Tuesday, 30 October 2007

The Right to Life and Survival in Nigeria

The right to life is the most obvious right that could be applied to protect a woman at risk of dying in childbirth due to lack of obstetric care. Given the magnitude of an estimated 1,400 maternal deaths worldwide each day, it is remarkable that so few legal proceedings have made their way into Nigeria's national courts to require that the government take all appropriate measures to identify the causes of maternal mortality. This is due in part to families and communities in which women have died of pregnancy-related causes not understanding how governmental neglect of the conditions in which women bear pregnancies and give birth violates their right to life.

Effective protection of the right to life requires that positive measures be taken to ensure access to appropriate health-care services, enabling women to go safely through pregnancy and childbirth and providing couples with the best chance of having a healthy infant. Positive measures might include progressive steps taken to ensure an increasing rate of births are assisted by skilled attendants.

The right to liberty and security of the person is one of the strongest defenses of the right of women to free choice of maternity. If governments and agencies which administer health services fail to provide conditions necessary for safe motherhood, they are accountable for violations of women’s right to liberty and security of the person, and must take all appropriate steps to prevent and remedy the situation.

The right to liberty and security of the person can be applied to require that positive measures be taken to ensure respect in the delivery of reproductive health services to women who are at particular risk. Sometimes adolescents hesitate to seek reproductive health services because they fear that their confidentiality might be breached. They fear, perhaps incorrectly, that information about their sexual behaviour, which they have to make for appropriate health care, will be disclosed to their parents, parents of their partners, teachers and others.

As a result, special care and attention needs to be given to informing adolescents in the community through positive assurances that confidentiality will be protected, and to training health personnel appropriately.

*Reported by Adanma Ike

Domestic violence spurs maternal and child deaths

While the level of violence against Nigerian women in the home remains poorly mapped, pilot studies conclude it is "shockingly high".

According to the Amnesty International 2005 Report on Violence Against Women in Nigeria, one-third of women in the country are believed to have experienced sexual, psychological and physical violence in the family. The report states that 50 per cent of men and women justified the beating of women. The study also showed that 64.5 per cent of women and 61.3 per cent of men said that a husband has the right in hitting or beating the wife for some reasons including lateness in cooking food.

Closer to home in Lagos state, up to two-thirds of women in certain communities are believed to have experienced physical, sexual or psychological violence in the family, and in other areas, around 50 percent of women say they are victims to domestic violence. In a recent small-scale study of gender inequality in Lagos and Oyo states, 40 percent of the women interviewed said they had been victims of violence in the family, in some cases for several years. The study concluded that such violence was not documented in Nigeria because of widespread tolerance of violence against women.

“Once a woman is married, she is expected to endure whatever she meets in her matrimonial home," according to information released by Amnesty International.

Though a bill on violence against women (prevention, protection and prohibition) is pending in Nigeria, many women are still denied a fair trial in cases relating to domestic violence. Many courts see domestic violence as a personal affair within the family, and leave the issue to husbands and male family members to judge.

But the consequence of hushing domestic violence is enormous. Researchers have found that abused women tend not to use family planning services, even if readily available, for fear of reprisals from husbands. Women in Nigeria and Kenya, for instance, often hide their contraceptive pills because they are terrified of the consequences should their husbands discover that they no longer control their wives' fertility. Similarly, abused women who participated in focus group discussions in Peru and Mexico said they did not discuss contraceptive use with their husbands out of fear that the men would turn violent. As a result many abused women have unwanted pregnancies resulting in unsafe abortions.

Domestic violence can cause sexually transmitted diseases, including HIV/AIDS, persistent gynecological problems, and psychological problems, including fear of sex and loss of pleasure. As such, domestic violence must be addressed as one of the crucial barriers to maternal, newborn and child health. Politicians, health workers, educators, and the media cannot hope to eradicate maternal and child deaths if such violence against women in Nigeria continues.

*Reported by Amanda Hale

Thursday, 25 October 2007

Advancing Safe Motherhood through Human Rights

Do laws and policies facilitate or inhibit women’s access to reproductive health care and obstetric care? Most systems have core principles of medical law that protect the right to informed and free decision-making by patients, their privacy and confidentiality, the competent delivery of services, and the safety and efficacy of products.

Laws that obstruct women’s access to information and care can function as direct causes of maternal mortality. Preventing access to services are laws that criminalize medical procedures that only women request, and that may be indicated to save their lives and health, such as those that govern contraception and abortion. While often tied to social or religious concerns, these criminal laws put women at risk when they prohibit treatment necessary to save the lives of pregnant women.

Systems of health law and policies that restrict women’s reproductive choices are usually based on historical connections between sexuality and morality. Many restrictive policies reflect the idea that women’s sexuality and access to birth control endanger morality and family security.

