Engendering the Attainment of the SDG-3 in Africa: Overcoming the Socio Cultural Factors Contributing to Maternal Mortality

Rosemary N. Ogu, Kingsley N. Agholor, Friday E. Okonofua


At the conclusion of the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) provide an opportunity to ensure healthy lives, promote the social well-being of women and end preventable maternal death. However, inequities in health and avoidable health inequalities occasioned by adverse social, cultural and economic influences and policies are major determinants as to whether a woman can access evidence-based clinical and preventative interventions for reducing maternal mortality. This review discusses sociocultural influences that contribute to the high rate of maternal mortality in Nigeria, a country categorised as having made ―no progress‖ towards achieving MDG 5. We highlight the need for key interventions to mitigate the impact of negative sociocultural practices and social inequality that decrease women‘s access to evidence-based reproductive health services that lead to high rate of maternal mortality. Strategies to overcome identified negative sociocultural influences and ultimately galvanize efforts towards achieving one of the tenets of SDG-3 are recommended. (Afr J Reprod Health 2016 (Special Edition); 20[3]: 62-74).

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United Nations. Resolution adopted by the General Assembly on 25 September 2015: Transforming our world: the 2030 Agenda for Sustainable

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Development.http://www.un.org/ga/search/view_ doc.asp? Symbol=A/RES/70/1&Lang=E. Accessed 17 April 2016. 2. The Millennium Development Goals Report 2015. New York: United Nations; 2015 http://www.un.org /millenniumgoals/2015_MDG_Report/pdf/MDG%2 02015%20rev%20 (July%201).pdf, accessed 10 June 2016. 3. Nigeria 2015 Millennium Development Goals (MDGs) Endpoint Report. Accessed 15th of June 2016. Available at www.mdgs.gov.ng. 4. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the United Nations Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387(10017):462-74. 5. Alkema L, Zhang S, Chou D, Gemmill A, Moller A, Ma Fat D et al. A Bayesian approach to the global estimation of maternal mortality. 2015 (submitted for peer review; http://arxiv. org/abs/1511.03330 6. World Health Organization. Trends in maternal. mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015. 7. National Population Commission [Nigeria]. Nigeria Demographic and Health Surveys, 2008 and 2013. Abuja, Nigeria: National Population Commission, Federal Republic of Nigeria and MEASURE DHS+ ORC Macro. 8. Friday Okonofua, Kingsley Agholor, Rosemary Ogu, Hadiza Galadanci, Abdulahi Randawa, Eghe Abe et al. A Review of Obstetric Complications and Maternal and Neonatal Mortality in 8 Secondary and Tertiary Hospitals in Nigeria: Results of Retrospective review of management of obstetric complications in the hospitals. 2016 (submitted for peer review). 9. Zubia Mumtaz, George T H Ellison, Alyssa Ferguson, Sarah Salway. A call for transparency in the evaluation of global maternal health projects. Lancet. 2016; 388(10043): 461. 10. Strategies towards ending preventable maternal mortality (EPMM). Geneva: World Health Organization; 2015 http://www.everywoman everychild.org /images/EPMM_final_report_2015.pdf, accessed 17 April 2016. 11. Nicolai S, Hoy C, Berliner T, Aedy T. Projecting Progress: Reaching the SDGs by 2030. London: Overseas Development Institute. 2015. Accessed 13 August 2016. http://www.odi.org/sites /odi.org.uk/ files/odi-assets/publications-opinion-files/9938.pdf. 12. Moss NE. Gender equity and socioeconomic inequality: a framework for the patterning of women's health. Soc Sci Med. 2002; 54(5):649-61. 13. Harrison K A. Childbearing, Health and Social Priorities:

