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Joint PEPFAR-UNAIDS mission spotlights progress and challenges in preventing new HIV infections among children

in Nigeria

After a great exploration trip to Nigeria in March 2013, we are excited to go back in July.

Abolishing female genital mutilation

March 6, 2013  by Punch Editorial Board

THE high incidence of female genital mutilation in Nigeria should provoke stakeholders to take a quick and decisive action to end the terrible practice of inflicting blinding and searing pain on innocent girls.  That one-quarter of the 140 million girls and women estimated by the World Health Organisation to be living with FGM worldwide are in Nigeria makes the case for the eradication of the barbaric practice of cutting off some part of female genitals even more urgent. Of the 101 million girls of 10 years old and above estimated by the WHO to have undergone FGM in Africa, over 40 million are in Nigeria (with a 41 per cent prevalence). Indeed, Nigeria has the highest absolute number of FGM cases in the world. Our governments should be embarrassed that we lead only in those things that spell human misery, but are in the bottom rung of global rankings in those things that edify humanity.

While the government needs to adopt a more vigorous eradication programme, our diverse communities will have to overcome age-long habits that promote the terrible practice. In a report released last month to mark the International Day of Zero Tolerance of Female Genital Mutilation/Cutting, the United Nations noted some reduction worldwide in the life-threatening practice, but warned that significant numbers of girls and women in the 29 FGM-endemic countries, including Nigeria, were still at risk.

FGM or female circumcision (clitoridectomy, excision or infibulations) is based on traditional beliefs and societal pressure and “includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.” Across the country, but especially in the southern states, the practice is still rampant despite a series of, and many years of, public enlightenment on its dangers. The Nigeria Demographic and Health Survey 2003 showed a prevalence of FGM among adult women by geopolitical zone to be highest in the South-West with 56.9 per cent; South-East 40.8 per cent; South-South 34.7 per cent; North-Central 9.6 per cent; North-East 1.3 per cent; and North-West 0.4 per cent.

The sad irony is that the southern states that have higher literacy levels are also the most involved in this primitive socio-cultural practice. Reasons range from a belief that it reduces sexual desire and promiscuity; promotes chastity and helps young ladies attract husbands early. It is also wrongly ascribed to religious beliefs and traditional norms of female rites of adulthood.

This is absurd. A joint statement by the World Health Organisation, UN Children’s Fund and UN Population Fund says “culture is not static but it is in constant flux, adapting and reforming.” People should be ready to change their behaviour when they understand the hazards and indignity of harmful practices and when they realise that it is possible to give up harmful practices without giving up meaningful aspects of their culture. WHO details the gruesome practice as the partial or total removal of the external female genital and/or injury to the female genital organs.

According to clerics, none of the three main monotheistic faiths – Judaism, Christianity and Islam – prescribe female circumcision. Even if they do, should religion be indifferent to a cruel and barbaric practice?  Worse, medical experts and studies by WHO and other world bodies assert that, unlike male circumcision, it has no medical benefits whatsoever. On the other hand, says the UN Population Fund, “FGM does irreparable harm. It can result in death through severe bleeding, pain and trauma and overwhelming infections.” WHO adds that it also results in problems with urinating, could cause cysts, infections, infertility and complications in childbirth. For the infants, young girls and women who are subjected to the dehumanising practice, it is routinely traumatic and has been linked to cervical cancer, a major killer of Nigerian women.  It is more often also undertaken by local birth attendants or untrained “surgeons” using crude and un-sterilised instruments. It is reported that FGM victims go through extremely painful menstrual periods when they reach puberty and painful sex in marriage.

Nigeria must therefore do more to tap into the resolution adopted by the UN General Assembly to eliminate FGM. It follows on an earlier resolution passed in 2008, emphasising the need for concerted action by all sectors – health, education, finance, justice and women’s affairs.  UNICEF, UNFPA and women’s rights groups have also identified FGM as a gross violation of human rights.

The federal, state and local governments need to urgently mobilise resources to step up the anti-FGM campaign. Remedies should include passing legislation criminalising FGM. States, mostly in the southern part of the country – where it is more prevalent – should not wait for federal laws, but should back up mass enlightenment with tough laws to discourage the filthy practice.

This brutal violation of the rights of girls and women must be brought to an end. Religious leaders and community heads should educate their people on the evils of FGM. The state governments should pursue FGM eradication measures with as much vigour as the polio immunisation programme. States and LGs should urgently revive the primary health care system and eliminate the local, untrained mutilators who use unsanitary tools to harm our girls in the name of circumcision.

