Opinion: Rural women deserve to be healthy too

by Florence Opeyemi Fasetan

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Every woman should have access to the quality of maternal healthcare that would provide reasonable assurance of safe childbirth. For Nigeria, the available statistics in this regard paint a horrendous picture.

Good health is at the centre of economic development and so we cannot talk about development if we continue to neglect the health of women in rural areas. Rural women play a key role in supporting their households and communities in achieving food and nutrition security, generating income, and improving rural livelihoods and overall well being. They contribute to agriculture, rural enterprises, and help to fuel local and global economies. Yet every day, in countries such as Nigeria, rural women and girls face persistent structural constraints that prevent them from developing and deploying their potential, thus hampering their efforts to improve their lives as well as that of those around them. It is thus an economic imperative for the whole country that women in rural areas enjoy the same opportunities (including access to healthcare) as their counterparts in the urban areas.

Figure 1: Source UNDP

Rural women spend more time than urban women and men in productive (outside the home) and household work, including: fetching water and fuel, caring for children and the sick, and processing food. This is because of poor rural infrastructure and services, as well as culturally assigned roles that severely limit women’s participation in formal paid employment.

Faced with this lack of services and infrastructure, rural women carry a greater part of the burden of providing water and fuel for their households. In the rural areas of Guinea, for example, women spend more than twice as much time fetching wood and water as men, while in Malawi they spend over eight times more than men on the same tasks. Girls in rural Malawi also spend over three times more time than boys fetching wood and water (Figure 1). This condition is surely the same in Nigeria as in other sub-Saharan African countries.

Every woman should have access to the quality of maternal healthcare that would provide reasonable assurance of safe childbirth. For Nigeria, the available statistics in this regard paint a horrendous picture. A comparison with Belgium, which is often erroneously derided by some Nigerians for being a purveyor of second-hand goods, tells the story.

Maternal mortality rate for every 100,000 live births is 840; whereas that of Belgium is a miniscule 5. A similar narrative is indicated by the infant mortality rates: Nigeria, 74.36 deaths per 1,000 live births; Belgium, 4.28 deaths per 1,000 live births.

It can be said that the underlying cause of this tragic status quo is the poverty that is attendant to a weak underdeveloped economy such as Nigeria’s. Whereas Nigeria spends only 5.8% of its GDP of approximately US$247billion (US$14.33billion) on its population of 170 million people, Belgium spends 11.8% of its GDP of US$529billion (US$62.4billion) on a population of just over 10 million people.

One is tempted to ask: why does Nigeria not, at the very least, spend a similar 11.8% of its relatively meagre GDP on health?

Nigeria’s spend on education is no better than it is for health. Comparing again to Belgium, which spends 6% of its GDP on education (US$31.8billion) on a population of 10 million; whereas Nigeria spends a scandalously low 0.9% of its GDP (US$2.2billion) on education for a population of 170 million. The difference is in the order of 245 times, i.e., Belgium spends 245 times more per person than Nigeria does on education! Little wonder we are still mired in poverty.

Anecdotal evidence from the rural areas, especially from the Northeast and Northwest zones of the country lends credence to these depressing statistics. There is the case, in Gusau, of a baby that contracted tetanus after the nurse (an obviously ill-trained one) used a rusty razor blade to cut the baby’s umbilical cord after birth, thus notching up the sad statistics for preventable deaths. And there is the depressing narrative of derelict, poorly equipped and poorly staffed healthcare centres, where such exist.

A vital component of alleviating poverty and thus strengthening the Nigerian economy would be to unlock the untapped potential of the 50% of the population that live in the rural areas, through much greater access to education, healthcare and basic infrastructure (such as potable water, electricity and access roads).

Aside from the economic issues involved, every case of maternal or infant mortality represents a personal tragedy to the woman or child that dies, and anguish for their families and friends. In Nigeria today, an unacceptably high proportion of women (especially rural women) still give birth without proper medical supervision. The importance of the provision of much greater access to medical care for women cannot be overstated. The lives of more mothers and children must be saved. Government efforts, in this regard, need to be more than tripled. The efforts and contributions of donor agencies, development partners and NGOs, though commendable, cannot, on their own, achieve the necessary development goals.

One of the numerous challenges that beset the communities of the rural areas is the lack of adequate access to well-equipped medical facilities and the shortage of medical personnel. Government needs to work towards raising the socio-economic life of people in the rural areas, through the provision of basic amenities, which should not be limited to just boreholes, wheelbarrows, motorcycles and other token gestures. Much more has to be done to improve rural infrastructure (roads, electricity, potable water), which would in turn attract the medical and educational personnel that would improve socioeconomic life in the these disadvantaged communities.

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The causes of the high rate of childbirth maternal deaths include the following;

Lack of access to healthcare, including antenatal care

Inappropriate and harmful cultural practices, arising from

Low educational and awareness levels in women of the rural areas and the general population

Poor infrastructure to support a standard of living that would be conducive to good health

All other causes of high maternal childbirth death rates flow from the foregoing, including the clinical symptoms that constitute the immediate causes of death.

SOME OF THE WAYS TO REDUCE MATERNAL MORTALITY IN RURAL AREAS MAY INCLUDE THE FOLLOWING;

Promotion of awareness among women on the need to attend antenatal clinics

Socioeconomic development of the rural areas, which should include education and promotion of awareness of women.

Training of more community-based health workers

Provision of free medical services at well-equipped primary health centres.

Of recent there have been newspaper reports of moves by the Federal Government to pay a sum of five thousand Naira (in three instalments) to all pregnant women in Nigerian, to help curb maternal and infant deaths. This will not help in any sustainable way. These resources would be better used to educate these women, provide them free healthcare services, given the fact that there are still many communities that lack primary healthcare centres, especially in the north of the country.

Aside from the dubious benefits, the country simply lacks the administrative capacity to execute the massive dole-out the N5,000-per-pregnant-woman payout would entail, in a transparent and corruption-free manner. Corruption and rumours of corruption would be the order of the day.

Such a dole would probably have the unintended consequence of encouraging higher birth rates, and thus accelerating population growth, which we really do not need at present. While it is acknowledged that some targeted incentives might be a good thing, an incentive that would spur population growth is not one of them for Nigeria at this time.

In summary, poor access to developmental infrastructure and services by women (who represent at least 25% of the population) in rural areas limits their opportunities for the wealth generation that would reduce poverty, disease and hunger. Our focus should be on improving rural infrastructure and services, which include roads, potable water, healthcare and education, and thus support rural women. This would the best strategy for poverty alleviation and real economic growth. A N5,000 handout will not even scratch the surface of the issues raised in this article.

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Florence Opeyemi Fasetan tweets from @flofash

 

Op-ed pieces and contributions are the opinions of the writers only and do not represent the opinions of Y!/YNaija.

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