Poverty and maternal mortality in Nigeria

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Poverty and low income are well-established determinants of ill health, with poorer nations generally experiencing worse health outcomes compared to their wealthier counterparts (Wagstaff, 2002). Poverty, fundamentally defined as the inability to achieve a basic standard of living (Aigbokhan, 2000), can be understood through two dimensions: pennilessness and powerlessness.

Pennilessness refers to a lack of financial resources and other essential assets, while powerlessness captures the sense of having one's life dictated by external forces beyond personal control (Ijaiya et al., 2011). Nigeria, ranked among the 20 poorest countries globally, has over 66% of its population living below the poverty line (Lanre-Abass, 2008; Anyanwu, 2012). For women of childbearing age, poverty poses an acute risk, as financial and resource deprivation often leads to malnutrition and the inability to access basic necessities. These conditions significantly increase their vulnerability to poor maternal health outcomes, including heightened risks of mortality.

Figure 1 :Trend in National poverty incidence in Nigeria (Anyanwu, 2012)

A significant consequence of high poverty rates is the increased vulnerability of women to infections, often stemming from the unhygienic conditions in which they are forced to live. Additionally, financial constraints make it less likely for these women to seek care from qualified health professionals or access essential healthcare services.

Evidence from the implementation of United Nations Population Fund country programs demonstrates that improving individual and household income can significantly enhance access to and utilization of fundamental social services, including healthcare and education. These findings should serve as a call to action for policymakers, compelling them to address the pressing needs of their constituents and implement tangible solutions.

As always please feel free to share your comments.

What are your dreams?

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Every day we go about hoping and wanting things to get better in our different communities, countries and the world.
We wish that our future generations has more than what we were provided.
We wish that our children achieve more than what we have attained.

In the famous words of Martin Luther King Jr.

"I have a dream that one day this nation will rise and live out the true meaning of its creed - we hold these truths to be self-evident: that all men are created equal."

And at this point I share some of my dreams with you:

I have a dream that we substitute trying to impress each other with caring for ourselves with the utmost love and respect.

I have a dream that in Africa, maternal deaths will be reduced to the barest minimum, with the maternal mortality ratios being comparable to those seen in developed regions.

I have a dream that we treat money as not just the end target, but as a by-product of pursuing our visions.

I have a dream that we communicate with deep meaning amongst ourselves, thereby encouraging a deep relationship that stretches across limitations, beliefs, religion, geography and any boundaries.

I have a dream that when anger and fear surfaces; we handle it courageously while maintaining our values.

I have a dream where we as citizens of the world, share our collective intelligence and wisdom, to generate strength, creativity and unity that our future generations can benefit from.

I encourage you to dream with me because:

“A dream you dream alone is only a dream. A dream you dream together is reality.” (John Lennon)

What are your dreams? Share them here with us!!

Framing of maternal health risk communication messages

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Tackling maternal deaths is a multi-dimensional, multi-perspective and multi-sectoral issue. The risk of maternal mortality is an important concept that requires comprehensive understanding from its stakeholders. This is because the methodologies for managing this risk are becoming more complex with the added complexity of stakeholders perspective and communication challenges.

A theoretical approach to constructing effective risk communication regarding behaviour change is “message framing” (Rothman et al., 1993). In this approach, health messages can be framed in terms of positive (gains) or negative (losses) associated with a particular behaviour, this framing then influences decision-making (Rothman & Peter, 1997). For example “presence of a skilled birth attendant during delivery, reduces the risk of mortality” (gain-framed), and absence of skilled birth attendants during delivery increases the risk of death” (loss-framed).

According to prospect theory, the way a message is framed determines the degree of acceptability and responses of different individuals. When the benefits are more salient, people are risk averse, on the other hand when presented with potential losses, individuals are more likely to tolerate risks (Kahneman & Tversky, 1979). As a result, this leads to two categories of behaviours. According to the theory, for detection behaviours perceived as risky (e.g. it may detect a health problem), a loss-framed health message is considered useful (Rothman and Salovey, 1997; Rothman et al., 2006). For perceived low-risk prevention behaviours (e.g. it prevents the onset of a health problem), a gain-framed health message is more compelling (Rothman & Salovey, 1997; Rothman et al., 2006).


The aforementioned concept has been utilised successfully in various interventions, from skin cancer prevention to smoking cessation. The relaying of messages effectively to stakeholders of maternal mortality depends on the output method of the message.

