GENDER MAINSTREAMING AND THE HEALTHCARE SYSTEM: NIGERIAN WOMEN IN PERSPECTIVE

• GENDER MAINSTREAMING AND THE HEALTHCARE SYSTEM: NIGERIAN WOMEN IN PERSPECTIVE

Introduction

From the pre-colonial times to the twenty-first century, the role and status of women in Nigeria have continuously evolved in various aspects and endeavour of human life. Conversely, little recognition has been given to the various functions that Nigerian women have performed throughout history. It is common knowledge that Nigeria is a paternalistic country despite its multicultural disposition. As such, Nigerian women across different ethnic boundaries are subjected to various forms of gender discrimination and segregation. They are been relegated to the background because of their gender which fallaciously is seen as weak and inferior. It is important to note that of all the various forms of gender discrimination meted out against Nigerian women, health discrimination remains significant and a theme for discuss in the course of this article.

Right from Nigeria’s independence in 1960, Nigerian women have suffered severe health-related challenges mostly as a result of poor healthcare system. This is particularly true both for those living in rural areas where the burden of disease is disproportionately high, as well as those in urban areas where religious, traditional and psychologically-related unhealthy beliefs and practices limit women from gaining quick access to quality healthcare.

According to A. I. Akinyemi, the average Nigerian woman or child faces a myriad of hindrances in accessing health services. For those from poor homes, accessing basic healthcare services is always a challenge because they lack the wherewithal. As such, they are exposed to diseases and sickness. On the other hand, Patriarchy also restricts women’s ability to make decisions about their healthcare in Nigeria. This is quite glaring as African culture requires men to take care of their women because they are the head of their households. However, one of the demerits of this practice is that it deprives women the opportunity to voice out their challenges especially those that are health-related..

Although women have the right to access to quality healthcare and life in general, it is unfortunate that at present, women in Nigeria suffer tremendously from poor healthcare system. It is against this background that this paper seeks to initiate advocacy for gender mainstreaming with the objective of exploring different ways of eradicating Nigerian women’s health challenges. The paper also seeks to examine the different health challenges which Nigerian women have suffered from 1960 till 2015.

Gender mainstreaming and the Sustainable Development Goal (SDG) 3

Gender mainstreaming can be described as the concept of accessing the different implications for women and men of any planned policy action, including laws and programmes in all areas and levels. Mainstreaming essentially offers methods that regard the diversity between men and women in society. It calls for positive action and also demands a lot of commitment and resources in the pursuit of a world where gender disparity will be relegated to the background. At the policy level for instance, mainstreaming ensures that issues bordering on gender equality become a visible and central concern in policy and planning. At the organizational level, it ensures that the opportunities for learning and growth are made available for women and men respectively.

Overall, the aim of gender mainstreaming is to ensure the political, economic, social and legal representation of men and women in every society. Its core values are hinged on equality and fairness and this is evident in its pursuit for equity and justice for men and women through its policies and programmes. Explaining mainstreaming as a strategy to addressing issues bordering on gender inequality, the United Nations Economic and Social Council (UNESCO) highlighted thus:

Mainstreaming a gender perspective is the process of accessing the implications for women and men of any planned action in all areas and at all levels. It is the strategy for making women’s as well as men’s concerns and experiences an integral dimension of the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres so that women and men can benefit equally and inequity is not perpetuated. The ultimate goal is to achieve gender equality.

Based on the foregoing, it is revealed that gender mainstreaming is the proper strategy to addressing all forms of discrimination against women.

Apart from the education, political and economic sectors, Nigerian women have experienced a high degree of ill-treatment in the health sector and such treatment does not align with the United Nations Sustainable Development Goal 3 which seeks to ensure healthy lives and promote well-being for all (men and women) at all ages. The SDG 3 targets the reduction of maternal mortality, ending all preventable deaths under five years of age; fight communicable diseases; ensure reduction of mortality from non-communicable diseases, promote mental health; prevent and treat substance abuse; reduce road injuries and deaths; grant universal access to sexual and reproductive care, family planning and education; achieve universal health coverage; and reduce illnesses and deaths from hazardous chemicals and pollution. Again, it not only aims to achieve universal health coverage that seeks equitable access of healthcare services to all men and women across different continents of the world on or before 2030 but also proposes to put an end to the death of newborns under five years as well as epidemics.

Certainly, good health is essential for growth and development. In fact, it is both a means and an end to good living in society. But the problem is that Nigerian women suffer the consequences of poor healthcare and thus become vulnerable to it. It is pathetic to note that despite the launching of the UN SDG 3 which focuses on the need for countries to make policies and programmes that would facilitate quality and affordable healthcare for all gender, the healthcare system in Nigeria has remained unchanged.

Unbundling Nigerian Women’s Health Challenges

According to the United Nations Children Emergency Fund (UNICEF), fourty million women of childbearing age between 15 and 49 years of age suffer a disproportionally high level of health issues surrounding birth in Nigeria. Furthermore, while the country represents 2.4 per cent of the world’s population, it, however contributes about 10 percent of global deaths for pregnant mothers. The UN body continued that the statistics show a maternal mortality rate of 576 per 100, 000 live births which is the fourth highest on earth. Additionally, each year, approximately 262,000 babies die at birth – the world’s second highest national total. Based on these figures, one can conclude that no much attention is given to the Nigerian healthcare system. And so, what then is the essence of having a government?

