CHAPTER ONE
INTRODUCTION
1.1. Background to the Study
Poverty exists when individuals lack the means to satisfy their basic needs. These may be defined narrowly as, those needs essential for human survival or broadly as, those needs reflecting the prevailing standard of living in the community, (Safra, 2010). Reproductive ill health is both a cause and consequence of poverty, (Family Care International, 2013). Sexual and reproductive health problems account for approximately 20% of the ill-health of women globally, and 14% of men as a result of lack of proper sexual and reproductive health services, (WHO, 2010).
Maternal and child mortality aren’t new concepts in the social and medical sciences. However, they both pose severe threats to human survival most particularly in the future generations. There is a saying that, the future of any society relies on the health condition of the women and the young population, (Odunlami, 2016). The sustenance of the society and the economy largely depends on these two groups to this end, their health and security is of utmost importance in order to avert feelings of sadness, depression and loss of lives. According to Myles (1953), the maternal mortality rate is the number of death registered during year of women dying from cause attributed to pregnancy and child birth for 1,000 registered total (life and still births) in the year while infant/child mortality rate is the number of deaths registered during the year of age per 1,000 registered births in the year. This is to say that, maternal mortality is simply deaths occurring from complications during pregnancy, labour delivery or child birth, while infant/child mortality can be any death arising under one year or five years of age.
Mothers and children are at highest risk for disease and death. While motherhood is often a positive and fulfilling experience, for too many women, it is linked with ill–health and even death, (Olatoye, 2015). The death of a woman during pregnancy, labor or pueperium is a tragedy that carries a huge burden of grief and pain, and has been described as a major public health problem in developing countries especially in Nigeria, (Aluko, 2014). Women have a huge impact on their families’ welfare. Deaths of infants/children under the age of 5years are peculiar and closely related to maternal health. One million children die every year simply because their mother has died, and the risk of death of children less than 5years doubles if mothers die in childbirth, (Shettima, 2014). More than 25,000 children die on daily basis and every minute a woman dies in child birth. Worldwide, every year about 500,000 women die due to child birth and over 9 million children under age five die mostly from preventable and treatable diseases, (WHO, 2006).
According to the tenth international classification of diseases (ICD) defined maternal death as, the death of a woman while pregnant or within the days of termination of pregnancy, irrespective of the duration and the site of the pregnancy from any cause related to, or aggravated by the pregnancy or its management, but not form accidental or incidental causes. In the same way, the America Medical Association (1954) defines maternal mortality rate as, the death of a woman while she is pregnant or within 90 days of termination of the pregnancy irrespective of duration of pregnancy at the time of termination or regardless of the method by which is terminated. There are many factors leading to maternal and child mortality in developing countries especially in Nigeria, and these involves complications arising during pregnancy and child delivery, hemorrhage, that is, severe bleeding generally occurring during post partum, it is unpredictable, sudden and more dangerous when a woman is anaemic, (Marchie, & Ayanwu, 2017). The loss of blood in the process can result to death if rapid attention isn’t given. Another factor that may lead to maternal and child birth is prolonged and obstructed labour, poverty exist when people lack the means to satisfy their basic needs”, (Pitterson, 2016). In Lagos State for example, poverty is indeed a threat to women in reproductive age bracket. This high level of poverty limits their access to health which contributes to a higher percentage of maternal and child mortality in Nigeria and Lagos State in particular, (Saraki, 2014).
Nigeria is the most populous Black Country in Africa with 140 million people including 75 million children (Olatoye, 2015). The child and maternal mortality rate of this country is very significant and has implications for the attainment of the MDGs. It has been noted that Nigeria is lagging behind in achieving universal coverage of key maternal and child health intervention and will unlikely meet the target of the MDGs. According to UNICEF Executive Director, Ann Veneman, “midway to 2015 deadline for MDGs, Nigeria continues to record unacceptably high maternal, newborn and child mortality”. Nigeria ranks as one of the 13 countries in the world with the highest maternal mortality rate and is still not listed among the 10 countries seen to have made rapid progress to meet the goals.
At the end of the last century, sub-Saharan Africa still had high maternal and child mortality rate with the goals of safe motherhood eluding many governments. A documentary report on Nigeria Television Authority (NTA) precisely 3rd May, 2014 revealed that malaria fever is very dangerous to pregnant mothers and children and more deadly then HIV/AIDS. The number of these groups malaria kills in one year is said to be what HIV/AIDS kills in 15 years. According to Dr. Adekunle (an NTA discussant, he as well stated that over 80% of 270 to 400 million clinical cases occur in the African continent). Similarly, on the 30th of August 2014, another documentary on the same station, (NTA) suggests that children under the age of 5years and a total of 300,000 Nigeria children and eleven out of hundred pregnant women die of malaria fever every year.
Apart from the death rate being recorded due to malaria fever of both pregnant women and children, it was as well reported on the Africa Independent Television (AIT) on the 6th August 2015 at the 8:00pm news that Nigeria spends over 130 billion naira on malaria control. Alubo (2014) opined that, women in Nigeria suffer from all kinds of ailment and ill conditions and run the risk of sudden deaths in child birth. The main causes of this sudden death in child birth are obstructed labour, uterine infection, anaemia, ectopic pregnancy and cepsis etc. These complications according to Alubo (2014) account for maternal mortality during labour and after child birth. All the factors by Alubo, as well as the previous explanations of various scholars of the concept under study showed that women suffer undue hardship during and after pregnancy. To put it right, many factors and complications can result to maternal and child mortality as stated all through but of interest is the impact of poverty on maternal and child mortality and it is of sociological importance to identify how poverty affect the health of the mother and the child and the definite responses of government. Therefore, it is against this background that this review examines poverty as a major cause of infant and maternal mortality in Nigeria.