Proper manipulation of evidence-based messages can lead to changes in attitudes, intentions, perceptions and actions. However, as compelling as the results from message framing studies have been, they should be treated with caution, given the paucity of well-designed experimental studies. Further research has been advised to examine the potential mediating process to changing behaviours (Pavey & Churchill, 2014). Indeed, the efficiency of message framing can depend on the disposition of the audience, and therefore, to maximise persuasiveness of a message, people’s differences and perceptions should be accounted for when tailoring risk communication strategies (Covey, 2014).

Perhaps a combination of message framing and efficient message dissemination strategies may be vital routes to take when embarking on communication interventions for the African women of childbearing age.

As always, please feel free to leave your comments.

Food taboos and nutrition during pregnancy in Africa

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Education and communication can influence the degree to which women of childbearing age understand the importance of proper nutrition during pregnancy. A Healthy balanced diet is a critical aspect of any pregnancy, as it will help the baby develop, and keep the woman in good condition. For instance, a firm link has been identified between malnutrition and anaemia during pregnancy (Rush, 2001).

The demand for iron and vitamins in women during pregnancy is increased due to the physiological burden, and these dietary deficiencies may give rise to anaemia. Unfortunately, African women are more prone to the risk of becoming iron and micronutrient deficient (Oye-Adeniran et al., 2014), potentially increasing their vulnerability to any concurrent condition. Maternal anaemia, however mild, enhances the risk of life-threatening postpartum haemorrhage (Allen, 2000; Rogo et al., 2006).

It is discouraging that reports show many women in Africa, especially the rural dwellers did not recognise the magnitude of the issue as they did not perceive anaemia as a priority health problem (Ejidokun, 2000; Ibrahim Isa et al., 2012). This same observation was made in less rural areas, for example, in Rivers State, Nigeria; there was a high prevalence of iron and zinc deficiency reported in the urban pregnant women (Oguizu et al., 2015).Indicating that women of different socio-economic backgrounds need an education intervention regarding nutrition during pregnancy.

Taking this topic a little closer to Sub-Saharan African countries like Nigeria, scholars have reported a link between food taboos and nutrient deficiency, because forbidding certain foods may deny healthy nutrients to the mother (Ono & Tukur, 2014). This issue contributes to the area of cultural impacts that can be detrimental to pregnant women’s health (Chukuezi, 2010). For example, in Nigeria, some cultures believe that women should avoid eating snails; otherwise, the baby eventually over salivates throughout their lifetime ( Ekwochi et al., 2016). Other examples exist such as mothers avoiding eggs to prevent the child becoming a thief, and avoidance of milk to stop the baby from growing up a weakling (Marchie & Anyanwu, 2009). On the other hand, some truth may exist to some of these food taboos. For instance, unpasteurised milk and soft cheeses (risk of listeria poisoning) are listed as foods to be avoided during pregnancy on the National Health Service, UK advisory website (National Health Service, 2015).

The aforementioned points emphasise the importance to empower the women through education, equalities in rights and fundamental socio-economics factors, for them to be properly equipped and informed to make better health care decisions irrespective of the deep-rooted cultural norms present in the communities.

Please feel free to air your views and contact me for a full reference list if interested.

International Day of Charity and stakeholder involvement

Hello everyone, today September 5th is the International Day of Charity, a day set aside by the United Nations where they invite all Member States and all international and regional organisations, as well as civil society, including non-governmental organisations and individuals. To commemorate the Day in an appropriate manner, by encouraging charity, including through education and public awareness-raising activities.

Health inequalities, poverty and suffering, persist in many parts of the world, especially in developing countries. Charity has a significant role to play in alleviating humanitarian crises and human ‎suffering within and among nations.


In addition to the efforts of charitable organisations ‎and groups, we can all get inspired to carry out acts of kindness and love in our various works of lives.

I feel that big multinational organisations should be encouraged to take their corporate social responsibilities as an act of charity, and not a mere obligation. Corporate social responsibility (CSR) is a practice in developing countries in which businesses are expected to meet some social commitments. Big multinational companies are known to be major players in leading CSR. However, the effectiveness of CSR initiatives by these firms is questionable, as there are gaps between their stated intentions and the real world impact. For example, there has been evidence that some multinational corporations provided some social amenities in the Niger Delta region of Nigeria, but these provisions (e.g., hospitals) been abandoned and did not meet the needs of the communities they were meant to support.

