Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.
PIP: This study describes the social context of maternal mortality (MM) and morbidity among the Hausa of Northern Nigeria. The analysis is based on a literature review and anthropological field research conducted in southern Katsina in 1975-77, 1994, and 1996. A study during 1975-79, at Ahmadu Bello University Teaching Hospital in Hausaland, found that the most common causes of MM were bacterial infection, pregnancy-induced hypertension and consequences, hemorrhage, anemia, and obstructed labor. The most common pattern was the interaction of two or more complications. Case fatality rates were high among teenage girls with complications; women older than 30 years with eclampsia; and women with uterine rupture. MM was highly correlated with maternal age, total number of pregnancies, absence of prenatal care, lack of formal education, and Hausa-Fulani ethnicity. The MM ratio among Hausa-Fulani was 3180 deaths/100,000 live births. Obstetric fistulas may affect nearly 250,000 women in northern Nigeria. Many other related problems occur. Estimated obstructed labor cases were 1238/100,000 births. The social context that contributes to high mortality and morbidity includes Islamic culture that undervalues women; control of women by men; seclusion of wives that limits access to medical care; female illiteracy; early marriage and pregnancy; high rates of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to treat obstetric emergencies; a declining economy; and a corrupt, inefficient political culture. Men need to be educated about the reproductive health of Hausa women.