Parents and guardians should remember that FGM has no single health benefit, but is always harmful; it has no basis in religion as erroneously thought; it does not even discourage promiscuity, but often condemns women to sexual frustration when married. They should, therefore, protect the precious gift of children by strictly steering clear of female circumcision. Non-governmental organisations should intensify their remediation activities in this regard.

Alarming rate of maternal mortality among Nigerian  women

On July 19, 2011  · In Viewpoint

NIGERIA as a nation is blessed with both human and natural resources, yet  women die everyday from the scourge of maternal mortality.

Nigeria has the second highest rate of maternal death in the world: One  in  every eight women die while giving birth. Most of these deaths are avoidable as  compared to the United States of America where only one in 4,800 obtains.

However, one of the millennium development goals is to improve maternal  health care. This was adopted by the international community at the United  Nations Millennium Summit in 2000 with the aim of achieving 75 per cent drop  from the level of maternal mortality in the year 2015.

But come to think of it, would this  really be possible in this country where  women die from a wide range of complications in pregnancy, child birth or  postpartum period which in most cases are caused by poor health at conception  and lack of adequate care needed for the healthy outcome of the pregnancy for  themselves and their babies.

Nigeria is still battling to achieve regular power supply in the 21st  century, a time where virtually every activity of man has gone digital and most  hospitals are not excluded from this reign of darkness. Some women are operated  upon using candles or kerosene lamps in the theatre.

Pregnancy which ordinarily should be a thing of joy  is now seen as a death  warrant for most women due to the weak and poor primary health care system and  less qualified staff in most rural communities. In the urban areas where some  good health services are available they are too expensive or reaching them is  too costly.

Every year, more than 133 million babies are born, 90 per cent in low and  middle income countries. When their mother die, the chance of their survival is  slim. Lack of maternal care is a major cause of babies death and disability  among infants.

Every year, three million babies are stillborn. Almost one quarter of these  babies die during birth. The causes of these deaths are similar to the cause of  maternal death: obstructed or prolonged labour, eclampsia and infection such as  syphilis.

Poor maternal health and disease that have not been adequately treated before  or during pregnancy contribute to intra-partum death as well as to many babies  born preterm and with low birth weight. Among the 133 million babies who are  born alive each year, 2.8 million die in the first week of life and slightly  less than one million in the following three weeks.

Therefore, for Nigeria to achieve an accelerated success in improving  maternal health, quality health system and barriers to access health services  must be identified and tackled at all levels, even down to the grassroots.  Proper education should be adequately given to pregnant women on how to take  care of themselves during pregnancy.

Adequate enlightenment campaign should be carried out in the rural areas  using the local chiefs and clergies in collaboration with the local media on the  importance of ante-natal care during pregnancy just the way the campaign against  polio is being done. During  ante-natal care, women are examined for possible  complications and also drugs are administered to cater for the health of  the  mother as well as the fetus in her womb.

In the Northern part of the country, VVF is very common mostly due to lack of  the care needed during pregnancy. And when this occurs their system becomes  damaged; carrying out their daily activities becomes difficult. Worst of all is  that most husbands leave their wives to suffer the pain alone without providing  the care they need.

Most maternal deaths are avoidable, as the health care solutions to prevent  or manage the complications are well known. Since complications are not  predictable, all women need care from skilled health professionals, especially  at birth, when rapid treatment can make a difference between life and death.

The Nigerian government should try and put smiles on the faces of  women,  especially the rural dwellers by putting different measures in place to cater  for their health. Money should not be a deterrence in procuring a good health in  Nigeria.

Ms. HAWWA  MUHAMMAD, a student , wrote from Bayero University, Kano.

According to Geoba.se, Nigeria, is Africa’s most populous country.  The 2013 population is approximated at 173,000,000 million people all whom live in an area that is roughly the size of the state of Texas.   Nigeria is ranked 3# in world population aged 0-4 years, at over 29,000,000 and #4 in the world rankings of infant mortality.

Note: Estimates for this country explicitly take into account the effects of excess mortality due to AIDS; this can result in lower life expectancy, higher infant mortality, higher death rates, lower population growth rates, and changes in the distribution of population by age and sex than otherwise be expected.

