CHAPTER TWO

LITERATURE REVIEW

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2.0   
INTRODUCTION

In this literature
review, effort will be made to discuss extensively on the following topics and
sub topics relating to maternal health and child care, and the involvement of
men. We will also be discussing the various variables that affect the
involvement of men in maternal health and child care.in Nigeria

2.1 MATERNAL HEALTH

According
to UNICEF, Maternal health refers to the health of women during pregnancy,
childbirth and postpartum period. While motherhood is often a positive and
fulfilling experience, for too many women it is associated with too many
suffering, ill health and even death. The major direct causes of maternal
morbidity include hemorrhage, infection, high blood pressure, unsafe abortion
and obstructed labor (UNICEF/Asselin).

Noel
Empraw(2017), advised pregnant women to take antenatal programs seriously while
officials in the healthcare system should also shun lackadaisical attitude to
their patients as this led to many avoidable deaths. Queen Ugo Onyeanu(2017),
stressed the need for women to shun unorthodox health care during pregnancy and
seek proper medication to avoid complications. She also advocated that women
should not be afraid of undergoing caesarean section as an alternative for
natural birth, when necessary. The death of women during pregnancy or delivery
is a major public health problem, especially of infants/children.this is even
double when the mother dies in chld birth due to lack of everyday care and
provision, which weakens the childs chances of reaching better live standards.
Maternal health issue is a human right concern and the government has the
obligation to ensure that womens rights are respected, promoted and protected.
“it is our belief that beyond the much touted medical  and social reasons for maternal deaths,
preventable and needless deaths of women at childbirth constitute a violation
of fundamental rights, including right to life and right to family life(Abiola
Afolabi Akiyode, 2017)

The millennium
development goal for improving maternal health calls first for a 75 percent
reduction by 2015 in the maternal mortality rate from 1990 levels- for Nigeria
(using estimates from the country’s 2008 Demographic and health survey, which
are slightly lower than UN estimates, a reduction to 250 maternal deaths per
100,000 live births, and second, for 100 percent of deliveries to be assisted by
a skilled birth attendant. It is possible, according to the Nigerian
government’s 2010 estimation that the country can reach the maternal mortality
target by 2015, but this will require dramatic and sustained progress in the
next three years. “on deliveries attended by skilled birth” (Jennifer G. Cooke,
2013)

 

2.1.1 BARRIERS OF MATERNAL HEALTH

The great and tragic
irony of maternal mortality –in Nigeria is that vast majority of maternal
deaths are avoidable through relatively uncomplicated health interventions. But
ensuring that women have access to and seek out these basic health services has
proved a daunted and complex task. The barriers to access are multiple ranging
from a woman’s immediate economic circumstances 
and cultural context to the weakness and limited reach of the country’s
primary health system to the financing, capacity, and capacity will that governments
devote to the issue. Maternal health in Nigeria is a powerful barometer of
broader trends in development, in health and health capacity, and ultimately in
governance and investment on behalf  of
societies least powerful citizens. The immediate cause of maternal mortality in
Nigeria with those in much of the developing world: Post-Partum  hemorrhage accounts for an estimated  23 percent of maternal deaths, sepsis for 17
percent , and enclampsia, unsafe abortion, obstructed labor, and anemia for 11
percent each (Jennifer G. Cooke, 2013)

 

MAJOR CAUSES OF MATERNAL
MORTALITY IN NIGERIA

Hemorrhage: Maternal
hemorrhage is severe bleeding that occurs most frequently after birth. Most
women exhibit no signs of risk before the bleeding begins, but death from
hypovolemic shock can occur quickly if unattended, with severe cases occurring
two hours of onset bleeding. A set of basic clinical procedures, can prevent
and/or effectively treat postpartum hemorrhage, and in the absence of a skilled
attendant, an oral close of Misoprostol or an oxytocin injection can prevent
excessive bleeding. The non- pneumatic anti shock garment recently introduced
in Nigeria is a low tech device that can be used to reverse or prevent shock by
maintain blood flow to the heart, lungs, and brain, buying time for a skilled
attendant’s arrival. These methods are particularly important in rural
settings, where distance often precludes prompt treatment.

Sepsis: Maternal sepsis
is infection of the genital tract occurring anytime between the onset of labor
and six weeks after birth. Contributing factors are home birth in unhygienic
conditions, poor nutrition unsafe abortion and caesarian section. Labor
management and training of traditional birth attendants are effective in
preventing sepsis, and antibiotics are the principal mode of treatment.

