PRESERVING THE REPRODUCTIVE HEALTH OF WOMEN IN NIGERIA

PRESERVING THE REPRODUCTIVE HEALTH OF WOMEN IN NIGERIA

Аlice John Emaimo

Assistant Lecturer, Institute of Medicine, Peoples Friendship of Russia (РFUR) Department of Foreign Languages,

Russia, Moscow

Dembele Liubov

Assistant Lecturer, Institute of Medicine, Peoples Friendship of Russia (РFUR) Department of Foreign Languages,

Russia, Moscow

Keywords: Women’s health, reproductive health, health care, health services.

INTRODUCTION

Public health as an important element of national security, does not only function to provide timely or adequate medical care. Public health, also functions in monitoring, tracking and controlling outbreaks of diseases. A country’s health care system effectiveness is central in delivery of its health goals. Women's health refers to the branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a women's both physical and emotional well-being. At the same time, in recent years in Nigeria, there have been significant changes in the life of society, which led to a certain extent to unfavorable trends in reproductive health indicators. These includes nutrition, living conditions, lifestyle, environmental pollution problems inadequate provision of social protection guarantees; change in the foundations of the medical care system (reduction of budget financing, inadequate resource provision and, as a consequence, insufficiency of universally available preventive and rehabilitative medical care, etc.), it’s a low level of adaptation to new economic conditions.

Reproductive Health

The right to health, including reproductive health, is an integral part of human rights. These concepts and terms in recent years have been clarified, expanded and defined both by documents in the field of human rights, and between UN people's declarations and conferences on women, population and development, WHO documents.

Reproductive health (RH) is a state of complete physical, mental and social well-being, and not simply the absence of diseases or ailments, in all areas relating to the reproductive system, its functions and processes (WHO).

BARRIERS TO ACCESS TO HEALTH CARE

Distribution of resources in Nigeria:

The Federal and State Government allocate 15% of the state budget to health services. Within the available resources, high priority shall be accorded to primary health care with particular reference to the less privilege areas and groups. Community and financial sector resources shall be mobilized in the spirit of self-help and self- reliance.

How the resource should be used in future:

1. In the light of importance of health in socio-economic development, all the governments of the federation should review their financial allocation to health in relation to the requirements of other sectors of the economy. High priority programmes for primary health care should have the first consideration on any additional resources that may be available
2. Within the health care system, effort should be made to redistribute the financial allocation among health promotion, preventive and curative health care services. This is to ensure that adequate emphasis and awareness are placed on health promotion and preventive services without comprising curative health services
3. Governments of the federation should explore additional avenues for financing the health care system especially health insurance schemes and health development levies.
4. The users should pay for curative services while the preventive services should be subsidized. Governments of the federation shall encourage employers of labour and the financial sectors to participate in the financing health care services.

Workforce and resource issues in Nigeria:

The workforce and resources issues have been a theme of discussion in the country. Earlier health services were focused primarily in the urban areas, this made them to be experiencing adequate health care delivery than rural areas. Even though health institutions such as leprosaria and dispensaries had been established for rural areas, these did not cater for the communities outside their immediate zones. The problem is that rural people were effectively overlooked in health care delivery, since the existing institutions were inaccessible to them due to cost and logistic constraints.

Another basic problem is the inadequate staff situation to meet the needs of the country. But after training the staff most of them get a job in urban area where they are paid more.

Quality of care issues in Nigeria: Quality of care varies among patients, politicians, managers, clinicians and other actors within the health care system. She stressed that quality occurs when good decisions regarding care are made so that resource are utilized effectively and better health outcomes are produced. Quality of health care is a multidimensional and multifaceted concept interwoven with value judgements about what constitutes good quality. There have been several definitions of quality of health care. “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge”.

Accessibility: assess to hospitals or medical centres from the rural areas can be problematic from the patients due to geographical or financial barriers. In some rural areas there are little or no infrastructure for primary care but also, there are no qualified doctors. This is due to the fact that most of the doctors are aboard or in the city trying to earn comfortable and decent living.

Comprehensiveness: Nigeria health system can be categorized into the Public and the Private health services. The public health sector is further divided structurally into the Primary Health Care (PHC), Secondary Health Care (SHC) and the Tertiary Heath Care (THC). Though, World Health Organization (1978) suggests that in order for primary care to be comprehensive, all development- oriented activities should be interrelated and balanced so as to focus on problems of the highest priority as mutually perceived by the community and the health system, and that culturally acceptable, technically appropriate, manageable and appropriately selected interventions should be implemented in combinations that meet local needs. This implies that single-purpose programs should be integrated into primary health care activities as quickly and smoothly as possible. In Nigeria, there are referrals but the problem of the patients (either rich or poor, over 60 of age or not) faces is that they must pay part for their hospital bill before any treatment may commence.

Co-ordination of services:  There is no sort of co-ordination of services because of the way things are in Nigeria neither is there any accountability of the patient’s medical history. Patient can decide to move from one doctor to another without any referral. The system is not like in developed countries where the technology is computerized that you can pull out a person’s medical records anywhere.

