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Speak Wednesday- Structural Inequality in Rural Communities

Structural inequality is a situation when social institutions offer a biased distinction which is advantageous to certain category of people and marginalizes some other set of people. In this case, the women. This marginalization is mainly a rural phenomenon. However, urban communities are not completely excluded.

The structural gender inequality persists in rural communities due to factors such as sexual orientation, tradition and religion. As a result of this, some women in rural communities are denied equal access to wealth, properties, wages, quality education, good health care and health insurance, employment, living standards, among others. Which is detrimental to the actualization of sustainable development goals and frustrates the economic growth of the society at large.

To combat structural gender inequality in rural communities, all private sectors should encourage maternity leaves with pay. Also, the government should without gender bias increase the minimum wage, end residential segregation, build affordable assets for working families, invest in infrastructure and public services, ensure the fair distribution and access to land, and end all forms of discrimination.

Speak Wednesday is an initiative of CFHI to address issues around gender-based violence and gender bias. Join us every Wednesday on all our social media platforms for more episodes.

#SpeakWednesday #StructuralInequality #GenderBias #RuralCommunities #Urbanization

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MONDAY HEALTH BURST – The Effects of Illicit Substance Use During Pregnancy

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It is often the desire of many couples to conceive and bear their child. While some due to one medical situation or the other find it impossible, and have to resort to adoption, surrogate mothers, etc., others are often fortunate to bear a child. Dr Kristen Cherney in a 2019 Health line publication defined pregnancy as a process that takes place when a sperm fertilizes an egg after it is released from the ovary during ovulation. The fertilized egg then travels down into the uterus, where implantation occurs. A successful implantation results in pregnancy. On average, a full-term pregnancy lasts 40 weeks.

Many factors can affect a pregnancy. When a woman is pregnant, everything that goes into her body has the potential to affect her unborn baby. Smoking, drinking alcohol, abusing prescription drugs or using illicit drugs can all pass through the placenta and have a negative effect on her and her baby. According to Florida Health, illegal drugs such as marijuana, cocaine, and methamphetamine aren’t the only drugs that are harmful to fetal development; Commonly used over-the-counter medicines, along with substances such as caffeine and alcohol, can have lasting effects on an unborn child.

It is possible that one may not have a serious or long-lasting problem after using drugs. But the same is not always true for a fetus. Studies show that using drugs — legal or illegal — during pregnancy has a direct impact on the fetus. If a pregnant woman smokes, drink alcohol, or ingest caffeine, so does the fetus. If she uses marijuana or crystal meth, her fetus also feels the impact of these dangerous drugs. And if she is addicted to cocaine — also called coke, snow, or blow — she is not only putting her own life on the line, but risking the health of her unborn baby. The consequences of using cocaine include heart attacks, respiratory failure, strokes, and seizures. And these life-threatening health problems can also be passed to an unborn baby.

According to an article titled “Drug Use and Pregnancy” by WebMD, taking drugs during pregnancy also increases the chance of birth defects, premature babies, underweight babies, and stillborn births. Exposure to drugs such as marijuana and alcohol before birth has been proven to cause behaviour problems in early childhood. This article also went further to elaborate that these drugs taken by a pregnant woman can also affect the child’s memory and attentiveness. For instance, babies who are exposed to cocaine tend to have smaller heads that indicate a lower IQ. Other effects of illicit substance use include injury to the fetus by the forceful contraction of muscles of the uterus, the dysfunctional placenta usually caused by blood vessels constricting, thus reducing the supply of oxygen and nutrients to the fetus, etc.

Illicit substance use in pregnancy remains a significant public health problem, which can lead to several harmful maternal and neonatal outcomes. Which drug is being used and the degree of use, as well as the point of exposure, all influence the effects of drug use in pregnancy. In addition to the direct effects of drug exposure in utero, several other variables are associated with deleterious maternal and infant consequences, including psychiatric comorbidity, polysubstance use, limited prenatal care, environmental stressors and disrupted parental care. In conjunction, these factors can negatively influence pregnancy and infant outcomes, and should be taken in to account when interventions and programs for prenatal substance use treatments are developed.