Laws that entrench women’s inferior status to men and interfere with women’s access to health services seriously jeopardize efforts to reduce maternal mortality. These laws take a variety of forms, such as those that obstruct economic independence by impairing women’s inheritance, employment or acquisition of commercial loans or credit. Account should be taken of criminal laws that condone or neglect violence against women, and, for instance, of inequitable family, education and employment laws that deny adult women alternatives in life to marriage, or that condition women’s self-realization on marriage and motherhood.

The cumulative impact of such laws is often that daughters are seen to burden their families, that their deaths in infancy are inconsequential, and that they will remain in the home to serve other family members until marriage. On marriage, they will obey their husband’s families by rendering services and bearing sons. Accordingly, daughters will be given in marriage to men they do not choose, have no independent status or means while unmarried, conceive early and often in marriage, obediently protect family, social and cultural values before and in child rearing, and be vulnerable to violence and death if perceived to endanger family honour.

A necessary first step towards applying human rights to advance safe motherhood is an assessment of the scope and causes of unsafe motherhood in a particular community, based on available data sources, or on the collection of relevant new data. Where possible, maternal death should be investigated. A maternal death investigation should establish both medical and non-medical causes of death, and whether the death occurs in a hospital or at home. Several factors may influence the success of a maternal death investigation. It must be made clear that the purpose of the investigation is to find ways to reduce maternal mortality – not to find blame.

Account should be taken of criminal laws that condone or neglect violence against women, and, for instance, of inequitable family, education and employment laws that deny adult women alternatives in life to marriage, or that condition women’s self-realization on marriage and motherhood.

Laws and policies that obstruct free choice of maternity, and the availability of and access to services, should also be identified, along with laws that facilitate women’s empowerment and laws that obstruct women's empowerment.

*Reported by Adanma Ike

Wednesday, 24 October 2007

Confronting the Issue of Unsafe Abortion

London, Oct. 22, 2007 (NAN): Every year, unsafe abortion kills more than 66,000 women worldwide and maims millions more, the latest statistics show that figure has remained virtually unchanged over the last decade.

The medical journal The Lancet which called it one of the most neglected public health issues of our time, also said that in Africa the statistics have even increased.

What actions can those in power take to stop these deaths? This will form part of the talks at the Global Confrence on Safe Abortion holding in London from Tuesday.

The News Agency of Nigeria (NAN) correspondent who is covering the conference interviewed some participants.

Mrs Maria Meva, a female activist and member of `Catholics Advocate for Choice' from Mexico who spoke with NAN said that those in power should look beyond religious and cultural sentiments and look at the maternal mortality rate in their countries.

She said: ``Mexico just de-criminalised abortion after several years of struggle and between April and now, maternal mortality has dropped trmendously in the city, where it is allowed.''

She said also the U.S restrictions have created a climate in which health care providers in developing countries cannot provide safe abortion care without jeopardising their US funding.

The Ipas co-ordinator of the Advocacy meeeting which took place in London today, Charlotte Horde told NAN that the few countries where the abortion laws had changed, maternal deaths had dropped significantly.

``Conversely, the new blanket abortion ban in Nicaragua pushed through by conservative church leaders has led to increased maternal death,'' said Christine

Gunzalose, a medical doctor and the Nicaraguan representative at the adocacy meeting.

``These deaths are an outrage and completely preventable,'' she added.

The conference which starts tomorrow is expected to have speakers Like Moji Makanjuola of Nigeria Television Authority presenting a paper on Media partnership and other speakers from various countries including Kenya. (NAN)

Melodrama as pro-life activists beseech conf. venue

London, Oct. 23, 2007 (NAN): A melodrama ensured today outside the Queen Elizabeth 11 Conference Hall, London as `Pro-life' activists beseeched hall chanting pro life slogans and giving out flyers.

Queen Elizabeth 11 Conference Hall is the venue of the Global Conference on Safe Abortion holding in London, the conference started today, few days after the Safe Motherhood Conference in the same city.

`Pro-Life' activists are those who do not believe in the reformation of abortion laws, they believe that any conception is Life and should not be terminated under any guise.

The News Agency of Nigeria NAN) reports that by eight in the morning, the activists were outside the hall holing placards bearing pro-life messages and distributing flyers with the same messages.

There was quite a number of security personnel clad in yellow reflective coats and helmets, holding batons and making sure the activists do not cross the line, and do not enter the hall.

Karen Fish, a pro-life activist, who gave the NAN correspondent a pro-life flyer said that the leaflet was meant for intelligent open minded people, discussing issues of justice and human rights around abortion.

`` So killing someone is now a human right ? who protects the rights of the unborn child ?'' she asked.

In Karen's hand was a banner bearing, ``Women's needs are more than Abortion''.

