Elevating women’s voices for quality maternal healthcare

Several studies have shown that elevating women’s voices and embracing the arts could be used to reduce Nigeria’s maternal mortality rate, which remains a public health concern, and ensure quality maternal healthcare.

According to Nigeria Demographic and Health Survey (NDHS) 2018, the country has maternal mortality rate of 512 women per 100,000 live births, which accounts for 20 per cent of global maternal deaths.

Stakeholders are unanimous that the high number of women who die while giving life calls for immediate attention and collaboration by all stakeholders (including the private sector, public agencies, civil society organisations, donors, and multinationals) to change the current negative outcomes of women when giving birth in Nigeria.

As part of efforts to advocate maternal health programmes and services that incorporate and centre on women’s experiences and perspectives to improve the quality of maternal care and to commemorate International Women’s Month, the Nigeria Health Watch, on Friday, held the second edition of ‘Celebrating Womanhood Art Gala’ themed “Elevating Women’s Voices for Quality Maternal Healthcare”, in Abuja.

Its theme acknowledges that women’s perspectives, insights, needs and experiences are frequently overlooked in decision-making, policy design and implementation.

In a remark, Managing Director of Nigeria Health Watch, Vivianne Ihekweazu said: “Progress in ensuring that quality improvements are incorporated into maternal healthcare service delivery will be impossible unless women’s voices and experiences are heard when developing policies.

“A woman’s perception of the care she receives is an integral part of her clinical experience and therefore, an important consideration in improving the quality of maternity care. Maternity care that focuses on women’s needs and treats women respectfully is likely to lead to greater satisfaction as well as better and more equitable health outcomes.”

The gala allowed guests to participate both physically and virtually through the Nigeria Health Watch website and social media platforms, allowing art lovers and interested stakeholders from around the world to interact with the artwork.

The art gala was organised with support from the National Gallery of Art (NGA) and Female Artists Association of Nigeria (FEAAN) who have curated art pieces from selected female artists.

Nigeria Health Watch held its first #HealthMeetsArt, Celebrating Womanhood Art Gala in 2021. Art has been used to record history, shape culture, cultivate imagination, and encourage individual and social transformation.

Recognising this, the organisation used creative art to raise awareness and motivate stakeholders to take action on maternal health and other gender-related issues.

The Celebrating Womanhood art gala brought together stakeholders from various sectors to raise awareness and provide a platform for discussion on maternal health in Nigeria, as they understand that issues relating to maternal health affect individuals from various sectors directly or indirectly.

First lady of Kebbi State and Chief Executive, Medicaid Cancer Foundation, Dr. Zainab Shinkafi Bagudu, said: “We have a lot of maternal health issues in Nigeria but through interventions, we are not doing so badly, we are improving some of our indices. We are using community development programmes with partners to bring change for women. The maternal health clinics offer improved opportunity to get cervical cancer screening. The outcomes we are seeing are enormous. Leveraging on this can impact on our cervical control programme.”

Director of Public Health, Federal Ministry of Health (FMoH), Dr. Ngozi Azodoh, said: “Women voices are important. I believe that women are powerful; we just need to remind them. We must remind mothers that they are so powerful; they can change the world. When we have the opportunity, we must create opportunity for other women to speak up, take them to rightful position. At the FMoH, we mentor young women. As a mother and wife, your platform is endless. Women are the neck that turns the head. As a sister, we stand in the gap all the time. Let us remind ourselves how powerful we are and can be.”

Resident Representative of United Nations Population Fund (UNFPA) in Nigeria, Ms. Ulla Elisabeth Mueller, said: “The power of what you are seeing today is that of voices. I really hope that the power of the arts and voices see. Today will be a reminder how many women die giving birth. I hope that we will bear that in mind and lend our voices to save our sisters, friends, mothers etc.”

Country Director PLAN International Nigeria, Dr. Charles Usie, said: “We want to celebrate womanhood in a very special ways- in the office our first assignment to ensure that our lives reflects women empowerment. For us is a connection that influences our everyday lives. Women issue is not a good thing to talk about but the right thing. We believe the issue women go through should be a thing of priority. Women should earn more in the allowance we pay for food contingencies. The women will need to take care of.

I believe in a world where women will earn more than the men and have more days for maternity leave.”

