Jenda: A Journal of Culture and African Women Studies (2001)
ISSN: 1530-5686
WOMEN, THE STATE AND REPRODUCTIVE HEALTH ISSUES IN NIGERIA
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Jenda: A Journal of Culture and African Women Studies (2001) ISSN: 1530-5686 WOMEN, THE STATE AND REPRODUCTIVE HEALTH ISSUES IN NIGERIA |
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Tola Olu Pearce
The relationship between Nigerian women and the State requires serious thought in all its dimensions. In whatever discipline one is working, a focus on the ‘woman question’ calls for close attention to other issues such as gender relations, ethnicity and religion, since each has an impact on women’s lives, and is mobilized within specific social contexts and historical periods. In this essay, I intend to address the problem of reproduction and reproductive health. Although this appears to be one area in which women have received more attention than men (there are increasing calls to ‘bring men into the picture’), it is clear that a good portion of this attention has not served women well. It is built on existing unfavorable gender relations and helps to perpetuate a range of subordinate relationships between men and women, as well as serve State interests. Even though the international population establishment became more interested in Africa’s population growth rates after the 1960s, and significantly increased pressure for fertility control in the 1970s, Nigeria and other countries resisted advice on policy development until the mid-1980s. Changes in population policies came after the economic recession, which began in the 1970s. In spite of the fact that Nigerian physicians had for a long time been privately concerned about mortality rates and the health of mothers and children, the push from the West to link fertility to national development in Third World nations only made headway as each African nation sank into an economic crisis.
Within this context, the Nigerian State made a U-turn and constructed a National Population Policy in 1988, which was implemented in 1989. This essay seeks to analyze what the policy, and its programs have meant for women. It also looks at how the construction of population ‘problems’ has influenced the State’s relationship to women. This includes several attempts to construct women in whichever way powerbrokers felt was appropriate. I will first briefly review the experience of women during the process of State formation from the precolonial era to the present day. I then analyze the politics of fertility control and the construction of the population programs. Finally, I look at the ongoing discourse between the State and women with regard to reproductive health issues.
No State is ever constructed in a vacuum. State formation occurs within specific historical periods and results from negotiations, conflicts, and consensus between many social groups. These include classes, ethnic groups, religious groups and genders. Each group attempts to legitimize its claims, impact policies, neutralise others or control resources as the need arises. I have here the image of the State as outlined by Bathily (1994). Throughout the precolonial, colonial and post-colonial eras, the composition and standing of village leadership, ancient kingdoms and the more recent ‘modern’ States were closely tied to the interests of segments of the population vying for prominence. Bathily (1994) notes that during the precolonial era, slavery brought looting and the economic dependency of African rulers on Western mercantile activities. Thus, according to Amin, this period was significant in the development of African States, since African societies were devastated: “Reduced to the function of supplying slave labor for the plantations of America, Africa lost its autonomy. It began to be shaped according to foreign requirements...” (Amin 1972:511). Where the slave trade strengthened the hands of rulers, it led to problems in the balance of power within communities. Where it brought the disintegration of central authorities, it fostered the flight of people to safety and brought wars. There was also the endless process of depopulation (Mahadi and Inikori 1994). The powerful became nonproductive and in fact, preyed on their own population (Bathily 1994). Tensions developed between rulers and the ruled, a phenomenon which may help explain some of the deep-seated distrust which, for instance, the Yoruba have towards Obaship and the State. As Pemberton and Afolayan (1995) argue, tensions between ruler and ruled are enacted each year in Odun Oba festivals throughout Yorubaland to the present day.
In the precolonial period, two organizing features had particular, though not the only, bearing on women’s relationship to political power. These were kin-based groupings and religion, and they were both intertwined. Regardless of their raison d’être, lineages were at the center of social identities and were concerned with their own social and physical reproduction. Property was controlled for this purpose, rather than for personal autonomy or private accumulation (Mafeje 1991). Although women were not without influence or personal rights within these kin-based groups, ultimately they were under the tutelage of elders, particularly male elders, within patrilineal descent groups. I begin with the important issue of lineage reproduction (both biological and social). Mafeje, Arigbede and other have pointed out that over much of Africa, married women bore the heaviest burden of all workers in African societies. (Arigbede 1997; Mafeje 1991). Women were of course responsible for births, but also for most of the domestic work that is involved in the social reproduction of labor power. They were often, as Ekejiuba writes of the precolonial Southern Igbo, also “expected to be self-sufficient”(Ekejiuba 1992:90). Where they remained outsiders to the patrilineage, women were not entitled to control lineage land, although it was allocated for use. User rights were later easy to ignore when privatization and purchasing began with Western contact. In some locations (Yoruba, Hausa), women could inherit land within their own patrilineage, but their claims were more easily contested than their brothers’ were, once women moved away after marriage.
In patrilineal/patrilocal extended family systems, (e.g., Yoruba, Lelna, Igbo, Ibibio), the ‘work’ required of women as bearers of children is often overlooked. Reproduction (pregnancy, delivery) is usually not thought of as ‘work’, but as Rothman (1989) points out, pregnancy is work, because in addition to the physical burden, all societies have behavioral expectations regarding pregnancy. The social, religious and food prescriptions and proscriptions reveal the extent to which pregnancy is a biosocial and not just a natural phenomenon, and women who do not behave as expected, run the risk of being blamed if anything goes wrong. It is interesting to note that the Yoruba imagery of pregnancy suggests that it is work, in that a pregnant woman is described as one who is trying to lug a gourd full of water (i.e. the pregnancy) home from a brook, over very difficult terrain. Further, where many children were expected, attempts to produce them in sufficient numbers and the appropriate sex takes a heavy toll on the female body (indigenous prenatal care, postpartum and terminal abstinence notwithstanding). Women must be properly socialized to face the physical risk to their lives, and ideologies or practices would have assisted, including the honors awarded a mother of many children. Generally, motherhood was held in high esteem, but the impact of patrilocality (living among ‘strangers’) is surely different from motherhood in uxorilocal (the Yao of Malawi), or virilocal societies. This is not to argue that wives within patrilineal compounds were slaves during the precolonial era, but that the social organization of childbearing had significant impact on their lives as working mothers. However, a wife’s situation usually improved with the birth of children (especially sons), age, seniority and hard work (Fadipe 1970).
