Cultural practices in Africa

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

  1. National Library of Medicine (PMC). Determinants of maternal healthcare service utilization in Nigeria.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
  2. National Population Commission (NPC) Nigeria and ICF. Nigeria Demographic and Health Survey 2024 (Key Indicators Report).
    https://dhsprogram.com
  3. World Health Organization (WHO). Trends in Maternal Mortality 2000–2023.
    https://www.who.int/publications
  4. Federal Ministry of Health Nigeria. 2025 Joint Annual Review Report & MAMII Initiative Update.
    https://health.gov.ng
  5. 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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The Role of Families and Communities in Preventing FGM

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In the landscape of global health in 2026, Female Genital Mutilation (FGM) stands as one of the most persistent violations of human rights, yet the tide is beginning to turn through sophisticated, community-led interventions. As of this year, over 230 million women and girls alive today have undergone the procedure, and UNICEF projects that 4.5 million more remain at risk in 2026 alone [1]. The struggle to end this practice is no longer just a legal battle; it has evolved into a deep-rooted cultural shift focusing on the intersection of family protection and communal health [4].

The prevention of FGM begins at the heart of the home, where families are being empowered to dismantle the “social obligation” myth. Recent research from the UNFPA-UNICEF Joint Programme indicates that when mothers are provided with formal education and economic agency, the likelihood of their daughters being cut drops significantly [3]. Families are now being reached through “Positive Masculinity” programs, where over 800,000 men and boys have pledged to protect their female relatives, challenging the outdated notion that FGM is a prerequisite for marriageability [3]. By addressing the family as the primary decision-making unit, advocacy groups are successfully replacing fear of social exclusion with a shared commitment to a daughter’s physical integrity and future health.

Moving beyond the front door, the most effective preventative measure in 2026 has been the rise of Public Declarations of Abandonment within local communities. This collective approach shifts the “social contract,” ensuring that no single family feels isolated in their choice to stop the practice. Many regions have successfully implemented Alternative Rites of Passage (ARP), which preserve the cultural celebration of womanhood through education, mentorship, and gifts minus the physical harm. This allows communities to maintain their rich heritage while evolving their health standards. Simultaneously, health systems are closing the gap on “medicalization” the dangerous trend of health professionals performing the cut. The World Health Organization has recently tightened codes of conduct, training midwives and doctors to serve as the first line of defense, educating parents on the $1.4 billion annual global cost of treating FGM-related complications, ranging from obstetric hemorrhage to lifelong psychological trauma [2].

To ensure these gains are permanent, a robust network of local surveillance and cross-border cooperation has emerged. In 2026, over 3,200 communities have established “watchdog” groups that monitor girls during school holidays, a peak time for the practice [3]. These grassroots efforts, supported by national laws that criminalize “vacation cutting,” create a safety net that follows a girl from her village to the city and beyond. The data proves that this holistic approach works; for every dollar invested in these prevention measures, there is a tenfold return in health savings and economic productivity [2]. By weaving together, the strength of the family unit with the collective will of the community, we are finally moving toward a world where every girl can grow up whole, healthy, and empowered.

Call to Action

The end of FGM is within our reach, but it requires your voice and your action. You can make a difference today:

  • Educate and Advocate: Share the facts about the health risks of FGM within your social circles. Silence is where the practice thrives.
  • Support Grassroots Organizations: Donate to or volunteer with local NGOs that facilitate Alternative Rites of Passage and provide education to at-risk families.
  • Report Risk: If you know a girl is at risk of being subjected to FGM, contact local child protection services or international helplines immediately.
  • Engage Men and Boys: Start conversations with the men in your community about the importance of protecting the rights and health of women and girls.

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

  • UNICEF Data (2025/2026): FGM Prevalence and Statistics
  • WHO Global Health Update: The Cost of FGM and Prevention Strategies
  • UNFPA 2025 Annual Report: Eliminating FGM through Community Action
  • United Nations: International Day of Zero Tolerance for FGM

 

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Creating a Safe Environment for Girls in Schools and Communities.

