THE SOCIO-CULTURAL CONTEXT OF MATERNAL HEALTH IN LAGOS STATE, NIGERIA

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ABSTRACT

Maternal health is one of the major concerns of the global health community. Pregnancy- related mortality is avoidable if preventive measures are taken and adequate care is  available. Yet women in sub-Saharan Africa continue to die due to pregnancy-related complications. This study set out to examine the socio-cultural context of pregnant women and how that context precipitates maternal morbidity and mortality. The study was prompted by the high rate of maternal death despite all efforts and the observation that studies had concentrated on the proximate determinants of maternal mortality, rather than also considering the social determinants. Five objectives were considered which were to: identify the social factors that precipitate the medical proximate determinants of maternal health, determine the cultural beliefs and stereotypes that are associated with maternal health, examine how role conflict influences maternal health, investigate how mothers’ working conditions affect maternal health, and evaluate how social support influence maternal health. Systematic review of literature was carried out while the study utilized Functionalism, Agency Structure Theory and Gender and Development (GAD) Theory for its theoretical framework. The study was conducted in the four selected Local Government Areas (LGAs) of Lagos State from November, 2011to January, 2012 using 1,362 respondents to whom a structured questionnaire was administered, 20 key informants were interviewed and 4 case studies were analysed. Five hypotheses were tested. The first hypothesis revealed age, education, occupation, income, religion, marital status and type of marriage are significant determinants of maternal health complications. Women in age group 20-24, 25-29 and 30-34 are 0.631, 0.621 and 0.756 respectively less likely to have health complications. The second hypothesis estimated significant influence of cultural beliefs and practices on maternal health. With p-values 0.021, 0.001, 0.050 and 0.011 respectively, women who experience swollen feet, dizziness, fatigue or more than one of these symptoms are more likely to be at risk of complication. The third hypothesis also indicated a significant influence of role conflict on maternal health. Women’s working conditions were found to significantly influence maternal health complications in the forth hypothesis. And the finding of the fifth hypothesis revealed that there is a significant influence of social support availab le to women on maternal health. The findings presented in this study show that maternal health

challenges will continue to shape national indicators on health, poverty, and other development issues, if adequate attention is not provided. The study suggests that to reduce maternal morbidity and mortality, intervention programmes must be introduced to deal with maternal health in a broad and multidimensional way. Every effort must be put in place to reduce poverty and enhance infrastructural development. Health promotion and education should be widely recognized and should be embarked upon as necessary primary approaches to ensure maternal health. Health policies toward maternal wellbeing during pregnancy in the place of work should be developed in the light of urban poor infrastructure. There must be a strong political will to help in the process of reducing maternal mortality in Nigeria.

Keywords: Socio-cultural, Maternal health, Complications, Lagos.

TABLE OF CONTENTS

Title page……………………………………………………………………………………………………….. i

Certification…………………………………………………………………………………………………… ii

Dedication…………………………………………………………………………………………………….. iii

Acknowledgements……………………………………………………………………………………….. iv

Abstract……………………………………………………………………………………………………….. vii

Table of Contents…………………………………………………………………………………………… viii

List of Tables………………………………………………………………………………………………… xiii

List of Figures………………………………………………………………………………………………. xv

Abbreviations………………………………………………………………………………………………. xvi

CHAPTER ONE: Introduction

  1. Background to the Study………………………………………………………………………….. 1
    1. Statement of the problem………………………………………………………………………….. 4
    1. Research Questions…………………………………………………………………………………… 7
  1. Aim and Objectives of Study…………………………………………………………………….. 7
    1. Justification for the Study…………………………………………………………………………. 8
    1. Operational Definition Terms……………………………………………………………………. 10

1.8 Organization of Chapters…………………………………………………………………………….. 11

CHAPTER TWO: Literature Review and Theoretical Framework

2.6.3  Synthesis……………………………………………………………………………………………………….. 65

CHAPTER THREE: Methods of Study

3.6.2.Procedure for Data Collection……………………………………………………………………………… 93

CHAPTER FOUR: Data Presentation and Analysis

4.1.2   Spouse’s Demographic Characteristics………………………………………………………………… 107

Maternal Health………………………………………………………………………………………………. 108

the odds of maternal health………………………………………………………………………………… 117

  • Logistic Regression Estimating the Influence of Cultural Beliefs and Stereotypes

on the Odds of Experiencing Maternal Health Complication…………………………………. 122

  • Logistic Regression Estimating the Influence of Role Conflicts on the

Odds of Experiencing Maternal Health Complication……………………………………………. 124

  • Logistic Regression Estimating the Influence of Working Conditions on the

Odds of Experiencing Maternal Health Complications………………………………………….. 126

  • Logistic Regression Estimating the Influence of Social Support on the

Odds of Maternal Health Complications……………………………………………………………… 131

Chapter Five: Summary, Conclusion and Recommendations

References……………………………………………………………………………………………………………….. 158

Appendix I:  Questionnaire Schedule………………………………………………………………………….. 181

Appendix II:    Key Informant Interview Guide (For Medical Practitioners)……………………… 189

