literature review on gender inequality in nigeria

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Gender Inequality, Maternal Mortality and Inclusive Growth in Nigeria

• Original Research
• Published: 26 August 2019
• Volume 147 , pages 763–780, ( 2020 )

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• Oluwatoyin Matthew 1 ,
• Anthonia Adeniji 2 ,
• Romanus Osabohien   ORCID: orcid.org/0000-0003-4359-1368 1 ,
• Tomike Olawande 3 &
• Tolulope Atolagbe 2  

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The relevance of women in contributing to inclusive growth and consequently economic development in Nigeria cannot be overemphasized. Women play important social, economic and productive roles in any economy. Maternal mortality rate refers to the annual number of deaths of women from pregnancy-related causes per 100,000 live births, and Nigeria’s rate is still relatively high at about 630 when compared with the figures of the developed countries. For inclusive growth to be achieved in Nigeria, women should not be neglected and marginalized so they can contribute their quota to the growth of the country, but maternal mortality rate needs to be reduced because it is only the living that can make contributions to growth. Thus, this study examined the long run effect of gender inequality, maternal mortality and inclusive growth in Nigeria using time series data spanning from 1985 to 2017, and employed the ARDL econometric technique. The results showed that gender inequality and maternal mortality have negative impacts on inclusive growth in Nigeria. Therefore, the study recommends that women should be properly taken care of during pregnancy so that the maternal mortality rate can be reduced and hence they will be able to make meaningful contributions to the growth of the Nigerian economy.

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Acknowledgements

The first draft of this paper was presented at the First International Multidisciplinary Women conference on advancing women in academia and industry: Strategies, policies and emerging issues in the 21st Century, held in Covenant University, Ota, Nigeria, between 11th and 12th September, 2018. Comments from the conference panelists are appreciated. Also, authors are highly indebted to two anonymous expert reviewers for their insightful comments which helped to improve the quality the work. The views expressed are that of the authors, disclaimer applies

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Matthew, O., Adeniji, A., Osabohien, R. et al. Gender Inequality, Maternal Mortality and Inclusive Growth in Nigeria. Soc Indic Res 147 , 763–780 (2020). https://doi.org/10.1007/s11205-019-02185-x

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Accepted : 21 August 2019

Published : 26 August 2019

Issue Date : February 2020

DOI : https://doi.org/10.1007/s11205-019-02185-x

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Women and Insecurity in Nigeria: The Way Forward

Associated data, introduction.

The level of insecurity in Nigeria was very high for more than a decade. Attacks were carried out relentlessly by Fulani armed men, Boko Haram insurgents, bandits, and herdsmen in many towns and villages in Nigeria. The above scenario has led to the untimely death of over 456,831 innocent lives in Nigeria as of April 2019 (Duru, 2019 ; Ososanya, 2019 ; Sahara Reporters, 2019 ). The frequency and ferocity of these insurgencies in Nigeria were quite alarming and unprecedented in the annals of the country, and have unexpectedly led to insecurity on a large scale in Nigeria.

The major challenge that has been faced by the Nigerian government for more than 10 years is insecurity and this has led to the loss of lives and properties. The attacks took the form of the bombing of churches, schools, and police stations using improvised explosive devices (IEDs), shooting of innocent citizens mostly using AK47 rifles, abduction of school girls and women (including males sometimes), destruction of oil facilities, and the bombing of railway happened on the 28 March 2022 in Katari, Kaduna State. There were also instances of destruction of crops, large-scale burning of residential buildings, and kidnapping of passengers traveling on the road for ransom. As a result of the above security challenges, many citizens have been rendered homeless and many children have become orphans without any hope for the future. Apart from the above, national growth could be adversely affected by the issue of insecurity as exemplified above (Obi, 2015 ). Many girls kidnapped have been forced into marriage by members of Boko Haram. A good example was the case of Leah Sharibu who already had two children (BBC News, 2021 ). This situation was a demonstration of a high level of insecurity. According to Premium Times ( 2021 ), Nigeria was one of the most threatened and unsteady nations worldwide. Nigeria ranked third in the world with a death toll of 25,711 from 2010 to 2019, not including women and girls raped and captured by Boko Haram insurgents in Nigeria since 2020. The majority of Nigerians lived in perpetual fear and anxiety of attacks from criminal elements in the country as people were no longer safe in their homes. They were afraid to go to farms or embark on journeys. Apart from this, students dreaded going to school. In fact, many parents withdrew their children from schools in the northern part of the country. However, the burden was more on women and children because they were more hit by the clashes, insurrection, and violence. The The Global Right Atrocities Report ( 2021 ) said that 4,556 Nigerians were killed in 2020, especially in North-Eastern Nigeria. Furthermore, over 220 abductions and at least 2,114 fatalities were on record and over 600 schools were closed down in six Northern States in the first quarter of 2021. There were also violent attacks in Abia, Benue, Imo, Niger, Ondo, and Oyo States from non-state actors, traceable to Boko Haram insurgency and farmers–herders clash, among others.

According to the Joint Shadow Report by the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) Committee, 67th Session (2017), the quest by herdsmen to find sufficient grazing land for their cattle has resulted in violent farmers–herders clashes in some parts of the country like North-Eastern Nigeria, Niger Delta, North Central and Southeast Nigeria. As a matter of fact, in many rural communities where there were many female farmers, the fear of cattle destroying their crops has discouraged many of these female farmers from continuing their farming activities which have resulted in rising scarcity and poverty among many rural dwellers, especially women. What compounded the problem was that security agencies were not always around to protect these women farmers and men from savage and brutal attacks purposely carried out by herdsmen and other criminal elements.

These insecurity occurrences in Nigeria have resulted in the displacement of inhabitants of villages and towns torn by insurgency. Many people who were driven away from their homes by Boko Haram insurgents or killer herdsmen were kept in Internally Displaced Persons' Camps (IDPCs) that were established by the government to accommodate the displaced men, women, girls, and children. Internally displaced persons are people who were forced to leave their homes but remain within the border of their country. According to the Internally Displacement Monitoring Centre ( 2021 ), 169,000 inhabitants have been driven away from their homes due to violence from 1 January to 31 December 2020. The total number of IDPs that resulted from Boko Haram attacks and other conflicts as of 31 December 2020 was 2,730,000. The IOM Displacement Tracking Matrix noted that in Rounds 35 and 36, 2,150,243 and 2, 184, 254 persons were displaced from their homes in December 2020. These people were displaced from 447,628 households (IOM Displacement Tracking Matrix, 2021 ). More worrisome was the fact that women and girls in these IDP camps were sexually assaulted by males from within and outside the camps, such as other male IDPs and men whom the abused females regarded as their protectors in the camps. Akanbi et al. ( 2019 ) reported that IDPs experienced at least one form of violence, which may be sexual, physical, economic, and emotional wreaked by Boko Haram rebels.

Women in Nigeria have been playing significant roles in national security in spite of cultural, religious, and demographic challenges facing them. Women are the most affected by uncertainties and different types of insecurities in all the geographical regions of Nigeria including the Federal Capital Territory. However, they have been found to participate in suicide bombings and acted as informants to Boko Haram members and the killer herdsmen. Despite the fact that women were the most affected when it comes to the issue of security, they seemed overlooked compared to their male counterparts in decision-making when it comes to finding solutions to violence and physical insecurity in Nigeria. Nigeria was ranked 139 according to the World Economic Forum's Global Gender Gap Report in 2018 in terms of the gender gap in political enablement and decision-making. The Women Advocate Research and Documentation Centre (WARDC) and Nigerian Women Thrust Fund (NWTF) noted that the Nigerian Women Charter of Demand wanted 35% of women to be involved in all aspects of decision-making in all sectors of government (Oluyemi, 2016 ; Kelly, 2019 and Peace Direct, 2019 ). However, women have not been prioritized when it comes to making decisions on how to end insecurity in Nigeria. Women have the right to partake in decision-making, including that of insecurity in the country. The United Nations Development Programmes' ( 1994 ) Human Development Report showed that global security should be long-drawn-out to include seven areas, such as economic, health, community, food, environmental, human, and political security (Idike et al., 2020 ). Premium Times ( 2021 ) stated that there was a need for Nigeria to build on women's original awareness and involve them in the communal peace architecture as peacekeepers and mediators to end insecurity.

Feminist scholars and gender campaigners working in conflict zones have emphasized the need to concentrate on the roles played by men and women during clashes, the gender discrepancy effects of violent conflicts, the need to address the various challenges faced by women, and the need to increase their involvement in peace and security issues and decisions. In all aspects of government, including the military and policy approaches, feminists had worked to ensure that women were effectively represented (Savage, 2021 ). Insecurity issues in Nigeria appeared alarming and women's involvement in the decision-making hierarchy on insecurity seemed minimal. Consequently, this paper focused on the burning issues of insecurity in Nigeria and the extent to which women have been involved in decision-making on insecurity in the country. The study employed the descriptive research design using secondary data on insecurity-related issues.

Statement of the Problem

There seemed to be incidents of insecurity in Nigeria but its level and extent are not known by many people. Also, women and children appeared to be the most adversely affected group by insecurity in the country but incidentally, they seemed less visible than their male counterparts when it comes to discussing issues related to how to tackle insecurity in the country. Furthermore, the issues of insecurity in Nigeria were solely reported in the newspapers meaning that researchers have not written much on this problem. Even the national dailies and medium through which this problem of insecurity has been discussed have failed to shed light on women's level of involvement in decision-making when stakeholders meet and take far-reaching decisions on how to solve or manage the problem of insecurity in Nigeria.

Objectives of the Study

The objectives of the study were to:

• find out the level of incidents of insecurity in Nigeria;
• assess women's insecurity challenges in Nigeria;
• determine the level of involvement of women in decision-making on insecurity in Nigeria; and
• proffer solutions to the low level of involvement of women in decision-making when it comes to tackling insecurity in Nigeria.

Research Questions

The study was guided by the following research questions.

• What was the level of incidents of insecurity in Nigeria?
• What were the insecurity challenges facing women in Nigeria?
• What was the level of involvement of women in decision-making on insecurity?
• How can the problem of low involvement of women in decision-making on how to tackle insecurity in Nigeria be solved?

Significance of the Study

The study would provide stakeholders with necessary information on insecurity at the state and federal levels and on the level of insecurity in Nigeria. The study would also inform people about the need for women's involvement in tackling and managing issues of insecurity in Nigeria.

The study would acquaint people with the insecurity challenges faced by women in Nigeria and the hurdles that women and girls face in the IDPCs in the country. The study would enable the relevant stakeholders in the area of insecurity to be aware of the suffering of women in the IDPCs which hopefully would enable them to put a stop to the irregularities and abuse of women and girls in camps all over the country.

The study would enable state and federal governments to embark on laudable initiatives to involve women just like their male counterparts in the management of insecurity in Nigeria. The study would provide information for governments on the need to find means of bridging the recruitment/appointment gaps between men and women in top management positions in security architecture in Nigeria.