Nigeria Director, MSD for Mothers, Iyadunni Olubode, said: “We’ve committed to ending preventable maternal deaths in Nigeria, not only because of the country’s high burden of maternal mortality, but also because we are optimistic about the tremendous potential of Nigeria’s local private health sector, which serves more than 60 per cent of the population, to help solve the problem and sustain gains in women’s health for years to come.”

The White Ribbon Alliance enumerated five reasons why women’s voices matter when it comes to reproductive and maternal healthcare.

Director, Advocacy and Programs, White Ribbon Alliance, Kristy Kade, advocates for improved quality, equity, and dignity in reproductive, maternal and newborn health services by raising women’s voices.

Kade said: “At White Ribbon Alliance, we push for women’s perspectives to be included in the design of new health programs and policies and the strengthening of existing services.

“It is such a fundamental part of who we are as an organization that we’re coordinating a global campaign around this principle. What Women Want: Demands for quality healthcare for women and girls aims to hear from one million women about their top priority for quality healthcare services.

“We want to know what quality healthcare means to women and girls no matter where they live, what religion they practice or economic status in which they fall. And while every woman’s voice matters, we hope to hear from those who are often most quiet. Why? Because without their guidance, the changes we hope to see in the world in terms of quality health and quality lives will never happen.”

Here are the top five reasons White Ribbon Alliance believes women’s and girls’ voices can transform healthcare for the better:
1. When women and girls have a voice, progress accelerates. Nobody knows the challenges or the solutions better than the people using the services meant for them — so involving them from the outset is a no-brainer.
2. Quality means different things to different people. In a community without running water, the top priority for women might be that all clinics are equipped with clean water and proper sanitation and hygiene. In another mired in ongoing conflict, it may be a safe place to give birth and care for an infant.
3. The global health community has made tremendous progress when it comes to women’s and girls’ health, but we are starting to see that progress stall, even slide backward in some countries. The missing piece is hearing from women and girls themselves. Now is the time to accelerate our efforts, and to do that we must put women at the center.
4. If we are to create truly sustainable, effective reproductive and maternal healthcare programs and policies for women and girls, they must be grounded in what matters most to those we are creating programs and policies for — until that happens, policies will not be enforced and services will go unused.
5. When women receive quality healthcare, they tell their sisters, daughters, friends and neighbors. Quality health services are born from involving those they are meant for; it’s not enough to encourage women and girls to seek care from trained midwives, health clinics or hospitals, the care they receive must meet their needs.

According to a study public in Policy Papers and titled “Improving Maternity Care through Women’s Voices: The Women’s Health Strategy Continues a Long Process of Advocacy”, effective maternity care has been hampered by limited service provision and inadequate funding throughout the twentieth and into the twenty-first century.

It noted: “After 1900, women became vocal in expressing their aims for improved maternity care, and their ambitions were most effective when they dovetailed with pronatalist goals, that is an advocate of the policy or practice of encouraging people to have children.

“Following the expansion of mass media, education, and employment for women since­ the 1960s, both women’s organisations and individuals developed greater confidence in their campaigns for change and in urging policy makers and health services to listen.

“Descriptions of their own experiences from women of all social circumstances and ethnicities can be converted into powerful tools for lobbying policy makers and government and for raising recognition of postnatal mental illness.”

Also, an editorial published in The Lancet Journal and titled “Achieving respectful care for women and babies”, every woman should have the right to dignity, respect, and skilled care during pregnancy and childbirth but not every woman receives it. Evidence is growing about the disrespect and abuse women can face when accessing maternity care in countries at all levels of development. Such abuse includes physical abuse, humiliation and verbal abuse, unconsented clinical care, lack of confidential care, and abandonment or denial of care. This abuse not only affects mothers but their babies too. Some groups of women are also more likely to experience disrespectful and abusive treatment, including women with Human Immuno-deficiency Virus (HIV), those from ethnic minorities, and unmarried women. Such abuse is a human rights violation and can also deter women from accessing health services in the future—whether for another pregnancy or for other health reasons.

The issue is complex and is not only about a lack of training and compassionate care. A Comment in The Lancet’s 2014 Midwifery Series noted that discrimination and abuse is linked to, and reinforced by, systemic conditions, such as degrading, disrespectful working conditions and multiple demands, and can be seen as a signal of a “health system in crisis”. It is also tied to power dynamics and the vulnerability of women and their babies during pregnancy and birth.