Preeclampsia/Eclampsia:
Preeclampsia (also known as toxemia) is the rapid elevation of blood pressure
during pregnancy. If untreated, it can lead to seizures (eclampsia), kidney and
liver damage and ultimately, death of the mother and/or the fetus. Injectable magnesium
sulfate is considered an effective low cost intervention for treating
eclampsia. Pre-eclampsia can often be diagnosed if the pregnant woman exhibits
edema(swelling)

 

EFFECT OF MALE
INVOLVEMENT IN MATERNAL HEALTH

The involvement of men in maternal
health is a new concept being adopted by the International community at the
conference on Population and Development (ICPD) in Cairo, 1994, after tracing
the remote causes of maternal mortality to cultural factors, chief of which is
patriarchy. Highlights at the conference included the critical role of men as
partners and change agents in improving maternal health and promoting healthy
reproductive lifestyle among men. The ICPD devoted an entire section of its
Programme of Action to male-involvement and responsibility. It called on men
and women to partner in making healthy reproductive choices/decisions and be
responsible for them. As UNFPA (1996:117) notes, this is to be achieved through

 

The pivotal role of men is depicted
in their decision-making power as husbands, fathers and leaders in political
and religious spheres. They are able to influence the reproductive life of
their wives by determining, if they can use available family planning methods.
Men control household decisions, their wives’ ability to earn and control
resources and the education of women and other members of the household
(Nkungula, 2007).

The participation of men as change
agents in reproductive health has a snowball effect in other areas such as abolition
of harmful cultural practices like female genital mutilation, gender-based
violence and the promotion of education and empowerment of the girl-child
(Kinanee, 2005). It is not hard to imagine the positive impact that will be
recorded, when men drive such burning issues, using their power to reverse
harmful trends and promoting healthy reproductive practices and empowering
their women. Discussing sensitive issues such as sexually transmitted disease
with the care-giver in the presence of men sometimes leads to physical violence
at home (Davis, Luchters & Holmes, 2013).

 

While male involvement can lead to better outcomes, it should
not prevent a woman from accessing care. Since when does attending ANC
without a spouse qualify a pregnant woman for a referral? Moreover in a setting
where every shilling is valuable and transport is hard to find,
referrals create increased costs and barriers for women to access care.
The above quotes from both a mother and a midwife depict
the potentially deleterious consequences of not incorporating the notion of
power and culturally accepted gender roles in policy making. They also
expose the insidiousness risk posed by leaving gender sensitive policies wide
open to interpretation.(Suzanne Kiwanuka ,2015)

Male involvement strategies are intended to encourage
men to accompany their spouses during ANC visits. Unfortunately the
interpretation of these policies has been left to health providers and
non-governmental organizations, who seek to demonstrate desirable outputs for
targets such as couples testing for HIV. It almost seems as if the
responsibility to “catch” the men who have long eluded the health
system and HIV screening has been unfairly transferred to the pregnant
spouse. Even prior to the launch of this strategy, some facilities all over
Uganda made it mandatory for a woman to bring her spouse if she wanted
access to ANC services. .(Suzanne Kiwanuka, 2015)

Men play a key role in decisions integral
to maternal and newborn health. For example, family planning, including
delaying first pregnancy, adequate birth spacing, reducing unplanned
pregnancies and limiting the total number of pregnancies, positively impacts
maternal health and reduces maternal deaths. Men are often responsible for
decision-making about family planning and use of contraceptives and program experience
suggests that male involvement can be a more effective strategy than including
women alone.
Men also play a
key role in determining women’s access to critical health services, including
antenatal and intrapartum care, through such mechanisms as determining the
availability of transport for women to reach a clinic and decisions that affect
whether a woman can be successfully referred to a higher-level facility if
required.
But in order to
make informed decisions, men need to know why ANC and skilled birth attendance
are important, the risks associated with pregnancy and childbirth, how to
prepare for childbirth and how to recognise signs of complications. Involving
men in clinical services may be one way to ensure men receive this information.
Pregnancy and the birth of a child are significant events for men and women and
are likely to be times when a man is open to new information about his role as
father and husband.
Non-intervention
studies tend to suggest that men who participate in antenatal education provide
information or other support to their pregnant wives and demand facility-based
childbirth.( Jessica Davis, Stanley Luchters, Wesley Holmes  2013)