Literature Review

For some years now, the insecurity and terrorism index in Nigeria rose from 6.95 in 2011 to 7.96 in 2012; 8.2 in 2013; 9.21 in 2014; 9.31 in 2015; 9.10 in 2016; 8.66 in 2017; 8.6 in 2018, and 8.31 in 2019. The index processed the direct impact of violence and anxiety on a scale from 0 (no impact) to 10 (highest impact) (Institute for Economics Peace, 2019 ). Notwithstanding a reduction compared to the preceding 5 years, Nigeria continued to be one of the countries with the uppermost insecurity threat levels in the world. In 2019, Nigeria documented the second largest number of deaths related to terrorism and insecurity worldwide (Trading Economics Strata, 2021 ). The actions of criminals using the banner of religion and herders turned into a serious cause of concern for Nigerians. This was connected to the long-time farmers–herders clash, but security experts thought that criminals and banished insurgents from other African nations may have broken into the ranks of the once peaceful herding community to perpetrate crimes and violence across Nigeria. The South-East region of the country is engulfed in the problem of the indigenous people of Biafra who are a separate group seeking autonomy from the Nigerian State (Omoniyi, 2021 ).

Continuous kidnapping of school children in Nigeria in the last 7 years seemed to be the new gold mine for criminals in recent times. This was especially a consequence of the huge cash that the government and individuals allegedly paid for the release of victims. As a result of the assaults on schools, over 618 schools were shut down by States in the North, thereby adding to the already deteriorating out-of-school students that Nigeria faced (Omoniyi, 2021 ). Diverse groups in Nigeria recourse to violence. The militant Islamic group, called Boko Haram, was devilishly active in Northern Nigeria. In the Southern part of Nigeria, the Niger Delta militants threatened war against the state (Trading Economics Strata, 2021 ). In some parts of Nigeria, ethno-religious crises, and farmers–herders clashes were common. According to Feminist Womanifesto Group ( 2021 ), insecurity jeopardized the continued survival of the country, and every citizen could be affected.

Insecurity is a state of lack of protection from danger in which one is not at ease with oneself. It is a situation that involves fear, anxiety, worry, and apprehension. Insecurity is the state of being open to danger or risk and the feeling of being unsafe (The NROC Project, 2021 ). There are various types of insecurity which include bodily insecurity, emotional insecurity, food insecurity, economic insecurity, political insecurity, and environmental insecurity among others but the focus of this paper was on physical insecurity which resulted from insurgency, terrorism, and other forms of violence. This type of insecurity involves killing and maiming people. Insecurity cuts people's life short and prevents the use of human potential, thereby disturbing access to long life (Stewart, 2004 ).

One of the major causes of the farmers–herders clash has to do with climate change which prompted the Fulani herdsmen to move from their settlements in the Northern parts of the country to other areas where they can graze their cattle. Climate change has led to desert encroachment, desertification, disappearance, or shrinking of Lake Chad, droughts, and other negative consequences affecting the Fulani cattle. This made the Fulani herdsmen, also known as Bororos, leave their communities and travel to Southern Nigeria where there were better vegetation, buoyant market chances, and hope. These herders were always in conflict with farmers for spaces to rear their animals. In fact, these herdsmen were moving down in their numbers, and they were confronting farmers working on their farms on a daily basis. The violence resulted in an unhealthy relationship between the Bororo Fulanis and Middle Belt farmers, Yoruba in the Southwestern States, and the Ibos in the Southern States; this is a serious issue of concern in Nigeria (Folami and Folami, 2013 ). Also, the uprisings in the South for the crude oil in the region added to the level of insecurity in the country. The religious conflicts between Christians and Muslims also powered insecurity in the nation. There were also cases of suicide bombing, border clashes between neighboring communities, ethno-religious crises, and so on which contributed to insecurity in Nigeria.

Due to insecurity issues, many Nigerians, especially in the North, have fled their homes and became IDPs. The cases of displacement in Nigeria were multilayered, complex, and overlapping. Boko Haram and other non-state armed groups (NSAGs) triggered significant displacement in the Northeast since 2012. Recurrent violence between Fulani pastoralists and Hausa farmers in Kastina, Sokoto, and Zanfara States of Nigeria became more rampant and rural banditry and criminal violence were on the rise (Internally Displacement Monitoring Centre, 2021 ). Criminal violence was also reported in Southern Nigeria, though data on displacement was rare. Clashes and violence led to increased new displacement in 2020 and about 2.7 million people were living in IDPCs at the end of 2020, there was an increase in the data for 2019. There were also secondary movements of IDPCs previously caused by violence, especially in the Northern part of the country. From 4 to 10 October 2021, 783 people were displaced in the Batsari Local Government Area of Katsina State (Internally Displacement Monitoring Centre, 2021 ). According to IOM Displacement Tracking Matrix ( 2021 ), 29,846 people were displaced from their homes in August 2021 from Benue, Borno, Kaduna, Katsina, Plateau, Sokoto, and Zamfara. Also, armed clashes displaced 573 in Isa Local Government Area of Sokoto State from 4 to 10 October 2021. Armed clashes between herdsmen, farmers, bandits, and local communities displaced 1,103 persons from 4 to 10 October 2021 in the Gumi Local Government Area of Benue State. Moreover, according to the United Nations High Commissioner for Refugees (UNHCR, 2021 ), a total number of 14,555 people were sent away from their homes in Benue, Borno, Katsina, and the Sokoto States in September 2021. All these displaced people were settled in IDPCs by the government. Over 17,000 babies have been lodged in Borno IDPCs since 2019 (Premium Times, 2021 ).

It is significant to note that IDPCs faced a lot of difficulties. One of them was that they were forced to flee or leave their homes. They were exposed to a number of dangers. Displaced persons suffered high rates of death than the general population in Nigeria. They were also abused bodily, financially, sexually, and emotionally at the camps. The Nigerian government bore the primary obligation for the shielding and wellbeing of IDPCs. If the national government was powerless or reluctant to meet their needs and tasks, the international communities have a role to play in endorsing efforts to ensure protection and to provide aid and solution to their problems (OCHA, 2021 ). According to Premium Times ( 2021 ), other challenges faced by internally displaced persons were food insecurity, unemployment, penury, lack of adequate health care, water, electricity, sanitation, sexual harassment, and abuse. Akanbi et al. ( 2019 ) and Women Media Centre ( 2021 ) agreed that instances of sexual abuse of women and girls in camps in Nigeria were very rampant and that the evil acts were committed by men whom they regarded as their protectors in the camps and other male IDPs. Some of the victims were raped which led to unwanted pregnancies and children for whom the women solely catered for. Inwlomhe ( 2021 ) reported that there were cases of sexual abuse including rape and maltreatment of women and girls in IDPCs in Adamawa, Borno, and Yobe. Government officials and other authorities in Nigeria raped and sexually abused women and girls displaced by the clashes with Boko Haram according to the report. The report added that the government neither did anything to defend the displaced women and girls nor ensured that they had access to adequate basic rights and services. Also, there was no serious punishment for the abusers, who were camp leaders, vigilante groups, policemen, and soldiers. In late July 2016, Human Rights Watch documented sexual abuse including rape and exploitation of 43 women and girls living in seven IDPCs in Maiduguri, the Borno State capital. There were security breaches in service delivery and access to justice for women and girls victims in the camps. It was also reported in an assessment in April 2016, that gender-based violence was a feature of displacement in the disasters of Northeast Nigeria. It also acknowledged the lack of prioritization of issues of gender-based violence programs designed by the humanitarian community in Nigeria as an issue. Moreover, Read ( 2017 ) also said that the culprits and perpetrators of gender-based violence (GBV) at IDPCs were civilians, military, and emergency management officers detailed to protect and support internally displaced persons.

Boko Haram, an Islamist terrorist group focused its attacks on government officials, Christians, school children, and Muslims who condemned their acts or were suspected of aiding the Federal Government of Nigeria. Boko Haram mainly attacked people in North-Eastern Nigeria. They cited increased western influence and corruption in the administration of the country as the reasons for their violent activities against people. Their action against Christians and schools was called jihad. The former leader of the group was Shekau. The terrorists have burnt churches, killed so many Christians praying in their Churches, and abducted mainly adult females/girls, some males, and many students (Human Rights Watch, 2012 ). Several students are still in their custody and the group was demanding millions of naira as ransom before they could be released to their parents.

The problem of insurgency initially started in Nigeria in the early 1990s over disagreements between foreign oil companies and a number of Niger Delta minority groups who felt that they were being exploited, particularly, the Ogoni and the Ijaw people. This continued until the government and the companies met some of their demands with the presidential amnesty program. However, there are some pockets of insurrection in the Niger Delta region. The Indigenous People of Biafra (IPOB) also contributed to cases of insecurity in Nigeria in their agitation for a Biafran nation. There was equally a non-violent demand by Yoruba in the Southwest for an Oduduwa State. The Middle Belt people also agitated for a separate nation. Though these two regions were non-violent, some of their protests had led to fear, injury, and death which are all parts of insecurity in the country.

The issue of internal security administration had attracted world attention since the events of the 11 September 2001 attacks on the World Trade Center in the United States. These attacks, together with similar attacks like the one in Istanbul in 2001 and the train bombing in Madrid, Spain in 2004 have made nations strengthen their internal security systems in order to meet the challenges of protecting citizens against terrorist activities (Alumona et al., 2019 ). According to Okolie-Osemene ( 2019 ), security is a vital prerequisite in the wherewithal of modern states and in the international political system. This was due to a result of the need for states to be recognized as really sovereign and to be able to preserve their territorial integrity without control by other states.

Of note is the fact that for a nation to achieve development and be successful in all areas, it is necessary to be gender friendly. With particular reference to the current topic, the point is that the female gender should not be seen as insignificant in the attempts of the Federal Government of Nigeria to solve the problem of insecurity in Nigeria because the process of security is governed by a principle called gender equality. The process of security is governed by a principle called gender equality. About 70% of the world's poorest were women. Nigerian women were an insignificant and weakened force (Idike et al., 2020 ). However, this development did not stop women from contributing to insecurity in Nigeria. According to Adams and Olajumoke ( 2016 ), women caused 26% of Boko Haram suicide bombing incidents in Northern Nigeria, 17% of oil bunkering in the Niger Delta region, 12% of the kidnapping in the Southern Nigeria, 38% of armed robbery in Southern Nigeria, 41% of cases of corruption, and 43% of political violence and uncertainty all over the country. The above statistics has clearly shown that the female gender has contributed to insecurity in Nigeria and that they cannot be ignored when thinking of how to stop the problem in the country.

In recent times in Nigeria, millions of students are becoming victims of the clashes caused by insecurity thereby leading to loss of lives and property. Security threats and challenges were acts or events that exposed the material or identity of individuals, societies, or states to dangers. National security threat contains programs of antagonistic governments, some resulting from foreign governments with hostile intentions. National security threat covers terrorism, insurrections, the proliferation of arms, cybercrime, natural calamities, and diseases (Idike et al., 2020 ). The national threat in Nigeria was due to some factors that included poor government policies, corruption, poverty, unemployment, and a weak judiciary system, among others. These have really affected the growth of the nation adversely (Idike et al., 2020 ). Obi ( 2015 ) found out that insecurity, such as terrorism had negative effects on the development of Nigeria. Insecurity has led to the diversion of resources meant for the development of the nation to procuring amenities, consulting security experts, recruiting additional soldiers, and seeking assistance from other nations through different diplomatic means.