Other male and female activists had banners bearing different messages like ``Women do not need Abortion'', ``To legalise abortion is to bring guilt of innocent blood upon the whole nation'' and ``Abortion is a sin against another human being and God''.

The activists were still seen outside the hall when the opening ceremony started at noon.

A black woman, who says she is just Ngwemu told NAN that, the donor bodies who want to help Africa could do other things for them other than abortion.

``Our women do not need abortion, they need empowerment, if they have things to do they will not get pregnant, nor seek abortion.

``These funds should be channelled towards skills acquisition and capacity building as well as loans for small scale enterprise for them to have economic power. (NAN)

Nigerian Women urged to stand-up for their rights

London, Oct. 23, 2007 (NAN): As the Global Safe Abortion Conference begins today in London, Nigeria women have been asked to stand-up for their rights.

Prof. Fred Sai, A former Senior Population Advisor to the World Bank on Population, and Adviser to the Ghanian President told the News Agency of Nigeria that for Abortion laws to be reformed, Nigerian women had to be stand up to say they want the reforms.

Sai, who said he knew when the late Prof. Olikoye Ransome Kuti was trying to get the laws reformed in 1994, that some women groups opposed it and up to last year women were still opposing the reforms of the abortion laws in Nigeria.

``There are many powerful women in Nigeria, when they stand up to say they want the laws reformed
they will get it reformed.

``Nigeria needs an internal revolution, the women should see the lives lost or maimed by the restrictive laws and speak out to keep women alive.

``Abortion happens whether legal or illegal, by making it legal, women would access it when they need in health facilities that are registered and with experts, Sai said.

The population expert told NAN that sometimes he wishes some African countries did not get their independence before 1967, because then they would have inherited the reformed abortion laws not the old one which was inherited.

He said : ``We inherited the abortion laws, fourty years after the colonial master reformed their laws, we are yet to change ours in most African countries.''

In a philosophical manner, he said we in Africa were like a choir and we take songs from the western world, change them into our local language and they become ours, that is what we have done with abortion laws, we have made it ours.

He said that before colonialism, there had been issues of unwanted pregnancies in Africa, in cases of rape or incest or pregnancy out of wedlock.

He said in such cases infacticides were committed. ``Any child who would bring dis-honour or stigma to
the family was killed at birth, why are we now behaving as if unwanted pregnancies was new to Africa.?''

He said that the number of valuable lives lost in Africa through unsafe abortions and unwanted pregnancies cannot be quantified economically.

He said some people commit suicide when they have unwanted pregnancies, some visit quacks and loose their lives or become eternally infertile.

``When will we begin to value these lives and allow the woman make her own choice,'' Sai questioned.

Expand access to safe abortion

London, Oct. 23, 2007 (NAN): Expanding access to safe abortion around the world formed the agenda for the opening ceremony of the Global Abortion Conference today in London.

The News Agency of Nigeria (NAN) reports that not less than 800 delegates, made of public health experts, government representatives and women's health advocates from 60 countries around the world are at the global meeting.

Mr Dana Hovig, Chief Executive of Marie Stopes International (MSI) who opened the conference said that the purpose of the global meeting was to build a momentum around the appalling toll on women's health and lives caused by unsafe abortion.

The organisers of the Conference, MSI, Ipas and Abortion Rights, all NGos working to promote women's reproductive health and rights, called for increased access to safe abortion services, recognised women's
right to self-determination in exercising their reproductive choices, and encouraged efforts to secure legal reform.

Christine McCafferty, a member of the British Parliament, chair of the All Party Group on Population, Development and Reproductive Health, who chaired the opening ceremony, said that the unsafe abortion.
was a tragedy.

``The tragedy of unsafe abortion is still greater given that we have the technology to prevent almost all of the these deaths resulting from unsafe abortion. we cannot sweep it under the carpet.''

Hovig told NAN that attention to the need for governments and donors to significantly increase their investment in making comprehensive sex education, contraception and safe abortion more widely accessible.

``All around the world especially in the poorest countries, unsafe abortion kills women and girls solely because they lack access to safe abortion care, of all the causes of maternal mortality, unsafe abortion is the easiest to prevent.

``It is time for governments and donors to step up and make resources available,'' the MSI Chief Executive said.

Ipas President, Elizabeth Maguire, told NAN that the continuing death toll and injury from unsafe abortion
was a moral outrage and a gross violation of women's basic human rights.

``How many more poor women and girls must suffer or die before we start taking action?'' she asked.


Friday, 19 October 2007

Child Brides: Stolen Lives

Bilikisu doesn't want to marry. She is adamant about this. But in her village nobody heeds the opinions of headstrong little girls. She is desperate to turn herself into an adult. Then maybe, just maybe, her family would respect her wishes not to wed. She could rebuff the strange man her papa has chosen to be her husband. And she wouldn't have to bear his babies.