Since Nigeria’s independence in 1960, the country has had a very limited scope of legal coverage for social protection. What this means is that a good number of Nigerians do not have health insurance. This is also evident as it is documented that over 90% of the Nigerian population have being without health insurance coverage. After many attempts of implementing the law on health insurance in 1960, the National Health Insurance Scheme (NHIS) – established in 1999 and launched in 2005 has in the course of its operation, targeted the most vulnerable population in the country most especially pregnant women, women and men with disabilities, the aged, and the sick. However, most of these services are self financed because free healthcare services and exemption mechanisms are politically motivated most times and are poorly implemented.

In another event, states in the northern region of Nigeria experience a much higher rate of under-five mortality unlike those in the southern region. On the other hand, the maternal mortality ratio in Nigeria as of 2016 stands at 814 per 10000 live births according to World Health Statistics. Across the country, pregnant women and children under the age of five are charged medical fees when accessing healthcare services despite the Federal Government’s declaration of free healthcare for pregnant women and children below five years in 2005. Marked by political irresponsiveness at the expense of people’s well-being, the Nigerian health system has overtime remained in a bad shape.

About 60% of pregnant women in Bayelsa, Plateau and Niger deliver their babies at home instead of a health facility. Most times, the distance of these pregnant women’ houses from health facilities are very far. Also, the cost of healthcare remains another factor that hinders them from delivering their babies in hospitals. The cost of healthcare and perceived low quality care by most health facilities like public and even private hospitals have been argued to be the reason for the poor utilization of maternal and child health services in Nigeria.

Again, widowhood practice which subject women to drinking bath water that was used in washing their deceased husbands’ corpse is another unhygienic and unethical factor that affects the health of Nigerian women. This practice has been in existence from the colonial to the post-colonial times. It does not only subject women to torture, but also endangers their health by exposing them to disease contraction as well as psychological trauma. Among the Hausa, women and girls are often times than not forced into early marriages which usually expose them to health complications due to very frequent and most times premature pregnancies, among others. For Yoruba women, the extreme use of herbal medicines by pregnant women usually cause them complications during childbirth and in most cases, this results in child deformity – a situation where the child may be born mentally or physically unstable or maternal mortality.

Eradicating Nigerian Women’s Health Challenges for Sustainable Development: Any way forward?

The United Nations women’s conference held in Nairobi in 1985 afforded third world countries, particularly Nigeria, the opportunity to redefine how women were to be catered for in order to enhance development. The sub-theme of the conference was “Employment, Health and Education.” This was taken as an issue to advance for women to be mainstreamed into development. In Nigeria, post 1985 responses to the UN decade actually meant development as the country policies on women development. According to the policies, health and education were at the forefront while women in the rural areas were prioritized.

Through the Better Life Programme which aimed at reducing the rate of rural-urban migration, the Better Life for Rural Women (BLW) was also founded by Mrs. Maryann Babangida. The organisation was founded with the primary objective of catering for the needs of women in rural areas. In the same vein, the Federal Ministry of Health embarked on a programme called “Promotional Health through Functional Literacy” for women in the rural areas. The programme was in collaboration with the BLW programme to reduce the rate of illiteracy on health issues because it was believed that if a woman is properly educated, she can be able to take good care of herself and children. The programme was also meant to enlighten women on basic health problems and solutions.

It is certain that in order to eradicate the health challenges that women face in Nigeria, there will be need for an intense health advocacy and enlightenment programme for Nigerian women. Through this process, they would be educated by health professionals on how well to live a healthy life as well as the necessary steps to take in order to maintain good life. This will increase the well-being of individuals, families and the community at large. However, it is quite absurd to note that despite the fact that family planning has been identified as a very important factor in addressing high-risk births, only about one-fifth of Nigerian women are currently using the modern method of contraceptive and about 23% opined that they have unmet needs for family planning while only 38% were satisfied with the family planning method they used.

Girl-child education is one of the major indicators of women empowerment, particularly at the secondary school level. It enhances women’s health literacy skills and has been identified as a major factor in the uptake of family planning and child healthcare. Girl-child education is also a fundamental human right entrenched in the Sustainable Development Goals. It enhances the socio-economic status of girls, their families and the society at large.

The government should increase its efforts to ensuring that women are safe and protected from gender-based violence. On this note, laws that protect women from abuse, torture and discrimination should be enacted and also implemented.

Conclusion

The article finds that Nigeria’s healthcare system is very poor as it ranks among the worst globally in terms of access and quality. Challenged by poor funding, system neglect and inefficiency of medical staff, prolonged industrial action by health workers, corruption and political interference, the system is in a state of comatose and thus cannot measure up to what is obtainable according to world health standard.

The article also finds that at the centre of this anomaly are Nigerian women who have become more vulnerable to the system. Making reference to the United Nations Sustainable Development Goal (SDG 3) which emphasizes the need for healthy living for all irrespective of gender, the article stressed on the essence of gender mainstreaming in the country’s healthcare system. It also examined some of the health challenges that have befallen Nigerian women especially those who have reached reproductive stages, as well as their resultant effect. Revealing that patriarchy equally contributed to the subjugation of Nigerian women to unhealthy practices, the article proposed different strategies that should be adopted and acted upon in order to eradicate the health challenges which limit Nigerian women from attaining greater heights in society. These strategies spans from the need for proper health education for women and girls, healthy living, girl-child education, to government support through the enactment of legislations that would protect women from being exposed to gender-based violence and discrimination in society.

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