outside those that are caused specifically as a result of pregnancy and labour can be mentioned here: HIV/AIDS, once again, because of its “female face”; female cancers because of how inadequately we treat them and the Non- Communicable diseases because of the futuristic harm that they can cause. Although any of these conditions can occur in the pregnant or puerperal woman and thereby complicate issues further, the brief annotations that will be made on them here will not take that into consideration.
The HIV infection is now pandemic in humans as it is estimated that 40 million of the world’s population now lives with the virus. As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the WHO estimate that AIDS has killed more than 25 million people since it was first recognized on December 1, 1981, making it one of the most destructive pandemics in recorded history (11).
Over time however, the disease has become essentially an African, and in particular, a sub-Saharan African problem where more than a third of the deaths occur, retarding economic growth, deepening poverty and making large of children orphans. Africa with just over 10% of the world’s population carries well over 75% of the burden of the disease and in 2005 lost 2.4 million adults and children to AIDS. (12,13). Southern Africa is home to 15 million people living with AIDS or 40% of the world wide total of 40 million people living with the virus.
Rather unfortunately, women, including married women, increasingly have to bear a greater portion of the burden of the disease especially in sub-Saharan Africa where almost 57% of all individuals living with HIV/AIDS are women (14). For Africans aged 15-24 years living with HIV/AIDS, women account for 76% of all infections. In South Africa, Zambia and Zimbabwe, young women ages 15-24 years have rates of infection that are between three and six times that of their male peers; while in Nigeria, the National Reproductive Health Survey of 2003 showed that young girls have a twice higher risk of contracting the HIV than boys of their age.
This feminization of the disease is sequel to some social determinants of gender disparities, including poverty, cultural and sexual norms, lack of education, men’s predatory sex behaviour and violence. Women are also more susceptible to HIV because of hormonal changes, vaginal microbial ecology and physiology, as well as a higher prevalence of sexually transmitted diseases. Prevention strategies must therefore address the wide range of gender inequalities that promote the dissemination of HIV (14).
Regarding female cancers, let us here limit ourselves again to just two: breast cancer and cancer from the neck of the womb (cervical cancer).They both cause sufficient deaths as to attract serious attention; with care, each can be identified in its infancy and extirpated; they lend themselves to some preventive measures which make them attractive as avenues for Governments to launch Cancer Prevention Measures for its citizens.
Patients with breast cancers in African populations tend to be young (average age 44 years) with about 86% of them presenting with large advanced tumours – a situation which most times allows hygienic mastectomy as the only means of intervention. This contrasts with the situation in the Caucasians where the disease is commoner in obese postmenopausal women (average age 55 years) and with less extensive growths – permitting the use of a wider array of curative measures. Accordingly, the five year survival rate of 85% in the Caucasians is markedly different from that in Africans, which is a mere 10%.
Over 80% of mortalities from carcinoma of the cervix occur in developing countries, usually from advanced end-stage disease. In Nigeria, the disease is found in parous women in their 40s and 50s and because presentation is usually late, treatment options are very limited.
Obesity (body mass index of 30 and above), Diabetes Mellitus (fasting blood sugar level of above 7mmol/litre) and Hypertension (BP reading of 140/90 mmHg and above), non communicable diseases, which are also known as silent killers, are becoming serious problems everywhere, including Africa. They are closely related as Obesity not only triggers Diabetes and Hypertension, it also makes their control that much difficult. Taken together, they constitute the commonest cause of sudden death in any society and their prevalence is on the increase in African communities due to ageing of the population and drastic lifestyle changes accompanying urbanization and westernization (15). They are associated with long term chronic debilitating conditions, especially clogging of the arteries known as atherosclerosis – a build up and hardening of fatty deposits within blood vessels, resulting ultimately in blockages. Left unchecked therefore, they will apply serious pressures on health delivery systems in the future particularly in African countries.
Other Issues that Impact on Women’s Health
The point was made earlier that good health is not merely the absence of disease, but also the presence of a state of physical and mental well-being. It is with this in mind that the lecture will now touch on some other issues which though not having a direct bearing on health, debase the status of women, portray them as inferior to men and so compromise their physical and mental well being. They include the obnoxious and discriminatory customs and laws in marriage, inheritance, bereavement and wealth acquisition. But in no where else is the situation starker as it is in the various forms of violence that women suffer. Just a few examples will suffice here.