Monday Health Burst is an initiative of CFHI to address issues of basic health concerns. Join us every Monday for more interesting episodes.

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Stroke – Men’s Health Month

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A stroke is also known as a cerebrovascular accident (CVA) or “brain attack.” Dr Benjamin Wedro defines stroke in an article published in 2019 titled “Stroke definition and facts”, as an occurrence when part of the brain loses its blood supply and the part of the body that the blood-deprived brain cells control stops working. This loss of blood supply can be ischemic because of lack of blood flow, or hemorrhagic because of bleeding into brain tissue. A stroke is a medical emergency because strokes can lead to death or permanent disability. According to the World Stroke Organization, there are three main types of strokes: Ischemic stroke, Hemorrhagic stroke and Transient ischemic attack and all involve blood deficiencies in the brain.
Stroke is a leading cause of morbidity and mortality worldwide, and it is likely to worsen in developing countries over the next two decades based on projections by the World Health Organization (WHO). Findings from Komolafe et al in 2015 in their research, “Stroke risk factors among participants of a world stroke day awareness program in South-Western Nigeria” shows that the prevalence of crude stroke in Nigeria is 1.14 per 1000 while the 30-day case fatality rate is as high as 40%. There are over 13.7 million new strokes each year. Globally, one in four people over age 25 will have a stroke in their lifetime; with almost 60% of all strokes occurring in people under 70 years of age. Each year, 8% of all strokes occur in people under 44 years of age, 52% in men and 48% in women. Stroke is the fifth-leading cause of death in men. Men are more likely to have a stroke in their younger years than women, but they’re less likely to die from it, according to the National Institutes of Health (NIH), however, men and women can have some of the same signs and symptoms.
Having a stroke is one of the most frightening prospects of ageing. Strokes can come on suddenly, stealing the use of an arm or the ability to speak. According to a 2019 WebMD publication, about half of all strokes are caused by atherosclerosis — the same process of narrowing and hardening of the arteries that causes heart attacks. Atherosclerosis progresses silently, without symptoms, putting our brains and our independence at risk. Each type of stroke has a different set of potential causes. Generally, however, stroke is more likely to affect a person if they: have overweight or obesity; are 55 years of age or older; have a personal or family history of stroke; have high blood pressure; have diabetes, cholesterol, heart disease, carotid artery disease, or another vascular disease; are sedentary, consume alcohol excessively, smoke, or use illicit drugs.
Stroke treatment depends on the type of stroke. For Ischemic strokes and TIA which are caused by blood clots or other blockages in the brain, use of anticoagulants and clot breaking drugs are used for their treatment. Other treatment options include mechanical thrombectomy, stents and surgery. For hemorrhagic strokes which are caused by bleeds or leaks in the brain, medication, coiling procedure, clamping and surgery are usually done (Healthline, 2019).
Knowing your stroke risk factors, following your doctor’s recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you’ve had a stroke or a transient ischemic attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterwards also play a vital role.

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The Psychological Effects Of Widowhood

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The Collins dictionary defines a widow as a woman whose spouse has died and who has not married again. On the other hand, widowhood according to the Merriam-Webster dictionary is the fact or state of being a widow. In general, the term widowhood relates only to married couples. However, with the growing incidence of cohabitation, civil unions and partnerships, some countries have broadened the concept of widowhood to include those who have survived the loss of a long-term partner (IPSNews, 2020). The estimated number of widowed persons according to an Inter-State press report for 2020 was approximately 350 million worldwide, with the large majority, approximately 80 per cent, being widowed women.#

In many developing countries, the exact numbers of widows, their ages and other social and economic aspects of their lives are unknown. Almost worldwide, widows comprise a significant proportion of all women, ranging from 7% to 16% of all adult women (UN Division for the Advancement of Women, 2000). However, in some countries and regions, their proportion is far higher. In developed countries, widowhood is experienced primarily by elderly women, while in developing countries it also affects younger women, many of them still catering for their children (Ibid). Irrespective of region, level of development, government, culture, etc., women are substantially more likely to experience widowhood than men. In countries such as China, Nigeria, Pakistan and the United States, where overall widowhood rates are lower, women’s widowhood rates according to an IPS 2020 study, are more than double those of men.

