Climate change – Centre for Family Health Initiative

Maternal Health – Access to Care

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Nigeria’s maternal health landscape continues to reveal stark inequalities that jeopardize the lives of women and newborns, particularly in underserved states like Adamawa and Zamfara. Despite global and national efforts to improve maternal survival, access to essential care remains limited for millions of women across the country. Research shows that utilisation of maternal healthcare services including antenatal care, skilled delivery, and postnatal care is persistently low, with only about 52% of women attending at least four antenatal visits, 38% delivering in health facilities, and about 37% receiving postnatal care. These gaps contribute directly to preventable complications and deaths during pregnancy and childbirth. ¹

According to the 2024 Nigeria Demographic and Health Survey (NDHS), while antenatal care coverage has improved to 63%, only 46% of births are attended by skilled health personnel, leaving more than half of Nigerian mothers vulnerable during their most critical hour.² The stakes are staggering; a woman in Nigeria faces a 1 in 19 lifetime risk of dying during pregnancy or childbirth, compared to 1 in 4,900 in high-income countries.³ Despite these daunting statistics, recent government reports from the 2025 Joint Annual Review indicate a 17% reduction in maternal deaths across high-burden areas, driven largely by initiatives like the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII), which facilitated over 4,000 free Cesarean sections and revitalized 435 health facilities within one year.⁴

At the heart of this changing landscape is the work of the Centre for Family Health Initiative (CFHI) through the BIRTH Project (Building Innovative Responses to Transform Healthcare), currently being implemented in Adamawa State and Zamfara State. In these regions, where geographical, financial, and systemic barriers often stand between a mother and survival, CFHI’s interventions are providing practical and life-saving solutions to improve access to skilled maternal care.

In Adamawa State, CFHI strengthened the Rumde Primary Health Care Centre in Yola North by installing a solar-powered birth suitcase, ensuring uninterrupted delivery services even in the absence of stable electricity. The intervention has become the primary source of light during childbirth in the facility, enabling safe deliveries at all hours. Beyond the health facility, the project promotes maternal wellbeing through community-led nutrition demonstrations aimed at preventing maternal anemia, a condition responsible for a significant proportion of pregnancy-related complications worldwide³.

In Zamfara State, where facility-based delivery rates have historically been low, similar solar-powered birth kits were installed at facilities such as Shagari Primary Health Centre, improving nighttime emergency response and increasing community confidence in the health system. However, the BIRTH Project goes beyond the provision of equipment. It directly addresses the five delays identified under the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII).

The consequences of poor access are not only clinical but social and economic. Women who cannot reach care in time often resort to unskilled birth attendants or home deliveries, increasing the likelihood of complications and long-term disability. National analyses show that financial constraints, distance to facilities, and perceived poor quality of care are major determinants of home births, even among women who attend antenatal care. ⁶ Beyond these structural issues, cultural norms and limited decision-making autonomy further restrict women’s ability to seek timely and appropriate maternal healthcare.

To transform maternal health outcomes in Nigeria with Adamawa and Zamfara as case studies sustained investment is required in strengthening primary healthcare systems, expanding referral networks, improving emergency transport, and increasing the availability of skilled health workers trained in emergency obstetric and newborn care. Governments, donors, and civil society must work together to remove financial barriers, improve transportation systems, and empower women socially and economically so that no woman is forced to choose between distance and survival.

CFHI’s ongoing MNCH interventions demonstrate that progress is possible when communities are engaged, health systems are supported, and maternal care is prioritized. The task ahead is to scale these efforts with urgency, political commitment, and adequate funding to ensure that every pregnancy is safe, and every mother survives childbirth.

Monday Health Burst is an initiative of CFHI to address issues of basic health concern. Join us every Monday on all our social media platforms for more episodes.

References

National Library of Medicine (PMC). Determinants of maternal healthcare service utilization in Nigeria.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
National Population Commission (NPC) Nigeria and ICF. Nigeria Demographic and Health Survey 2024 (Key Indicators Report).
https://dhsprogram.com
World Health Organization (WHO). Trends in Maternal Mortality 2000–2023.
https://www.who.int/publications
Federal Ministry of Health Nigeria. 2025 Joint Annual Review Report & MAMII Initiative Update.
https://health.gov.ng
National Library of Medicine (PubMed). Barriers to facility-based delivery after antenatal care attendance in Nigeria.
https://pubmed.ncbi.nlm.nih.gov

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Economic Exclusion as Gender-Based Violence

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Gender-based violence (GBV) is most often associated with physical or sexual abuse. However, economic exclusion – the systematic denial of women’s access to jobs, income, assets, and economic decision-making is itself a form of violence that harms individuals, families, and societies. When women are excluded from economic opportunities, the impact goes far beyond loss of income; it restricts freedom, autonomy, safety, and long-term development ^(1).