a survey of 22774 consecutive hospital births in Zaria, Northern Nigeria. BJOG 1985, 92, Supplement 5, 1-119. 14. Kelsey A Harrison. The Struggle to Reduce High Maternal Mortality in Nigeria. Afr J Reprod Health. 2009;13(3):9-20. 15. Ezeanochie MC, Olagbuji BN, Agholor KN, Okonofua FE. Attaining MDG 5 in northern Nigeria: need to focus on skilled birth attendance. Afr J Reprod Health. 2010; 14(2):9-15. 16. Doctor HV, Findley SE, Afenyadu GY. Estimating maternal mortality level in rural northern Nigeria by the sisterhood method. Int J Popul Res. 2012;2012 :464657. 17. Fiske EB. World atlas of gender equality in education. United Nations Educational, Scientific and Cultural Organization. 2012. Accessed 10 August 2016. http://www.uis.unesco.org/Education/Documents/u nesco-world-atlas-gender-education-2012.pdf. 18. Brock C, Cammish N. Factors affecting female participation in education in seven developing countries. Second Edition. 1997. Department for International Development - Education Papers. 19. Fetuga MB, Njokanma O, Olanrewaju D: Child Labour and School Absence in Sagamu Local Government Area of Ogun State. Niger Med Practition 2004, 46. 20. Owoaje ET. Ige OK, Bamgboye E. Working School Children in a Nigerian Community: Revisiting the Issues Int J Health Res, March 2011; 4(1): 11 – 19 21. World Health Organization. Health in Asia and Pacific. 2008. http://www.wpro.who.int/health_ information _evidence/documents/Health_in_Asia_Pacific.pdf,a ccessed 24 April 2016. 22. Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study. BMC Public Health. 2009; 9: 462. 23. Esiet AO, Esiet U, Philliber S, Philliber WW. Changes in knowledge and attitudes among junior secondary students exposed to the family life and HIV education curriculum in Lagos State, Nigeria. Afr J Reprod Health. 2009; 13(3):37-46. 24. Arnold R, Maticka-Tyndale E, Tenkorang E, Holland D, Gaspard A, Luginaah I; HP4RY Team. Evaluation of school- and community-based HIV prevention interventions with junior secondary school students in Edo State, Nigeria. Afr J Reprod Health. 2012; 16(2):103-25. 25. Okonofua FE. Promoting Youth Sexual and Reproductive Health in Africa: The Need for a Paradigm Shift. African Journal of Reproductive Health. 2012; 16(2): 9-11. 26. Kivela J, Ketting E, Baltussen R. Cost analysis of school-based sexuality education programs in six countries. Cost Eff ResourAlloc. 2013; 11(1):17. 27. Oshi, D.C., Nakalema, S., & Oshi, L.L. (2005). Cultural and social aspects of HIV/AIDS sex education in secondary schools in Nigeria. J Biosoc Sci. 2005;

Ogu et al. Over coming Inequality in sub-Sahara Africa

African Journal of Reproductive Health September 2016 (Special Edition); 20(3): 73

(2):175-83. 28. UNESCO. Comprehensive Sexuality Education: The Challenges and Opportunities of Scaling-up. Paris: UNESCO. 2012. 29. Ahmed SM, Rawal LB, Chowdhury SA, Murray J, Arscott-Mills S, Jack S et al. Cross-country analysis of strategies for achieving progress towards global goals for women's and children's health. Bull World Health Organ. 2016;94(5):351-61. 30. Raynor J, Wesson K. The girls‘ stipend program in Bangladesh. J Educ Int Dev. 2006;2(2):1–12) 31. Marchie CL, Anyanwu FC. Relative contributions of socio-cultural variables to the prediction of maternal mortality in Edo South Senatorial District, Nigeria. Afr J Reprod Health. 2009;13(2):109-15 32. Vladimirova K, Le Blanc D. How well are the links between education and other sustainable development goals covered in United Nations flagship reports? A contribution to the study of the science-policy interface on education in the United Nations system. United Nations Department of Economic and Social Affairs Working paper no. 146. 2015. 33. United Nations International Conference on Population and Development, Programme of Action, 1994, , accessed June 15. 2016. 34. Fawole OI, Adeoye IA. Women‘s status within the household as a determinant of maternal health care use in Nigeria. African Health Sciences. 2015; 15(1):217-225. 35. Acharya DR, Bell JS, Simkhada P, van Teijlingen ER, Regmi PR. Women‘s autonomy in household decision-making: a demographic study in Nepal. Reproductive Health. 2010; 7:15. 36. Federal Ministry of Health, Nigeria/UNICEF. Women and children rights in Nigeria: A wake up call - Situation assessment and analysis. Abuja, Nigeria: Federal Ministry of Health; 2002. 37. Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middleincome countries: a qualitative evidence synthesis. Reprod Health. 2014;11(1):71. 38. National Population Commission [Nigeria]. Nigeria Demographic and Health Surveys, 2008. Abuja, Nigeria: National Population Commission, Federal Republic of Nigeria and MEASURE DHS+ ORC Macro. 39. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5.Lancet.2010;375(9726):160923. 40. A global financing facility in support of every woman every child: concept note. Executive summary. Washington DC: World Bank; 2014 (http://www.