Appendix III:  Key Informant Interview Guide (For Women Ages 15-49)………………………… 190

Appendix IV: Maternal Mortality Rate in Lagos State……………………………………………………. 192

Appendix V: List of State-Owned Health Institutions and Registered Private

Health Facilities in Lagos State…………………………………………………………….. 193

Appendix VI:    Population Figure of Lagos State…………………………………………………………. 194

Appendix VII:  Photographs……………………………………………………………………………………… 195

LIST OF TABLES

Table 2.1:   Derivation of Actual Achievements on MDG 5 from Target…………………………….. 30

Table 3.1: Results of 2010 Maternal Mortality Study for the 20 Local Government

Areas (LGAs) of Lagos State, Nigeria……………………………………………………………. 80

Table 3.2: Distribution of Selected EAs in each of the LGAs and Streets

in each of the EAs……………………………………………………………………………………………… 81

Table 3.3:   Distribution of Health Facilities in the Study LGAs………………………………………… 88

Table 3.4:  Ratio of Health Facility to Total Population…………………………………………………….. 89

Table 4.1:  Distribution of Respondents’ by Demographic Characteristics………………………….. 105

Table 4.2:    Distribution of Respondents by Type of Marriage Contracted,

Age at Marriage, and Position among Wives………………………………………………… 106

Table 4.3:  Demographic Characteristics of Spouses……………………………………………………….. 107

Table 4.4:  Health Complication during Pregnancy………………………………………………………….. 108

Table 4.5: Cross Tabulation of Socio-economic Factors and Period of Pregnancy

before Antenatal Visit……………………………………………………………………………….. 110

Table 4.6:    Cross Tabulation of how Cultural Beliefs and Stereotypes affect

Maternal Health…………………………………………………………………………………………. 112

Table 4.7:   Frequency Distribution by Role Conflict……………………………………………………… 113

Table 4.8:   Role conflict influence on maternal health……………………………………………………. 114

Table 4.9:   Working conditions that influence maternal health………………………………………… 115

Table 4.10: Social Support Influence on Maternal Health………………………………………………… 116

Table 4.11: Odds Ratio of Logistic Regression on the Influence Social-demographic

factors on Proximate Determinants of Maternal Health Complications…………….. 121

Table 4.12: Logistic Regression Estimates of the Influence of Cultural Beliefs

and Stereotypes on the Odds of Experiencing Maternal Health Complication….. 124

Table 4.13: Logistic Regression Estimates of the Influence of Role Conflicts

on Maternal Health……………………………………………………………………………….. 125

Table 4.14: Logistic Regression Estimates of the Influence of Working Conditions

on Maternal Health……………………………………………………………………………….. 130

Table 4.15: Logistic Regression Estimates of the Influence of Social Support

on Maternal Health………………………………………………………………………………… 133

LIST OF FIGURES

Figure 2.1: Schematic Representation of the Conceptual Framework……………………………….. 70

Figure 3.1  Map of Lagos State…………………………………………………………………………………… 77

Figure 4.1: Frequency of the Proximate Determinants of Maternal Health………………………… 108

LIST OF ABBREVIATIONS

EOCEmergency Obstetric Care
HEFAAMALagos State Health Facility Monitoring and Accreditation Agency
HDRHuman Development Report
ICDInternational Classification of Diseases
ICMInternational Conference of Midwives
ICRWInternational Centre for Research on Women
MMRMaternal Mortality Rate
NDHSNigeria Demographic and Health Survey
NPCNNational Population Commission Nigeria
PHCPrimary Health Care
TBATraditional Birth Attendant
UNUnited Nations
UNDPUnited Nations Development Programme

UNFPA            United Nations Fund for Population Activities UNICEF          United Nations Children Fund

USAID            United States Agency for International Development WHO              World Health Organization

1.1  Background to the study

CHAPTER ONE

INTRODUCTION

The growing concern on improving reproductive health in the global south has created a demand for research especially in the area of maternal health. Maternal health, which is the physical well being of a woman during pregnancy, childbirth, and postpartum period (WHO, 2011; Fadeyi, 2007), has been a major concern of several international summits and conferences since the late 1980s, which culminated to the Millennium Summit in 2000 (WHO, 2007). At that summit, it was generally agreed that maternal health care  has a crucial role to play in the improvement of reproductive health and that women deserve to be well informed and empowered to have unhindered access to safe, effective, affordable, acceptable and appropriate health care service. These will enable them to go safely through pregnancy and child birth and provide couples with the best chance of having healthy infants (United Nations, 1996). While motherhood is often a positive and fulfilling experience, for

THE SOCIO-CULTURAL CONTEXT OF MATERNAL HEALTH IN LAGOS STATE, NIGERIA