Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment

Influence of intimate partner violence and male involvement on maternal healthcare services utilisation in Nigeria

Introduction

Low maternal health care services utilisation, especially antenatal care attendance and skilled birth attendance, has been documented to be responsible for maternal mortality and morbidity in Nigeria. While available evidence suggests mixed findings on uptake of maternal health care services in the context of abusive spousal relationships, male involvement in household and health decision-making has been established to promote uptake of maternal health care services. Yet, studies which consider mediating influence of intimate partner violence on male involvement and maternal health care services uptake are sorely missing in Nigeria. We hypothesised that maternal health care services uptake in abusive marital unions has implications for male involvement in pregnancy care and this has been largely overlooked in Nigeria.

Materials and methods

This study extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The 2018 NDHS is a nationally representative secondary data which collected population, demographic and health information on women, men and households in Nigeria. The secondary data used a two-stage stratified and multistage sampling technique to collect information from the respondents. In this study, data were extracted for women who were sexually active, within the reproductive age (15-49 years) and not pregnant in five years prior the survey (n = 7,847).

Results

The results indicated (77%) antenatal care attendance and (47%) skilled delivery. The mediating influence of IPV on male involvement resulted in women who experienced sexual violence more likely to use heath facility for antenatal care (OR = 3.20; C.I: 1.20-8.50). Women whose partners were involved in health decision making had lower odds of antenatal care attendance (OR = 0.64; C.I: 0.44-0.94). Also, women whose partners were involved in spending their earnings had lower probability of antenatal care attendance (OR = 0.72; C.I: 0.55-0.96). Yet, the mediating influence of intimate partner violence on male involvement resulted in a lower likelihood of use of skilled delivery for emotionally abused women (OR = 0.58; C.I: 0.39-0.85). Women whose partners were involved in spending their earnings had higher odds of using skilled delivery (OR = 2.15; C.I: 1.79-2.56). Yet, women whose partners were involved in their health decision-making had lower odds of using skilled delivery (OR = 0.46; C.I: 0.34-0.62).

Conclusion

This study held the philosophical stance that intimate partner violence mediated the influence of male involvement on maternal health care uptake while intimate partner violence had an inconsistent influence on maternal health care uptake. Policies and interventions should aim at addressing deep-rooted gender norms which promote IPV and limit male involvement in pregnancy care in Nigeria. Programme and policy interventions should focus on enhancing socioeconomic status of women.

Gender inequities in women's access to maternal health care utilisation in Zambia: a qualitative analysis

BACKGROUND

The role of gender inequities in women's ability to access maternal health care has mainly been analysed from either women's or men's perspective only. In this article, we explore the role of gender inequities in maternal health care utilisation from both men's and women's perspectives.

METHODS

Thirty-six interviews were conducted with reproductive age women (n = 24), and men whose wives/partners gave birth within the last three years prior to our study in Zambia (n = 12). Our study sought to improve understanding of the normative environment in which women and men make decisions on maternal health care utilisation in Zambia.

RESULTS

We found that men and women had different expectations regarding their gender roles in maternal health care utilisation, which created inequities reinforced by societal norms and traditions. Men make most household decisions including those related to reproductive health and they often have the major say in access to maternal health services despite not having holistic maternal health information which creates challenges in maternal health care utilisation.

CONCLUSION

The study highlights the need for maternal health care utilisation decisions to be made by both men and women and that men should be fully involved in maternal health care from pregnancy until after child birth. Further, there is urgent need for concerted and sustained efforts to change traditional norms that reinforce these inequities and affect maternal health care utilisation if Zambia is to meet Sustainable Development Goal-3.1.

Predictors of knowledge and practice of newborn care among post-natal mothers attending immunisation clinics in Southeast Nigeria

Objectives

Evidence-based newborn care practice recommended by WHO reduces neonatal mortality and improves neonatal outcomes. This study assessed the knowledge, practice-associated factors and predictors of essential newborn care among post-natal mothers in two primary health care centres in Southeast Nigeria.

Methods

Design

A cross-sectional total population study.

Setting

Two primary health care centres in two local government areas in Southeast Nigeria.

Participants

Post-natal mothers who attended immunisation clinics.

Data collection

Quantitative data was collected over four weeks from 400 post-natal mothers. Chi-square test and logistic regression were carried out for associations and predictors, respectively. Analytical decisions were taken at p<0.05 and 95% confidence interval.

Outcome measures

Knowledge, attitude, the practice of essential newborn care; predictors of practice.

Findings

Mean age of participants was 28.68±5.4. The majority (78.9%) had been counselled on newborn care and 85.2% delivered in a formal health facility. The majority (77%) had good knowledge of essential newborn care and practices (61%). More than half (62.3%) reported support from health workers. Predictors of good practice were older age (AOR: 0.435; 95%CI: 0.212-0.893), being married (AOR: 8.095; 95%CI: 3.732-17.558), living in the urban area (AOR: 0.478; 0.291-0.784), and having good knowledge of newborn care (AOR: 0.239; CI: 0.139-0.411).

Conclusions

Good practice was identified in the majority. Being married, older, living in urban areas and having good knowledge were predictors of good practice. Health facility delivery, continuous support by health workers and post-natal education to mothers in rural areas are recommended policy priorities.

Funding

None declared.