The loss of a spouse is one of the most negative life events, next only to the loss of a child (Bennett et al., 2005). Ironically, the disorganization and trauma that follow the death of a spouse seem to be greater in women than in men whenever either loses their spouse (Fasoranti et al., 2007). Many studies have concluded that a higher rate of mental illness exists among the widowed than their married counterparts. Even a study conducted by Chen et al., (1999) concluded that widows had higher mean levels of traumatic grief, depressive and anxiety symptoms (compared to widowers). Another problem associated with widowhood is loneliness. Many widows live by themselves. They suffer the fear of being alone and loss of self-esteem as women, in addition to the many practical problems related to living alone, they feel the loss of personal contact and human association; therefore, they tend to withdraw and become unresponsive (Fasoranti et al., 2007). The greatest problem in widowhood is still emotional. Even if it had been a bad marriage, the survivor still feels the loss- The role of spouse is lost, social life changes from couple-oriented to association with other single people; and the widowed no longer have the day-in, day-out companionship of the other spouse that had become an intrinsic part of their lives. Behavioural changes are often observed in women after divorce or bereavement. These changes are often overlooked and assumed to be a normal reaction to an adverse life event. It is now known that the changes may be due to an underlying psychiatric disorder.

In all, more attention or awareness needs to be given to women facing psychological issues so that the suffering women may receive appropriate care and treatment.

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FOSTERING AN AFRICA FIT FOR CHILDREN

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Africa is the world’s second-largest and second-most-populous continent, after Asia in both cases. With 1.3 billion people as of 2018, it accounts for about 16% of the world’s human population. Africa’s population has rapidly increased over the last 40 years and is consequently relatively young. Over 400 million children are currently living on the African continent – and the number is rising. The United Nations estimates that Africa’s population will double to 2.4 billion by 2050. That’s one-quarter of the world’s population. 40 per cent of all children under the age of five would live in Africa in the middle of the 21st century, according to the prognosis.

Although there are major regional and social differences, children in Africa are the poorest in terms of population. The situation of African kids in sub-Saharan Africa is particularly critical: 33 of the world’s 48 least developed countries are located in this region according to an SOS Children’s villages publication. Africa made great progress in several fields in 2019, including holding peaceful elections in many parts of the continent and increased economic growth. But several unresolved challenges still stagnate any meaningful development in the continent. Challenges like Insecurity, corruption, population growth, unemployment, poor governance, to mention but a few are some of the issues that have left the continent at the bottom rung of the developmental ladder. These issues have snowballed quite dangerously, affecting virtually everyone in the region, children most especially, who become the victims of these developmental setbacks.

This has birthed in earnest the need for African states to prepare to meet the needs of their growing young population, and commit to urgent, concrete actions to protect and promote the rights of all children – now and in future generations. Only recently, the African Committee of Experts on the Rights and Welfare of the Child (ACERWC) adopted AGENDA 2040, Africa’s Agenda for children: Fostering an Africa Fit for Children. This agenda emanates from the conclusions of the High-Level Conference to assess the status of the rights of children in Africa 25 years after the adoption of the Charter, this Agenda takes cognizance of the elucidation in Agenda 2063 (paragraph 53) that ‘African children shall be empowered through the full implementation of the African Charter on the Rights of the Child. By nurturing and nourishing its children, the present generation of Africans will promote the growth of the continent and secure its future. (BCN, 2020). Amongst its 10 major aspirations include, that every child survives and has a healthy childhood; every child grows up well-nourished and with access to the necessities of life; every child benefits fully from quality education; every child is protected against violence, exploitation, neglect and abuse, etc.

A great need to ensure each child is supported to achieve their full potential is becoming paramount as the 22^nd-century dawns. Governments of countries can make this possible by firstly eradicating every form of child labour and child trafficking for children’s rights ought to be respected. They can also emphatically enforce policies and national bodies to protect children from abuse, maltreatment, neglect and other forms of violence. Also, the government can put in place programmes that focus on the physical and psychological health of adolescents, with special provisions for girls. Furthermore, legislation to support disabled children; provide improved immunization and nutrition services, and prevent homelessness among children should be enacted. Not forgetting the excluded children in the society from the poorest households who are unable to afford education, talk more of quality education, government and well-meaning civil organizations can make provisions of free education for these.