What type of political power did women wield at this time? There are differing views on this, not only because there is a paucity of written material of everyday life in the precolonial era, but also because there was such variation between ethnic groups. I hold the view that although women had recognized decision-making positions both within lineages (natal and marital), and in the community at large (in age-sets, secret societies, occupational and political bodies), overall, it is unlikely that their political voice was as strong as men’s during this period. I also agree that political ground was lost after colonization (Pearce 1965). There is evidence that prior to colonization, some individuals rose to eminence and various associations had political clout. However, I would argue that in many societies women’s political power was not as prominent and stable as men’s were. For example, quoting Taiwo’s and Adeleye’s work among the Yoruba, Barber (1995) argues that “however great their involvement in political processes, Yoruba women have never been politically salient in the sense of being able successfully to initiate or direct political decisions that affect the polity as a whole (Taiwo n.d.). As Adeleye also insists, women have never occupied the key political offices, whether in precolonial kingdoms, or in the colonial or post-colonial state.”(Barber 1995:76). Igbo women are said to have had well defined political rights, and conducted much of their business without male interference. Village wives associations for instance, had political power and could impose collective sanctions on individuals (male or female), as well as on the entire male community (Mba 1992). However, some scholars (Ekejiuba 1992; Korieh 1996) believe that all this notwithstanding, men dominated Igbo society. But it has been noted that there are important variations among Igbo subgroups on the degree of political power held by women. Male dominance did not exist among the Onitsha Igbo, for instance (Nzegwu 2000). In the North, we have the well documented history of female rulers in the Hausa States, before the tenth century and even later during the sixteenth century (Abubakr 1992) and others have written about Queen Amina, other leaders, and the political offices reserved for women in the precolonial North (Awe 1992).
Religion and politics were closely intertwined in the precolonial period and women were often politically powerful as priestesses to indigenous gods and goddesses. These indigenous religions were important in molding moral order in Yoruba towns and villages. For instance, royal daughters, palace wives and priestesses were significant actors in constructing a community’s response to royal authority. Even though individual women often had political positions, an interesting observation has been made by Barber regarding women’s ability to amass and retain popular power within communities. Using the Yoruba, she discusses the well-known fact that women were often quite successful economically and had ample personal autonomy. However, they were blocked when it came to developing and retaining power within the general community. Socio-political power came from ‘possessing people’, and building up a large household of supporters. Wealth had to be translated into people and loyalty. The expectation was that women “should be the source of further people for men’s households, not a magnet attracting people into households of their own” (1995: 77). It was therefore difficult for them to translate wealth into power, and those who tried to build large households, like Efunsetan in the 1860s, were suspect, were perceived as deviant, and their power seen as destructive. The designation of ‘witch’ was never too far away from such women.
During the colonial period, the political scene became more complex and increasingly exploitative as a result of the agendas of the British government, the indigenous business class and political leaders. Watts (1983) shows how this system of governance further restructured relationships between local communities and indigenous rulers. While appearing to keep African political structures in place, the colonial method of governance drastically reduced the accountability of rulers within indigenous systems. Responsible to the colonial administration, obas, chiefs, emirs and other local administrative officials of Native Authority systems often descended mercilessly on their own communities. Mamdani (1995) refers to this as ‘decentralized despotism.’ The new Native Authorities had a free hand in interpreting local customs and in making new rules, even though the system (indirect rule) was billed as upholding the people’s way of life. Indirect rule accomplished the brilliant task of “harnessing the moral, historical and community impetus behind local custom to a larger colonial project” (Mamdani 1995:286), which was solely to extract resources. Many ‘customs’ were manufactured to suit the foreign administration and it’s local agents.
Women suffered important setbacks during the colonial era, both economically and politically. The gendered dimension of State formation became obvious. For one, the State and private corporations became interested in the production of cash crops and the acquisition of land. In the Western region for example, wives were often allocated smaller or less fertile plots, or plots were sold without their knowledge. Further, colonization brought political problems for women: “women were particularly disenfranchised as the process of indirect rule rendered them invisible in the governing process and challenged their decision- making roles in the economy...”(Johnson-Odim and Mba 1997:68). The representation women had within indigenous political organizations were not recognized with the creation of the Native Authority system. Regardless of the fact that a few rose to prominence and became icons (Funmilayo Anikulapo-Kuti; Margaret Ekpo; Gambo Sawaba), the growing disadvantage of the general female population became a sore point, particularly in the South. Additionally, women were used to mediate ethnic-regional conflicts. For instance, as Nigeria moved towards independence, religion and gender became tightly knit issues in the North/South political divide. The status of women in the North became a political issue. The Islamization of the North progressed steadily during British rule, partly as a negative reaction to British penetration and partly as a result of political stability and an improved communication network (Imam 1994). Gradually a stricter code of behaviour, the seclusion of women, and other conservative practices spread from elite women down through the rest of society. According to Imam, by the end of the colonial area “to argue for women’s political rights or possibilities of leadership was... Characterized as anti-tradition..., un-Islamic..., and anti- Northern...” (1994:131).
