Of Safe Motherhood And Men’s Behaviour

Motherhood is the state of being a mother. It means having a child and nurturing the child. Motherhood entails the period of pregnancy, through delivery and upkeep of the child. Safe motherhood is thus a reproductive health service that ensures that no woman going through pregnancy and child bearing suffers any injury or loses her life or that of the baby.

Nigeria, regarded as the most populous country in Africa, is said to have the highest maternal mortality ratios in the world. According to the newly revised estimate of the World Health Organisation (WHO), there are 1,100 maternal deaths in every 100,000 live births in the country, and a woman’s lifetime chance of dying during pregnancy, child birth, or the postpartum period is 1 in 18.

WHO also estimates that annually, 59,000 Nigerian women die in childbirth, which is the second highest in the world, after India.

Many factors have contributed to the above scenario. They include; severe bleeding (haemorrhage) which accounts for 25 per cent of deaths, infections (15%), unsafe abortions (13%); enclampsia (12%); and obstructed labour and other direct causes (16%).

Maternal deaths from direct  causes account for the remaining 20% of deaths. These deaths, according to WHO, result from diseases (usually present before or during pregnancy) such as malaria, anaemia, hepatitis, heart disease and HIV/AIDS that are not complications of pregnancy, but complicate pregnancy, or are aggregated by it.

In a presentation on Safe Motherhood in September, 2012 on “Women’s Reproductive Heath and Rights” organised by Ipas, Nigeria in Port Harcourt, Mrs Mikiai Amachree Desk Officer, Safe Motherhood in the Rivers State Ministry of Health said only 10 per cent of women deliver in government-owned healthcare facilities in the state.

According to her, “Statistics show that out of 237,114, which is 80 per cent of our target pregnant women, estimated to register for antenatal care services, last year (2011), only 120,990,which is 62.8 per cent, came for antenatal care services.

She continued that out of this number “only 11,878, which is 10 per cent of them, delivered in our health care facilities. This reveals gross under-utilization of the Services”.

Such records cannot be easily ascertained in the secondary, tertiary and private health facilities as well as traditional birth attendants (TBAs).

One way to check the trend of poor record keeping as it concerns the secondary, tertiary, private and TBAs according to Mrs Amachree is to make the Ministry of health a record bank of all deliveries in Rivers State.

Where to begin to keep records would be ensuring that all Health facilities involved in deliveries in the country are made to submit their records bi-annually to the state Ministry of Health.

“The implication of this is that the state governments need to make it mandatory, including enacting a law to that effect, for such health facilities to submit their records of deliveries and death to their various state Ministries of Health”.

Also, a study of deliveries that occurred in Kano State, Northern Nigeria, for instance, revealed a very high maternal mortality ratio of 2,420 deaths per 100,000 live births.

About half of these deaths were caused by enclampsia, rupture of the interns, and gnaemia.

Based mainly on data from two data national surveys, this report examined trends from 1990 to 2003 in selected factors that are directly and indirectly related to maternal mortality in Nigeria. Such factors include: the educational and social status of women of child bearing age, average family size, patterns of contraceptive use, and unmet need for family planning, levels of unintended child bearing and proportions of birth that constitute a high risk to mothers and their infants.

The report further looked at the willingness to, and patronage to health services by Nigerian women during pregnancy and child birth, as well as recent estimates of levels and sources of overall health care expenditures in Nigeria, in addition to examining the policies and programmes that affect maternal health in the country.

High risk births have persisted in Nigeria, though patterns vary according to region. In fact, from 1990 to 2003, two-thirds of all births were high risk because of the mother’s age, parity or spacing of births. More than 40 per cent of women who give birth do not receive prenatal care from a trained health provider, a situation which is above average in the North East and North West regions.

Although government at various levels, including international organisations such as WHO, United Nations Development Programme (UNDP) and USAID have done a lot to change the trend for the better, and there had been subsequent improvements, more still needs to be done to ensure safe motherhood in Nigeria. This is why male involvement at various levels of reproductive health has become pertinent.

Male involvement is used as an umbrella term to encompass the various ways in which men relate to reproductive health problems and programmes, reproductive rights and reproductive behaviours.

Male involvement in reproductive health has two major facets: the way men accept and indicate support to their partners’ needs, choices and rights in reproductive health; and men’s own reproductive and sexual behaviour.

Other terms that are often used in this context are male responsibility and participation. The terms “responsibility” stresses the need for men to assume responsibility for the consequences of their sexual and reproductive behaviour, such as caring for their offsprings, using contraception to take the burden off their partners and practicing safer sexual behaviours to protect themselves, their partners and their families from sexually transmited diseases, including HIV.

On the other hands, participation refers to men’s supportive role in their families, communities and work place to promote gender equity, girls education, women’s empowerment, and the sharing of house chores and child bearing.

It also suggests a more active role for men in both decision-making and behaviours, such as sharing reproductive decisions with their partners, supporting their partners choices and using contraceptive or periodic abstinence.

Men in family planning out- reach and service delivery programmes could contribute to more equitable relations between partners and improved communication, regarding reproductive goals.

Men have a stake in reproductive health through their multiple roles as sexual partners, husbands, fathers, family and household members, community leaders and gate-keepers to information and services.

To be effective, reproductive health programmes need to address men’s behaviour in these various roles. The first reason to involve men in reproductive health, therefore, stems from the need to promote observance of human rights and the need to enforce equity. Men are partners in reproduction and sexuality, hence it is logical that they share satisfying sexual lives and the burden of preventing diseases and health complications.

Another reason to involve men in reproductive health matters is that they are responsible, socially and economically, at least in part, for their children:

Involving men in reproductive decisions will, therefore, forge a strong bond between them and their off springs and can easily result in greater responsibility for their families well-being.

Also, men are de facto involved in fertility, and have important roles to play in contraceptive decisions. The support of men and women throughout their reproductive lives is crucial, especially before, during and after delivery, during breast feeding, and when women are experiencing serious conditions, such as malignant or chronic gynecological problems and before, during and after an interrupted pregnancy (voluntary or Spontaneous abortion?

Educating men in reproduction and contraception seems especially relevant and important in male dominant cultures where men already have an all-encompassing involvement in decisions pertaining to family and society.

Men need information, counseling and services to address wide range of problems and concerns related to reproductive health. Many men are poorly informed regarding sexuality and reproduction, hence they need information about male and female anatomy, contraception, STD and HIV/AIDS prevention, as well as women’s health care needs during pregnancy and child birth.

Again, family planning programmes until now have focused primarily on women because of their direct involvement in child bearing, and the predominance of effective female methods. However, in cultures where men dominate reproductive decision-making, the exclusion of men from reproductive health, including family planning and sexual health activities may contribute to low levels of the utilisation of such reproductive health services among women.

From the fore-going, it is obvious that a lot still needs to be done about male involvement in reproductive health matters.

Firstly, as part of efforts to ensure that men are involved in reproductive health matters, government at all levels need to give more attention to training of health care providers on ways of counseling male clients and couples in reproductive health, including family planning and sexual health as well as promotion of male involvement in the mass media. This can be achieved through drama sketches, jingles etc.

Government can also promote greater male involvement in reproductive health by ensuring that male services and information are offered throughout existing systems, looking for ways to adapt existing services to meet men’s needs and preferences, and supporting information Education and Communication (IEC) Interventions that encourage male involvement and communication between partners regarding reproduction and sexuality.

If all or most of these steps are taken into consideration, Safe Motherhood would be greatly enhanced in Nigeria.