So important is the issue of violence against women that the theme was chosen by the United Nations for the 2007 International Women’s Day, which was observed on the 8th of March, 2007.The topic was “Ending Impunity for Violence Against Women and Girls” and on that day, which was set aside for a reflection on the health and lives of women and their progress in civil society, many persons received messages from the International Federation of Gynaecology and Obstetrics (FIGO), urging them to persuade civil society to respect and value women and to support their sexual and reproductive rights.
The message identified gender-based violence, which could have serious health consequences for women, including adverse outcomes of pregnancies, as a public health problem affecting girls and women in all social strata in all countries of the world.
In Nigeria, as is elsewhere, gender-based violence as it affects women is manifested in many forms, including wife battering, physical violence, sexual abuse, genital mutilation, trafficking of women and girls and child marriage – again, time will allow only a cursory elaboration on just a few of these.
The term “trafficking in persons” is restricted to instances where people are deceived, threatened, or coerced into situations of exploitation, including prostitution. Trafficking of Nigerian girls and women, usually between the ages of 17-20, to Europe for prostitution, which began in 1992, has become a big business in recent times. The largest group of prostitutes in Western Europe from sub-Saharan Africa comes from Nigeria while Italy remains the country of first choice for would-be Nigerian prostitutes probably because prostitution is legalized in that country.
Female Genital Mutilation (FGM) or Female Genital Cutting (FGC), also known as Female Circumcision (FC), is a practice that is widespread in Nigeria, embraced to varying degrees, as a cultural dictate, by many ethnic groups in the country. Estimates obtained from the 1999 Demographic and Health Survey indicated that about 25.1% of women had had one form or the other of this surgical operation.
The erroneous belief is that uncircumcised women are promiscuous, unclean, unmarriageable, physically undesirable and/or potential health risks to themselves and their children, especially during childbirth. One traditional belief is that if a male child’s head touches the clitoris during childbirth, the child will die (16).
While it is doubtful if any good follows any type of female circumcision, the condition, especially in the cases in which large measures of vaginal and vulval tissues are removed, is clearly associated with social as well as medical complications which could be life threatening especially during labour. Aside from compromising the pleasure which sexual stimulation of the clitoris brings about, FGM can lead to infection, haemorrhage, vaginal stenosis, infertility and obstructed labour.
Implementing the MDGs
From the above text it can be surmised that Implementing the MDGs with respect to Women’s Health will have to be a two-prong attack: preventing and dealing with major disease conditions that affect women’s health on the one hand and using legislation to do away with those obnoxious and discriminatory customs, taboos and laws that debase women and condemn them to an inferior status as well as empowering them financially and otherwise, so as to reduce their level of poverty and dependency, on the other hand. In all this, Government must be seen to take the lead and to provide the actions, policies and enabling environment for, implementing the MDGs is a responsibility of Government in the first place.
Regarding the medical conditions, those that cause death and disabilities in pregnant and puerperal women should take precedence as indeed maternal death has become a yardstick by which the quality of maternal health is appraised and in this respect, as was stated elsewhere (17), the path to improving maternal health involves an integrated range of care which should commence from the early childhood of the female child. Furthermore, with specific reference to reduction in maternal mortality ratio it should be understood that an important way by which this can be achieved, is to get basic health services, including maternity care, which is rooted within the context of Primary Health Care (PHC), to women in rural communities where they live and work (17).
The integrated range of care for the female child to which reference is being made involves the array of strategies which promote child survival, growth and balanced development. They include the avoidance of infanticide, exclusive breastfeeding, complete immunization, and paying attention to febrile and diarrhoeal diseases. In the adolescent period, the female child should be properly educated including on family life matters and should be made to acquire skills. She should avoid risky sexual behaviours that could expose her to an unwanted pregnancy or contracting the HIV virus.