Bilikisu's short legs can't carry her away fast enough from the death of her childhood. Her wedding is five days away. And she is seven years old.

Child Brides: Stolen Lives is the title of one of the many documentaries showcased at this year's Women Deliver Global Conference, a conference aimed to reduce maternal and child mortality. The conference, held on October 18-20 in London, brings together medical practitioners, health workers, government bodies, teachers, and advocates to pressure governments into integrating maternal, newborn and child health into their budgets and health plans.

Bilikisu's story is one of many. Coerced by family and culture into lives of servility and isolation, scarred by the trauma of too-early pregnancy, child brides represent a vast, lost generation of children. According to child-rights activists, an estimated 50 million Bilikisus are scattered across the world--young teen or preteen girls whose innocense is sacrificed to arranged marriages, often to older men.

The most far-reaching injustice of child marriage by far is probably its most subtle: it pries millions of young girls out of school. Confined to their husbands' homes, cheated of the benefits of education, these legions of demoralized children are condemned to lives of ignorance and dire poverty from which they rarely escape, and which they endure with numbed desperation.

All the misery and pain occur in silence. They are just children. They don't speak out. They are never heard from.

Problems attributed to child marriage include health and education issues such as poor health, early death and lack of educational opportunities. Education is the most important key to helping end the practice of forced child marriages. Many believe that education may prove to be more successful in preventing child marriages than simply banning child marriages. It is important to provide education to children and parents that will broaden their horizons and convince parents that educating their children is beneficial to their future.

Apart from reading, math, and writing, young girls should learn life skills (including reproduction and contraception information), as well as how to have fun and how to play in sports--all of this is proving to be a positive way to change the lives and futures of adolescent girls.

In India, child marriages have reduced by up to two-thirds due to more educational opportunities for young girls. Girls who are able to complete primary school tend to marry later and have fewer children, thus lowering the rate of maternal and child mortality.

*Reported by Adanma Ike

Thursday, 18 October 2007

Investing in Women Is Smart Economics, Women Deliver Conference Shows

A Family Care International Press Release

LONDON – Skyrocketing health care costs and slow economic growth in developing countries could be combated by government investments in family planning, antenatal care for mothers-to-be and skiled care at delivery, according to reports prepared for an upcoming conference here.

Financial experts and leading economists are among more than 1,500 world leaders taking part in Women Deliver, a landmark gathering 18-20 October at the ExCel Conference Centre on reducing pregnancy-related deaths and disabilities worldwide. The theme of the conference is "Invest in Women: It Pays!"

One study estimates that the global economic impact of maternal and newborn deaths at US$15 billion per year in lost potential production, half associated with women and half with newborns. At the moment, one woman dies every minute from complications of pregnancy and delivery--some ten million per generation--and four million newborns die every year.

The World Bank says much of the illness and death that strikes down women and their children each year could be avoided if they had access to stronger helath systems capable of providing core programs of maternal and child health, nutrition, and family planning. Stronger systems could help developing countries to improve the health and well-being of millions of the world's poorest people, boost economic growth, and reduce poverty caused by catastrophic illness.

"Investing in better health for owmen and their children is just smart economics," said Joy Phumaphi, the World Bank's Vice President for Human Development, a former WHO Assistant Director General for Family and Community Health; and Health Minister in Botswana, 1999-2003. "Good health is often thought to be an outcome of economic growth, but increasingly, good health and sound health systems policy have also been recognized as major drivers of economic growth. Educating girls, equal economic opportunities for women, and fewer households living below the poverty line are also vital parts of a strategy to achieve lasting good health for mothers and their children."

At the moment, women's work in housholds, farms, and care-giving equals about a third of the world's gross national product, according to repeated studies--and that is just unpaid work. In addition, women are the sole income earners for up to a third of all households. A mother's disability or death not only raises death and illness rates for her children and destroys families; it also lowers overall community productivity.

Documents prepared for the gathering argue that spending on women's needs creates a "virtuous circle" that raises productivity and lowers overall health care spending. Investing in family planning, for example, lowers the rate of unintended pregnancies, which reduces unsafe abortions, which reduces health care costs. In some countries, up to half of all hospital spending on obstetrics and gynecology goes for treating complications of unsafe abortions.

"Investing in saving women's lives is an incredibly cost-effective thing to do," said Jill Sheffield, president of Family Care International, organizing partner for the conference. The package of services needed to make significant improvements in maternal health would cost less than US$1.50 per person in the 75 countries where 95 per cent of maternal deaths occur, she said.

"This amount is well within reach of donor countries and governments," Sheffield said. "Ministers of health, finance, development and economy are going to hear this message loud and clear at Women Deliver."