Theoretical Orientation

The theory underlying this study is the feminist theory that favored equal opportunity for all men and women in all societies and nations including women's equal involvement in issues of insecurity like men. The feminist theory initially emerged in 1794 through the publication of Mary Wollstonecraft, entitled “A Vindication of the Rights of Woman”; The Changing Woman, a Navajo Myth; and Ain't I a Woman in 1851 by Truth ( 2005 ) among others. The extension of feminism into theoretical, fictional, or philosophical dialogue can be called the feminism theory. Its objectives were to understand the nature of gender equality, examine the social roles of women and men, interests, responsibilities, and feminist politics in a variety of fields, such as anthropology, sociology, communication, media studies, psychoanalysis, ecology, home economics, literature, education, and philosophy (Brabeck and Brown, 1997 ). The themes covered by feminist theory often included discrimination, objectification, oppression, patriarchy, stereotyping, arts, history, and aesthetics (Lerman and Porter, 1990 ; de Zegher, 1999 ; Armstrong and de Zegher, 2006 ). The main forms of the feminist theory were Liberalism, Socialism/Marxism, and Radical Feminism (Cott, 1987 ). The main focus of all these feminist theories was enhancing gender equality in society and the inclusion of women in all programs, opportunities, chances, and choices like their male counterparts.

Feminism, simply put, is a range of movements and ideologies that shared the same goal which was to define, establish, and achieve equal political, economic, cultural, personal, and social rights for women. These encompassed the establishment of equal opportunities for women in education, decision-making in vital areas and opportunities (including decision-making on insecurity issues). Feminists pointed out that in most cultures throughout history, men have been given more opportunities than women (Curran and Renzetti, 1998 ). In essence, feminism aids women to have integrity and equality with men.

Regarding any serious academic discourse, people cannot discuss works on gender equality without reference to feminism. Feminism addressed the issues of gender inequality, patriarchy, and sexism. Feminism, therefore, advocated for a change toward greater equality between men and women, promoted the expression of opportunities and choices for women, favored the elimination of gender stratification and reproduction, and championed how to put an end to all forms of violence in and outside the home.

There existed a cultural dichotomy between the male and the female gender. Socially, women and men were not equal or treated the same way in the world. Women were exploited by men. Society was male-dominated and patriarchal. Feminism was borne out of this discriminatory situation. Feminism was a movement directed at turning things around and causing a change in the unnatural recognition, power, and honor given to the male gender. Feminism, therefore, believed that men and women should enjoy equal status socially, politically, and economically. This means that feminism promotes equality for both sexes. That is, women are valued as equals, have equal rights, chances, and capacities with men. The belief was that if women are given equal opportunities like men, they would contribute equally and significantly to the growth and development of any nation or society. Feminism is a recognition and analysis of male supremacy and the efforts to change it. Feminism solicited equal rights for men and women in any society (Curran and Renzetti, 1998 ).

The goals of feminism were to establish the importance of women in society and prove that women were not passive, reveal that women had been subservient to men, and as well bring about gender equality. Given these three goals, feminism was concerned with equality of men and women meaning that women should share with men equally the scarce national resources (including top positions in the army, police, and other security/insecurity architecture). It was a movement formed to bring about social, political, and cultural rights, especially for women. Nevertheless, it had become a contentious concept (for women, men, and religious groups among others) and it is often seen as a threat to men. Feminist theory is about the way societal norms, roles, values, and institutions have restricted women's behavior, choices, and opportunities, how gender inequality and gender oppression could be understood, and it also shows the way in which women's control can be explained.

Methodology

The study employed the historical descriptive research design and used existing secondary data sources to access information. The secondary sources used included articles, dailies, journals, documents, books, and libraries on security issues.

Incidents of Insecurity in Nigeria

The fact that various insurgent groups were attacking and killing army officers, the police, and other security agents is worrisome. These security agents were expected to overwhelm and eradicate the insurgencies in the country but the reality on the ground was the opposite which was frightening. Insecurity, such as terrorism and others were global issues that demanded urgent consideration from governments worldwide. In this direction, the Nigerian government had made desperate efforts to curtail insecurity challenges in the country, but the efforts had not yielded the desired result at all (Obi, 2015 ). These various forms of insecurity had overwhelmed the nation because of the huge number of fatalities recorded and the humongous expenses incurred in fighting it. Nevertheless, Olonisakin ( 2019 ) noted that the government's key concern was protecting the citizens from danger and fear. He added that the ability of any government to live up to its responsibility is hinged on its security architecture.

Note that the data that portray the level of incidents of insecurity in nigeria is uploaded separately as additional material.

The data are really alarming, outrageous, horrible, and saddening. Starting from 1980, kidnappings carried out for different reasons remained a feature of the landscape of criminal victimization in the country. Moreover, the menace of kidnapping for ransom (K4R) became a serious obstacle to human security in Nigeria (Onuoha and Okolie-Osemene, 2019 ). The new pattern of insecurity was the kidnapping of students from schools in Northern Nigeria by insurgent gangs who demanded millions of Naira for their release.

Women and Insecurity Challenges in Nigeria

Women were not actively involved in insecurity issues, especially at the top or leadership level where efforts to put an end to the ills are made though they were the most adversely affected, counting their female children. According to Savage ( 2021 ), peace and security were areas in which women had particularly been relegated when key policy decisions were made, and resource distribution was decided. The continued relegation of women in peacebuilding and conflict determination processes had affected development, particularly at the local level since tradition did not inspire the leadership of women. According to Kolawole ( 2020 ), all over the world, women and children take the impact of the world's clashes and wars. During these clashes, they were often exposed to inconceivable dreadful mayhems like massacres, sexual assaults, kidnappings and slavery, forced marriage, disfigurements, and forced pregnancy. Rape is actually being used as a weapon during wars. It was a well-known fact that women and girls were largely invisible when it came to conflict management and peace building. It was not due to any biological or operational reasons that women or girls were unable to participate in conflict resolution. The point was that women were often seen only as feeble victims of violent wars, rather than as agents of change whose ability could be exploited in peace processes. However, the United Nations Security Council also recognized the importance of increasing women's involvement in conflict determination and peace-building processes, particularly at the decision-making level (O'Reilly et al., 2015 ). Adeni ( 2015 ) noted that there were some cultural obstacles affecting women when it comes to active participation in conflict resolution in their states.

An alliance of women groups under the aegis of Women's Voice and Leadership Nigerian Project, urged the Nigerian President, Muhammad Buhari, to engage more women in the decision-making process and in the management of the country including insecurity architecture. The body, which made the call at its second Annual National Women Conference held in Abuja, implored the President to raise the level of women's inclusion in the nation's workforce and leadership. The body went further to uphold that involving women in decision-making procedures would help the country to find solutions to some of the difficulties it was facing, especially, the issue of insecurity. The Director of Action Aid Nigeria opined that what people saw in Nigeria was conflicts fought over women's bodies. Women have been used as arms and targets of violence (Vanguard News, 2016 ). The uneven impact of insecurity on women, girls, and children could not be overlooked. The group revealed that Nigeria needed to act as fast as possible to stop this increasing insecurity in Nigeria. The Action Aid wanted Nigeria to operationalize in all regions of the country, the provisions of the United Nations Security Council Regulation 1325, which charged all states to enable women's involvement in leadership in the area of peace and security that Nigeria was committed to. Action Aid Nigeria called on all state and non-state actors to reconsider the country's security design and ensure women's presence in the peace processes so that insecurity would be eradicated (Vanguard News, 2016 ). Women could be engaged informally through peace contests, the conception of unions and organizing peace coalition. The country should understand that having women at the peace table does not mean that they would drive for a gender-sensitive approach in the process or would advocate for women's issues alone (Savage, 2021 ). According to Kolawole ( 2020 ), women's involvement in grassroots peace-building in Nigeria is very key to her development and growth.

The Joint Shadow Report of CEDAW Committee ( 2017 ) noted that women in Nigeria had paid a weighty price in the conflicts devastating the century, especially, in the past two decades. They have suffered unparalleled stages of sexual violence and internal dislocation. Constant clashes in Nigeria include those related to fierce fanaticism in the Northeast and clashes over resource control, kidnapping in the Niger Delta, and complaints over land use due to antagonism between farmers and herders. Conflicts in the Northeast have resulted in enormous loss of lives, properties, and areas of livelihood. Boko Haram assaults and increased militarization in the region continued to have overwhelmingly negative effects on women and girls. In addition to Boko Haram's abduction of girls, their recruitment as suicide bombers, sex slaves, and forced laborers, Boko Haram's attack had escalated the number of women and girls who had been internally banished and therefore forced to seek shelter in various camps across the Nigerian nation (Joint Shadow Report of CEDAW Committee, 2017 ).

Peace and security are areas in which women have been predominantly marginalized, especially where key policy resolutions are made, and allocation of resources are decided. Women's continual marginalization in peace-building and conflict-resolving procedures has affected the country's growth and development, predominantly at the local level, since custom does not inspire women's headship (Garba, 2016 ).

There should be a framework that addresses the root causes of conflict and at the same time, ensures that women's equal and meaningful involvement in peace-building and conflict-resolution processes and decision-making are fundamental elements of conflict avoidance. According to Onyejekwe ( 2009 ), the acknowledgment of the conflicts affecting women was well-recorded in conflict and peace-building works. Although women were severely affected by war through vulnerability to sexual and gender-based violence including rape, forced recruitment, sexual slavery, kidnapping, and forced impregnation among other ills, it does not mean that they cannot play more positive roles as well. To Hassan ( 2015 ), the issue of women not inhabiting top positions was a challenge in Nigeria and across all sectors because the majority of these positions (even in security outfits) are occupied mostly by men, therefore giving few chances to women.

There were challenges to women's involvement in decision-making in Nigeria. The National Action Plan aims to achieve one important thing for women which is making them relevant in peace and security issues in Nigeria and in the process, demands women's equal and full participation at all levels of decision-making including insecurity in the country (Premium Times, 2021 ). Womanifesto Group demanded that Nigeria should set up frameworks and mechanisms that will make it possible to detect potential conflicts very early and also ensure women's involvement in peace and security decision-making. The group added that Nigeria should launch an early warning and response mechanism to track, in real-time, when an incident occurred and when security agents responded. The group declared that incidents of invaders spending hours killing and injuring citizens in communities must end and that the country should build on women's indigenous information gathering methods and involve them in the community peace architecture, as intermediaries (Premium Times, 2021 ).

According to Quadri ( 2015 ), the more women asked for more presence in decision-making in the country through their various groups, the less their involvement in decision making. Hence, the efforts expended by Nigerian women on political agitations and appointment into management positions would be fruitless exercises in bureaucratic architecture and the democratic project of the country, if care is not taken to bring about the desired change. These fruitless agitations have not only negatively affected the development of the country but have also weakened the country's development. Savage ( 2021 ) opined that Women, Peace, and Security Programme was viewed by many as the most momentous global plan for increasing the role of women in conflict resolution. The risk to women and children and the importance of involving women in peace issues have been documented as a global concern. There was a growing understanding of violence against women, generally and particularly in armed conflicts including the issue of sexual violence. Women were often exempted from the peace process, thereby reproducing the fact that most of the actors in conflicts were men. There was a gap in the gender participation of women in issues relating to peace and security in Nigeria. Savage ( 2021 ) recommended that the Nigerian government should have legal structures and policies that would promote the presence of women in conflict resolutions.