At its core, GBV includes economic abuse, where financial control is used as a tool of power and coercion. Economic violence may involve denying women access to money, preventing them from working, confiscating earnings, or restricting access to education and financial resources, forcing dependency and disempowerment ^(1). In many contexts, economic abuse is one of the most widespread yet least recognized forms of gender-based violence.

Economic exclusion is sustained by discriminatory laws, weak institutional protections, and unequal social norms. Globally, over 2.7 billion women live in countries where laws restrict the types of jobs they can do, and at least 43 economies still lack legislation addressing workplace sexual harassment, creating unsafe and unequal labor environments ^(2).

Intimate partner violence which frequently includes economic abuse affects approximately one in three women worldwide, limiting their ability to earn, save, and participate fully in public and economic life ^(3). In South Africa, studies indicate that one in eight adult women has experienced economic abuse, including being deliberately deprived of money or access to financial resources by a partner ^(4).

The consequences extend beyond individuals to national economies. Gender-based violence, including its economic dimensions, has measurable effects on productivity and growth. Evidence suggests that GBV can cost countries between 1–2% of Gross Domestic Product (GDP) due to absenteeism, reduced productivity, healthcare costs, and forced withdrawal from the workforce ^(5).

In Nigeria, the economic cost of gender-based violence is estimated at approximately USD 3 billion annually, equivalent to about 1% of the nation’s GDP, underscoring the scale of economic loss linked to women’s exclusion and abuse ^(6).

Economic exclusion intersects with social norms that treat women as inferior, dependent, or secondary earners. When women lack control over income, are denied access to employment, or are discouraged from education and financial decision-making, the result is structural violence a normalized and persistent denial of rights and well-being.

This exclusion is not accidental; it is deeply rooted in patriarchal systems and discriminatory practices that limit women’s autonomy and participation. The World Bank has emphasized that violence against women undermines economic growth and damages communities and future generations by restricting women’s productive potential ^(7).

Experts have consistently highlighted both the human and economic costs of this form of violence. According to the World Bank:

“Violence against women and girls is a global epidemic that endangers lives and carries wide-ranging consequences for individuals, families, and communities.” ⁽⁷⁾

Research further shows that economic abuse and exclusion lead to long-term psychological harm, loss of independence, and restricted life opportunities for women and girls. Conversely, policies that promote women’s economic empowerment are associated with reduced exposure to GBV and increased participation in education, employment, and leadership ^(8).

Ending economic exclusion as a form of gender-based violence requires deliberate and sustained action, including:

Strong legal protections guaranteeing equal work rights, pay equity, and safeguards against economic abuse.
Transformation of harmful social norms that portray women as dependents rather than economic actors.
Targeted economic empowerment initiatives that expand women’s access to education, finance, and entrepreneurship.
Inclusive workplace policies that ensure safety, fair remuneration, and career advancement for women

Economic exclusion is not merely an economic challenge it is a human rights violation. Recognizing it as a form of gender-based violence strengthens advocacy, accountability, and policy responses, and is essential to building societies where women can live, work, and thrive free from coercion and inequality.

References

Women’s World Banking. What is economic violence against women and why does it matter? Available from:
https://www.womensworldbanking.org/insights/what-is-economic-violence-against-women-and-why-does-it-matter/
UN Women. Facts and figures: Women’s economic empowerment. Available from:
https://knowledge.unwomen.org/en/articles/facts-and-figures/facts-and-figures-economic-empowerment
Asia-Pacific Economic Cooperation (APEC). Violence against women: An overlooked economic barrier. Available from:
https://www.apec.org/press/blogs/2025/violence-against-women–an-overlooked-economic-barrier
Independent Online (IOL). Economic abuse: The most common yet overlooked form of GBV in South Africa. Available from:
https://iol.co.za/mercury/2025-07-02-economic-abuse-the-most-common-yet-overlooked-form-of-gender-based-violence-in-south-africa/
International Monetary Fund. How domestic violence is a threat to economic development. Available from:
https://www.imf.org/en/blogs/articles/2021/11/24/how-domestic-violence-is-a-threat-to-economic-development
The Whistler Newspaper. Nigeria loses estimated $3bn annually to gender-based violence. Available from:
https://thewhistler.ng/nigeria-loses-estimated-3-0bn-annually-to-gender-based-violence/
World Bank. More than 1 billion women lack legal protection against domestic and sexual violence. Available from:
https://www.worldbank.org/en/news/press-release/2018/02/01/more-than-1-billion-women-lack-legal-protection-against-domestic-sexual-violence-finds-world-bank-study
MDPI. The quest for female economic empowerment in Sub-Saharan Africa and implications for GBV. Available from:
https://www.mdpi.com/1911-8074/17/2/51

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UHC Day 2025: Unaffordable health costs? We’re sick of it!