Nigeria is composed of over 250 ethic groups and over 500 indigenous languages.
Major cities are:
Lagos 10.203 million; Kano 3.304 million; Ibadan 2.762 million; ABUJA (capital) 1.857 million; Kaduna 1.519 million (2009)

Nigeria defines an orphan as a child (0-17 years) who has lost one or both parents. A child is vulnerable if, because of the circumstances of birth or immediate environment, is prone to abuse or deprivation of basic needs, care and protection and thus disadvantaged relative to his or her peers (FMWA&SD 2008). A vulnerable child is one (that): with inadequate access to education, health and other social support, has a chronically ill parent, lives in a household with terminally or chronically ill parent(s) or caregiver(s), lives outside of family care (lives with extended family, in institution, or on street), is infected with HIV (FMWA&SD 2006).

The number of adults and children living with HIV is one of the highest in the world, at 2,800,000. Official figures estimate that there are 17.5 million OVC, including 7.3 million orphans; although practitioners in the field believe these figures could be underestimating the size and scope of the problem (Nigeria OVC Situation Analysis 2008). The

4 UNICEF/Childinfo data base estimates the number of orphans to be 9.7 million.

According to the 2008 Situation Analysis:

• There are 17.5 million OVC, including 7.3 million orphans.

• 2.39 million orphans are due to AIDS (FMOH, 2008)

• 10.7% of the 69 million children are vulnerable (UNICEF, 2007)

• 10% of children are orphaned (7% in North-west to 17% in South-East), 10% in rural, 11% in urban

• Benue state has the highest prevalence of orphans (25%), followed by Akwa Ibon (approx 22%); while Niger has the lowest (2.7%).

• 24.5% of children interviewed in households are OVC (26% in rural, 21% in urban)

• Benue state has the highest prevalence of OVC aged 6-17yrs (49%), followed by Imo (45%), and Rivers (41%); with Kwara having the lowest (9%)

According to the National Plan of Action for OVC:

• 39% of children 5-14 are engaged in child labour

• Up to 40% of children may have been trafficked

We are at Mom and Dad’s house in Chilliwack waiting to walk out the door. That is Mom (Catherine), Dad (Steve) and I are here. We are waiting for my brother-in-law Darren to arrive and Norm, who is coming out with the van to transport us. We will pick up Dale on the way down the mountain and hit to road for Seattle. We have finished packing and weighing all the bags. We are slightly under weight or bang-on for all of them…YAY! I just had my last hot, running shower for the next two weeks, and am mentally preparing for my bucket and cup cold water ‘baths’, eeek.
Here’s to hoping and praying the boarding crossing with all of us and our bags goes smoothly.

I can’t believe I have one more night here in Canada, one night in the USA and then my running feet will touch the ground where my heart is…in Nigeria. There are six of us going on this trip for two weeks. The anticipation is beyond words, for both us who are returning, and those who will be seeing it for the first time. The amount of luggage is unreal, the pending questions insurmountable, and the peace and excitement of knowing ‘now is the time’, undeniable. And those emotions are just ours, I cant even describe what I have heard about those who are waiting for our return, still, after years of oppression. We are SO ready for this!

Just before Christmas I spent a few days with some friends, a couple, one of who has been my boss for the past year and a half that I have been a Special Ed Teacher and Case Manager. We had wonderful discussions surrounding walking in the call that God has placed on one’s life. Through those talks I realized even more assuredly that I was making the right decision in reading myself to return to Nigeria on a full time basis. In all my years of being back here, since having spent several years living in Nigeria, I have always felt a restlessness and a tugging at my heart. I have been unable to calmly settle into a job and feel confidently about it being right. At least not on a long term basis. Finally being able to accept that the last four years here have not been a waste, but that I have grown and learned, both academically, spiritually and personally, has lifted a heaviness in my heart in knowing I am to return to where my heart is. Plans are set in motion to return to Nigeria over Spring Break. We will be taking a team of people this time :)

Well, it has been a long road for TWCF. As of September 2012, after more than four years of being out of the country on a permanent basis, we have decided it is time to return. A short visit in August 2011 confirmed that while the vision to have our home for orphans and vulnerable children was still alive, it was also still too difficult to remain in the country safely. It took all of 2012, filled with tears and frustration, prayer for direction, and meetings locally in BC, and Nashville, TN to lead us back to entering Nigeria. Our hearts are still filled with passion to love and provide for these children. It is going to be exciting to see how our preparation to return unfolds!