Reproductive health interventions, beliefs and attitudes of pregnant women

Safe maternity and improved neonatal outcomes are predicated on proper antenatal care services. The fundamental aspect of women’s lives and an important constituent of antenatal care that should not be ignored is exercise. More so, it is noteworthy and also a common knowledge according to the American Congress of Obstetricians and Gynaecologists, that pregnant women can exercise very moderately for about 30 minutes at most during the days of the week. In accordance with these recommendations and irrespective of the pregnant woman’s physical fitness level, exercise should be low-impact, moderate-intensity, and quite very regular. Also, exercise in pregnancy is very much correlated with a low decrease in many common problems encountered in pregnancy. The stress of exercises allows some certain adaptations such as a healthier placenta and also an increased ability to deal with short a decrease in oxygen.

It is noteworthy that continuous studies have also recommended that women should start to initiate exercises if they have not or continue exercise if they have in most pregnancies as it is quite safe and not harmful to the foetus. The health benefits of regular physical exercise in pregnancy are outlined and included but not limited to:

• Maintaining and the improvement of physical fitness.
• Endurance.
• Prevention of excessive gestational weight gain and glucose intolerance.
• Conditioning of the muscles needed to facilitate labor.
• Improvement in psychological adjustment to changes in pregnancy.

Also, exercise in pregnancy is very much correlated with a low decrease in many common problems encountered in pregnancy. The stress of exercises produces certain adaptations such as a healthier placenta and an increased ability to deal with short decrease in oxygen. In spite of the fact that exercise programs during pregnancy and after childbirth are designed to minimise impairment and help the woman to likely maintain or regain most function while she prepares for the arrival of the newborn and also caring for the infant. It is observed that most women are not meeting the exercise recommendations needed.

A group of factors that is not limited to beliefs and attitudes of women with respect to exercise in pregnancy includes:

• Levels of knowledge
• Level of education
• Ethnicity
• Previous involvement in regular exercise that have been implicated as important factors which are predisposing factors to pregnant women.
• Adolescent sexual and reproductive health (fistula)

Historically, adolescent sexual reproductive health (ASRH) has been overlooked despite very high risks Nigeria as a country faced for its neglect. The major immediate challenging factors faced by adolescents are:

1. Early pregnancy and parenthood.
2. Difficulties accessing contraceptives.
3. Unsafe abortion
4. Awareness inadequacy from primary caregivers.
5. Illiteracy
6. Stigmatisation
7. Religious Beliefs
8. Sexual education inadequacy
9. High rate of sexually transmitted infection/diseases.

Other factors are undeniably political, economic and a sociocultural restriction that aids delivery of information and services for healthcare workers. These barriers aid the failure to provide young people with supportive or non-judgmental services.

Obstetric fistula is known as the presence of a hole between a woman’s genital tract and urinary tract (i.e. vesicovaginal fistula) or between the genital tract and the intestines (i.e., rectovaginal fistula). The vesicovaginal fistula is characterised by the leakage of the urine through the vagina. While the rectovaginal fistula is characterised by the leakage of flatus and stool through the vagina. Both vesicovaginal and rectovaginal fistula are strongly associated with a persistent offensive odour leading to the social stigma and exclusion/excommunication of these affected women.

There are three prominent causes of obstetric fistula:

• The first cause of obstetric fistula is ischemia of the soft tissue between the vagina and the urinary tract or between the vagina and the rectum by compression of the foetal head.
• The second most common cause of obstetric fistula is the direct tearing of the same soft tissue during precipitous delivery or obstetric manoeuvres.
• The last and least common cause is elective abortion. These causes are not mutually exclusive and may have additive effects.

Each of these occurs as a complication of delivery or uterine evacuation usually in the absence of skilled medical staff assistance.

Obstetric fistula is a childbirth injury that disproportionately affects women in Nigeria today. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices cannot be overlooked because it has a significant influence on susceptibility to the condition. Two to three million women around the world live with urinary incontinence or faecal incontinence caused by genital fistulas. Further complications may include nerve damage to the muscles in the lower legs, and the damage of vaginal tissue.

Obstetric fistula has devastating effects on women’s lives. Needless to say, that they are often really stigmatised and socially excluded, they have limited employment opportunities and restricted participation in community activities. Most reasons for stigmatizations are due to lack of awareness in the society and lack of proper medical help.

CONCLUSION

The importance of tackling obstetric fistula in Nigeria cannot be overemphasized. It poses a major setback to the reproductive health of young girls and women in Nigeria. Majority of the sexual reproductive health (SRH) services were available and geographically accessible, but very few were financially accessible to adolescents. These services were not specifically for the adolescents and therefore, may hinder their access as well as utilization. Socio-demographic factors associated with adolescent’s access to geographical and financial to SRH services were age, education and income. It is therefore suggested that adolescents-friendly SRH services should be made available and accessible. To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth assistants can be regulated and the primary health care services strengthened.

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