Expert care during pregnancy, labour and the puerperium that is available to all women irrespective of where they reside and work is the fundamental approach to reduction in maternal deaths and disabilities and in this respect, we wish to observe that since the ground-breaking Safe Motherhood Conference of 1987 in Nairobi, Kenya, global attention has been directed to the issue of poor maternal health leading to deaths and disabilities, as has never been the case. At the country level, the former President, Chief Olusegun Obasanjo, appointed a Special Adviser on Maternal Health, and followed this up with the announcement that subsequently, medical care for all pregnant women and children under five, are to be free in all Federal Government-owned Health Institutions, a measure that was already in place in some States in the Federation, including Rivers State. Furthermore, the wife of the current President, Ahjia Turai Yar’ Adua, has made it known that she would mount programmes that will aim at reducing maternal and childhood mortalities. These measures, coupled with the on-going reactivation of Primary Health Care (PHC) centres across the country, the revamping of tertiary hospitals via the VAMED programme, and the proposed inclusion of Midwifes into the National Youth Service Corps (NYSC) programme, are seen by many as bold steps which ultimately should help in reducing the number of women who die in pregnancy-related circumstances.
Additionally, steps must be taken to streamline, through Family Life Education, repeal of outdated laws and contraceptive usage, the issue of unsafe arbortions, where current estimates have it that as many as 610,000 are procured each year in Nigeria at a rate of 25 abortions per 1000 women aged 15-44 years (19).
Institutionalized routine screening of all vulnerable groups in the community and early intervention is the way by which many developed countries have brought down cancer related deaths. For cervical cancer, this has been through expanded national cytology screening through pap smears. It is therefore unfortunate that in many developing countries, there are no national cancer screening services. Because cancer of the cervix is essentially a sexually transmitted disease arising as a result of infections with types 16 and 18 Human Papilloma Virus (HPV), a new vaccine, Gardasil Vaccine, is being developed to fight the infection. As prevention against the disease, it is planned to vaccinate young girls between the ages of 9 and 26 years in three separate injections over a period of six months (0,3,6), before they commence sexual intercourse with Merck’s quadrivalent HPV vaccine, Gardasil, which has now been licensed in more than 45 countries. However, the vaccination does not guarantee protection against the cancer and several groups are already voicing disquiet on the intervention since the vaccine is really one to prevent a sexually transmitted disease.
Self breast examination which should be taught at schools remains an important way of identifying early cases of breast cancer. Also child bearing is known to protect against the disease and so does breastfeeding. On the whole, the longer a woman breastfeeds, the more she is protected against breast and ovarian cancers.
Multilateral initiatives and philanthropic organizations are currently contributing to the control of malaria. Many of the programmes that they run are integrative between the efforts aimed at ameliorating the effects of three infections: Malaria, HIV and Tuberculosis. The programmes include the Roll Back Malaria (RBM) project of WHO, the Global Fund For Malaria, HIV/AIDS and Tuberculosis to which the industrialized G8 nations have subscribed, Belinda and Bill Gates Funds and PEPFAR- President (Bush) Emergency Fund for AIDS Relief.
The distribution and use of insecticide treated bed nets is the main proposition of the RBM project which was launched in 1998, bringing together multilateral, bilateral, non-governmental, and private organizations. The plan of the project which was endorsed by the African Heads of State at a Summit in Abuja, Nigeria, in 2000, was to halve deaths from malaria by 2010.
Recommended for use by especially pregnant women and children under five, the nets which are effective for up to four years, prevent users from mosquito bites, and repel, as well as kill the insect. In addition, RBM advocates the use of combination therapies which contain artemisinine compounds for the treatment of cases of malaria to stem the high resistance rate of the parasites to conventional anti malarial drugs. It also advocates the intermittent treatment and protection of pregnant women against the infection throughout the course of pregnancy. However, environmental sanitation activities which reduce pools of stagnant water in cans, gutters and ditches that provide breeding grounds for mosquitoes or their treatment with pesticides such as DDT still have a major role in the control of malaria.
With a high burden of disease in Africa, including Nigeria, characterized by a wide array of infectious disorders, trauma and non-communicable ailments, which exist against a backdrop of poor and inadequate health services as well as constraints to socio-economic development, Nigerians must learn to assume some responsibilities for the maintenance of their own health by taking proactive actions on best practices that support good health. This is what is required with respect to a number of the conditions that cause mortality and morbidity. For instance the abstinence and faithfulness which serve as main antidote to contracting HIV infection and life style of abhorrence of physical inactivity, refraining from cigarette smoking, and the avoidance of obesity that ward off many non communicable diseases and sustain good heart health are issues that depend largely on personal responsibilities.