In the conflicts and struggles for power between the North and South, religious differences were played up. The South saw the North as wanting a theocratic State under Islamic rule, and the North felt that the South identified itself more with Christian values which were the foundation of colonial secular views of State formation (Williams and Falola 1994). By the time of limited self rule in 1954, control of regional political apparatuses in the North, West, and East was perceived as mandatory, by regional elites because this meant control of educational, health and political programs, all of which had long term implications for the development project as well as for women’s status and gender relations. At different times, ‘progressive’ politicians paid attention to the situation of women in their region, but more often than not, the ‘woman question’ became a front on which politicians constructed the type of regional enclaves they intended to administer. For example, at the time of independence, the premier of the Northern region (Abubakr, The Sardauna of Sokoto) declared that female suffrage was “inimical to the customs and feelings of the great part of the men of the region” (quoted in Callaway 1987), and Northern women did not receive the vote until the late 1970’s.
But one should not make too much of these legal differences, because the bulk of women across Nigeria bore children under one or more of the following constraints: work overload on the domestic and public fronts, polygynous ideologies, levirate, early marriages, female genital surgeries, the pressure of many pregnancies, State laws that made abortion illegal, and marital practices which gave fathers the right over children in a marriage. Also, after amalgamation in 1914, there was room for confusion with the simultaneous legality of customary, statuary, and Islamic laws. Both men and women with wealth or power could weave in and out of the separate legal systems. For instance, in places like Lagos, Ibadan and Abeokuta men contracted marriages through more than one legal system over their lifetime. The rights (e.g. inheritance) accorded wives and children differ for each system. In Lagos for example, this often resulted in families ignoring the deceased’s will, or men lodging wills in the high court in anticipation of problems. In the larger community, as women were edged out of local political positions, protests began. The protests in Abeokuta, in the West (1946) and Oloko in the East (1929), highlight these problems. The successful campaign of Anikulapo-Kuti to depose the Alake of Abeokuta was part of women’s struggles to retain a place in the new political machinery, at the local level (Native Authorities), but was soon extended to national politics.
Tensions between North, West and East persisted into the post-colonial era. While national integration was seen as an important goal following independence, each of the three regions sought to control the center (federal government) and mold national institutions. Thus according to Dare (1986), the irony lay in the fact that none of the parties which developed in each of the three regions (AG, NCNC, and NPC) were ‘national’ organizations, “yet each wanted to govern a united Nigeria” (1986: 76), while championing ethnic interests. Men controlled the political parties but often succeeded [by means of the politics of education/religion] in coopting women’s time and allegiance in their race for power, sometimes to the latter’s detriment. For instance, the female wings of political parties were generally denied autonomy even though and women served mainly as political mobilizers, and sometimes as entertainers or praise singers at political rallies. In the ever escalating battle for political control between the North and the South, dramatized as a battle between Muslims and Christians, the Northern Muslims only reconsidered their opposition to female suffrage when it became clear that female votes were needed to stop Southern male politicians from controlling the center (federal government). In the conversation between Northern and Southern elite men (the political class), women became useful or as Imam argues, “the fear that non- Muslims will win the federal government has meant that, since non-Muslim women have the vote and are unlikely to give it up, Islamists no longer insist that ‘their’ women should not vote” (1994: 133). Thus, the interest in allowing women to vote, run for office or mobilize others, only surfaced in 1979 as a strategy for Northern elite men to control federal institutions. During the colonial era, politics was constructed as a ‘modern’ activity from which illiterate citizens, especially those who were female, and indigenous rulers were to be edged out. This intensified after independence. Politics was ‘dirty business’, too corrupting for educated (and devout) ‘ladies.’ Furthermore, campaigning became increasingly expensive and beyond the ability of aspiring female leaders. What have flourished among women are the old-style community-based associations and the new-style NGOs, to be discussed shortly. But, the position of women in the post-colonial era has been described as “negligible, ineffective and voiceless” (Nwapa 1987: 119).
So far, I have highlighted the struggles and strategies used by the powerful in their attempt to gain political control. It is clear from this discussion that gender relations were an integral part of these struggles and the process of State formation. While women lost ground at the local, state and federal levels, their body count was useful in men’s ride to the top. Once formed, the male-dominated State had the power to further construct gender relations in the home, community and beyond, after independence. This, as we shall see, has been important in constructing the ‘population problem’ and programs for fertility control. Except for a few issues such as abortion, the Nigerian government stayed out of the world population debate until the mid-1980s, as already noted. It was one of several African States (e.g. Ethiopia, Tanzania, and Somalia) that refused to pay attention to international concerns over high growth rates. In Nigeria, the earliest government concerns were the maldistribution of people between rural and urban areas and migration. Through the 1950s and 1960s the focus was on resettlement schemes, and developing other strategies which would help stem the flow of migrants from rural to urban areas. During this period, private clinics and external funds were allowed to handle birth control, but a national population policy was not a major concern of the government. Therefore, couples, lineages and communities were left to their local practices and perspectives on fertility control. Indigenous forms of contraception were used by women largely for spacing, and outside of the control or scrutiny of their men folk.
However, as noted earlier, all this changed in the 1980s. At the time of the 1988 national population policy, the annual population growth rate was estimated to be 3.3, the infant mortality rate was 87 per 1,000 and the maternal mortality rate was reported to be among the highest in Africa. In Ife a study conducted in 1979/80 showed a maternal mortality rate of 1,170 per 100,000. Another in Zaria revealed a rate of 800 per 100,000 with significant increases when the mother was 15 years (2,700 per 100,000) or less than 15 years (3,100 per 100,000) (Rossites et al 1985). Since the late 1980s, there has been an explosion of studies on maternal health and female reproductive behaviour (Adetoro et al 1991; Alade 1989; Backer and Rich 1992; Caldwell 1987; Feyisetan and Pebley 1989; Harrison 1997; Makinwa-Adebusoye 1991; 1992; Odujirin 1991; Omorodion 1993; Okonofua 1994; 1997; Okonofua et al 1992; Pearce 1995; Renne 1993, etc.)