Contact: Philip Hay at phay@worldbank.org.

UK Pledges 100 million Euro to UNFPA to make childbirth safer and promote reproductive health

UNFPA and DFID Joint Press Release

18 October 2007

LONDON, -- Maternal deaths and unwanted pregnancies can be cut dramatically in countries around the globe after hte British government today pledged 100 million Euro to UNFPA, the United Nations Population Fund, to achieve universal access for reproductive health.

"Maternal health can be improved through strengthened political commitment and the dedication of increased resources. Life or death is a political decision," said Thoraya Ahmed Obaid, UNFPA Executive Director. "The United Kingdom's generous investment in women will enable UNFPA to provide urgent, coordinated and sustained action to save mother's lives. There can be no safe future without safe motherhood--no women should die giving life."

The 100 million Euro over five years was announced today by Douglas Alexander, the UK's Secretary of State for International Development, who called on leaders of the world's poorest countries, especially in Africa, to make women's health a priority on the opening day of Women Deliver, a three-day global conference aimed to reduce maternal mortality.

"The death of a mother deprives a child, a family, a community and ultimately a couny of one of its most valuable sources of health, happiness and prosperty," said Alexander, addressing delegates on the opening day of Women Deliver, a global conference aimed at reducing maternal mortality. "Every minute a woman dies from complications during pregnancy or childbirth. More than 10 million women have died in the last 20 years. This is a tragedy but so is the fact these deaths could have been prevented."

To address this challenge, the UN General Assembly endorsed earlier this month a new target to acheive universal access to reproductive health as part of the Millennium Development Goal 5, which calls for hte reduction of maternal mortality by three quarters by 2015.

Although progress has been made in such countries as Egypt, Honduras, Sri Lanka and Thailand, maternal deaths remain high, particularly in sub-Saharan Africa and South Asia. A woman in Africa faces a 1 in 26 lifetime risk of maternal death compared to 1 in 8,200 in the United Kingdom.

An estimated 720,000 unwanted pregnancies could be averted, 300,000 abortions could be prevented and the lives of 1,600 mothers and 22,000 infants could be saved for every 1 million Euro invested in family planning, Alexander said.

Capps to Lead Bipartisan Women’s Caucus Congressional Delegation to Represent United States at Women Deliver Conference in London


Press Release from U.S. House of Representatives

Contact: Emily Kryder
October 16, 2007 202-226-7747 office
202-225-6513 cell

WASHINGTON, DC – Congresswoman Lois Capps, Co-Chair of the Congressional Caucus for Women's Issues, will lead a bipartisan Congressional delegation in representing the United States at the Women Deliver Global Conference on Maternal Mortality. The delegation members, Congresswoman Hilda L. Solis, Congresswoman Gwen Moore, Congresswoman Donna Christensen,Congresswoman Louise Slaughter, and Congresswoman Candice Miller will join more than 1500 world leaders--including cabinet ministers, heads of United Nations and other multilateral agencies, senior government officials, health professionals, researchers, economists, and reproductive health advocates- in a historic conference in London from October 18-20. Conference participants are meeting in an effort to reduce the 500,000 deaths that occur annually due to pregnancy and childbirth.

Despite advances in medical care and technology around the world, motherhood remains a risky endeavour that results in millions of tragic deaths annually. These fatalities are a major factor in persistent global poverty, yet many of these needless deaths could be prevented with effective, low-cost investments in preventive health care and education. The Women Deliver Conference participants will examine strategies to improve how health information and care are funded and provided as well as address other important issues for women including poverty reduction, women's human rights, and economic development.

Nigeria’s Minister of Health presents Maternal, Newborn and Child Health Strategy benefits at Women Deliver Conference in London

Nigeria’s Honourable Minister of Health travels to London this week to present at the 2007 Women Deliver Global Conference on how a national maternal, newborn, and child health strategy can promote a continuum of care and reach out to mothers and newborns everywhere.

The Women Deliver conference, from October 18th to 20th, marks the twentieth anniversary of the world's first-ever Safe Motherhood conference in 1987 in Nairobi, Kenya, where delegates gathered to protest the near-silent tragedy of mothers dying from childbirth, and issued an international call to action to cut maternal mortality in half by the year 2000.

Now, twenty years later, mothers and children are still dying from avoidable deaths. In Nigeria alone, six women die every hour from birth-related causes that could be prevented from simple medical interventions such as cesarean sections or malaria vaccinations. Funding for state and local hospitals, while increasing, is still only about 20 per cent of the overall government health funds in Nigeria, which is not enough to provide adequate staff, equipment, or medical training.