Women and Decision-Making on Insecurity in Nigeria

Decision-making is the process of making choices through the identification of a decision, assembling relevant information, and carefully evaluating other possible options (with a particular reference to insecurity issues in this case). Women are more likely to partake enthusiastically in both private and public decision-making if they have better information and economic power which in turn will boost their self-esteem and self-assurance under consideration. Various women's group demonstrated their effectiveness, authority, and influence in many establishments. Women are often vibrant leaders of transformation in that they stimulate women and men to get involved in asserting their rights, affecting their communities positively as well as safeguarding their planet or space. Their involvement in decision-making is necessary for good governance. When women are involved in decision-making, they could be very fruitful and successful, including in the area of insecurity in Nigeria.

Women appeared to be less involved and less visible in decision-making in the area of security or insecurity in Nigeria. Nigeria has involved several women in decision-making positions like Senators, Members of the House of Representatives, Chief Justice of Nigeria, Vice Chancellors; Deans of Faculties in Universities; Directors of Institutes; Heads of Departments in many Nigerian universities; Nigerian Ambassadors; Ministers of Finance, Aviation, Agriculture and Water Resources, Foreign Affairs, Transport; Mines and Steel Development, Petroleum Resources; Senior Special Assistants; Director General, NAFDAC; Nigeria's Permanent Representative to the United Nations' World Tourism Organisation and Deputy Secretary-General of the United Nations. However, women had not been made to head core agencies and other bodies in charge of insecurity in the country like the military and the police as they should. The only exceptions were the appointment of women like Mrs. Olusola Obada as Nigeria's Minister of State for Defense from 2011 to 2012 and then the substantive Minister of Defense from 2012 to 2013 (superintending over the Nigeria military structures) and Fidelia Njeze who was the Minister of State for Defense in July 2007 (Idike et al., 2020 ). It is worthy to note that even these women were merely Ministers of State for Defense and when Mrs. Olusola Obada became the substantive Minister of Defense, she only supervised the military structures. In other words, men were the heads of Ministers of the core agencies in charge of security/insecurity in Nigeria. The positions controlled by women in these security agencies were less important than those occupied by men which made men as more superior to women. Simply put, women were less visible in the leadership of defense ministries than in the other ministries. This factor accounted for the momentous gender imbalance in the Nigerian democratic structure, and it related more to the non-institutionalized male gender bias that resulted in masculine or male-dominated politics and bureaucratic appointment in the public civil service and security apparatus (Quadri, 2015 ; Orji et al., 2018 ). Men were the current power controllers in Nigeria. Understanding gender equality involved losing some of the powers enjoyed by men to women (Idike et al., 2020 ).

There were no women appointed directly as the Minister of Defense and in other security-related institutions. Also, women in top positions in the military were never appointed as the Chief of Army Staff; Chief of Defense Staff; Chief of Naval Staff, and Air Marshal. Also, there have been no women Inspector General of Police or Controller General of Immigration or Commandant General of Nigeria Security and Civil Defense Corps, and Director General of the State Security Service (SSS) among others. Adams and Olajumoke ( 2016 ) noted that only 30% of women were in the military service as against 70% who were men. This is an indication that the involvement of women in decision-making on insecurity issues in Nigeria was negligible. According to Idike et al. ( 2020 ), national development continued to be stunted in Nigeria as gender-balanced representation remained compromised (including the headship of security agencies). According to Pereira ( 2009 ), Chinekezi ( 2014 ), Okemakinde ( 2014 ), and Frazier ( 2016 ), African and Nigerian women had a secondary role to play than their male counterparts. There were twice as many females below the poverty line as males and up to 19 times more men than women were in decision-making posts including leadership and decision making on combating insecurity in Nigeria.

The military and other security agents were charged with protecting the Federal Republic of Nigeria, encouraging Nigeria's global security concerns, and supporting peacekeeping efforts, especially in Africa. This was a result of the doctrine called Pax Nigeriana. The Nigerian military consisted of the army, navy, and air force. The military in the country had played important role in the country's history since independence. According to Olonisakin ( 2019 ), most nations of the world have attained peace as the main landmark for their people, stating that the pursuit of peace was often combined with the quest for security. He added that all the security operatives were devoted to ending terrorism and banditry in Nigeria. Being Africa's most populated nation, Nigeria had repositioned its military as a peacekeeping force on the continent since 1995. The Nigerian military, through ECOMOG instructions, had been deployed as peacekeepers to Liberia in 1997; Ivory Coast from 1997 to 1999, and Sierra Leone from 1997 to 1999. With the mandate of the African Union, Nigeria stationed her forces in Sudan's Darfur region in order to bring peace back there. The Nigerian army had also been deployed across West African countries to combat terrorism in nations, such as Senegal, Chad, and Cameroon, as well as dealing with the Mali War including getting Yahya Jammeh out of power in 2017 (O'Loughlin, 1998 ; Lancia, 2011 ). It is important to note that women did not hold any significant leadership posts in all of the peacekeeping efforts mentioned above. The leadership of all ECOMOG teams was mostly men.

The girl-child continued to be under-represented in governments, legislative bodies, and in many other crucial sectors affecting public opinion, such as mass media, the arts, religion, culture, and insecurity in Nigeria. Worldwide, there were only 16% of countries where more than 15% of ministerial positions were held by women; however, in 59 countries, there were no female ministers at all (UN Women, 2021 ). Although women had the right to vote in nearly every country globally, there were few females in government. In 1994, only 10% of the world's Parliamentary Deputies were females (FAO, 1995 ). As of 1 April 2019, the global average of women in assemblies was 24.3% and as of October 2019, the global involvement rate of females in the national-level parliament was 24.5% (Inter-Parliament Union, 2020 ). Females accounted for 8% of all national leaders and 2% of all presidential posts in 2013 (Jalaza, 2016 ). These global leadership representations depict a picture of gender disparity against women as it happens even in the sphere of insecurity.

Even at the IDPCs in Northern Nigeria where displaced people fled, women were not involved in the headship of decision-making and at the management level like men. Some of the men leaders in the camps were found to be sexually abusing the female IDPCs. Women leaders may not do this if they are made to head the camps. There were very few females in Nigeria's political arena both at the state and federal levels, that is headship of Nigerian establishments saddled with political responsibilities (and insecurity in the country) (Akudo, 2013 ).

The obstacles faced by women's participation in politics, including security, were negative attitudes toward women in leadership positions. Women continued to suffer from election violence, intimidation, or hate speeches, and this discouraged women's participation. In order to increase the number of women working in government agencies (including security structures), the NWTF utilized networking chances, funding, mentoring, and training for leadership and advocacy (Oluyemi, 2016 ; Kelly, 2019 ; Peace Direct, 2019 ). Aluko ( 2011 ) discovered that political leadership (and headship of security operatives) in Nigeria was stratified on the bases of gender distinction, thereby questioning the adoption of gender neutrality in the political and appointment process of the nation (including decision making) by the stakeholders in the area of security.

The gender disparity in the nation's politics and appointments, including the security sector, was rooted in cultural history, characteristic of patriarchal African societies (Izueke and Ezichi-Ituma, 2018 ). Gender inequality in the country was enhanced by different cultures and beliefs which subordinated women to men. In most parts of Nigeria, women were considered subordinates to their male counterparts, especially in the Northern States and in other areas (Babalola, 2014 ; Mp3bullet, 2021 ) including the gender gap against women in the headship of the army and other security agents who were in charge of security in Nigeria.

According to Kolawole ( 2020 ), evidence showed that peace-building and resolution processes had higher proportions of success and were more likely to last when women were significantly involved. An analysis of 40 peace processes in 25 countries over three decades revealed that an agreement would always be reached when women's groups were able to effectively affect a peace process. From just being the victims of the harm caused by war, women in the 25 countries referred to the above-assumed leadership roles and in the process were able to address the causes, and consequences of the lingering crises unlike what obtained in Nigeria where women did not play any leadership or significant role in conflict resolution and management. The involvement of Nigerian women in peace-building has been a very marginalized and unbalanced one since the rise of violent clashes in Nigeria. Nigerian women had taken peace-building initiatives only within the non-formal sphere at the grassroots or community level. This was because it happened to be the only medium available to them through avenues, such as non-governmental civil society groups, informal female-based groups, and very little or no involvement at the governmental level.

The study examined the level of insecurity in Nigeria. The study specifically addressed security challenges facing women in the country and their level of involvement in decision-making processes toward putting an end to the security challenges. Apart from the above, the study proffered solutions for ending the security challenges in the country. Through the statistics provided, the study was able to prove that there was a high level of insecurity in Nigeria. This situation of insecurity has led to the death of thousands of people through insurgency, kidnapping, banditry, and armed robbery in the country.

The statistics provided indicated the number of people killed and injured as well as the locations, dates, and perpetrators of the acts of insecurity. The causes of all these alarming massacres were many, such as religious conflicts between Christians and Muslims, revenge for the January 15, 1966 coup when many Northern leaders were killed by the Igbos, the Nigeria-Biafra war, internal conflicts, Ogoni crises on environmental degradation and pollutions by crude oil refineries in Balyesa State, Cross Rivers State, and Rivers State, the conflict with soldiers at Odi, various attacks by Boko Haram insurgents, and the struggle between farmers and the Fulani herdsmen over land. Apart from the above, there is the issue of kidnapping for ransom. In all the above, women and children were the worst affected by insecurity in Nigeria. Women bore a lot of burden during insecurity. However, women were less visible than men when talking of the headship of the army and other security agencies in charge of the administration of insecurity. All the number one officers in the army, police, and other security agencies had always been men.

The Way Forward

Women and girls in Nigeria have basic human rights to be enlightened on; they should be given equal standards and quality education in order to be well developed to enable them to occupy their places in the employment spheres including the officer cadres in the army, police, and other security agencies. They should also be able to function as leaders in IDPCs. Female education could have an important effect on the development of a nation, and this could lead to empowered, productive, and active citizens. Adequate education of the girl-child develops growth rates and reduces social disparities. Females with higher educational qualifications would function in formal wage employment than those with elementary education. Education gives women chances and choices for a lifelong acquisition of knowledge, values, attitudes, skills, technological abilities, competence, and talents to compete with men for opportunities and allocation of available resources. More women and girls should be adequately educated like men and boys.

Women should be appointed or promoted to the post of substantive Minister of Defense, Chief of Army Staff, Chief of Defense Staff, Chief of Naval Staff, Air Marshal, Inspector General of Police, Comptroller General of Immigration, Commandant General of Nigeria Security and Civil Defense Corps, Director General of the State Security Service (SSS), and heads of IDPC. In other words, women should be appointed, like men to top posts/ranks in the Nigerian security architecture and establishments in order to enhance their efficiency and effectiveness in their operations against cases of insecurity in the country.