Gradually, the fertility control scene was transformed. Once it put a policy in place, the State began to face pressures and criticisms from both Nigerians and organizations outside the country. Internally, resistance to population control and the use of ‘modern’ contraceptives is strong among segments of the population, particularly men. Power brokers within lineages, husbands and religious leaders are some of the critics of modern contraception. Olusanya’s (1969) statement three decades ago that men did not like the distribution of contraceptives among wives was recently echoed by Jinadu and Ajuwon (1997). In their study of 142 married women in the Oranmiyan area around Ife in Osun State, the authors found that potential users stayed away from family planning programs out of fear of spousal displeasure. Some women reported that female friends often hide the pill for them, to avoid detection. UNFPA also notes in its Programme Review and Strategy Development Report (PRSD 1996) that there is still limited commitment to the population policy among community leaders, religious groups and there are significant numbers who hold “traditional values and attitudes with respect to fertility and family size” (UNFPA 1996:23). The PRSD report argues that “proponents of population and reproductive health programs in Nigeria do not seem to have sufficient influential allies and partners” (UNFPA 1996:24). In other words, there is still a lot of local resistance. The use of modern contraceptives, although rising, is still low -- 4% in the early 1980s, 6% in 1990 and 12% by 1996 (WFS 1981/2; NDHS 1990; UNFPA 1996). This compares unfavorably to other countries like Kenya (1993), Ghana (1993) and Morocco (1992) where contraceptives prevalence rates are 32.7%, 33.5% and 35.5% respectively (DHS reports). Furthermore, there is evidence of differential contraceptive practices between regions in Nigeria. In 1990, data revealed that the percentage of women using some form of contraception (modern or traditional) was 1.6% in the North and 11.9% in the South. While the total fertility rate in the North was 6.6 it was 5.5 in the South (NDHS 1992).
Fearing the displeasure of husbands and family members because of the new freedoms that modern contraceptives might bring, the government constructed a policy that supported the subordinate position of a wife in the patriarchal family. The population policy document therefore states that “the patriarchal family system in the country shall be recognized for the stability of the home” (FMOH 1988; 19). The document endorses polygyny, procreation for men up to the age of 60, and a voluntary limit of four children for women only. Given these perspectives on marital and reproductive behaviour, the rights and freedoms of husbands and wives have thus been constructed as significantly different, and unequal. In addition, one should note that the precise meaning of ‘patriarchal family system’ differs from one ethnic group to the next. A wide range of cultural practices point to quite different expressions of patriarchy among different ethnic groups. One might ask; which of these practices do those with vested interests in patriarchy consider to be necessary for “the stability of the home”: seclusion, levirate, childhood marriages, female genital surgeries, and the corporal discipline of wives? Following these policy statements, the initial focus of implementation was an aggressive family planning program which was devised mainly to reach married women. The State defined the population problem largely in terms of the reproductive behaviour of wives, that is, married women. All males and single females (e.g. Adolescents) were of secondary interest until quite recently (Caldwell et al 1992; Jinadu and Ajuwon 1997; Makinwa-Adebusoye 1993). The public sector has been slow in providing services to adolescents and the needs of this group has been left to NGOs and the private sector. Although recently the government, NGOs, and community-based organizations jointly drafted an Adolescent Reproductive Health policy, no one is sure what the future role of the government will be in service delivery (UNFPA 1996).
There is increasing concern that not enough attention is paid to men’s attitudes, responsibilities, and sexual behaviour, and that it does not correspond to their power and influence in reproductive behaviour, at both micro and macro-levels. Men dominate the reproductive arena as researchers, clinicians, lawmakers, funders, university professors and policy makers (Berer 1996). Furthermore, at the micro-level of households and lineages, men and patriarchal interests cannot be ignored. Isiugo-Abanihe (1994) discovered from a national sample of 3,073 couples that husbands are more likely to want more children than wives. The vast majority of his sample (97% of the men and 91% of the women) believed this to be the case. Both male and female respondents generally felt that men make the reproductive decisions, “decide whether or not to have sexual relations, decide upon the duration of abstinence and makes choices about the practice of family planning” (1994: 153). Bankole (1995) shows, from a study in Ife, that a husband’s fertility decisions dominate at the early stages of a marriage when the wife is still in a relatively weak position vis-a- vis husband and lineage. This is not to argue that wives cannot influence procreative outcomes. They do, as the earlier information on secrecy shows. Also, educated couples are more likely to discuss matters openly (Renne 1995). Nonetheless, the entire edifice of polygyny, modified polygyny and threat of polygyny has left its mark on the competition among women to produce children. The pressure on women to have many children has been great but the population program was enacted as if reproductive matters were “best left to women” (UNFPA 1996: 31). What this means is that women are left to struggle with what are essentially marital or family and cultural issues.
Beyond pressures from segments of the population, the State is also under pressure from international development interests (Pearce 1992). During the military rule of Babangida ‘population’ was used to legitimize claims that it was still a ‘development State’, in the face of continuing economic stagnation. The 1988 population control policy was initially sold to the public as a health and development benefit. Through externally funded population programs, the State has been able to obtain external funds, technical advice, technology and equipment. In some quarters, the government is still seen as actively pursuing development (i.e. ‘doing something’) although there is no improvement in people’s lives. For almost a decade, the supply of contraceptives has come from overseas donors. For instance, USAID spent about $15 million a year during this time. Other organizations that have provided funds include Britain’s Overseas Development Agency and the International Planned Parenthood Federation. Increasingly, it is believed that the future of the entire family planning program is in jeopardy, since much of the external funding has dried up and the government believes that neither it, nor the public can bear the cost of supplies (UNFPA 1996). Even with the cost sharing experiments that were tried out in the early 1990s, the funds raised through government family planning clinics are not able to cover the price of contraceptives, equipment and materials. Inflation and a devalued currency are major stumbling blocks. All the same, population issues receive a lot of attention and the numbers of agencies, programs, commissions and task forces working on different dimensions of the population program make it appear that the Nigerian State is officially committed to population ‘problems.’ As global concerns have moved from MCH to reproductive health and reproductive rights, the appropriate noises are made with the right buzzwords in official circles.