It is conditions like these in Nigeria and around the world that prompts the Women Deliver conference to revisit the 1987 goal of reducing maternal mortality and cast an urgent cry to governments and agencies to invest in women, mothers, and children. The conference, themed, "Invest in women--it pays" focuses on improving women's and newborn health, advancing human rights, expanding financial resources, building political will, and promoting women in the world.

Women are central to every society, and investing in women's health will not only save lives but strengthen the economic, social, and political health of every nation. Following this theme, the conference includes personal testimonials from women and children illustrating how small investments helped them to become agents of change in their communities. As well, representatives of World Health Organization (WHO), International HIV and AIDS Alliance, United Nations Population Fund and more will present studies on how improvements in the lives of women and girls translate into improvements in their health, in the health of their children, reductions in fertility, and high returns to overall economic progress. Delegates will be given the opportunity to then devise innovative strategies and partnerships for increasing investment in women’s health.

By encouraging governments to integrate women’s health and rights into national plans and strategies, the health policymakers, medical professionals, and public-health experts at the conference can fulfil the promise made in Nairobi, Kenya, and deliver for today’s women, mothers, and children in Nigeria and around the world.

*Reported by Amanda Hale

Tuesday, 16 October 2007

It’s a Boy!...but she died

Somewhere in rural Nigeria...Zeinab had been pregnant six times within eight years, and had given birth to six girls. Though they had decided not to have another child, they felt they could not afford to see a family planning method just yet. During the time her husband was putting aside money so she could go and obtain a contraceptive method, she became pregnant for the seventh time.

The pregnancy proceeded normally, but when she went for her first and only visit to the village health post, the local nurse’s aide told her she was anemic and recommended that she take iron supplements.

Late one night, Zeinab began to feel abdominal pains and thought it was time to give birth, though the pain seemed different.

By dawn, eight hours later, the baby was still not coming out and she started to bleed. A local birth attendant was summoned who administered some herbal medications for the bleeding and attempted to manually manipulate the baby.

By then Zeinab’s husband was terrified, and gathered his savings to get a vehicle to take her to a health centre. Finally, at 1:00 in the afternoon, Zeinab’s husband managed to hail a truck to transport his wife. They arrived at the health centre, but had to wait for a doctor to eventually deliver her of a baby boy. However, the arrival of the baby boy rather than kickstart a phase of joy for the family, began what seemed an endless moment of grief. Zeinab began to hemorrhage shortly after child birth. There was no blood available for a transfusion, and Zeinab died.

This scenario depicts the social and health situations that give rise to the high maternal mortality rate in Nigeria. Lack of decision-making power and insufficient access to resources prevent women from making the strategic decision to seek medical help at the point where it can determine if she or her baby dies or lives. Often male members of the family, who largely control the resources, make these decisions. This underscores the importance of male involvement to ensure that resources are available to women in need. Effective male involvement will ensure that childbearing is made safer for mother and child.

Lack of resources is another reason why women fail to use available health facilities. 67 % of Nigeria’s population lives below poverty line, and bills for hospital treatment do not rank high for families, especially where traditional birth attendants are available. Low use of contraceptive contributes to high fertility rates thus increasing the risk for mother and child. Though family planning awareness is increasing, contraceptive use is still low. Place of delivery and the quality of maternal health care have a significant impact on maternal mortality. At present only 37 per cent of births take plaace in a health facility though the figure varies slightly in different regions of the country. Malaria is known to predispose women to anemia, low birthrate babies, spontaneous abortions and premature deliveries while HIV/AIDS make them vulnerable to opportunistic infections besides passing the virus to their babies during pregnancy, delivery and/or through breast feeding.

The goal of the Reproductive Health (RH) Policy is to create an environment for appropriate action and provide the necessary impetus and guidance to national and local incentives in all areas of RH. In this regard, greater attention shall be paid to reducing high maternal mortality through effective antenatal, prenatal, and neonatal care, delivery, post-natal and breast feeding programs. The overall goal of the Reproductive Health Policy are laudable but the issue at stake is how effective have the policy strategies to achieving this goal been?

*Reported by Nnenna Ike

Married at Seven: Stories from Child Brides in Nigeria

“I was married at the age of seven. My husband was much older than me. He waited until I was nine years old to have intercourse. It was very difficult. He passed away when I was 12 years old. I was pregnant at the time, but lost the baby after a difficult labor, which went on for days. I do not want to re-marry. I do not want any man to come near me.”
-Amina, a child bride

Amina is one in thousands that has such a story. Around 15 million young women between the ages of 15 and 19 give birth annually, accounting for more than 10 per cent of the babies born worldwide. Because adolescent females are not yet fully developed emotionally and physically, pregnancy and childbirth are often life threatening and the outcomes for their newborns are much worse than for older women.

