ACKNOWLEDGEMENTS He who embarks on a research or writes a book is one of the most indebted of men. So many persons contribute and assist in so many direct and indirect ways that complete recognition and repayment becomes impossibility. Who can ever adequately evaluate the influence of close friends, associates, and teachers? Yet their influence upon us and anything we undertake is deep and lasting. For most, all that can be done is humbly to acknowledge their value and influence. There are always a few, however, without whose help and encouragement the immediate task would not have been possible. In the case at hand, I wish to express particular thanks and gratitude to a few such specific individuals: To Dr. David Le Cornu for his professional guardian and inspiration and my supervisor Dr. B Rundle. To Sareola Olusola E. and my sister Mary Wilkie both of Centre-Fold Computer Training Centre and the Director for their assistance during the typing of the manuscripts. I want to also thank Dr. Fola Awosika, Medical Director Coastal Clinic and Hospital Ltd., and President Nigeria Complementary Medical Association. Feyi Oshifeso of The Lagos State Ministry of Information and Culture. Ambassador and Mrs. Martins, Dr (Mrs.) Sabina A. Ofoegbu, Assistant Director Federal Ministry of Women Affairs and Social Developments - Abuja. J. Kayode Tejumola Ajiboye Snr Research/Evaluation Officer JOHN HOPKINS UNIVERSITY CENTER FOR COMMUNICATION PROGRAMS, Nigeria Office. Felix N. Awantang, Director USAID - Nigeria. Chief Mrs. Jokotifa Ajanaku Scott, The Iyanifa of Lagos. Chief Mrs. Ogunaike - Ministry of Agriculture Lagos state. Chief A. Ijabadeniyi - Ministry of Information and Culture - Lagos. Chief David Adegbohum, Chief Adesola, Mrs Timilehin Fatunde. Unyinmadu John Paul - Environmental Scientist, Dr Nwobi, Engr Ayantoga all of the Nigrian Institute For Oceanography And Marine Research, Victoria Island, Lagos. Professor Friday Okonofua, of the Women’s Health and Action Research Centre, Jona I.V. Odirho of Hollytex Medicals And Diagnostic Centre, and a host of others without whose assistance this dissertation would have not seen the light of the day. I want to say a big thank you to Caroline, Ejiro, Pauline and other members of my staff who stood beside me during this trying period. Many persons, directly or indirectly, have contributed to the preparation of this dissertation - some through their vision and foresight, some through their dedicated research which was carried out often in the face of great odds and skepticism, still others through their careful attention to the many details that are inevitable in such an undertaking. To everyone I owe a big gratitude!!! III I wish to acknowledge here the immeasurable contributions of several international agencies and organizations – The UNITED NATIONS, UNDP, UNFPA, UNICEF, UNIFEM, WHO, CIVIL LIBERTY ORGANISATION (CLO), FEDERAL OFFICE OF STATISTICS (FOS), INTER-AFRICAN COMMITTEE (IAC) NIGERIA, ON TRADITIONAL PRACTICES AFFECTING THE HEALTH OF WOMEN AND CHILDREN IN AFRICA, SOCIETY FOR FAMILY HEALTH (SFH). As well the following newspaper organisations and publishers, CHAMPION, DAILY TIMES, PM NEWS, THE GUARDIAN, THE POST EXPRESS, THE PUNCH, ETC., and the WEST AFRICAN JOURNAL OF MEDICINE. Last, but not least, I thank my wife, Lelia, for her support and forbearance towards a husband whose mind was constantly preoccupied. ACRONYMS AHI Action Health Incorporated APPER African Priority Programme for Economic Recovery CASSAD Centre for African Settlement Studies and Development ECA (UNECA) United Nations Economic Commission for Africa FAO Food and Agricultural Organisation of the United Nations FC Female Circumcision FCT Federal Capital Territory (Abuja) FEAP Family Economic Advancement Programme FIDA Federation of International Women Lawyers FHS Family Health Services FGM Female Genital Mutilation FMOH Federal Ministry of Health FOS Federal Office of Statistics FLS Forward Looking Strategies for the Advancement of Women FSP Family Support Programme FTC Federal Technical College GADA Gender And Development Action GDP Gross Domestic Product IAC Inter-African Committee On Traditional Practices Affecting The Health Of Women And Children ICAN Institute of Chartered Accountant of Nigeria ICPD International Conference on Population and Development IPPF International Planned Parenthood Federation JSS Junior Secondary School LBW Lower Birth Weight LPA Lagos Plan of Action MCA Matrimonial Causes Act IV NAWOJ National Association Of Women Journalist NBC National Broadcasting Commission NCP National Council for Population NCWS National Council of Women Society NDHS Nigeria Demographic and Health Survey NFS Nigeria Fertility Survey NGO Non Governmental