Nigeria’s societal structure is deeply rooted in patriarchy, a system in which authority predominantly rests with men, allowing them to exert control over women across various aspects of life. This cultural framework has far-reaching implications for women’s health and the choices they make concerning their well-being.
The realm of women’s health isn’t solely influenced by medical conditions and childbirth; cultural norms and traditions play a crucial role. Moreover, gender disparities in healthcare access and employment opportunities can significantly impact people’s ability to lead healthy lives.
Obioma Nnaemeka, a Nigerian feminist scholar, introduced the concept of “negofeminism,” which characterizes African feminism as a process of negotiation and compromise. This framework underscores a collaborative approach rather than confrontational exchanges.
As a global health researcher, I applied this concept to comprehend the perspectives of rural Nigerian women on seeking healthcare during and after pregnancy.
In a recent study, my colleagues and I engaged women and their spouses from two rural communities in southern Nigeria, delving into the intricate dynamics of healthcare decision-making.
Our research revealed how women navigate patriarchal norms by entrusting the role of decision-maker to their male partners while retaining influence over their pregnancy-related healthcare choices and actions. This approach highlights the principles of alliance, community, and interconnectedness inherent in negofeminism, as men actively participate in maternal health matters.
Our findings demonstrated that women are far from being passive victims. Instead, they adeptly maneuver within patriarchal environments to secure optimal maternal health outcomes by asserting control over their healthcare choices.
Recognizing this form of agency is pivotal for crafting policies and programs that acknowledge the impact of women’s broader social contexts on their health.
In Nigeria, inadequate access to quality healthcare contributes to a staggering rate of 556 pregnancy-related deaths per 100,000 live births. Disturbingly, Nigeria shoulders 10% of the global burden of pregnancy-related deaths, according to UNICEF.
Some scholars posit that women can only access healthcare if they possess autonomous decision-making abilities. However, this perspective often overlooks the reality that women’s social networks, including mothers, grandmothers, spouses, and community members, profoundly influence their utilization of healthcare services.
Our study contradicts the assumption that social dynamics inherently hinder women’s autonomy.
Hence, discussions surrounding maternal health in an African context must embrace the complexity of women’s identities as both “African” and “women.”
Our study was conducted in two primarily rural communities in Edo State, Nigeria. We engaged in five women-only focus group discussions comprising 39 women and three men-only focus group discussions involving 25 men. Participants were drawn from a database of women participating in maternal health interventions.
We inquired about whom women consulted first for pregnancy care, as well as who made decisions regarding maternal healthcare seeking. We also explored men’s roles in maternal and child health.
The prevailing sentiment was that men held decision-making authority within households. Participants stressed that a woman’s spouse should be her first confidant about her pregnancy. Both men and women agreed that men should take charge of healthcare decisions during pregnancy, even though women often wielded influence over these decisions.
One participant shared her experience:
“When it comes to care, I’ll inform my husband, and he will decide. After he’s informed, I’ll visit the hospital to consult the doctor for guidance.”
Conversely, men acknowledged that women “can’t simply seek healthcare facilities without their husband’s consent.”
However, they also acknowledged:
“My wife will ask me to take her to see the nurse. If I’m not around, she can see the doctor independently. It’s quite common in our community.”
Both genders emphasized the importance of skilled care, especially in cases of complications.
The act of women informing men can be interpreted as a form of negotiation, enabling women to influence decisions about accessing maternal healthcare. They acknowledge the patriarchal context by assigning decision-making authority to men, yet they also exercise their agency within this context.
Notions of men’s responsibility and collective action in maternal health were evident in the study. In these communities, expectant fathers’ primary responsibilities were providing financial support for pregnancy-related expenses, including clinic visits, delivery costs, essential medications, and nutrition.
This dynamic suggests that by attributing decision-making authority to men, women leverage men’s role as providers. Women noted their inability to afford the high costs of maternal healthcare independently, fostering a dynamic of “give and take.”
Interestingly, some women resisted men’s involvement in their pregnancies. They admitted to seeking maternal healthcare without informing their partners, asserting control over their own lives.
Our study underscores the importance of engaging women’s communities and spouses in maternal health programs. It emphasizes that patriarchy grants men authority over decision-making and financial resources. Yet, women are far from passive in such circumstances; they adeptly navigate these dynamics to ensure access to skilled maternal healthcare.
This research underscores that maternal health isn’t solely an individual responsibility; it extends to the woman’s community and the nation at large. Neglecting this perspective can undermine initiatives and policies aimed at enhancing women’s well-being.