The impact of early marriage is tremendous on women and their families worldwide. Besides the number of health issues associated to early marriage such as fistula or maternal death, child bridges are typically deprived of an education, and thus condemned to a lifetime of dependence on her husband and his family. More than one third (35 per cent) of Nigerian women experience their first pregnancy by the age of 19 or below (10 per cent have their first pregnancy by age 16).

The early age of marriage, especially in certain parts of Nigeria, puts these girls at great risk. The earlier a girl is married, the earlier she starts having children. The earlier she starts getting pregnant without a fully developed body and reproductive system, the higher her risk of dying with the pregnancy or from birth complications. Many of these young mothers, due to natural ignorance, cannot decipher and alert
others of the signs and symptoms of pregnancy malfunctioning and/or labour complications. These often lead to help getting to them when its too late.

Many of these women die in the prime period of their lives; the last glimpse of life being that of pain and great distress: from hemorrhage, convulsions, obstructed labour, or severe infection after delivery or unsafe abortion.

Research findings indicate that younger adolescents have a higher risk of delivering babies with low birth weight and delivering prematurely than older adolescents and persons who are 20 to 34. One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviours such as touch, smiling, and verbal communication.

*Reported by Adanma Ike

Practices in the Dark: Unsafe Abortion in Nigeria

Imagine you're travelling down a dark alley in Lagos. The road is uneven; potholes and open gutters seem to cover every step as you walk home. Grilled suya and plantain drifts into the air from cluttered street stands, and high life music mixes with hip-hop in the city's medley of car horns. The only light to guide you comes from amber flames lit in tin trashcans, and you stretch your arms out in front of you with each step, feeling for anything you may not see in the dark.

Now imagine that a young girl is crouched behind a cement wall, not five feet away from you. You don't see her, but she's there. In her hands are a small hanger and a pair of knitting needles. She's about to perform surgery. Armed with nothing but a pair of sharp objects and a bucket of water, she stabs her uterus and cervix until she nearly faints, unsure of whether she'll live or die. Today is her fifteenth birthday.

This is Nigeria's reality. Every day young girls and women perform unsafe abortions on themselves to terminate unwanted pregnancies, and no one notices. Moral and cultural beliefs prevent open dialogue about abortion, and laws prohibiting the procedure unless in order to save a woman's life make it very difficult for women to seek help when faced with an unwanted or accidental pregnancy. Because of this women must turn to private or unlicensed clinics, traditional healers, or themselves to terminate their pregnancy, which often ends with serious medical complications.

According to the World Health Organization, an unsafe abortion is “a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.” Untrained medical practitioners, incorrect equipment, and unsanitary conditions in developing areas combined with certain laws that restrict abortion as a legal practice can lead to unsafe abortions for such women, resulting in deaths or serious infections that lead to infertility.

About 20 million, or approximately half, of the induced abortions each year are estimated to be unsafe. Out of these 20 million, ninety-five percent occur in developing countries like Nigeria.

But most deaths and complications from unsafe abortions are preventable. Abortions performed by trained health care providers with proper equipment, correct technique and sanitary standards are relatively simple and safe. According to the Alan Guttmacher Institute in the United States, the likelihood of women dying as a result of abortion performed with modern methods is no more than one per 100,000 procedures. In developing countries, this figure is several hundred times higher. This is due to factors like discrimination against abortion patients, inaccessible services in rural areas, poor medical equipment, and lack of attention to patients' medical, social, and cultural circumstances.

There is hope, however, for Nigerian women who face the uncertainty of an unwanted pregnancy. Many organizations and advocacy groups, such as Centre for Reproductive Rights and World Health Organization, have advocated that abortion procedures be made legal in non-emergency situations, to avoid women visiting non-licensed medical practitioners and putting themselves at risk of illness or death. These organizations demand that abortion delivery be improved around the world, and recommend the use of manual vacuum aspirations (MVA) for treatment of complications, that health care providers should be trained in the use of MVA, and that post abortion care services should be established throughout to offer contraceptive counseling and services to women who've had an abortion.

With these organizations lobbying for safe abortion practices, and with the rise of women undergoing painful procedures to terminate unwanted pregnancies, the Nigerian government will have to re-examine its abortion policies and determine whether the lives of thousands of women are worth throwing into the dark.

*Reported by Amanda Hale

To learn more about safe abortion advocacy, please visit the World Health Organization website at www.who.int.

Thursday, 4 October 2007

Nigeria hosts Global Mission for Maternal, Newborn and Child Health

Abuja, Nigeria— Efforts to reduce maternal mortality and improve child health in Nigeria are on the front burner as Nigeria joins the Partnership for Maternal, Newborn and Child Health. The Mission met with top government functionaries including Nigeria’s Honorable Minister of Health in Abuja.