The appointments of heads of the army, police, and other security agencies should be done with a gender-sensitive lens to enable women to display their potential and capacity in resolving issues of insecurity in Nigeria. Gender equality is an integral component of every aspect of the social, economic, daily, official, and private lives of individuals and society with reference to men and women. There is a need to mainstream gender equality into all appointments into decision-making positions in the army and other security agencies saddled with tackling security/insecurity issues in Nigeria. Gender Mainstreaming means ensuring that women and men have equal access to and control over resources, development benefits, appointments, recruitments, and decision-making at all stages of development processes, projects, programs, or policies. Gender equality is the ultimate goal of gender mainstreaming.

Government should safeguard women's involvement in peace and security resolution-making as well as build on women's native knowledge for the purpose of including them in community construction as peacekeepers, envoys, and negotiators.

Since insecurity was the major challenge in Nigeria, the government at the federal, state, and local levels should do all it could to protect the nation from internal and external aggressions. Emergency aid, conflict avoidance and resolution, and peace-building should be the main concerns of Nigeria at present.

Government should seek help and advice from countries that have tackled insecurity challenges and have overcome them to a reasonable extent. The Nigerian Military should be empowered more with the required arms to fight insurgency. Adequate ammunition, vehicles, and other required equipment should be acquired for all security agents to enable them to tackle the rebels headlong and put an end to insecurity in the country or reduce it to the barest minimum. Government should improve security surveillance in the Northern, Eastern, and Southern parts of the country to curb the danger of insecurity. A provision could be made for grazing land for cattle.

Government should bridge the gaps of security intellect that existed between the ordinary citizens and the various security agencies in Nigeria, provide information and communication technological (ICT) innovation that would be used to detect any form of security threats, and make available security gadgets that would be used to neutralize explosive devices. All these, if put in place, could end incidences of insecurity in the country.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

Conflict of Interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fsoc.2022.734190/full#supplementary-material

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Understanding gender issues in Nigeria: the imperative for sustainable development

Affiliations.

• 1 Department of Sociology, Covenant University, Ota, Nigeria.
• 2 Centre for Economic Policy and Development Research, Ota, Nigeria.
• 3 Department of Sociology, University of Ibadan, Ibadan, Nigeria.
• 4 Department of Population and Development Higher School of Economics, Moscow, Russia.
• 5 Department of Sociology, College of Business and Social Sciences, Landmark University, Nigeria.
• PMID: 34377858
• PMCID: PMC8327645
• DOI: 10.1016/j.heliyon.2021.e07622

Whenever the term "Gender" is mentioned, many readily attribute it to the womenfolk who, in many societies, are challenged and often put in a disadvantaged position concerning the men. As a result, many women empowerment programs are being championed to cushion the effects of this subjugation on women. This paper attempts to look into gender and understand what has been in existence concerning gender roles, especially for females, and how it contributes to development. It is also important to note that development is not something that happens in space or the product of eventualities but a concrete phenomenon that requires all to achieve. There is a specific role to play by both men and women to attain African development. Therefore, gender issues with all that relates to it can impinge on societal development. The secondary data collection was used by empirically engaging literature and British council report in tracing how Gender inequality began to be perceived. The study applied the theory of recognition by Axel Honneth and the functionalist approach in explaining the issues of gender and how it can engender development if adequately handled. It was discovered that if both genders are correctly appreciated with each playing their role, not discriminating or demeaning any position, the resultant effect will not only result in development; instead, sustainable development will be attained.

Keywords: Development; Gender; Gender inequality; Gender roles; Sustainable development.

© 2021 The Author(s).

Publication types

• Research article
• Open access
• Published: 04 March 2021

Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment

• Chioma Oduenyi   ORCID: orcid.org/0000-0002-5445-4513 1 ,
• Joya Banerjee 2 ,
• Oniyire Adetiloye 1 ,
• Barbara Rawlins 2 ,
• Ugo Okoli 1 ,
• Bright Orji 1 ,
• Emmanuel Ugwa 1 ,
• Gbenga Ishola 1 &
• Myra Betron 2  

BMC Health Services Research volume  21 , Article number:  198 ( 2021 ) Cite this article

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Poor reproductive, maternal, newborn, child, and adolescent health outcomes in Nigeria can be attributed to several factors, not limited to low health service coverage, a lack of quality care, and gender inequity. Providers’ gender-discriminatory attitudes, and men’s limited positive involvement correlate with poor utilization and quality of services. We conducted a study at the beginning of a large family planning (FP) and maternal, newborn, child, and adolescent health program in Kogi and Ebonyi States of Nigeria to assess whether or not gender plays a role in access to, use of, and delivery of health services.

We conducted a cross-sectional, observational, baseline quality of care assessment from April–July 2016 to inform a maternal and newborn health project in health facilities in Ebonyi and Kogi States. We observed 435 antenatal care consultations and 47 births, and interviewed 138 providers about their knowledge, training, experiences, working conditions, gender-sensitive and respectful care, and workplace gender dynamics. The United States Agency for International Development’s Gender Analysis Framework was used to analyze findings.

Sixty percent of providers disagreed that a woman could choose a family planning method without a male partner’s involvement, and 23.2% of providers disagreed that unmarried clients should use family planning. Ninety-eight percent believed men should participate in health services, yet only 10% encouraged women to bring their partners. Harmful practices were observed in 59.6% of deliveries and disrespectful or abusive practices were observed in 34.0%. No providers offered clients information, services, or referrals for gender-based violence. Sixty-seven percent reported observing or hearing of an incident of violence against clients, and 7.9% of providers experienced violence in the workplace themselves. Over 78% of providers received no training on gender, gender-based violence, or human rights in the past 3 years.

Addressing gender inequalities that limit women’s access, choice, agency, and autonomy in health services as a quality of care issue is critical to reducing poor health outcomes in Nigeria. Inherent gender discrimination in health service delivery reinforces the critical need for gender analysis, gender responsive approaches, values clarification, and capacity building for service providers.

Peer Review reports

Nigeria has one of the highest rates of maternal mortality in the world (576 deaths per 100,000 live births) [ 1 ] and accounts for 19% of the world’s total maternal deaths [ 2 ]. Reproductive, maternal, newborn, child, and adolescent health (RMNCAH) outcomes are poor in Nigeria due to low coverage of health services such as antenatal care (ANC), high unmet need for FP, low rates of facility-based childbirth, poor quality of services, and an array of inequities and inequalities [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ].

Research in recent years has increasingly demonstrated that gender-based attitudes and practices of health providers and gender dynamics in health facilities contribute to issues of access and quality of RMNCAH care. Gender norms frequently expose women to early or forced marriage, adolescent pregnancies, unintended pregnancies, and sexual or physical violence [ 10 ]. These biases and norms include women’s subordinate position within the home, lack of control over household decision-making (including health-seeking decisions), lack of money to pay for transport to distant facilities, and lack of mobility outside the home without male permission or a chaperone [ 5 , 11 , 60 , 13 ]. Where women lack autonomy and mobility outside the home, their access to safe, adequate, timely, and affordable health services, particularly emergency obstetric care, is undermined [ 14 , 15 ]. These norms also influence whether or not people seek care and the quality and effectiveness of the care as the Lancet series on maternal health identified gender inequality as a barrier to accessing high-quality care, noting that gender inequality influenced women’s decision-making for seeking health care [ 16 , 17 ]. Even when health services are available, gender bias and harmful norms can lead to sex-based inequities in accessing services [ 18 ].

A large FP program in six Nigerian cities (2009–2015) found that many Nigerian health providers discouraged the use of contraceptives among women who were newly married because they believed that women should have children immediately after marriage. Providers often believed that people with small families should have bigger ones or that women should obtain the consent of their husband to receive contraception [ 19 ]. In a 2018 study in South West Nigeria, providers encouraged young, sexually active, unmarried clients to abstain from sex instead of using a FP method, discouraged women from using contraceptives (due to the mistaken belief that contraceptives impair future fertility), and sometimes requested a husband’s permission before providing a woman with contraceptives [ 20 ].

Increased rates of skilled birth attendance and facility-based childbirth that meet basic quality standards are key to reducing maternal mortality and morbidity. Gender discrimination in health service delivery leads to poor quality care that can prevent women from visiting facilities even when health services are available [ 21 ]. Approaches to quality of care in low-resource settings have mainly focused on the clinical effectiveness of care. But recognition of clients’ preferences and experience of care as central elements for improving the quality of person-centered health services is increasing [ 22 , 23 ]. The 2016 WHO Quality of Care framework for improving maternal and newborn health care emphasizes experience of care, which includes respectful client-provider interaction as a core dimension of quality of care and a key determinant of women’s use of services [ 24 ].

Women are more likely to be poor than men in most societies, and this status is an important driver of providers’ mistreatment of women during care, which contributes to poor quality of care and potentially reduces women’s subsequent utilization of care [ 9 ]. Mistreatment and abuse of mothers and newborns includes failure to meet professional standards of care, poor rapport between women and providers, [ 10 ], physical abuse, non-consented clinical care, non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific patient attributes, abandonment or denial of care, and detention in facilities [ 25 ]. Verbal abuse, including shouting, insulting, or threatening a woman or her newborn as well as physical abuse, such as slapping a woman or her newborn, remain antiquated practices that violate the rights of patients and compromise the quality of care [ 26 , 27 ]. These harmful practices reinforce gender norms and are often normalized by both providers and clients [ 28 ]. Bohren et al. conducted a study on mistreatment in childbirth in Nigeria in 2017 and found that women reported experiencing or witnessing physical abuse, including slapping, physical restraint to a delivery bed, and detainment in the hospital, and verbal abuse, such as shouting and threatening women with physical abuse. Some women were forced to give birth on the floor, unattended by a provider [ 21 ].

Women in low- and middle-income countries frequently choose not to give birth in health facilities because prior experiences of mistreatment and health facilities’ poor reputations have eroded their trust in the health system [ 21 ]. A study in Enugu State in South East Nigeria found that utilization of services is largely determined by women’s perceptions of the quality of care that will be received, specifically provider behavior [ 29 ]. Other studies in Nigeria also found that the key reasons women said they did not use facility-based maternal and child health services were poor provider attitudes [ 5 ] and perceived provider biases based on age, marital status, parity, and socio-economic status; such attitudes and biases can result in restricted services and skewed provision of information [ 30 ].

On the other hand, growing evidence suggests that positive male engagement in RMNCAH can improve access to services, quality of care, and health outcomes. The United States Agency for International Development (USAID) qualifies positive male engagement as “the involvement of men and boys across life phases in family planning, sexual and reproductive health, maternal and child health, and HIV programs as a) clients/users; b) supportive partners; and c) agents of change to improve health and gender equality outcomes, actively address power dynamics, and transform harmful masculinities. Engaging men and boys also includes broader efforts to promote equality with respect to sexual relations, caregiving, fatherhood, division of labor, and ending GBV” [ 31 ]. Increased male participation in RMNCAH that promotes couples communication, equitable joint decision-making and gender equity can also lead to greater uptake of modern FP methods, ANC services, HIV testing and treatment, facility-based childbirth, breastfeeding, housework and childcare sharing, and child immunization [ 32 , 25 , 26 , 27 , 36 ]. The World Health Organization (WHO) recommends the presence of a labor and birth companion of choice, if desired by a woman, as a core element of care to improve labor outcomes and women’s satisfaction with care [ 34 , 37 ]. A 2013 Cochrane review found that supportive companionship increased the likelihood of vaginal births (reducing the need for cesarean sections, forceps, or vacuum delivery), reduced the need for pain medication, shortened labor, and improved newborn Apgar scores [ 38 ].