During pregnancy and the breastfeeding
period, there is also a particular need to involve both men and women in
efforts to prevent STIs and HIV. Physiological changes during pregnancy and the
postpartum period mean that women are more susceptible to HIV and other
infections.4Traditional beliefs,
concerns about whether sex is safe during pregnancy, and health workers
conveying incorrect information, can result in long periods of marital sexual
abstinence during pregnancy and postpartum. During this time, men may be more likely
to seek sex from other partners and may not use a condom.3 If an expectant father
acquires an STI such as syphilis during this time, he is in danger of passing
an STI to his pregnant or breastfeeding partner, which can seriously affect the
health of both mother and baby.In the first weeks after infection with HIV,
viral load in the blood is very high. If a man aquires HIV during extramarital
sex, he will be highly infectious to his pregnant or breastfeeding partner. A new HIV infection
during pregnancy or breastfeeding will further result in a high maternal viral
load, which greatly increases the risk of mother to child transmission of HIV. To protect pregnant and
breastfeeding women and their babies from HIV infection it is therefore
imperative that men have adequate knowledge and skills. .( Jessica
Davis, Stanley Luchters, Wesley Holmes  2013)

 

Men also play a role in decisions relating
to breastfeeding. There is strong evidence that exclusive or predominant
breastfeeding for the first six months of life significantly improves child
survival  Studies in high-income countries
have revealed that partner support is an important factor in successful
breastfeeding.

( Jessica Davis, Stanley Luchters,
Wesley Holmes  2013)

 Although most breastfeeding promotion efforts
in low-income countries are aimed at women, many women do not make choices
about infant feeding in isolation and experience significant influences and
pressures from family members, including male partners, parents, and
parents-in-law. Yet, many men have not been exposed to breastfeeding messages
and have insufficient knowledge to positively influence infant feeding
decisions. .( Jessica
Davis, Stanley Luchters, Wesley Holmes  2013)

 

Engaging men may also have benefits
for maternal mental health. A recent review found that perinatal mental
disorders are common in low and lower middle-income countries. These disorders
affect maternal wellbeing and the health and development of the baby. The
authors note that, when other factors were controlled for, higher rates of
common perinatal mental disorders were observed among women who experienced
difficulties in the intimate partner relationship, including having a partner who
was unsupportive and uninvolved.
.( Jessica Davis, Stanley Luchters, Wesley Holmes  2013)

 

Including men in maternal and child
health services may have further benefits for men’s own health. For women,
contact with health centres during pregnancy and childrearing provides an
opportunity to connect with a range of services, including treatment for
malaria, anaemia and HIV infection. In many settings, however, men have very
little contact with the formal health system, and even less engagement with
preventive health services. Men more often seek curative services, and often
attend a traditional healer or a pharmacy over a health centre.  For men, as for women, pregnancy provides an
opportunity to link men to the health system, to detect and treat conditions
such as STIs and other infections, and to provide relevant health messages. .( Jessica Davis,
Stanley Luchters, Wesley Holmes  2013)

 

Finally, research indicates that many
men and women would like to see greater male involvement in maternal and child
health services. In a qualitative study of the sexual practices of expectant
fathers in Laos, focus group discussions with pregnant women reveal that
although many men, particularly those from urban areas, accompany their
pregnant partner to the clinic and women would like their husbands to be
included in the consultation, they are rarely included. One expectant father in
a men-only focus group discussion noted that ‘Some men would like to go in with
their wife but instead end up asking them “what did the doctor say…oh yes, you
should do that. Similarly,. Men wanted to know how much work their pregnant
wife can do, at what stage in the pregnancy she should stop working, how to
keep her healthy, when she should go to the clinic and whether it is safe to
have sex. They also asked how to know when the baby would be born, why some
babies are born early or are stillborn, and how to feed and care for the baby.
Several studies have reported men’s interest in learning more about how to
support the health of their family and their frustration regarding lack of
information. It is also clear that many men care deeply about the welfare of
their families and respond positively to attempts to engage with them. .( Jessica Davis,
Stanley Luchters, Wesley Holmes  2013)

 

This report explores the potential
health benefits for women, newborns and families associated with involving men
more in maternal and child health. We also examine potential harms and
challenges associated with involving men more, and describe strategies for male
involvement that have been evaluated. The findings could inform and prompt
policy makers and health professionals to give greater priority to reaching and
involving men, and to develop effective policies and programs to overcome the
challenges and take up the opportunity of men’s interest. .( Jessica Davis, Stanley Luchters,
Wesley Holmes  2013)