worldbank.org/content/dam/Worldbank/document/ HDN/Health/GFFExecutiveSummaryFINAL.pdf, accessed 5 February 2015. 41. Okonofua F, Lambo E, Okeibunor J, Agholor K. Advocacy for free maternal and child health care in Nigeria--Results and outcomes. Health Policy. 2011; 99(2):131-8. 42. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion. Paper 2 (Policy and Practice). 43. Veenema TG, Thornton CP, Corley A. The public health crisis of child sexual abuse in low and middle income countries: an integrative review of the literature. Int J Nurs Stud. 2015; 52(4):864-81). 44. Nasrullah M, Zakar R, Krämer A. Effect of child marriage on use of maternal health care services in Pakistan. Obstet Gynecol. 2013; 122(3):517-24. 45. International Centre for Research on Women (ICRW). Child Marriages, Facts and Figures; 2010 46. Walker JA. Early marriage in Africa--trends, harmful effects and interventions. Afr J Reprod Health. 2012; 16(2):231-40. 47. Erinosho O, Isiugo-Abanihe U, Joseph R, Dike N. Persistence of risky sexual behaviours and HIV/AIDS: evidence from qualitative data in three Nigerian communities. Afr J Reprod Health. 2012; 16(1):113-23. 48. Ahanonu EL. Attitudes of Healthcare Providers towards Providing Contraceptives for Unmarried Adolescents in Ibadan, Nigeria. Journal of Family & Reproductive Health. 2014; 8(1):33-40. 49. Gladstone R. Nigerian President signs ban on same-sex relationships. [accessed Aug 14 2016]; 2014 Jan 13; http://www.nytimes.com/2014/01/14/world/africa/n igerian-president-signs-ban-on-same-sex-relation ships.html. 50. Gboyega Akinsanmi. Nigeria: Reproductive Health Bill, Have We Seen the End? Accessed 15 August 2016. This Day http://allafrica.com/stories/2006 0510 017 0.htmlref. 51. Child Right Act. 2003. Accessed 15 August, 2016. http://www.lawyard.ng/wp-content/uploads/201 6/01/CHILD%E2%80%99S-RIGHT-ACT.pdf. 52. Braimah TS. Child marriage in Northern Nigeria: Section 61 of Part I of the 1999 Constitution and the protection children against child marriage. African Human Rights Law Journal. 2014; 8 (2): 24). 53. Doctor HV, Findley SE, Ager A, Cometto G, Afenyadu GY, Adamu F, Green C. Using community-based research to shape the design and delivery of maternal health services in Northern Nigeria. Reprod Health Matters. 2012 Jun;20(39):104-12. 54. Ahmed S, Li Q, Liu L, Tsui AO. Maternal Deaths Averted by Contraceptive Use: An Analysis of 172 Countries. The Lancet 2012; 380(9837): 111–25. 55. Okpani AOU, Ogu R, Okonofua FE. Promoting Sexual and Reproductive Health in Africa: The Role of