Finally, health providers also experience gender discrimination and violence that can impact the delivery of care. Violence toward health providers in their personal lives, from clients, or from others in the health workplace is not uncommon. WHO estimates that between 8 and 38% of health providers worldwide suffer physical violence at some point in their careers. Nurses are most at risk. A 2012 study on workplace violence against health providers in Abia State (adjacent to Ebonyi State) found that 88.1% of health providers had experienced workplace violence (25.1% experienced physical assault and 4.5% experienced sexual harassment) [ 39 ]. Violence not only impacts the psychological and physical well-being of health providers, but also affects job motivation and compromises the quality of care they deliver [ 40 ]. In a landscape analysis of disrespect and abuse in facility-based childbirth, Bowser and Hill noted that “the perspective of the women who provide that care, however, has remained virtually absent from the discourse” [ 25 ]. Filby et al. point to the violence and poor working conditions midwives encounter as a driver of moral distress, burnout, poor retention, and poor quality of care [ 41 ].

For efforts to improve RMNCAH outcomes in Nigeria to succeed, the impact of gender on access to care and quality of care must be understood and addressed. A gender perspective is necessary to understand health facility-level factors that deter women from seeking facility-based care [ 42 , 43 ].

Purpose of the study

Harmful gender norms can reduce women’s ability to obtain health care, influence how health providers treat women, and exclude men from reproductive health. For example, norms that dictate a woman must obtain permission to seek care for herself or children, that restrict women’s ability to make decisions about their reproductive health, or those that prevent men from participating in equitable joint-decision making around health care can lead to poor health outcomes. These norms can also subject health providers to violence and poor working conditions that, in turn, impact the quality of service delivery. Evidence shows that when clients experience poor treatment in health facilities, they are less likely to use contraceptives, deliver in a health facility, seek care for sick children, or use other health services. This perpetuates maternal and newborn death and disease.

Programs that focus on RMNCAH typically focus on women and girls. These programs may examine health conditions associated with women’s reproductive roles, but often fail to consider the unequal gender dynamics that characterize health service delivery and produce poor health outcomes for women and girls. They also often miss how women’s subordinate roles within households, communities, and societies contribute to negative health behaviors and outcomes. Additionally, programs may not consider how women’s health is impacted by the unequal division of labor, allocation of resources, decision-making, caregiving, or mobility outside the home.

This study was conducted at baseline to inform the focus and program design of an integrated maternal and child health project in Kogi and Ebonyi States supported by the USAID-funded Maternal and Child Survival Program (MCSP). MCSP in Nigeria’s goals included building the capacity of health care providers to address gender attitudes, dynamics and disparities in service delivery in the pursuit of more equitable maternal and newborn health outcomes. Among other aims, the study sought to assess whether or not gender plays a role in access to, use of, and delivery of health services— and if it does, how.

In this study, we define gender dynamics as relationships and interactions among girls, boys, women, and men. Gender-sensitivity, in this context, refers to providers’ knowledge, attitudes, practices, and beliefs about gender equity that take into account gender differences in access to health information, service delivery, and health outcomes. Providers’ knowledge of RMNCAH was assessed using structured interview guides with gender-specific questions [ 24 ]. Instances of unequal or disadvantageous treatment of clients on the basis of gender that were reported during interviews or observed during ANC consultations and L&D were considered gender discrimination.

Earlier studies recommended considering gender barriers while designing, implementing, monitoring and evaluating interventions to ensure program objectives are achieved and that efforts do not create unintended consequences, particularly for women and girls [ 44 , 45 ]. Hence, a gender analysis— a systematic methodology for examining how differences in power relations result in differential risks, exposures, vulnerabilities, and outcomes in health for men and women— is required [ 46 ].

The gender analysis within this quality of care assessment sought to answer the following research questions and were categorized into the following domains from USAID’s Gender Analysis Framework [ 44 , 46 ]:

Are gender-related factors associated with health providers’ attitudes toward clients’ access to ANC, labor and delivery (L&D), and FP services in Kogi and Ebonyi States? (Domain: Practices and participation)

Are health providers gender-sensitive in their attitudes and practices during ANC, L&D, and FP services? (Domains: Practices and participation, Beliefs and perceptions)

What gender dynamics exist among health providers in the workplace? (Domain: Institutions, laws, and policies)

Are there barriers to gender-sensitive maternal and newborn service delivery? (Domains: Practices and participation, Beliefs and perceptions, Access to assets)

Study setting and design

The baseline quality of care assessment was a cross-sectional, health facility-based study which examined service providers’ knowledge, skills, and gender-related beliefs, practices, and policies with respect to ANC services, labor and vaginal deliveries, and FP services.

Study instruments included the following: ANC Observation Checklist, L&D Observation Checklist, FP Consult Observation Checklist, and a Maternal and Newborn Health Service Provider Interview Guide and Knowledge Test for providers who offered ANC and L&D services. Clinical observations of client-provider interactions were conducted by trained, practicing clinicians who directly observed care in real-time while using structured, standardized observation checklists. The checklists were developed and used by USAID’s Maternal and Child Health Integrated program, based on WHO-recommended evidence-based practices for ANC and L&D care [ 47 ]. The structured provider interview and knowledge test was a verbally-administered, quantitative tool (vs. a self-administered survey) that primarily included close-ended questions but also a few open-ended questions on the following topics: provider background charateristics and work environment, knowledge of evidence-based maternal and newborn health interventions, experience with violent and disrespectful treatment, and gender-specific atttitudes and beliefs that can affect client care [ 24 ]. The ANC checklist and provider included questions from the Service Provision Assessment, which has been widely used in low-and middle-income countries [ 48 ].

Sampling methodology and sample characteristics

Samples were drawn from different units of the health facilities, including the maternity, antenatal, and FP units, with clustering of data by facility. A total of 40 health facilities targeted to receive quality improvement interventions in the first phase of MCSP implementation were purposively selected from a larger list of 120 health facilities in Kogi and Ebonyi States that were identified in consultation with the State Ministries of Health to receive support from MCSP. The study was powered based on the number ANC consultations to be directly observed. For observations of labor and delivery care, the plan was to observe all deliveries during the days of the study team’s visit because of the low caseload of deliveries in most of the facilities.

Based on an assumption of 220 working days per year, ANC data extracted from registers of the selected health facilities indicated a combined average of 197 and 170 ANC visits per day in facilities in Ebonyi and Kogi, respectively. The desired sample size of ANC consultations to be observed was based on cluster sampling calculations (assuming health workers and clients are clustered within facilities) with a median design effect of 1.5 to allow + 12% precision in quality of care indicator estimates. The assumed prevalence for the quality of care indicators of interest was set at 50% to generate the most conservative sample size, with approximately 200 ANC consultations planned to be observed in each state. Target sample sizes were distributed across facility types based on identified ANC caseloads—proportional to size. Since more services took place at the tertiary level, the protocol planned for the observation of 20 ANC consultations in the tertiary facility, 12 consultations in each of the general and mission hospitals, and 5 consultations in each of the primary health centers and private clinics.

Current national standards require that a minimum of four service providers work in the maternity unit of a facility to operate a shift-duty system. Therefore, based on an estimated minimum population of 160 eligible service providers (4 providers in each of the 40 health facilities), a 5% margin of error, and a 95% confidence interval, we planned to interview 136 ANC and labor and delivery providers.

Data collection procedures

Twenty-two obstetricians, pediatricians, medical officers, nurses, and midwives were selected as data collectors for all the study tools based on their active clinical practice and data collection experience. All data collectors received 2 weeks of training that included a briefing on the background and rationale of the study, an overview of the study instruments and informed consent process, and orientation on all data collection tools, including gender-related aspects of the observational and interview tools and technical instructions for using CommCare technology, the mobile software used for data collection. Data collectors were trained on gender terms and to review records for missing or inconsistent answers before submission. Data collectors practiced using the study instruments in the classroom with colleagues during role plays and clinical simulations using anatomic models and inter-rater reliability of the observers’ scores was tested. Field tests using the tools were conducted over 2 days in five health facilities in Kogi States, and feedback was used to revise the tools and reword questions as necessary.

Data collectors worked in teams whose staffing was based on the number of observations to be made and classifications of the health facilities. Data collection lasted 1–2 days in primary health centers and 2–4 days in larger secondary and tertiary health facilities. Repeat visits were made to complete the target number of ANC observations if needed; repeat visits were required more frequently in tertiary health facilities and general hospitals. Supervisors visited data collection teams to provide ongoing quality control.

Data were collected in Kogi and Ebonyi States from 1 April through 30 June 2016 and entered directly on android-enabled tablet PCs using custom-created data entry programs developed with the password-protected CommCare software package. Technical and information technology staff monitored data sent to the CommCare HQ online site and verified data completeness and accuracy.

Data analysis

Data were exported from CommCare to Excel before being converted to SPSS for cleaning and analysis. Data analyses performed included percent distributions, counts, means, medians and cross-tabulations. Responses to open-ended questions from the provider interview were collated and summarized by theme. Results for Kogi and Ebonyi States were analyzed separately due to significant sociocultural and normative differences in gender and health practices. For example, 74.2% of women in Ebonyi State have undergone female genital mutilation compared to 1.7% of women in Kogi State [ 1 ].

Descriptive gender analysis was used to answer the gender assessment questions of the quality of care findings. Gender analysis emphasizes the importance of examining not only supply-side issues in health service provision, but also demand-side issues and the interrelation of the two [ 42 ]. Gender analysis can reveal the complex interplay of gender inequality and other inequities that constitute barriers or facilitators for access to health services and provider-client interactions. It can also provide baseline information about providers’ knowledge, attitudes, and practices around gender during RMNCAH service delivery and uncovered gender-related barriers that hinder the provision of quality, respectful, and equally accessible health care.

A descriptive analysis of gender-specific quality of care findings was conducted using USAID’s Gender Analysis Framework (Fig.  1 ) [ 44 , 46 ] to examine gender-based constraints and opportunities in four domains: (1) Practices, roles, and participation; (2) Beliefs and perceptions; (3) Access to assets; and (4) Institutions, laws, and policies:

Gender analysis framework

Sample characteristics

Twenty-six facilities were hospitals (tertiary, secondary, mission or private) and 14 were lower level clinics/health centers. (Table  1 ).

Although the majority of the providers were female (73%), 40% of the supervisors were male. Most providers were between the ages of 30–59 as shown in Table 2 .

Overall, (Table 3 ) 435 ANC consultations (190 in Ebonyi State and 233 in Kogi State), 47 L&Ds (19 in Ebonyi and 28 in Kogi) were conducted. Additionally, 138 maternal and newborn health providers (71 in Ebonyi and 67 in Kogi) were interviewed about maternal and newborn health topics, as well as their knowledge, beliefs, and perceptions about gender and workplace gender dynamics. Providers included community health extension workers, midwives, nurses, nurse-midwives, general doctors, obstetricians, pediatricians, and other specialists who offered ANC and/or L&D services.

The results of the assessment are categorized according to the gender analysis framework domains that relate to quality of care most strongly: Beliefs and perceptions; Practices, roles, and participation; and Institutions, laws, and policies.