Technically, the new family planning facilities were to be incorporated into the Primary Health Care System (PHC 1987), within which family planning was an important dimension. The PHC system was said to be the best way of extending medical services to rural and underserved locations. It was to be the cornerstone of a National Health Policy (1988) which incorporated the idea of local materials and community participation to overcome long-standing problems within the medical care delivery system. From its inception in the colonial era the State’s medical services favored urban populations, was hospital-based and curative- oriented (Pearce 1980). It has been an uphill task to reach the most of the population in rural locations. Today, this delivery system is divided into three tiers, of which the first level is administered by local governments, which handles primary health care in communities. The secondary tier is administered by state governments and consists of specialised hospitals and training programs for health providers. At the federal level, the government is responsible for policy making, technical assistance, financing and coordination. In 1992, local government areas were give autonomy in providing primary health care. Formerly, funding at the local level was funneled through state governments, which then had a stranglehold over the affairs of local governments. Later, with the creation of the National Primary Health Care Development Agency (NPHCDA) in 1992, money was to be allocated directly to local governments. At the primary health level, village health committees work with district health committees that are under the jurisdiction of Local Government Primary Health Management Committees (Salako 1993). At the State level, the entire nation is divided into four health care zones for implementation of national health programs.
This official structure however masks major inequalities in access to services between regions, locations and socio-economic groups. In addition, the entire delivery system is deteriorating as a result of the economic downturn and markedly so after Structural Adjustment Program (SAP- 1986), when funding for public services was curtailed. The family planning program implemented through the PHC program was introduced at a low and chaotic point in the history of medical care delivery. Plans for improving health care were undercut by shortages in medical supplies, increases in the cost of drugs and reduction in services. For instance, in a study of pregnant women at the Obafemi Awolowo University Teaching Hospital in Ile- Ife, Okonofua et al (1992) reported that 40% of the 35 maternal deaths recorded between October 1989 and April 1991 were “attributed to inadequacies in the health care delivery system.” The deaths were due to “delays in referrals from health centers, lack of facilities, incorrect treatment and poor attitudes of staff” (1992: 323). Kisekka et al (1992) found a similar situation at a major teaching hospital in the North. As reported, the average number of hours between admission and surgery for pregnant women with complications rose from 3.5 in 1983 to 6.9 in 1988. They found that “this type of delay was attributed to shortage of supplies and equipments, drugs, blood, gloves, sutures and antiseptics. Patients’ relatives had to procure these...To crown it all, there was no adequate theatre space because the labor room was out of function and therefore, staff had to compete with other surgeons for the only theatre available” (1992:60- 61).
Throughout the 1990s, the population program grew and the number of contraceptive service delivery points grew even faster. In 1996, there were over 33,366 throughout the nation (UN FPA 1996). However, this expansion, coupled with the political interests of those in the field (women’s NGOs, in the Nigerian government, private medical personnel, external donors) resulted in chaos. Research indicates that many facilities are poorly managed, poorly equipped and underfunded. According to the 1996 UNFPA report, in over 50% of service delivery points one was likely to find only one (any one), rather than a range contraceptive methods available to the public. There was therefore no contraceptive choice in many of the clinics. Basic items such as water, sanitary examination tables, disposal gloves and sterilizing liquid are often not available. In addition, records are inadequately kept and follow up examination of clients is rare, and the system of referral is unreliable (Mensch et al 1994; Okafor and Rizzuto 1994; Pearce 1995; UNFPA 1996).
Financing this sudden growth has been a serious obstacle to quality care. Between 1986 and 1992 an average of 1% of the national budget was allocated to health, a figure that is well below the 5% recommended by WHO (UNICEF 1995). In 1994, this rose to 2.3%, which is still inadequate. There has been heavy reliance on external funding by governments (e.g. Britain, USA), United Nations agencies (e.g. UNFPA, UNICEF and NGOs (e.g. The Ford Foundation, IPPF). The entire program is under the threat of collapse, as agencies have begun to withdraw. Even though a wide range of agencies, task forces and programs have been established to address population issues (e.g. The National Primary Health Care Development Agency, National Population Program, Population Activities Fund Agency, National Population Commission, Population and Family Welfare Education, etc) funds remain scarce.
As the situation deteriorated, confrontations between segments of the public and the government grew. Nigeria is a nation in which nongovernment organizations, at the local level, were a precolonial invention, and served as pressure groups. (Kisekka 1992b; Mba 1982; Pearce 1989). However, with continued economic problems, and the feeling that the government was not working in the people’s interest, these organizations multiplied to handle community problems. By the early 1990s, much political hope was riding on the role that NGOs could play in addressing the problems of the marginalized, especially those in the rural areas.
Nonetheless, one needs to take a second look at the niche these associations are carving out. First, their rapid expansion has made the NGO scene chaotic, or as one observer argued, there is now anarchy (Arigbede 1992). The duplication of health and reproductive projects among competing groups (both locally and externally driven) is now a major problem, and opportunistic organizers are everywhere. The military government of Babangida attempted to bring some order to the situation by establishing the National Commission for Women in 1989 to serve as a blanket organization to oversee and register NGOs. Unfortunately, the First Lady consistently sought to control the Commission and strip the Chairperson of power. The Commission itself thus became the site of political struggle.