1.2. Statement of Problem
The issue of poverty is a multifaceted condition, which has many dimensions, among which are poor access to public services and infrastructure, unsanitary environmental surrounding, illiteracy and ignorance, poor health, insecurity, voicelessness and social exclusion, as well as low levels of household income and food insecurity, (Hodges, ed). All these aspects of poverty are life-shortening, involve great suffering and pain (from disease and hunger) and they undermine an essential dignity and decency to life, (Dower, 2015).
It was observed that, Nigeria is reported to have one of the highest occurrences of maternal mortality in the world with figures ranging from 704 to 1,500 (federal office of Statistics, 2018), maternal deaths per 100,000 live births. Figures based on the results of the 2015 Multiple Indicators Cluster Survey (MICS) show a wide variation from 166 per 100,000 live births in the South West to 1,549 per 100,000 live births in the North East, with a national average of 704 deaths per 100,000 live births, (Multiple Indicator Cluster Survey, 2015)
The Nigerian health system as a whole has been plagued by problems of service quality, including unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, chronic shortages of essential drugs and the well-known "out-of-stock: syndrome", (Hodges, ed). In some hospitals, equipment such as sphygmomanometers, thermometers, weighing scales, delivery kits, waste bins and mucus extractors are unavailable. Many do not have regular supply of electricity because they cannot maintain a standby generator. Some do not even have a regular water supply and thus require their patients to provide their own water. Coupled with all these, staffs are demoralized by inadequate and irregular remuneration, (Odunlami, 2016). Many have relocated to industrialized countries where they will be adequately remunerated.
Based on the above, there arises questions in relation to this research and getting answers to them will be beneficial to humanity and they are;
- a. What is the relationship between poverty and mortality rate in women and children?
- b. What are the other factors responsible for children and maternal mortality?
- c. What is the level of awareness of the residents on maternal mortality and family planning?
- d. Are there policies of government towards the reduction of maternal and child mortality rates?
1.3. Research Objectives
The primary objective of this study is to assess the role of poverty in infant mortality and maternal mortality in Lagos State, Nigeria. However, the following specific objectives are to;
- find out the rate at which poverty affects women and children’s health status in Lagos State;
- determine the factors responsible for children and maternal mortality in Lagos State;
- examine government policies towards the reduction of maternal and child mortality rates in Lagos State; and
- find out the level of the prevalence of maternal and child mortality among Lagos State residence.
1.4. Research Questions
Based on the above research objectives, the following research questions were poised.
- To what extent does poverty affects women and children’s health status in Lagos State?
- What are the factors responsible for children and maternal mortality in Lagos State?
- How does the policies of the government helps in the reduction of maternal and child mortality rates in Lagos State?
- What is the level of the prevalence of maternal and child mortality among Lagos State residence?
1.5. Research Hypotheses
The following research hypotheses will be formulated in their null form.
Ho1: Poverty has no significant effect on women and children’s health status in Lagos State
Ho2: Government policies has no significant effect in the reduction of maternal and child mortality rates in Lagos State.
1.6. Significance of the Study
Fundamentally, this study will help residents in Lagos State learn preventive measures on maternal and child mortality. Findings of this study will as well help policy makers and authorities of Lagos State Government improve on development programmes thereby taking adequate steps towards reducing and alleviating maternal and child death in our society. Further, it is hoped that the findings from the study will enable medical officials and expectant mothers to embark on preventive measures against such mortality.
In addition, this study will equip men with the necessary information concerning infant, and maternal mortality in the society such that they will begin to provide more and adequate care for their wives, mothers and children (both born and unborn). These ones represent the future of the society.
1.7. Scope of the Study
This study is basically centered on Lagos State. It is aimed at determining the magnitude damage poverty has done on the lives of women of reproductive age during child birth and death of children between 0-2 years.
1.8. Methodology of the Study
This study will be carried out using a descriptive survey research. The research work will be conducted using a primary data in which data will be gathered using a self-structured questionnaire. The research for using a questionnaire is to gather first hand information from the respondents on the subject matter.
1.9. Operational Definition of Terms
Impact: to have strong impression or effect on e.g., the economy. Also, a significant or strong influence. Here, we are determining the effect/influence of poverty on mother and child mortality.
Poverty: The absence of those needs necessary for human survival. Poverty can also defined as the situation of people whose “resources (material, social and cultural) are so limited as to exclude them from the minimum acceptable way of life in the countries where they live.
Maternal: Maternal means a mother, related through the mother’s side of the family, (Advanced Learners Dictionary).
Child: children, a young person birth to the age of 7 full physical development, a boy or a girl; a child of size.
Mortality: Means death and dying, the irreversible caesarian of life and the imminent approach of death.
1.10. Chapterization
This study is organized into five main chapters. Chapter two consists of the literature review that reveals the findings and research that already exists on the topic. Chapter three summarizes the scope and methodology used to organize and carry out this study. The discussion of the results after analysis of the findings and comparison to the information revealed within the literature review is conducted within Chapter four. Chapter five provides a summary of the study, its limitations and further recommendations.