Organisation NPC National Population Commission NRC National Republic Convention OAU Organisation of Africa Unity ODA Overseas Deveopment Administration PFA Platform For Action PHC Primary Health Care PPFN Planned Parenthood Federation of Nigeria QLS Quality Of Life Survey RTI Reproductive Tract Infection SDP Social Democratic Party SFH Society For Family Health SIDA Swedish International Development Authority SSS Senior Secondary School STD Sexually Transmitted Diseases UBTH University of Benin Teaching Hospital UN United Nations UNDP United Nations Development Programme UNIFEM United Nations Fund For Women UNFPA United Nations Population Fund for Action UNICEF United Nations Children Fund USAID United States Agency for International Development VAW Violence Against Women WEM Women Empowerment Movement WFS World Fertility Survey WHARC Women’s Health Action Research Centre WIN Women In Nigeria WJP Women Justice Programme WHO World Health Organisation WHO/AFRO World Health Organisation Regional Office For Africa WPPA World Population Plan for Action V CONTENTS CHAPTERS PAGES I. FOREWORD I II. PREFACE II III. ACKNOWLEDGEMENT III IV. LIST OF TABLES IV V. LIST OF FIGURES VI VI. LIST OF PLATES VII VII. ACRONYMS VIII 1. INTRODUCTION 1 2. THE PROBLEMS OF DISPARITY 7 3. TOLL OF PREGNANCY AND CHILDBIRTH 34 4. TEENAGE MARRIAGE AND PREGNANCY 41 5. THE FEMALE PELVIS AND GENERATIVE ORGANS 61 6. FISTULAE 79 7. FEMALE GENITAL MUTILATION 86 8. EXISTING LAWS AND POLICIES AIMED AT PROMOTING AND IMPROVING THE STATUS OF THE FEMALE CHILD 103 9. DATA ANALYSIS 153 10. CONCLUSION 226 VI 11. APPENDIXES 240 FOREWORD The country Nigeria is made up of a wide expanse of landmass of 923,768 square kilometers that is blessed with fertile soil and green vegetation. It is situated in the West African sub-region with an estimated population of about 120 million inhabitants. It is the most populous country in black Africa. Like many developing countries of the world, the health problems are numerous. Maternal death rate is estimated to be as high as 1500 per 100,000, this incidentally is the highest in the world. Adolescent reproductive health is said to be the poorest in the world. Early marriages of girls is quite prevalent, and there is the tendency for many of them to embark on pregnancy as early as 13 - 14 years of age, have babies as they come and never stop until nature says so. Overall, the life time risk of a Nigerian woman dying from pregnancy, childbirth or pregnancy related causes is about 1 in 20. Births to mothers too young, or too old. Births that are too closely spaced, too many and unsafe abortions resulting from unwanted pregnancy are the major factors that contribute to maternal deaths. Women are further exposed to a lot of risks during their reproductive life due to harmful traditional practices such as female circumcision or female genital mutilation (FGM), lack of or poor existence of facilities especially in the rural areas, poverty coupled with poor nutrition and lack of/or access to resources, land education etc., necessary to make life meaningful. Fertility remains high in Nigeria; at current fertility level, Nigerian women will have an average of 6 children by the end of their reproductive years. Knowledge of contraception remains low, with less than half of all women age 15 - 49 knowing of any method. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one - third of births and over 60 per cent of all babies are born at home. Only one third of births are assisted by doctors, trained nurses or midwives. Women received antenatal care from a traditional birth attendant (TBA) for only 4 per cent of births. VII There is a strong association between education and receiving antenatal care. Births to women with no education are about as likely to receive some kind of care as not; whereas it is unlikely that a birth to a woman who has had some education will receive no antenatal care. The infant mortality rate is high. Nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born 87 die during their first year of life. These problems are more severe in rural areas and in the North. LIST OF FIGURES FIGURE PAGE 2.1 Productive hours/day by gender: selected countries 8 2.2 A Time use by adults out of 1440 minutes per day 9 2.2 B Time use by adults out of 1440 minutes per day – Women 10 2.2 C Time use by adults out of 1440 minutes per day – Men 10 5.1 The Bony Pelvis 61 5.2 Pelvic Measurements 63 5.3 A The Female Generative Organs 66 5.3 B The Female Generative Organs 68 5.4 Uterus 72 5.5 The Fallopian Tubes 74 5.6 The Ovaries 76 9.1 Trends in the Total Fertility Rate Women 15-34, NFS, NDHS Surveys 160 9.2 A Adolescent fertility rates, by age of woman and by region , level of development and