The CSR concept still suffers some level of abstraction, shrouded in organisation politics; however, the stakeholder approach offers a practical alternative. If we all commit to the well-being of individuals, communities and nations, I believe a significant difference will be achieved.


“If you judge people, you have no time to love them.

There are no great things, only small things with great love. Happy are those.

Spread love everywhere you go. Let no one ever come to you without leaving happier.

Be faithful in small things because it is in them that your strength lies.

If we have no peace, it is because we have forgotten that we belong to each other.

Peace begins with a smile.

Kind words can be short and easy to speak, but their echoes are truly endless.

I have found the paradox that if I love until it hurts, then there is no hurt, but only more love.

If you can't feed a hundred people, then feed just one.

Joy is a net of love by which you can catch souls”(Mother Teresa A.KA Saint Teresa of Calcutta)


Please feel free to share your thoughts.

Patriarchy and Gender Inequality in Africa

Patriarchy is a system of social differentiation and stratification on the basis of sex, where the men have authority over women and children, and ultimately are the head of the household. In many parts of Africa, women have been discriminated against from infancy and this gender disparity exists to the disadvantage of the women as it affects their social status and access to quality services

While patriarchy is a vital concept for feminist analysis, it has been reported that not all women are in subordinate positions and that women’s perceptions are shaped and affected by the constraints of patriarchal structures.

These include:

•    Patriarchal mode of production in which women’s labour is expropriated by their husbands
•    Patriarchal relations within waged labour
•    The patriarchal state
•    Male violence
•    Patriarchal relations in sexuality
•    Patriarchal culture

If the constraints within these structures are tackled, the implication is that these women may be able to initiate good health seeking habits, feel more empowered, and reduce harmful traditional practices (e.g. female genital mutilation). For example changing discriminatory legislations, which potentially weakens the influence of patriarchy should encourage women’s empowerment to practise good maternal health practices without the need for permission from husbands.

Sadly, many developing countries have continuously failed to stop gender discrimination, as evidenced by the recent failure of the Nigerian Senate in passing the proposed gender and equal opportunity bill. Measures such as changing legislation may however, be a longer-term strategy, as it concerns bureaucracy and government system processes. It is, therefore, vital to continuously seek out ways to empower women with the right tools to making practical life-saving decisions.

Intervention studies have indicated that the higher a woman’s socio-economic characteristics (e.g. wealth and education) the more averse her attitude is towards the continuation of harmful cultural norms and practices such as female circumcision. One immediate strategy may be to utilise efficient communication and education in informing these women on the usefulness of good health care seeking behaviour, and their fundamental rights within the current patriarchal systems.

Equal rights should be accorded to everyone without any form of discrimination, if the ambitious Sustainable Development Goals are to be met by the year 2030.

As always please feel free to comment.

Native midwives (traditional birth attendants) and maternal health

The potential negative health influence of native/home births and utilisation of unskilled native midwives has been indicated. However, training of these native midwives has been advocated, in conjunction with an understanding of the principal mode of sepsis treatment, which is antibiotics.

Scholars have over the years advocated for the usefulness of native midwives because they play a significant role in the women’s lives. However, other authors questioned their importance, as they believed that these native midwives do more harm than good if they don’t work in conjunction with hospitals. Arguing that the women have little or no place in improving maternal health, as they are too old and conservative to adapt to modern healthcare methods. Also, they are mainly illiterate, and cannot keep reliable records of their practices.

The opposing scholars argued that the native midwives have a valuable place in maternal health care. The increasing shortage of health-care workers in developing countries, especially in rural areas suggests the importance of native midwives training and inclusion. Irrespective of the issue that some are illiterate and have no formal training, they are ubiquitous, easily accessible, and hold a high value in communities because they are knowledgeable about the traditions, culture and language of the women.

Highlighting the use of native midwives in the community due to their cheap services, their cultural and traditional practices, the importance of their inclusion has been emphasised, because trust and cultural habits are important factors influencing why women visit them. The salient point drawn here is the need to communicate to the women of childbearing age the importance of  having a skilled birth attendance at delivery. This information will empower the pregnant women to make effective health care decisions.

Furthermore, if the suggestion regarding training native midwives is to be adopted, the educational method has to be tailored according to the capabilities of the target audience, because improper training may result in failure of the exercise. Highlighted patronisation of the native midwives, suggests that it may be beneficial to integrate and formally train them on the effectiveness of referrals and standard practices for patient care.

Please feel free to air your views, and leave comments.