Ogu et al. Over coming Inequality in sub-Sahara Africa

African Journal of Reproductive Health September 2016 (Special Edition); 20(3): 74

Family Planning. In: Okonofua FE (Editor). Confronting the Challenge of Reproductive health in Africa. Brown Walker Press, Florida, USA. ISBN-13: 978-1-62734-508-8. 2014; 263 – 279. 56. Ogu R, Okonofua F, Hammed A, Okpokunu E, Mairiga A, Bako A, Abass T, Garba D, Alani A, Agholor K. Outcome of an intervention to improve the quality of private sector provision of postabortion care in northern Nigeria. IJGO 2012:118(2); S121-S126. 57. Onwuzurike BK, Uzochukwu BS. Knowledge, attitude and practice of family planning amongst women in a high density low income urban of Enugu, Nigeria. Afr J Reprod Health. 2001; 5(2):83-9. 58. Adanikin AI1, Onwudiegwu U, Akintayo AA. Reshaping maternal services in Nigeria: any need for spiritual care? BMC Pregnancy Childbirth. 2014; 14:196. 59. Udoma EJ, Ekanem AD, Abasiattai AM, Bassey EA. Reasons for preference of delivery in spiritual church-based clinics by women of south-south Nigeria. Niger J Clin Pract. 2008 Jun;11(2):100-3. 60. Friday Okonofua, Kingsley Agholor, Rosemary Ogu, Ola Okike, Adeola Abdus-salam , Mohammed Gana, et al. Opinions and Perceptions of Nigerian Women Regarding the Quality of Maternal Health Care in Referral hospitals: Results of Focus Groups Discussions. BMC Reprod Health. Article in press 61. Widmer M, Betran AP, Merialdi M, Requejo J, Karpf T. The role of faith-based organizations in maternal and newborn health care in Africa. Int J Gynaecol Obstet. 2011;114(3):218-22. 62. Okonofua FE. Maternal mortality prevention in Africa— need to focus on access and quality of care. Afr J Reprod Health. 2008; 12(3):9-16. 63. Piotrow PT, Rimon JG, Winnard K, Kincaid DL,

Huntington D, Convisser J. Mass media family planning promotion in three Nigerian cities. Stud Fam Plann. 1990 Sep-Oct;21(5):265-74. 64. Fatusi AO, Jimoh A. The roles of Behaviour Change and Communication and mass media. (2006). In O. Adeyi (Ed.), AIDS in Nigeria: A nation on the threshold. (pp. 323-348). Cambridge, MA: Harvard Center for Population and Development Studies. Retrieved from http://www.apin.harvard.edu /Chapter15.pdf. Assessed 13th August 2016. 65. National Action Committee on AIDS. National HIV and AIDS Behavior Change Communication. Five-Year Strategy (2004–2008). Abuja: National Action Committee on AIDS, 2005. 66. Knowledge for Health. Community Based Family Planning (CBFP) Approaches. Accessed 31 Aug 2016. Available at https://www.k4health .org/tool kits/ communitybasedfp/cbfp-strategies. 67. Population Services International (2011). Total Market Approach to Family Planning in Cambodia: A Case Study. Washington, DC: PSI. 68. Abdul-Hadi RA, Abass MM, Aiyenigba BO, Oseni LO, Odafe S, Chabikuli ON et al. The effectiveness of community based distribution of injectable contraceptives using community health extension workers in Gombe State, Northern Nigeria. Afr J Reprod Health. 2013 Jun;17(2):80-89. 69. United Nations Population Fund (UNFPA). UNFPA Strategy on Adolescents and Youth: Towards realizing the full potential of adolescents and youth. Accessed Aug 30 2016. Available at: (https://www .unfpa.org/sites/default/files/resource-pdf/ UNFPA %20Adolescents%20and%20Youth%20Strate gy.pdf).


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