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Universal Health Coverage (UHC) Day is a global reminder that access to quality health care is a fundamental right, not a privilege reserved for the wealthy. This year’s theme, “Unaffordable health costs? We’re sick of it!”, speaks directly to one of the biggest barriers facing millions of Nigerians: skyrocketing healthcare costs and the widening gap between health needs and the ability to pay.

While achieving UHC requires multisectoral commitment, one of the most critical systems needed to bridge this gap is health insurance, an essential mechanism designed to protect individuals from financial hardship, ensure continuity of care, and promote equitable access to essential services. Yet, despite the existence of the National Health Insurance Authority (NHIA) and state-level schemes, enrolment remains abysmally low. Out-of-pocket payments still account for over 76% of total health spending in Nigeria, pushing millions deeper into poverty every year.

Health insurance providers cannot succeed alone; they face chronic underfunding, limited subsidies, weak enforcement, and low public awareness. Sustainable progress requires stronger government leadership, increased premium subsidies for the poor, upgraded health facilities, and digital systems that make enrolment seamless.

Yet progress is possible, and CFHI is proving it every day.

Through relentless community mobilization and strategic partnerships with philanthropists like Satoshi Koiso and development partners such as the Institute of Human Virology Nigeria (IHVN), CFHI has successfully enrolled 224 vulnerable individuals into NHIA-supported health coverage this year alone.

These are not just numbers.

They are mothers who no longer skip medication.

They are children who can see a doctor without their parents selling assets.

They are families now protected from choosing between medicine and food.

Health insurance must be affordable, accessible, and functional for every Nigerian. It is not just a policy tool; it is a lifeline that protects households from falling into poverty and guarantees timely care, especially for vulnerable groups.

On UHC Day 2025, our message is unequivocal:

No Nigerian should be denied quality care because they cannot afford it.

We call on federal and state governments to:

Fully subsidize premiums for low-income and vulnerable households
Strengthen primary health care facilities that deliver insured services
Enforce mandatory coverage and streamline digital enrolment

It is time to end the era of unaffordable health costs.

Health care is a right for every Nigerian, irrespective of socio-economic status.

Together, we can make “We’re sick of it” a rallying cry that finally delivers results.

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Ending HIV Stigma: Community Support Beyond World AIDS Day

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Ending HIV stigma remains one of the most critical steps in achieving an effective HIV response globally. Even though scientific progress has transformed HIV from a life-threatening illness to a manageable condition, stigma continues to undermine prevention, testing, treatment, and quality of life. Studies show that nearly 1 in 4 people living with HIV report experiencing discrimination in healthcare settings, which discourages timely care-seeking and contributes to poor health outcomes ^(1). Community stigma also remains widespread; in sub-Saharan Africa, where the burden of HIV is highest, research found that over 35% of adults still hold discriminatory attitudes toward people living with HIV ^(2). These attitudes are deeply rooted in misinformation, fear, cultural norms, and moral judgments that continue to silence individuals and limit their ability to access support.

Stigma does not only affect individuals emotionally; it has direct medical consequences. Evidence shows that people who experience HIV-related stigma are three times more likely to delay or avoid HIV testing and up to 50% less likely to adhere to treatment due to fear of being discovered ^(3). This delay fuels the cycle of transmission and reduces the chances of achieving viral suppression. Yet, viral suppression keeping HIV levels undetectable is proven to eliminate the risk of sexual transmission entirely, a fact summarized in the principle U=U (Undetectable = Untransmittable) ^(4). Ending stigma, therefore, is not only a human rights issue but a powerful public health strategy.

Beyond World AIDS Day, communities must unite to promote supportive environments where people living with HIV feel safe to disclose, access services, and receive continuous care. Community-led awareness, inclusive language, youth-friendly education, and culturally sensitive advocacy have proven to reduce stigma by strengthening empathy and understanding ^(5). Empowering young people with evidence-based information also plays a vital role since adolescents remain vulnerable to societal misconceptions and pressure surrounding HIV.