To commemorate the Day of African Child 2021, Centre for Family Health Initiative (CFHI) will be setting up school libraries in communities where we have our vulnerable children. This will play a great role in the life of the students by serving as the storehouse of knowledge which will enable them to develop an excellent reading habit. This is what CFHI is known for, making impacts.

All this and more would ensure the all-around growth of a robust and fit Africa for the younger generation.

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Monday Health Burst

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CHALLENGES AND EFFECTS OF POOR MENSTRUAL HYGIENE MANAGEMENT

Menstruation is a naturally occurring physiological phenomenon in adolescent girls and pre-menopausal women. Menarche is an important biological milestone in a woman’s life as it marks the onset of the reproductive phase of her life. The World Health Organization (WHO) defines Menstrual Hygiene Management (MHM) as ‘Women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation -period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials.

Menstrual hygiene management can be particularly challenging for girls and women in developing countries, where clean water and toilet facilities are often inadequate. A World Bank report estimates that at least 500 million women and girls globally lack adequate facilities for menstrual hygiene management (MHM). The challenge menstruating girls and women face is often less tangible than simply the availability of infrastructure and is rooted in social norms and beliefs. In many cultures, menstruating women are considered impure and are systematically excluded from participating in everyday activities, such as education, employment, and cultural and religious practices. A growing body of evidence shows that girls’ inability to manage their menstrual hygiene in schools, results in school absenteeism, which in turn, has severe economic costs on their lives and the country.

According to the Economic times’ health magazine, menstruating women need to pay particular attention to personal hygiene. During this time, a woman’s vulnerability towards potentially life-threatening ailments increases. Poor menstrual hygiene can lead to many issues, such as fungal or bacterial infections of the reproductive tract and the urinary tract. Irritation of the skin causing discomfort and possibly dermatitis, the introduction of bacteria into the urethra leading to possible urinary tract infections (UTIs), alteration in the pH balance of vaginal secretions, amongst others. Asides from its health effects, poor MHM impacts the economy through absenteeism which results in lost wages, with women working in the formal sector missing on average 2.5 days per month. A World bank study linking menstruation to increased absenteeism revealed that not only do women take more sick leave (likely due to menstruation), but a small but measurable portion of the gender wage gap can be attributed to increased absences from work.

Hygiene-related practices of women during menstruation are also of considerable importance because if left unmet can lead to serious psychological impacts. Lack of knowledge regarding menstruation and menstrual hygiene leads to poor attitude and practice. There are various issues such as poor awareness; unavailability of quality sanitary napkins, poor WASH facilities; poor disposal of sanitary napkins, poor sexual and reproductive health rights education which also needs simultaneous attention for the promotion of menstrual hygiene. In this vein, Centre for Family Health Initiative has put at the forefront of its SRHR and WASH activities by adding a gender perspective to its programs by providing girls with not just adequate information on issues around menstruation but also providing these girls with access to conveniently maintaining good hygiene during their menstrual periods, through the provision of reusable sanitary napkins and equipped WASH facilities.

Though according to World Bank, promoting menstrual hygiene management (MHM) is not only a sanitation matter; it is also an important step towards safeguarding the dignity, bodily integrity and overall life opportunities of women and girls that is why an increased global awareness needs to be encouraged to accelerate a social and behavioural change as it relates to Menstrual Hygiene Management.

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SPEAK WEDNESDAY

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TABOOS AROUND MENSTRUATION

According to Wikipedia, “Menstruation (also known as a period and many other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina”. Menstruation is a phenomenon unique to girls. However, it has always been associated with shame, stigma and surrounded by taboos and myths that have an impact on girls’ and women’s emotional state, mental health, lifestyle, education and most importantly, health.
Such TABOOS include but not limited to:
1. Women are impure, dirty, or sinful while they’re menstruating. (Suneela and Tanu, 2015).
2. According to Friends of UNFPA (2021), Menstruating women are unclean and that they bring bad luck.
3. Menstruating women are not allowed to touch certain foods as it is believed that they will go bad. (Friends of UNFPA, 2021).
4. Menstruating women are not allowed to walk through agricultural fields in fear that the crops will wilt or die. (Kavya, 2019).
5. Menstruating women are advised not to wash their vaginal region during menses because it is believed to cause infertility. (Kavya, 2019).
6. According to United Nations Children’s Emergency Fund (UNICEF), disposal of menstrual pads and other garbage can lead to sickness or cancer. In some communities, it is believed that the use of tampons and menstrual cups lead to loss of virginity.