Beliefs and perceptions

This domain includes gendered norms, such as attitudes and beliefs about what it means to be a woman or a man in a specific context. Beliefs and perceptions affect a person’s behavior, participation, dress, and decision-making capacity [ 10 ].

Observation of ANC consultations and interviews with providers revealed that gender-inequitable attitudes toward service provision are prevalent where 98% of providers agreed that men should be involved in RMNCAH services, but only 10% asked women if they wanted their partner to participate in ANC. Providers had deep-rooted patriarchal beliefs and perceptions about gender, women’s autonomy, and gender-based violence (GBV) hence information on gender-based violence (GBV) or referrals to GBV services were not offered at all. Providers held contradictory beliefs that women were responsible for pregnancy, childbirth, and childcare, but that men should be the primary decision-makers controlling whether women seek care, including whether or not to use contraceptives as only about 3% of pregnant women were asked about who the decision maker will be for labour and delivery. The study also showed an acceptance by providers and clients of practices related to mistreatment of women and their newborns during facility-based care as about 51.6% providers engaged in at least one harmful practice during labour and delivery (Table  5 ).

Ninety-five percent of providers agreed or strongly agreed that every woman who visits the facility should be given the same quality of treatment irrespective of whether she has a companion. Still, 4.2% of providers disagreed, strongly disagreed or were neutral that women without accompanying partners should be treated the same way as any other patient.

In Ebonyi State, 67.6% of healthcare providers disagreed or strongly disagreed that a woman should be able to choose a FP method on her own, compared to 50.7% of providers in Kogi State. Providers also held moralistic beliefs about contraceptives and premarital sex. In both states combined, 23.2% of providers disagreed that unmarried clients should use FP.

Practices, roles, and participation

This domain includes roles and responsibilities that are traditionally expected of men and women, which are influenced by gender norms and beliefs [ 10 ]. The majority of gendered practices related to patient-provider interactions and how patients were treated by providers. Other issues concerned experiences of violence by both clients and health providers. Across both districts, the majority of health providers strongly agreed (73.2%) or agreed (26.8%) with the statement: “Both male and female clients deserve to receive services without violence.”

The majority of ANC providers observed greeted clients in a friendly and respectful manner (Table  4 ). However, few providers asked clients if they would like their husband/partner to participate in ANC consultation.

Respectful maternity care findings for women in labor were mixed. During the initial client assessments for women in labor, the majority of clients (90%) were respectfully greeted by providers. However, only 45% of providers encouraged women to have a support person present during labor and birth, and only 50% of providers asked women (and the support person, if present) if they had any questions. Notably, no providers in either state told the woman or her companion what was going to be done, listened to the woman or provided support and reassurance.

During L&D, providers made an effort to provide respectful care. More than half of providers (57.1% in Ebonyi State and 76.9% in Kogi State) explained the procedures being performed to women. However, a gap in quality of services related to vaginal examinations was identified between the two states. In Ebonyi State, 28.6% of clients were informed before a vaginal examination was conducted compared with 92.3% of clients in Kogi State. Similarly, only 14.3% of clients in Ebonyi State were informed of the examination findings compared with 92.3% of clients in Kogi State.

At least one potentially harmful practice, such as applying fundal pressure to hasten delivery of baby or placenta, was performed during delivery in 59.6% of encounters and at least one disrespectful or abusive practice was observed in 34.0% of encounters across Ebonyi State and Kogi States (Table 5 ). Episiotomies were performed in at least one-quarter of the observations across the two states.

Institutions, laws, and policies

This domain includes the ways in which women and men are dissimilarly affected by institutional structures, policies, and rules both within the health system and beyond and includes considerations of formal and informal rights [ 10 ]. Violence directed toward health providers is included within this domain as it occurs at the institutional level, must be addressed at the institutional level, and can affect the care patients receive.

Seventy-eight percent of providers had received no training on gender, gender-based violence or human rights in the last 3 years. Fewer than half of providers in Ebonyi (40.8%) and Kogi (31.3%) reported that their facilities were equipped to allow for the presence of a birth companion through ensuring visual privacy in the delivery ward. Most facilities were open wards where multiple women delivered without a wall, curtain or other visual barrier. As a result, men who accompanied their partners for L&D were often not allowed (according to the facility’s policy) inside the labor or postnatal wards to act as supportive companions. The majority of providers did not allow women to choose their delivery position; supine, dorsal, or lithotomy positions were permitted, but women were unable to deliver in a non-horizontal position.

While the majority of providers interviewed believed that they were treated respectfully in the facility, 8% of providers across the two states reported that they or a colleague had experienced at least one form of violence by a colleague or supervisor (Fig.  2 ). Violence in the workplace was more frequently reported among health providers in Ebonyi state (9.7%) than Kogi state (7.9%). No experiences of sexual violence were reported in Kogi State, but 1.4% of the female health providers in Ebonyi State reported being physically forced to have sexual intercourse or perform other sexual acts while on the job. Providers were not asked about whether the violence was perpetrated by co-workers, supervisors or clients. Physical violence was reported to occur more frequently in the workplace in Ebonyi State (7.9%) than in Kogi State (1.4%).

Provider-reported incidence of violence against themselves or other providers in the workplace

Sixty-seven percent of providers also reported high rates of experiencing, observing or hearing of at least one incident of violence against clients (Fig.  3 ).

Provider-reported Incidence of violence against clients in the health facility by providers

Gender, age, and marital status should not affect the right to receive high-quality, gender-sensitive, and respectful services when seeking ANC and L&D care or other health services, such as family planning. Yet gender norms embedded in sociocultural practices persist, and drive providers’ poor attitudes, perpetuate violence, limit the utilization of facility-based services, and contribute to poor RMNCAH outcomes [ 5 , 6 ]. It is worth noting that age and sex clearly did not show any remarkable difference throughout the study as beliefs and practices seem to cut across age and sex of female providers and the male providers and between older and younger providers as 73.9% of providers interviewed were women while over 70% were aged 40-59 years. Apparently the belief systems and practices found in the study indicates social acceptance and cuts across the two genders (male and female). The current findings have implications for designing interventions to help improve the provision of gender-sensitive and respective care: program planners must be intentional about addressing and measuring inequalities, as well as improving quality, respectful care.

Virtually all healthcare providers surveyed in both states (98.5%) agreed that men play a role in maternal, newborn, and child health.. This is consistent with previous findings from hospitals in Nigeria where midwives acknowledged the benefits of having a partner present, for example, contributing to pain relief during childbirth [ 49 ]. Previous studies have found that engaging men in reproductive, maternal, and newborn health can increase care seeking, improve home care practices, and support more equitable communication and decision-making among couples related to maternal and newborn health [ 1 , 36 ]. Despite this recognition, facilities did not have adequate privacy in the L&D and postpartum wards to enable men to attend L&D and did not allow or encourage men to participate. At the same time, the finding could imply that many providers believe the man should be the decision-maker about a woman’s reproductive health, given that providers’ subsequent responses prioritized men’s decision-making authority over women’s reproductive autonomy.

However, as a reflection of gender norms that prioritize men’s power in decision-making, most providers did not think women should have autonomy in FP decision-making—67.6% of providers interviewed in Ebonyi State and 50.7% in Kogi State believed that a woman should not choose a FP method on her own. Even though multiple studies have shown FP to be generally accepted as women’s responsibility [ 50 ], in Kogi and Ebonyi States, providers believed the decision of whether or not to use FP should be made by the man or by the couple together, and the woman should be responsible for implementing FP decisions. A previous study in Nigeria found that men often think that women should take responsibility for using contraception, but that men should control the decision-making [ 51 ]. These perspectives may be at odds with current programs in Nigeria that direct FP awareness raising toward women alone, excluding men, given that Nigerian couples often do not discuss FP [ 52 ] and that men typically do not participate in FP consultations.

Providers also held discriminatory beliefs about who should be allowed to use FP. Beliefs were based on culture, gender, and religion rather than medical need or client preference. According to the Demographic and Health Survey, “Women and men in Nigeria tend to initiate sexual activity before marriage.” Approximately one-third of women in Ebonyi and in Kogi had sex before the age of 18, but the median age of marriage for women in Nigeria was 18.1 [ 1 ]. Our study found that 23.2% of providers did not think unmarried clients should use FP services. A study in Ibadan, Oyo State, Nigeria, found that 57.5% of providers believed that unmarried adolescents should be told to abstain from sex rather than be provided with contraceptives, which they believed would promote sexual promiscuity. Providers also believed that contraceptives should not be provided to adolescents, whether married or unmarried [ 53 ]. Another program in Nigeria found that providers turned away unmarried clients, newly married couples, or couples with only one baby from FP services based on personal beliefs that unmarried clients should not be having sex and that newly married couples should begin childbearing right away to produce large families [ 19 ].

As in many health settings globally, we found that the majority of health providers were female, but the majority of supervisors were male [ 10 , 41 ]. This relative exclusion of women from equitable leadership positions could be due to a number of factors, including discriminatory attitudes about women’s ability to be managers, a lack of gender-sensitive workplace policies such as breastfeeding rooms and parental leave, and sexual harassment and violence. These factors have been shown to lead to burnout, attrition, mistreatment of patients, and the delivery of poor quality health services [ 10 ].

Birth preparedness counseling observed during ANC consultations revealed low levels of interaction and engagement between providers and clients. Women were inadequately informed about the status of their pregnancy and their options for childbirth, which may reflect providers’ bias about women’s agency and dignity.

Over one-third of respondents reported having experienced, observed, or heard of at least one incident of violence or mistreatment against clients. This included being yelled at, threatened, or ignored by facility staff and, in a minority of cases, being punched, kicked, dragged, or beaten.

Mistreatment of women in labor is common in many RMNCAH service delivery settings [ 6 ]. Our study observed no occurrence of slapping, hitting, or pinching clients during or after labor in either state. However, potentially harmful practices were observed. For example, routine episiotomies that are not required (and put women at risk of harm, infection, and sepsis) signify acts of mistreatment [ 54 ]. Our findings are consistent with an earlier study that found women’s perception of quality of care was lowest related to respect for clients [ 55 ].

Enhancing privacy during care was a gender-based constraint to accessing high-quality RMNCAH care. Our study found that only 36% of facilities were equipped to accommodate male birth companions due to limited privacy. Despite the recognition that engaging men in maternal and newborn health is beneficial [ 1 , 36 ], even if men wanted to accompany their wives, facilities were unequipped to allow men to do so while maintaining the privacy of other clients.

Study strengths and limitations

This was a small-scale cross-sectional study that included direct observation of antenatal and labor and delivery care, the gold standard for understanding quality of care; and interviews with health care providers to inform programmatic activities that strengthen the quality of RMNCAH service delivery. Observations were limited to ANC consultations and and births that occurred on the days data collectors were present. The final number of L&D observations was small due to low caseloads therefore the margins of error are wide. However, the study was not designed to be representative of the entire country but to provide baseline data within the two states to inform local project design. Another limitation is that it was unfeasible in this study to track specific providers’ knowledge, attitude and practives (KAPs). Also the sex and age of providers were not specifically compared with their beliefs and practices. Given that health service providers across Nigeria operate under similar conditions and that the gender norms present in our study exist throughout Nigeria, we believe that the findings of this gender analysis can effectively inform gender integration for maternal and newborn health programming across the country.