At the Centre for Family Health Initiative, efforts to end HIV stigma go beyond commemoration events. CFHI continues to create safe spaces within communities through targeted HIV education, gender-sensitive communication, counselling support for adolescents and caregivers, and stigma-reduction sessions integrated into school and community health activities. Through the ASPIRE project and other community interventions, CFHI consistently promotes testing uptake, linkage to care, and treatment adherence especially among vulnerable populations. Last year in Imo State, CFHI carried out a community HIV awareness and testing outreach that reached dozens of individuals with prevention messages, counselling, and referrals, reinforcing the message that HIV is manageable and that stigma must never stand between anyone and access to care. As we move beyond World AIDS Day, CFHI encourages everyone to be intentional about kindness, to challenge myths, to stand against discrimination, and to help build communities where people living with HIV are treated with dignity. Ending stigma begins with each of us, and together we can create a society where support is stronger than silence

References

Joint United Nations Programme on HIV/AIDS (UNAIDS). Confronting Discrimination: Overcoming HIV-related Stigma and Discrimination in Health-care Settings. 2020. Available from: https://www.unaids.org
United Nations Children’s Fund (UNICEF). HIV and AIDS Statistical Update. 2023. Available from: https://www.unicef.org
Turan B, et al. The Impact of HIV-related Stigma on Treatment Adherence. AIDS Behav. 2017;21(1):283–291. Available from: https://link.springer.com
Prevention Access Campaign. The U=U Declaration. 2016. Available from: https://preventionaccess.org
World Health Organization (WHO). Global HIV Programme: Eliminating Stigma and Discrimination. 2022. Available from: https://www.who.int

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MONDAY HEALTH BURST

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IMPACT OF CLIMATE CHANGE ON HUMAN HEALTH

Changes in the overall climate of the planet cannot be over-emphasized. Continuous rise in temperature of the planet is becoming alarming and the root cause is Global warming. Fossil fuels are being continuously used to produce electricity. The burning of these fuels produces gases like carbon dioxide, methane and nitrous oxides which lead to global warming. Also, deforestation leads to warmer temperatures, hence, the hazard of global warming is continuously causing major damage to the Earth’s environment.

According to the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report (AR5) in 2014, the net warming from 1850 to the end of the 20th century was equivalent to nearly 2.5 W/m2 with carbon dioxide contribution about 60% to this figure, methane about 25%, with nitrous oxides and halo-carbons providing the remainder. The major cause of global warming is the greenhouse gases. They include carbon dioxide, methane, nitrous oxides and in some cases chlorine and bromine containing compounds. The build-up of these gases in the atmosphere changes the radiative equilibrium in the atmosphere. The overall effect is to warm the Earth’s surface and the lower atmosphere because greenhouse gases absorb some of the outgoing radiation of Earth and re-radiate it back towards the surface.

Another major cause of global warming is the depletion of ozone layer. This happens mainly due to the presence of chlorine-containing source gases. When ultraviolet light is present, these gases dissociate releasing chlorine atoms which then catalyzes ozone destruction. Many industrial processes produce a wide diversity of aerosols depending on what is being burned or generated in the manufacturing process. These aerosols in the atmosphere also cause global warming by changing the climate in two ways. Firstly, they scatter and absorb solar and infrared radiation and hereby warming the air directly. Secondly, they may alter the micro-physical and chemical properties of clouds and perhaps affect their lifetime and extent.

Effects of climate changes could be very hazardous to human health. Some effects includes; Air pollution and airborne allergens to likely increase, worsening allergy and asthma conditions; climate change including rising temperatures and changes in weather extremes. This will increase health risks and require greater vigilance in food safety practices and regulation because of the exposure of food to certain pathogens and toxins; extreme weather and other events related to climate change will impact health by exacerbating underlying medical conditions like food-borne and waterborne illnesses, and disrupting infrastructures that are essential to maintaining access to health care and emergency response services. Also, climate-related exposures may lead to adverse pregnancy and newborn health outcomes, including low birth weight, preterm birth, dehydration and associated renal failure, diarrhea, and respiratory disease.

Climate action meaning stepped-up efforts to reduce greenhouse gas emissions and strengthen resilience and adaptive capacity to climate-induced impacts is necessary to combat climate change. The most significant solution to put an end to this disaster is the use of alternative energy sources. They include wind, solar, bio mass, geothermal and hydro. The most noteworthy point in using these sources is their clean nature. These sources do not produce any sort of pollution or toxic gases that can lead to global warming. They are friendly to the environment and pose no threat to ecological balance.

Monday Health Burst is an initiative of Centre for Family Health Initiative (CFHI) to tackle issues of basic health concerns. Join us every Monday for more health related articles on all our social media platforms.

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