However, there are strategies or approaches to improve the status of women and to tackle this problem as highlighted below:

1. Increased awareness among adolescent girls related to menstrual health and hygiene (MHH) management.
2. Increased community-based health education campaigns.
3. Empowerment of women through education and increasing their role in decision-making.
4. Convenience Facilities should have provisions of sanitary napkins and adequate facilities for sanitation and washing.
5. Affordable sanitary towels can be locally made and distributed to girls and women in rural communities.
CFHI in a bid to overcome the challenges surrounding menstruation and menstrual hygiene practices, partners with several local and international bodies in supporting students and households in hard-to-reach communities with water provision, water storage facilities, sanitation and toilets, sanitary pads – and also sensitizing these communities on Water, Sanitation and Health (WASH) and the importance of education for a girl child.

Speak Wednesday is an initiative of the Centre for Family Health Initiative (CFHI) to address issues around gender-based violence and gender bias. Join us every Wednesday on all our social media platforms for more interesting episodes.

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Monday Health Burst

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Cervical Cancer

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Cervical cancer affects the entrance to the womb. The cervix is the narrow part of the lower uterus, often referred to as the neck of the womb. (MNT, 2019). Cervical cancer is the second most common cancer among women in Nigeria. There were 31,955 new cervical cancer cases in West Africa in 2018, and Nigeria accounted for almost half (14,943). There were also 10,403 deaths (28 deaths every day) from cervical cancer in the country in the same year. (Balogun F., 2021).

According to Mayo Foundation for Medical Education and Research (MFMER), Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. It isn’t clear what causes cervical cancer, but it’s certain that HPV (Human Papilloma Virus) plays a role. HPV is very common, and most people with the virus never develop cancer. The most common mode of transmission is through sex, but it can also be transmitted through the use of contaminated hospital equipment and from mother to child. The cancer is ranked second in the number of years lost to disability among women in Nigeria.

One can reduce their risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection. Screening tests include, Pap test and HPV DNA test. These are secondary preventive measures that detect early-stage cervical cell abnormality and the virus’s presence. However, only 8.7% of Nigerian women had a pap smear in 2018, and fewer had HPV screening. (Balogun. F. 2021). The HPV vaccine is an effective primary prevention measure for cervical cancer. The vaccine is most effective when started before sexual debut, which is the reason for the recommendation of its administration in early adolescence.

There are, however, two main obstacles on this path, one of which is its exorbitant cost and secondly, developing countries like Nigeria are yet to identify an organised structure through which most of the eligible adolescents can be reached with the HPV vaccine. Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations of these. Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as age and overall state of health. (MNT, 2019).

To better fight and overcome the rampage caused by Cervical Cancer especially in Africa and Nigeria particularly, it is essential to carry all stakeholders along especially as regards the introduction of the HPV vaccine to ensure total annihilation of cervical cancer. A concerted effort is required to demonstrate the relationship between HPV and cervical cancer and the role of the vaccine in the prevention of cancer. However, this would require special health education skills and intense awareness or sensitisation.

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Speak Wednesday

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WOMEN IN LABOUR FORCE IN NIGERIA

One of the most striking phenomena of recent times has been the extent to which women have increased their share of the labour force; the increasing participation of women in paid work has been driving employment trends and the gender gaps in labour force participation rates have been shrinking. Especially in the 1980s and early 1990s, labour force growth was substantially higher for women than for men for every region of the world except Africa. (UNPD, 2003). This problem is particularly marked in Northern Africa and the Arab States, where unemployment rates for women exceed 16%. (ILO, 2017).

