Lorretta Ntoimo

Patriarchy and Singlehood Among Women in Lagos, Nigeria

Singleness for women beyond the age considered conventional for marriage is regarded as a misnomer in Nigeria. Such women are pitied and blamed for their status. Often the blame is based on assumed personal character defect of the women. Nevertheless, empirical research by some sociologists and other women scholars has linked singlehood to demographic, economic, religious, and personal causative factors. Building on these past studies, this article employed aspects of Silvia Walby’s “theorising patriarchy” to examine patriarchy, a structural determinant of singlehood that has not received much attention in the study of singlehood in Nigeria. Twenty-nine involuntary, childless, never-married women aged 30 to 48 years were interviewed in urban Lagos, Nigeria. The women’s narratives revealed the limiting effects of the six patriarchal structures identified by Walby in their opportunities to marry. This study provides relevant information for attainment of Nigeria’s gender policy and contributes to intercultural understanding of singlehood.

Determinants of Singlehood: a retrospective account by older single women in Lagos, Nigeria

Although the population of older never married women in Nigeria is increasing considerably, negligible attention has been paid to this emerging social reality. This paper examined the determinants of singlehood from the life experience of never married women. Aspects of Giddens’ Structuration theory provided theoretical framework for the study. Empirical Data were drawn from twenty-seven In-depth Interviews, two Life Histories, and seven Focus Group Discussions conducted between 2010 and 2011 in Lagos, Nigeria with involuntary and childless never married women aged 30 and above. The major determinants of singlehood among them were drive for economic empowerment and financial independence, personal mate selection preference, marital experience of other women, cultural beliefs and practices, family background factors, and higher education. Increasing singlehood among women threatens Nigeria’s traditional nuptiality pattern of early and universal marriage and could become one of the most important components of demographic transition in 21st century Lagos.

Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria

BackgroundThe paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria.MethodsClient-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011–2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers.ResultsA total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories.ConclusionWe conclude that the maternal mortality ratios in Nigeria’s referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria.Trial registrationTrial Registration Number: NCTR91540209. Nigeria Clinical Trials Registry. Registered 14 April 2016.

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Introduction While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria. Methods A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics. Results The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity. Conclusion MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Women's Perceptions of Reasons for Maternal Deaths: Implications for policies and programs for preventing maternal deaths in low-income countries

ABSTRACT We investigated perceptions of the causes of maternal mortality by women attending referral hospitals in Nigeria. Focus group discussions were conducted with various categories of women. Our results showed that women were aware of the medical causes of mortality, although a few listed divine reasons. Delays in reaching hospitals or after women arrive in hospitals featured prominently as lead causes mentioned by women. Listening to women as end-users is an important approach to identify points of remediation in the provision of maternal health care. This should be taken into cognizance when policymakers or international agencies plan the prevention of maternal deaths in developing countries.

Increasing women’s access to skilled pregnancy care to reduce maternal and perinatal mortality in rural Edo State, Nigeria: a randomized controlled trial

BackgroundNigeria presently has the second highest absolute number of maternal deaths and perinatal deaths (stillbirth and neonatal deaths) in the world. The country accounts for up to 14% of global maternal deaths and is second only to India in the number of women who die during childbirth. Although all parts of the country are worsened by these staggering statistics, several lines of evidence show that most maternal, and perinatal deaths occur in the north-east and north-west geo-political zones where women have limited access to evidence-based maternal and neonatal health services. The proposed project intends to identify the demand and supply factors that prevent women from using PHCs for maternal and early new-born care in Nigeria, and to test innovative and community relevant interventions for improving women’s access to PHC services, and thus, ultimately, to prevent maternal and perinatal deaths.MethodsAn open-labelled, randomized controlled trial will is carried out in two local government areas selected based on three criteria (i) maternal mortality rates (ii) PHC utilization rates and (iii) and geographic localization. The study will be conducted over 54-months in six communities, with PHCs in six communities of similar status serving as control sites. Surveys about quality of care and maternal health services utilization will be carried out at baseline, at midterm and at end of the project to test the effectiveness of the intervention, alongside conventional epidemiological measures of maternal and perinatal mortality. Ethical approval for the study has been granted (reference no. NHREC/01/01/2007). The findings will be published in compliance with reporting guidelines for randomized controlled trials.DiscussionThe current Federal Government in Nigeria has identified PHC as its main strategy for increasing access to health in Nigeria. However, despite numerous efforts, there are persisting concerns that there is currently no scientific evidence on which to base the improvement of PHCs. The results of this study will identify barriers in the use of PHCs and will provide scientific evidence for effective and innovative interventions for improving PHCs that can be rolled out throughout the country.Trial registrationClinical Trials.gov NCT02643953.

Predictors of women’s utilization of primary health care for skilled pregnancy care in rural Nigeria

BackgroundAlthough Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care.MethodsThe study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods.ResultsThe results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16–8.28) and secondary (OR 2.37, CI 1.19–4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00–2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04–7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19–3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more autonomy (OR 0.75, CI 0.57–0.99) as compared to women with higher autonomy.ConclusionWe conclude that efforts devoted to addressing the limiting factors (distance, costs and quality of care) using creative and innovative approaches will increase the utilization of skilled pregnancy care in PHCs and reduce maternal mortality in rural Nigeria.

Homogamy and heterogamy in sub-Saharan Africa: Implications for couples’ fertility behaviour

ABSTRACT This study examines patterns of homogamy and heterogamy and their implications for couple’s fertility behaviour. Data were obtained from demographic and health surveys conducted in Ghana, Nigeria and Zambia between 2001 and 2014. The study population were couples in a monogamous union where wives were aged 35 years and over: 1785 in Ghana, 3185 in Nigeria and 3175 in Zambia. Results of the descriptive analysis show that educational, religious and ethnic homogamy and occupational heterogamy were predominant among the couples and mean children ever born varied according to couples’ characteristics. The significant predictors of fertility as revealed in the multivariate analysis included educational homogamy and heterogamy, occupational homogamy, age difference and religious and ethnic homogamy. To expedite fertility transition in the three countries and other sub-Saharan African countries, programmes and policies aimed at reducing fertility in the region should incorporate strategies that focus on the characteristics of couples in union.

Living arrangements and nutritional status of under-five children in Sub-Saharan Africa

Despite efforts aimed at improving the nutritional status of children under-five years, only a slow progress has been made in Sub-Saharan Africa (SSA). Using data from the latest Demographic and Health Surveys of 17 countries in SSA, we illuminate the association between living arrangement and the nutritional status of 144,765 children under five years. Results showed that living with only the father compared to both parents was associated with a higher risk of malnutrition in SSA [OR:1.18, CI:1.03-1.30] while not living with both parents was associated with a higher risk of malnutrition in West Africa [OR:1.25, CI:1.02-1.54]. Lower risk of malnutrition was observed among children residing in households headed by their mother compared to those headed by their father in West Africa [OR:0.76, CI:0.66-0.87] and SSA [OR:0.83, CI:0.77-0.90]. These results suggest that with whom and where children live as well as biological relationships are vital in improving children’s nutritional status in SSA.