Apart from government officials, the Global Partnership met with UNAIDS, the World Bank, the Society of Obstetricians and Gynaecologists of Nigeria, the Nigerian Medical Association, the Governor of Niger State, and the Honourable Speaker of the House of Representatives, among other professional health bodies. The purpose of the Partnership’s visit was to advocate a national strategy to eliminate maternal, newborn and child health across Nigeria, and to create a strong alliance among government agencies, NGOs, professional bodies, and media organizations to support the strategy.

The Partnership for Maternal, Newborn and Child Health is a new global health partnership launched in September 2005 to accelerate action towards achieving Millennium Development Goals (MDGs) 4 and 5. The Partnership joins the maternal, newborn and child health (MNCH) communities into an alliance of currently more than 125 members representing governments, donors, United Nation agencies, non-governmental organizations, private institutions, and academic and research institutions—all committed to ensuring that women, infants and children not only remain healthy, but thrive.

Since the Maternal, Newborn and Child Health National Conference held in March 2007, Nigeria has undertaken a number of steps towards rolling out the Integrated Maternal, Newborn and Child Health (IMNCH) Strategy. These include stepping up advocacy for strong and wide support; re-organizing the country’ Ministry to meet the challenges of roll-out; finalising the IMNCH Strategic document for printing and dissemination; mobilising resources for kick starting roll-out, and other support.

But much more needs to be done. Nigeria still suffers from one of the worst maternal mortality rates in the world; in fact, six women die every hour in Nigeria from birth-related complications. This is why members of the Global Partnership for Maternal, Newborn and Child Health met with Nigeria’s top government figureheads, including the Honorable Minister of Health and the Governor of Niger state, to discuss the growing need for a more effective implementation of a national maternal and child health care policy in Nigeria.

Following the Partnership’s advocacy tour, the Nigerian Federal Ministry of Health held a week-long orientation and planning workshop for selected stakeholders and partners on their roles in rolling out the IMNCH strategy. Development Communications Network will coordinate the media efforts behind Nigeria’s initial implementation of the Maternal, Newborn and Child Health strategy.

*Reported by Amanda Hale

Harvard-PEPFAR Tri-Country Conference concludes in Abuja

Abuja, Nigeria—The Harvard-PEPFAR Tri-Country conference wrapped up on September 15 in Abuja, after an intense round of forums, debates, and interactive sessions sharing the challenges and successes of Harvard-PEPFAR’s HIV/AIDS prevention projects in Nigeria, Tanzania, and Botswana.

Patient adherence, hospital and lab infrastructures, and challenges of administering antiretroviral treatment in resource-poor countries were among the top topics discussed at the conference this year. Harvard-PEPFAR directors also elaborated on the need to build partnerships with local and international NGOs and health institutes over the next ten years, so as to transition to sustainable and completely African-governed programs by the year 2017.

The conference, themed “Building Sustainable Partnerships in HIV/AIDS Programming” took place at the Abuja Sheraton and Towers from September 11 to 15, 2007 and featured delegates and partners from Botswana, Nigeria, Tanzania and the Harvard University teams based in Boston and Chicago, United States. The two previous conferences were held in Botswana and Tanzania respectively and allowed in-depth review and visits to PEPFAR supported sites in the host country.
“We want to show the world that African institutions can responsibly manage these large programs,” said Dr. Joe. Makhema of Botswana’s Harvard-PEPFAR program.

The PEPFAR ten year plan also calls for treating more than 2.5 million people and preventing more than 12 million new infections in Africa. To aid this ambitious vision, President George Bush of the United States announced a five-year, $30 billion proposal in addition to the United States’ initial $15 billion commitment made in 2003.

The keynote address of the conference was presented by Dr. Phylis Kanki, Principal Investigator of the Harvard-PEPFAR program, and focused on overlapping uses of antiretroviral drugs for HIV/AIDS prevention and therapy. Kanki’s presentation showcased the dilemma of researchers who struggle to create effective drug therapy in the face of high mutation rates and multiple AIDS subtypes that resist patients’ immune systems. The solution so far has been to overlap uses of antiretroviral drugs to target different subtypes, but according to Kanki this always runs the risk of generating drug resistance in patients.

There are no easy answers to the challenges facing researchers and medical staff in Harvard-PEPFAR’s programs, but as Dr. Joe Makhema stated at the end of the conference, “We need to carry these challenges on our shoulders and move forward.”

With plans for sustained HIV/AIDS prevention and treatment over the next decade, Harvard-PEPFAR will continue to be a leader in working with African institutions, international organizations and other partners to put accessibility, quality and sustainability at the center of all HIV/AIDS work. Next year’s Tri-Country conference will be held in Botswana, and will once again share the latest best practices and lessons learned from Harvard-PEPFAR’s treatment programs across the continent.

*Reported by Amanda Hale