Secondly, there is the need to make some sense of the range of associations, in order to assess their potential for work in reproductive health. To make a difference, NGOs need to retain decision-making powers for themselves. If they merely become conduits for external funding on projects and programs from which the government has withdrawn its assistance, neither the government, nor the NGOs will be able to control policies and activities designed for women’s health. External funds bring external control. If this trend continues, the expectation that NGOs, as part of civil society, can serve as a training ground for democracy, as advocates for the poor, or as watchdogs to hold those in power accountable, will go unfulfilled. Dependence on foreign aid affects local activities, goals and organizational structures, (Silliman 1999; Turshen 1999). It is now believed that many associations run the risk of being compromised in terms of policy development and decision-making. While advocating democratic ideals, donors control the activities of local NGOs through funding, which has given rise to donor-driven priorities, work schedules and methods of executing projects (Dicklitch 1998).
Finally, NGOs frequently came into conflict with the government on policy issues, as when 140 associations working on health and development formed a coalition to make sure that the official statement prepared for the 1994 population conference in Cairo included the interests and views of NGOs working on women’s reproductive health. According to Peju Olukoya, a leader and spokesperson for the coalition, “we wanted to make sure Nigeria’s agenda for population policies included plans for economic development and other issues that affect women’s health” (Olukoya 1996). The Nigerian government like its counterparts elsewhere in Africa, has generally been intolerant of NGOs that take up the watchdog or advocacy role. Both Imam (1994) and Shettima (1995) discuss the hostility towards Women in Nigeria (WIN), a socialist - feminist organization established in 1982. WIN was formed to challenge both class and gender oppression, is nation- wide, and has been involved in health research throughout Nigeria. Given its critique of government activities and policies, it has not received official support in the same way as other conservative associations like the National Council of Women Societies (NCWS) and the Federation of Women’s Association of Nigeria (FOMWAN).
The political role of NGOs is still difficult to assess. But it is becoming increasingly clear that their impact will differ according to membership and source of funds. NGOs working in Nigeria can be broadly divided into three groups: 1) indigenous or local community-based associations created and managed by members. Examples of these include the well known market women’s associations, rotating credit unions, improvement societies, cooperatives and religious associations; 2) local organizations organized by the elite/educated who work to assist the more disadvantaged. These include organizations like WIN, Empower and Action Research Centre, and Professional associations (Law, medicine, journalism, university women, etc); and 3) regional or foreign-based organizations such as Soroptismist International, Associations of African Women for Research and Development (AAWOR), the Federation of African Women Educators (FAWE), Society For women and Aids in Africa (SWAA), and the Democracy and Governance Program in Nigeria (John Hopkins University). Stated briefly, the extent to which these organizations are able to manage their own affairs, influence policy makers, or are dominated by external funds and agendas differs considerably, with the first group retaining the most decision-making power within the organization but having the least resources and link to the State. The independence from State control that externally funded NGOs have is obtained at the expense of external control. They walk a tight rope.
Even as women lost direct political participation in the colonial and post- colonial periods, government officials argued that they were mindful of women’s concerns. However, this was usually not the case and indeed the argument that family planning was really a maternal health measure belies its role in entrenching old gender relations and assigning to women’s bodies major responsibility in ‘development.’ Somewhere along the way it was assumed that if women could be provided with certain basic needs (including water, contraceptives, immunization), development would follow, because they were the most disadvantaged, the weak link in the development process. The focus was on providing basic services -- especially health services. However, as Kabeer (1994) and other development scholars point out a distinction must be made between ‘needs’ and ‘interests’. Further, each of these involves separate political debates, as Kabeer shows. Building on the work of Fraser (1989), she argues that we should distinguish between: a) the politics of identifying a need as legitimate; b) the politics of interpreting how the need is to be satisfied; and c) the politics of securing resources to satisfy needs that have been recognized (Kabeer 1994: 193). By focusing on the politics involved in these activities, Kabeer makes it clear that power relations and interests are an integral part of the problem. She suggests that we move beyond the needs of women, in terms of mere access to reproductive health services, to interests, and women’s power to identify and control the interpretation of needs. The issue therefore is not merely the provision of services, but the very process of identifying and producing services. The focus on interests exposes differences in structural relations in society. This highlights women’s ability to make decisions that affect their lives and those of their children. However, it does not assume that women will not make mistakes as they struggle to improve the quality of life. When you think about it, development ‘experts’ consistently make mistakes, but are given other chances again and again.
Moreover, technical and professional experts must accept that the population debate needs to be opened up and moved beyond the narrow confines of fertility control. This was the main message of women who attended the Cairo conference in 1994. It was argued that population growth rates will fall when the status of women and their political participation change. Similarly, the health of women improves when their status changes. This is the larger issue for activists like Ilumoka and Olukoya who believe that women’s health problems in Nigeria are directly tied to their low status and the lack of control over their own lives. The usual way of dealing with new issues by reconstruction them to fit (e.g. reproductive health, reproductive rights, and empowerment) into old frameworks and processes is a continued recipe for failure. There is still hope however, that the associations springing up across the nation will forge alliances across ethnic, religious and class differences and demand political participation and real change.