While vulnerable employment is widespread for both women and men, women tend to be overrepresented in certain types of vulnerable jobs: men are more likely to be working in own-account employment while women are more likely to be helping out in their households or in their relatives’ businesses. From an economic perspective, reducing gender gaps in labour force participation could substantially boost global Gross domestic product (GDP). The regions with the largest gender gaps would see huge growth benefits. Many developed countries would also see their average annual GDP growth increase, which is significant during times of near-zero economic growth. (ILO, 2017).

A report by PwC Nigeria on “Impact of Women on Nigeria’s Economy” in 2020, have it that Nigeria ranked 128th out of 153 countries and 27th out of 53 countries in Africa, on the World Bank’s Global Gender Gap Index 2020. This means, Nigeria has a lot to do to curtail this. 2019 statistics by the World Bank reveals that women accounts for 48.52 per cent of labor force participation in Nigeria. Despite this figure, only about 12% of directors on corporate boards of directors are women. It is discouraging to know that since the history of the Nigeria Labour Congress (NLC), there has been no woman leader.

The relatively lower economic position of women vis-a-vis men can be attributed to some of the prevailing factors such as:

1) The historical discrimination against women in terms of output.

2) The high rate of urbanization which is unmatched by the rate of urban demand for labor in the modern sector of the economy.

3) Low level of female educational attainment and skills which restrict their entry into modern employment.

4) The case of entry into informal sector activities such as petty trading with little capital outlay, flexibility of working hours and the ability to accommodate domestic roles as well as the independence attached to such activities.

5) The widespread assumption that women’s roles in the household are supportive, hence their contributions and rewards in gainful employment are expected to be merely supplementary to those of the males who are supposed to be the bread winners. (Fadayomi, T., 1991)

The data is clear: women want to be in paid employment, but a persistent set of socio-economic barriers keep them out of the workforce. However, identifying and quantifying these barriers allows us to develop smarter policy responses for eliminating them.

Ultimately, closing gender gaps in the labour force is not just good for women and their households, but for the global economy as a whole.

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Monday Health Burst

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Ovarian Cancer

Medical News Today defines ovarian cancer as “any cancerous growth that begins in the ovary”. According to World Cancer Research Fund, Ovarian cancer is the 18th most common cancer worldwide, however, it is currently the 7th most common malignancy globally and the most lethal gynecological cancer (Siegel RL et al) while in Nigeria it is the second commonest gynecological malignance (Adekunle O. Oguntayo et al.).

Ovarian cancer often goes undetected until it has spread within the pelvis and stomach region. It has warning signs, but the earliest symptoms are vague and easy to dismiss. The symptoms of Ovarian cancer are easily dismissible because they are like the symptoms of other common illnesses. The symptoms include: abdominal bloating, pressure, and pain; abnormal fullness after eating; difficulty eating; an increase in urination; an increased urge to urinate; fatigue; indigestion; heartburn; menstrual irregularities; painful intercourse among others. Although some of these symptoms if not caused by Ovarian cancer goes away when treated, however, if caused by Ovarian cancer, the symptoms persists, and the discomfort increases as the tumor spreads.

Cancer Treatment Centers of America says, that although there is no exact cause of Ovarian Cancer, research however, identifies some number of factors that could put one at risk which include: a family history of ovarian cancer; a personal history of breast, uterine, or colon cancer; obesity; the use of certain fertility drugs or hormone therapies; no history of pregnancy or endometriosis.

Unfortunately, there is no routine diagnostic screening available for ovarian cancer and as such unusual or persistent symptoms is advised to be reported to one’s doctor. There are four (4) stages of Ovarian cancer with Stage 1 been the earliest stage of which when detected can be treated, while stage 4 is the advanced stage of this malignance.

Well, treatment depends on how far the cancer has spread, however, it usually includes two or more of the following treatment plan namely: chemotherapy, surgery to stage the cancer and remove the tumor, targeted therapy or hormone therapy.

There are no proven ways through which this malignance can be prevented, however, research outlines factors that have been shown to reduce the risk of developing it, namely: the use of oral birth control pills, breastfeeding, pregnancy or surgical procedures on one’s reproductive organs.

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