Gender Equity and Maternal Health Outcomes in Nigeria
Universal Health Coverage (UHC) is based on principles of equity (WHO, 2022). Gender inequality remains a critical challenge in the health sector. UHCC can only indeed be achieved if gender and other drivers of disparities within the health systems are actively considered and addressed. The WHO recognizes that gender is an essential determinant of health in two dimensions: gender inequality leads to health risks for women and girls globally, and addressing gender norms and roles leads to a better understanding of how the social construction of identity and unbalanced power relations between men and women affect the risks, health-seeking behavior and health outcomes of men and women in different age and social groups (WHO, 2021).
Gender Equity and Maternal Health Outcomes in Nigeria
Gender equity and maternal health outcomes are intricately linked in Nigeria, as in many other countries around the world, and there is a strong correlation between gender inequality and poor maternal health outcomes in the country. Reproductive, maternal, newborn, child, and adolescent health (RMNCAH) results remain poor in Nigeria due to low coverage of health services such as antenatal care (ANC), poor quality of services, and an array of inequities and inequalities. Nigeria has one of the highest rates of maternal mortality in the world and accounts for 19% of the world’s total maternal deaths (WHO, World Bank, and UNICEF, 2015). The 2018 Nigeria Demographic and Health Survey (NDHS) revealed a MM ratio of 512 per 100 000 live births (National Population Commission and ICF, 2019); recent estimates rank Nigeria fourth among nations with the highest MMR globally (UNICEF, 2021; 2023). Gender equality in Nigeria was reported at 0.33333 % in 2020, according to the World Bank (Trading Economics, 2023). Also, in the report released by the World Economic Forum (WEF), in 2018 (WEF 2018), Nigeria ranked 133 among 149 countries surveyed for gender gap reduction. In the 2020 report, Nigeria rose to 128 out of 153 countries.
One of the key ways in which gender inequality impacts maternal health outcomes is through limited access to healthcare services. The WHO associated the high prevalence of maternal death in Nigeria with inequalities in access to health services. (WHO, 2019). Gender inequality in Nigeria is pervasive, with women facing various challenges that can negatively impact their health. Women in Nigeria often face barriers to accessing quality maternal healthcare, including limited financial resources, limited access to education, lower social status, limited economic opportunities, and cultural and social norms that restrict women's mobility and decision-making power.
Gender norms frequently expose women to early or forced marriage, adolescent pregnancies, unintended pregnancies, and sexual or physical violence. Young girls forced into marriage and childbirth before their bodies are fully developed are at a higher risk of complications during delivery, including eclampsia, hemorrhage, and maternal mortality (WHO, 2022). Where women lack autonomy and mobility outside the home, their access to safe, adequate, timely, and affordable health services, particularly emergency obstetric care, is undermined. These norms also influence whether or not people seek care and the quality and effectiveness of the care, as gender inequality affects women’s decision-making for seeking health care (Global Health 50/50, 2018). Research has increasingly demonstrated that gender-based attitudes and practices of health providers and gender dynamics in health facilities contribute to issues of access and quality of RMNCAH care (Oduenye et al., 2021). Even when health services are available, gender bias and harmful norms can lead to gender-based inequities in accessing services. All of these factors can contribute to poorer maternal health outcomes.
To improve maternal health outcomes in Nigeria, it is essential to address gender inequality and promote gender equity. This can be achieved through various interventions, improving access to education, increasing economic opportunities for women, and promoting women’s participation in decision-making processes. Investing in maternal healthcare services and infrastructure is crucial to ensure women have access to quality care during pregnancy and childbirth.
For RMNCAH programming in Nigeria to be successful, programs must meaningfully engage men, women, and community leaders in awareness raising in ways that respect women’s reproductive autonomy, agency, and rights. Capacity building of providers, health facilities, and national policies should reinforce that health service delivery should not be influenced by morals, gender biases, or religion but should focus on medical needs, client preferences, and evidence-based approaches to care.
Health providers have been identified as pivotal in changing the adverse effects of harmful gender norms and stereotypes by empowering women and men to make informed choices about their health. Interventions include provider training to clarify values and transform attitudes to facilitate understanding of gender discriminatory behaviors and attitudes. For example, the Jhpiego (2019) Gender Transformation for Health Toolkit can be part of broader efforts to engage policymakers to focus on mistreatment during labor and childbirth and to support accountability by strengthening community and health facility linkages, putting in place systems to gather patient complaints and feedback and developing patient charters at the facility level.
By identifying and addressing the influences and unintended consequences of gender discrimination in health service delivery, providers, governments, and stakeholders in health systems can improve countries’ progress toward universal health coverage and attaining national and global Sustainable Development Goals.
Global Health 50/50. The Global Health 50/50 report: how gender-responsive are the world's most influential global health organizations? London, UK; 2018. http://globalhealth5050.org/report/
JHPIEGO (2019). Gender Transformation for Health-A participatory Tool Kit. Available at: https://www.jhpiego.org/wp-content/uploads/2022/03/Gender-Transformation-for-Health-Full-Manual.pdf Accessed 6 April 2023
National Population Commission and ICF (2019) Nigeria Demographic and Health Survey 2018 Final Report. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. Available at: https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf
Oduenyi, C., Banerjee, J., Adetiloye, O. et al. (2021). Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment. BMC Health Services Research 21, 198. https://doi.org/10.1186/s12913-021-06204-x
Trading Economics (2023). Nigeria- Gender Equality. Available at: https://tradingeconomics.com/nigeria/gender-equality-wb-data.html Accessed 5 April 2023
UNICEF (2021). Maternal Mortality. Available at: https://data.unicef.org/topic/maternal-health/maternal-mortality/ Accessed 6 April 2023
UNICEF (2023). Situation of Women and Children in Nigeria | UNICEF Nigeria. Available at: Situation of women and children in Nigeria | UNICEF Nigeria
World Economic Forum (2018). The Global Gender Gap Report. Available at: https://www3.weforum.org/docs/WEF_GGGR_2018.pdf Accessed 5 April 2023
World Health Organization (2019). Maternal Health in Nigeria: Generating Information for Action. Available at: https://www.who.int/news/item/25-06-2019-maternal-health-in-nigeria-generating-information-for-action
World Health Organization (2021). Gender and Health. Available at: https://www.who.int/news-room/questions-and-answers/item/gender-and-health Accessed 6 April 2023
World Health Organization (2022). Adolescent Pregnancy. Available at: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy Accessed 6 April 2023
World Health Organization (2022). Universal Health Coverage (UHC). Key Facts. Available at: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
World Health Organization, World Bank, United Nations Population Fund & United Nations Children's Fund (UNICEF). (2015). Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization. https://apps.who.int/iris/handle/10665/194254