Among the many groups working on reproductive issues either as their main focus, or as part of their mandate, are Women’s Health Organization of Nigeria, the Association for Reproductive and Family Health, Empowerment and Action Research Center, the Aba Women Volunteers, FOMAN, WIN, IAC, COWAD, the Grassroots Organization, Women’s Health Action Research Center, etc. Increasingly these organizations have identified the issue of governance and decision-making as central to the problem of change. Political participation allows for decision-making at the local, community and national levels to help create jobs, improve education and develop relevant policies. Nonetheless, funding remains a major obstacle for these groups. Strangely enough, we often forget that much of the funds from external sources come from foundations set up by wealthy individuals in their own countries. Within their cultural contexts and value systems, such persons have been persuaded, or find it expedient, to invest their vast wealth in private foundations. We are told that Nigeria has many dollar millionaires. It is no longer any good lamenting the fact that private foundations have not become a cultural phenomenon. A major task for those who are concerned about this is to develop culturally meaningful strategies that will persuade the wealthy to set up these organizations in the country. Western philanthropists do it for a variety of reasons (for reasons of power, image management, pure philanthropy or a guilty conscience.). Regardless of why they are established, Nigeria needs locally funded foundations.
1. Summary of Policy:
Abubakr, S. 1992. “Queen Amina of Zaria,” in Nigerian Women in Historical Perspective. Ed. Awe, B. Ibadan: Sankore/Bookcraft.
Adetoro, O. Et al. 1991. “Socio-Cultural Factors in Adolescent Septic Illicit Abortions in Ilorin, Nigeria.” African Journal of Medicine and Medical Sciences, 20: 2: 149-153.
Adetunji, J. 1996 “Preserving the Pot and the water: A Traditional Concept of reproductive health in a Yoruba Community, Nigeria”. Social Science and Medicine, 43: 11: 1561-1567.
Alade, M. 1989. “Teenage Pregnancy in Ile-Ife, Western Nigeria.” Western Journal of Nursing Research, 11: 5: 609 - 613.
Amin, S. 1972. “Underdevelopment and Dependency in Black Africa - Origins and Contemporary Forms.” The Journal of Modern African Studies, 10: 4: 503 - 524.
Arigbede, M. 1997. Development and Women’s Health in Africa. Annual Lecture: Series 3. EMPARC monograph.
Awe, B. 1992. (Ed). Nigerian Women in Historical Perspective. Ibadan: Sankore/Bookcraft
Backer, G. And Rich, S. 1992. “Influences and Adolescent Sexuality in Nigeria and Kenya: Findings from Recent Focus Group Discussions.” Studies in Family Planning, 23: 3: 199-210.
Bankole, K. 1995. “Desired Fertility and Fertility Behaviour Among the Yoruba of Nigeria: A Study of Couples Preferences and Subsequent Fertility.” Population Studies, 49: 317 -328.
Barber, K. 1995. “Going Too Far in Okuku: Some Ideas About Gender, Excess and Political Power”, in Gender and Identity In Africa Eds. Reh, M and Ludwar- Ene. Hamburg: LIT VERLAG. 77-83.
Bathily, A. 1994. “The West African State in Historical Perspective,” in Between State and Civil Society in Africa. Ed. Osaghe, E. Dakar: Codesria Book Series.
Berer, M. 1996. “Men.” Reproductive Health Matters. 7: 7- 10.
Callaway, B. 1987. “Women and Political Participation in Kano City.” Comparative Politics. 19: 4: 379-393.
Caldwell, J. Et al 1992. “Fertility Decline in Africa: A New Type of Transition?” Population and Development Review. 18: 2: 211 - 242.
Caldwell, P. And Caldwell, J. 1987. “Fertility Control as Innovation: A Report on Indepth Interviews in Ibadan, Nigeria,” in The Cultural Roots of African Fertility Regimes. Ed. Van de Walle, E. and Ebigbola, J. Philadelphia: Univ. of Pennsylvania, 233 - 251.
Dare, L. 1986. “Political Change in Nigeria,” in Social Change in Nigeria. Ed. Afonja, S. And Pearce, T. Essex: Longman, 71 - 91.
Dicklitch, S. 1998. The Elusive Promise of NGOs in Africa. New York: St. Martin’s Press.
Ekejiuba, F. 1992. “Omu Okwei of Osomari, in Nigerian Women in Historical Perspective, Op cit 90-104.
Fadipe, N. 1970. The Sociology of the Yoruba. Ibadan.
Federal Ministry of Health. 1988. National Policy on Population for Development, Unity, Progress and Self-Reliance. Lagos: Govt. Printer.
Feyisetan, B. and Pebley, A. 1989. “Premarital Sexuality in Urban Nigeria.” Studies in Family Planning, 20:6: 343 - 354.
Fraser, M. 1989. “Unruly Practices: Power, Discourse, and Gender,” in Contemporary Social Theory. Cambridge: Policy Press.
Harrison, K. 1997. “Maternal Mortality in Nigeria: The Real Issues,” African Journal of Reproductive Health (AJRH), 1:1: 7 - 13.
Imam, A. 1994. “Politics, Islam and Women in Kano, Northern Nigeria.” Identifying Politics and Women. Boulder: Westview Press, 123 - 144.
Isiugo-Abanihe, U. 1994. “Reproductive Botwation and Family Size Preferences Among Nigeria Men.” Studies in Family Planning, 25: 149 - 161.
Jinadu, M. and Ajuwan, B. 1997. “Traditional Fertility Regulation Methods among the Yoruba of Southwestern Nigeria.” African Journal of Reproductive Health (AJRH), 1:1: 65 - 73.
Kabeer, N. 1995. Reversed Realities. London: Verso.
Kisekka, M. et al. 1992. “Determinants of Maternal Mortality in Zaria Area,” in Women’s Health Issues in Nigeria. Ed. Kisekka, M. Jos: Tamaza Publishing Co., 51 - 66.
Kisekka, M. 1992b. “Women’s Organized Health Struggles: The Challenge to Women’s Organizations.” Op. cit, 105 - 121.
Korieh, C. 1996. Widowhood among the Igbo of Eastern Nigeria M.A. Thesis, Department of History, University of Bergen, Norway.