Providers may have delivered care differently because they were under observation (Hawthorne effect), resulting in underreporting of gender discrimination or mistreatment in care. Social desirability bias may have impacted providers’ interview responses.

Another limitation of the study stems from the sensitivity towards terms such as gender , gender-based violence, disrespect and abuse , or mistreatment among providers in Nigeria. These terms were included in the survey instruments and potentially affected responses from providers because these terms may have elicited negative reactions, particularly for questions regarding workplace gender dynamics. Widespread conflation of the term “gender” with women’s issues—which are often dismissed as a western imposition, a modern fad, an attack on men’s rights, an attack on tradition/culture/religion, or an accusation that all men are bad—may have influenced respondents interpretations of the term. Some respondents may have not understood what was meant by gender within the study. Additionally, some types of violence may not have been considered violent by respondents due to the high acceptance of violence against women and the culture of silence surrounding gender-based violence in Nigerian society. Further validation of the study tools would have helped to limit misinterpretation.

Recommendations

Gender-discriminatory beliefs and practices identified in our study hold far-reaching implications for the ability of women to make self-directed decisions about RMNCAH. Gender-discrimination negatively impacts the ability of providers to deliver gender-sensitive care that respects women’s human rights, dignity, and bodily autonomy [ 19 ]. For RMNCAH programming in Nigeria to be successful, programs must meaningfully engage men, women, and community leaders in awareness raising, in ways that respect women’s reproductive autonomy, agency and rights. And efforts must go beyond just the benefits of healthy timing and spacing of pregnancies and limiting family size. Capacity building of providers, as well as health facility’s and national policies, should reinforce that health service delivery should not be influenced by morals, gender biases, or religion, but should focus on medical needs, client preferences, and evidence-based approaches to care.

Our findings indicate an opportunity to improve reproductive health outcomes and leverage couples counseling to mitigate power imbalances between men and women around fertility and encourage women to participate in joint decision-making. In order to transform perceptions of RMNCAH services from being solely a woman’s issue to a joint endeavor between couples [ 23 ], previous studies [ 16 , 56 ] recommended the creation of a supportive and male-friendly environment at health facilities that encourages men to be involved in maternal health services [ 22 ]. Further interventions are therefore needed at the institutional level to ensure that men are able to accompany their partners to L&D, including creating private L&D and postpartum spaces within health facilities, sensitization, training and guidance for health providers on how to engage men along the RMNCH continuum.

Such capacity building, guided by a 2018 gender capacity building framework for providers [ 57 ], can improve providers’ ability to counsel men and couples and advocate for facility preparedness to engage men in pregnancy and childbirth (when women desire men’s presence). Such efforts, however, must ensure that attempts to engage men do not infringe upon women’s reproductive autonomy by encouraging men to take control of reproductive health decision-making. Instead, they should increase and uphold women’s agency, self-efficacy, and decision-making power.

Health providers were identified as having a key role in changing the negative effects of harmful gender norms and stereotypes by empowering both women and men to make informed choices about their health. A study on improving reproductive health outcomes, Stover et al. highlighted the importance of creating opportunities for providers to clarify personal values and offer services in a nonjudgmental way to meet clients’ reproductive health needs [ 58 ].

There are not many RMNCAH interventions which address gender as a determinant of mistreatment during maternal and newborn health care [ 10 ]. Interventions include provider trainings to clarify values and transform attitudes in order to facilitate understanding of gender-discriminatory behaviors and attitudes, which influence mistreatment during labor and childbirth (for example, the WHO Health Workers for Change quality of care curriculum [ 59 ] and the Jhpiego Gender Transformation for Health Toolkit) [ 60 ]. These can be part of wider efforts to engage policymakers to focus on mistreatment during labor and childbirth and to support accountability by strengthening community and health facility linkages, putting in place systems to gather patient complaints and feedback and developing patient charters at the facility level [ 10 ]. Interventions that support a positive work environment for health providers are also needed. For example, the Heshima Project in Kenya worked at the community, facility and policy levels to examine the extent and causes of mistreatment in care in Kenya, and designed and implemented interventions to promote respectful care [ 61 ]. MCSP provided recommendations to the Nigerian MOH including a scale up of the Health Workers for Change Curriculum; capacity building and ongoing mentorship on gender-sensitive service delivery, male engagement and couples’ counseling; and first-line support to survivors of GBV. MCSP also recommended a scale up of efforts to improve infrastructure for privacy in L&D and post-natal wards in health facilities.

Our study identified several RMNCAH quality of care issues affected by gender inequalities and harmful norms in Kogi and Ebonyi States. We found that some providers upheld harmful, traditional gender norms that did not respect women’s right to make decisions about the use of contraceptives or health services. ANC providers did not offer services to survivors of sexual assault or intimate partner violence or encourage men to participate in health care for themselves, their partners, or their families. Some health providers who were observed mistreating clients and their newborns reported they were subject to disrespect and abuse themselves, including experiencing workplace physical and sexual violence. These findings point to the need to train providers and address attitudes and conditions within the health system that perpetuate gender discrimination and discourage women and men from seeking and using potentially life-saving care. Also, these findings can inform the development of gender-transformative interventions and measurement approaches to address and assess the impact of harmful gender norms and practices, as well as power imbalances between men and women, on service delivery. Integrating gender into the design of interventions and capacity building efforts is key to improving quality of services. Gender analysis remains a critical step in identifying gender-based constraints and opportunities. Empowering women, involving men, transforming service providers’ negative attitudes, and encouraging respectful care are critical approaches to promote better utilization and quality of maternal health services and, ultimately, to improve maternal and newborn health outcomes [ 32 , 62 , 63 ]. By identifying and addressing the influences and unintended consequences of gender discrimination in health service delivery, providers, facility managers, and stakeholders in health systems can improve countries’ progress toward universal health coverage and the attainment of national and global goals such as the Sustainable Development Goals.

Availability of data and materials

The de-identified datasets generated and analysed during the current study are available in USAID’s public data development library at this link: https://data.usaid.gov/Maternal-and-Child-Health/Maternal-Child-Survival-Program-Baseline-Quality-o/3zqw-f3e4

Abbreviations

• Antenatal care

Demographic and Health Survey

• Family planning

Gender-Based Violence

Human immunodeficiency virus

Institutional Review Board

Labor and Delivery

Maternal and Child Survival Program

Reproductive, maternal, newborn, child and adolescent health

United States Agency for International Development

World Health Organization

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Acknowledgements

The authors are grateful to the providers and clients who generously provided their time to participate in this study. We would like to express deep appreciation for the support and thoughtful contributions of our principal investigator in Nigeria, Dr. Emmanuel Otolorin; study team members, Mark Kabue and Hannah Tappis; reviewer Niyati Shah from USAID; reviewer Rosemary Morgan from the Johns Hopkins Bloomberg School of Public Health; and reviewers Gilliane McShane, Bianca Devoto, Alishea Galvin, Geoff Prall, Kathleen Hill, Anne Pfitzer, Gabriel Alobo, and Judith Fullerton from Jhpiego.

This study was made possible by the generous support of the USAID under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government.

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Contributions

All authors contributed to the writing of the manuscript, edited, and approved the final manuscript. BR was the principal investigator of the study. BR, BO, GB, OA, and EU designed the study tools. MB, JB, CO, and BR integrated gender into the study tools. BR, BO and GI led implementation of the baseline assessment. CO and JB led analysis of the gender findings and data interpretation, writing of the manuscript, review of the literature, extraction of relevant data from articles, and editing of the manuscript. GI led statistical analysis of the study findings. MB, OA, UO contributed to reviewing, data analysis, writing, and editing the manuscript. JB led management of the manuscript submission.

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Correspondence to Chioma Oduenyi .

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The study team received ethical approval to conduct the quality of care baseline study from the National Health Research Ethics Committee in Nigeria and the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB Study # 006632). Both ethics committees approved the procedure for oral/verbal consent for this study because study participants were also receiving health care at the facility and have limited time to spare. Oral/ Verbal informed consent was obtained from both the health providers observed and/or interviewed and clients observed as described in the consent script embedded in each tool and participants consent were recorded on the tool before commencing the observation and/or interviews. However, in situations where obtaining consent from a client was impractical, observation was not done.

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Oduenyi, C., Banerjee, J., Adetiloye, O. et al. Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment. BMC Health Serv Res 21 , 198 (2021). https://doi.org/10.1186/s12913-021-06204-x

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Published : 04 March 2021

DOI : https://doi.org/10.1186/s12913-021-06204-x

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RAPID GENDER ANALYSIS: NORTH EAST NIGERIA

The ongoing humanitarian crisis in North East Nigeria, driven by the Boko Haram insurgency and the counter-insurgency operations by government and security forces, has left 7.9 million people in need of humanitarian assistance. Of these, more than 1.8 million are internally displaced. Borno, Adamawa and Yobe (BAY) States host the highest proportion of internally displaced persons, 54 per cent of them female. The current situation in the most conflict-affected states (the BAY states) presents a major challenge to efforts to mitigate the impact and spread of coronavirus disease 2019 (COVID-19) in Nigeria. This is due to pre-existing vulnerabilities as well as overcrowded settlements inside and outside internally displaced person (IDP) camps, which make social distancing almost impossible. UN Women, CARE International and Oxfam conducted a joint Rapid Gender Analysis in Borno, Adamawa and Yobe States to understand the gender-related and comparative impact of COVID-19 on women, men, boys and girls. The purpose of this Rapid Gender Analysis is to inform the design, programming, implementation and monitoring of humanitarian response towards COVID-19, particularly for the North East region in Nigeria. 

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Nigeria: Breaking Gender Barriers Through Education

Nigerian gender advocate roots for empowerment of women and girls

Roseline Adewuyi is a fervent advocate for gender equality in Nigeria, driven by a passion for dismantling entrenched gender stereotypes. She spoke to Africa Renewal's Kingsley Ighobor on the need to empower girls through education. This is in line with the African Union's theme for 2024: Educating and skilling Africa for the 21st Century.

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"For example, we have laws [in Nigeria] that provide for women's rights to land, but many communities still prevent them from owning a piece of land. We also have situations in which widows are not allowed to inherit the properties of their husbands.

She says: "So, we have a lot more work to do. We need effective community engagement in raising awareness among women about their rights.

"Importantly, we need to provide women with access to education to equip them with the knowledge and skills to assert their rights effectively."

In her ongoing advocacy work, she acknowledges facing cyberbullying, which she attributes to resistance from elements of a patriarchal society reluctant to embrace progress.

Roseline's final message to young African women and girls is for them to drive positive change, stand up for their rights, and challenge gender norms.

Read the original article on Africa Renewal .

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The STEM Gender Gap: A Literature Review

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Science, technology, engineering, and mathematics (STEM) is vital for any advancing society. While diversity in STEM has improved significantly over the years, there is still evidence that gender inequality persists. The lack of diversity regarding gender is often referred to as the STEM gender gap.  To delve deeper into this topic, the information presented in this literature review discusses the issues, causes, consequences, and solutions of the STEM gender gap. 

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