As for violence against women, be it rape, wife battering, trafficking in women or genital mutilation, nothing can justify this horrendous atrocity. Government, through public enlightenment, education, and enforcement of the law, must seek to extirpate such unwarranted assaults on women.
Happily, these practices are currently receiving widespread condemnation in Nigeria as well as in many others from NGOs, Cultural organizations, Professional Bodies, Women’s Organizations and various Governments. Every woman indeed counts and by raising awareness that these practices are unacceptable, a lot can be done to protect the fundamental rights of women.
Juxtaposed against these specific approaches to death, ill health and disabilities, nations of the world must now take steps to adequately address the issue of poverty especially among their susceptible and at risk groups, including women. And in this respect, it must be pointed out that the will that has been demonstrated by the international community to achieve the MDGS, including those that affect Women’s Health, is laudable. It has led to the invigoration of existing development agencies and the establishment of new ones. The Global fund for the Eradication of Malaria, Tuberculosis and HIV/AIDS is a good example. While in Africa, where some of the poorest countries in the world, with little or no development, exist, there is now NEPAD – the New Partnership for Africa’s Development.
Poverty is at the heart of the matter regarding the difficulty Nigeria as well as many other sub-Saharan African countries are facing in meeting the MDGS and to alleviate poverty, Nigeria must increase the opportunities for economic advancement while concurrently providing essential social services to the poor, especially women and children, and with particular reference to those in its fractured communities like the Niger Delta. Women empowerment through affirmative actions like female education, skill’s acquisition and micro credit financing as well as other well tested strategies are options for government which must act in this vein and support organizations that are ready to partner with it in such ventures.
Bangladesh with a population of 150 million, with frequent natural disasters and catastrophic seasonal floods, has now banished famine and put poverty on the retreat through a well-organised social empowerment scheme for the very poor, most of whom are women, through the Grameen Bank which was established by Mohammad Yunus, a university professor of economics and the recipient of the 2006 Nobel Peace prize. With an HDI of 0.345 in 1975 Bangladesh belonged to the group of low human development countries. By 2003 its HDI had moved up to 0.520 with the country placing among medium development countries. Nigeria and indeed Rivers State can make it also.
Conclusion
Eradicating poverty sets the scene for the implementation of the MDGs with respect to women’s health. Since their needs and responsibilities are so immense, diverse and complex, women consciously divert attention away from themselves to others – rearing children, caring for the household and contributing to its financial requirements. Forced by these circumstances and aggravated by their dependency, they subsume and sacrifice their own needs, especially with respect to their health. Therefore, tackling women’s health issues through the establishment of vertical programmes that principally address issues of mortality especially in mothers and children, as desirable as they are, are unlikely, on the final analysis, to have a profound and lasting impact on women’s health.
What is required is a combined assault on global poverty which is concentrated in the underdeveloped parts of Africa, Asia and Latin America, so as to elevate the quality of life of all mankind but especially women – providing them with the basic necessities of adequate food, potable water, livable shelters, a sustainable environment and functional education, while at the same time establishing basic care at the community level that is robust enough to satisfactorily handle most of the health needs of the people.
Good governance that is accountable, transparent and people oriented is fundamental to this transformational change. Nigeria must apply the full weight of its numerous recently acquired developmental tools – DUE PROCESS, EFCC, NEEDS, SEEDS, LEEDS, NEPAD, VISION 2020,SEVEN POINT AGENDA, to mention just a few, to establish policies and strategies that address the needs and efforts of women in poverty so as to ensure for them, equal rights to economic resources.
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Society of Gynaecology and Obstetrics of Nigeria (SOGON).
19.Henshaw Sk; Singh S; Oye-Adeniran B; Adowole IF et al (1998).The Incidence of Induced Abortions in Nigeria. International Family Planning Perspective; 24, 156- 163.
Implementing The Millennium Development Goals With Respect to Women’s Health, by Nimi Briggs, MD, FAS.*, Preye Fiebai, FWACS.**, Rosemary Ogu, FWACS, FMCOG (Nig)*** A Paper Presented at the Summit on Empowering Women Organized by Rivers State Ministry of Women’s Affairs.
*Professor ** Lecturer ***Senior Registrar
Pro-Chancellor and Chairman of Council, Federal University, Lokoja, Nigeria. February 2016
Member, Court of Governors, College of Medicine, University of Lagos, October 2015 for four years.
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