Mafeje, A. 1991. African Households and Prospects for Agricultural Revival in Sub- Saharan Africa. Working Paper 2, Codesria. Dakar: Codesria Publication Unit.
Mahadi, A. and Inikori, J. 1994. “Population and Capitalist Development in Precolonial West Africa,” in African Population and Capitalism. Madison: the University of Wisconsin Press, pp. 62 - 75.
Makinwa-Adebusoye, P. 1991. Adolescent Reproductive Behaviour in Nigeria: A Study of Five Cities. NISER, Monograph Series No. 3.
Makinwa-Adebusoye, P. 1992. “Sexual Behaviour, Reproductive Knowledge and Contraceptive Use among Urban Youth in Nigeria.” International Family Planning Perspectives, 18:2: 66 - 70.
Mamdani, M. 1995. Citizen and Subject. Princeton: Princeton University Press.
Matory, J. 1994. “Rival Empires: Islam and the Religions of Spirit Possession among the Oyo Yoruba.” American Ethnologist, 21:3: 495 - 515.
Mba, M. 1982. Nigerian Women Mobilized. Berkeley: International Studies, University of California.
Mensch, B. Et al. 1992. “Using Situational Analysis Data to Assess the Functioning of Family Planning Clinics in Nigeria, Tanzania and Zimbabwe.” Studies in Family Planning, 25: 18-31
Nigeria Demographic and Health Survey. 1990. Lagos: FOS.
Nzegwu, N. 2000. Personal Communication. Professor N. Nzegwu teaches Philosophy at Binghamton University.
Odujirin, O. 1991. “Sexual Activity, Contraceptive Practice and Abortion among Adolescents in Lagos, Nigeria.” International Journal of Gynaecology and Obstetrics, 34: 4: 361-366.
Okafor, C. and Rizzuto, R. 1994. “Women’s and Health-Care Providers’ views of Maternal Practices and Services in Rural Nigeria.” Studies in Family Planning, 25: 353-361.
Okonofua, F et al. 1992. “Maternal Mortality in Ile-Ife, Nigeria: A Study of Risk factors.” Studies in Family Planning: 23: 319-324.
Okonofua F. 1997. “Preventing Unsafe Abortion in Nigeria.” African Journal of Reproductive Health (AJRH), 1: 1: 25-36.
Olukoya, P. 1996. “NGOs: Banding Together to Shape Policy in Nigeria.” MacArthur Home Page.
Olusanya, P. 1969. “Nigeria: Cultural Barrier to Family Planning among the Yorubas.” Studies in Family Planning, 33: 13-16.
Omorodion, F. 1993. “Sexual Networking Among Market Women in Benin City, Bendel State, Nigeria.” Health Transition Review. Supplement to Volume 3: 159-169.
Pearce, T. 1965. “The Changing Status of African Women South of the Sahara”. Paper presented at the Southwestern Anthropological Association meetings, San Francisco.
Pearce, T. 1980. “Political and Economic Changes in Nigeria and the Organization of Medicare Care.” Social Science and Medicine, Vol. 14B: 91- 98.
Pearce, T. 1989. “Popular Participation for Women and Youth in Development.” Report submitted to United Nations Economic Commission for Africa (ECA).
Pearce, T. 1992. “On Many Fronts: Developments in Political and Academic Feminism in Nigeria.” Paper presented at Summary Workshop of the Canadian/Nigerian Linkage Program in Women Studies.” Ibadan: Institute of African Studies.
Pearce, T. 1992. Importing the New Reproductive Technologies: The impact of Underlying Models of the Family, Females and Women’s Bodies in Nigeria.” Paper presented at an International Conference on Women, Equality and Reproductive Technology. WIDER, Helsinki Finland (forthcoming: Glover, J. and Nussbaum, M. (Eds.)).
Pearce, T. 1993. “The Country Strategy for the Population Program in Nigeria.” Report submitted to the MacArthur Foundation. Chicago.
Pearce, T. 1995. “Health and Reproduction: Monitoring the Impact of Contraceptive Technology on Women in Nigeria,” in Hay, T. And Stichter, S. (Eds.) African Women South of the Sahara. Essex: Longman.
Pemberton, J. and Afolayan, F. 1995. Yoruba Sacred Kingship. Washington: Smithsonian Institution Press.
Renne, E. 1993. “Gender Ideology and Fertility Strategies in an Ekiti Yoruba Village.” Studies in Family Planning, 24: 343-353.
Rothman, B. 1989. Recreating Motherhood New York: WWW Norton and Publishing Company.
Salaka, L. 1993. “Nigeria’s National Health Policy in Perspective.” Health Research and Health Policy in Nigeria. Ed. Erinosho, O. Et al. Ibadan: Adebanke Press.
Silliman, J. 1999 “Expanding Civil Society, Shrinking Political Space: The case of Women’s Nongovernmental Organizations” in Dangerous Intersections Ed . Silliman, J and King, Y. Cambridge, MA: South End Press. 133-162.
Turshen, M 1999. Africa Privatizing Health Services in Africa New Brunswick, NS: Rutgers University Press.
United Nations Population Fund 1996 Programme Review and Strategy Development Report: Nigeria.
Watts, M. 1983. Silent Violence: Food, Famine and Peasantry in Northern Nigeria. Berkeley: University of California.
Williams, P. and Falola, T. 1994. Religious Impact on the Nation State. Aldershot, Eng: Avebury.
Copyright 2001 Africa Resource Center, Inc.
Citation Format
Pearce, Tola Olu (2001). WOMEN, THE STATE AND REPRODUCTIVE HEALTH ISSUES IN NIGERIA. Jenda: A Journal of Culture and African Women Studies: 1, 1.