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Creating a safe environment for girls in schools and communities is not a luxury; it is a necessity for national growth, justice, and human dignity. When a girl walks into a classroom, she should be thinking about her lessons and dreams not about fear. Yet for millions of girls around the world, safety is not guaranteed. According to the Malala Fund State of Girls’ Education Report, more than 120 million girls globally are out of school, with insecurity, poverty, and gender discrimination among the leading causes (Malala Fund, 2023). Behind these numbers are real girls whose futures are delayed or permanently disrupted.

Nigeria reflects this global crisis in painful ways. Data from UNICEF shows that Nigeria has one of the highest numbers of out-of-school children in the world estimated at over 18 million with girls disproportionately affected in conflict-affected regions (UNICEF Nigeria, 2023). The abduction of schoolgirls from Chibok in 2014 drew global outrage, yet attacks on schools have continued in parts of Kaduna, Niger, Zamfara, and Sokoto States. Recent education security reporting highlights ongoing threats and forced withdrawals of girls from school due to fear of violence. (See UNICEF Press Release on education safety.)

Violence is not only external. Research by Plan International shows that many girls experience harassment, bullying, or sexual violence within school environments, often from peers or authority figures. Such incidents frequently go unreported due to stigma and weak reporting mechanisms (Plan International, 2022). When girls feel unsafe in school, attendance drops and dropout rates increase. According to UNESCO Global Education Monitoring Report, school-related gender-based violence significantly affects learning outcomes and contributes to early school leaving (UNESCO, 2023).

Infrastructure gaps also contribute to insecurity. Thousands of schools in Nigeria lack perimeter fencing, security personnel, and adequate lighting, making them vulnerable to intrusion, theft, and attacks (Nigeria Security and Civil Defence Corps Report, 2024). Beyond physical security, access to water, sanitation, and hygiene (WASH) facilities is essential. The WHO/UNICEF Joint Monitoring Programme reports that inadequate sanitation disproportionately affects adolescent girls, especially during menstruation, leading to absenteeism and reduced participation (WHO/UNICEF JMP Report, 2023).

Community norms further shape girls’ vulnerability. According to UN Women, harmful gender norms, early marriage, and tolerance of violence increase girls’ risk of dropping out and experiencing abuse. In areas with high gender inequality, girls face restricted mobility and limited decision-making power, undermining their educational continuity and safety (UN Women, 2023).

Creating safer environments therefore requires coordinated action. Governments must strengthen school security architecture, implement early warning systems, and enforce child protection policies. Schools should adopt safeguarding frameworks and confidential reporting systems. Communities must challenge harmful norms and actively support girls’ education. Civil society organizations should be supported to expand advocacy, mentorship, and survivor support services.

Ensuring safety for girls is not simply about protection it is about possibility. When girls learn in secure environments, they are more likely to complete their education, participate in the workforce, delay early marriage, and contribute to economic growth. Safety forms the bedrock of confidence and achievement. If development is truly our goal, then protecting girls in schools and communities must be our shared responsibility.

Speak Wednesday is an initiative of CFHI to address issues around gender-base violence and gender-bias.

References

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Families as Frontline Defenders Against Harmful Practices.

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Across the world, harmful practices such as female genital mutilation (FGM) and child marriage continue to violate the rights, health, and futures of millions of girls and young women, often entrenched in patriarchal norms and social pressures. UNICEF estimates that at least 230 million girls and women alive today have undergone FGM, and over 12 million girls are married before age 18 every year, both of which are rooted in gender inequality and harmful social norms upheld at the family and community level. These practices not only harm physical and psychological wellbeing but also constrain girls’ access to education, livelihoods, and basic human rights. (UNICEF)

Families are not merely passive bystanders in this landscape they can be frontline defenders against harmful practices. Research shows that families influence health behavior, decision-making, and wellbeing from early life through adolescence and adulthood, making them invaluable actors in preventing and countering abuse and discrimination. Family-oriented health promotion strategies have been found to be effective in reducing child maltreatment and strengthening protective factors by enhancing parenting practices, social support, and overall family wellbeing. (PubMed)

In many communities where harmful practices like FGM and child marriage persist, decision making often occurs within the household, with parents, extended family members, and elders shaping whether girls are subjected to such rites. In parts of sub-Saharan Africa, families fear social ostracism and harm to a girl’s “marriage prospects” if she is not cut or married early beliefs that are enforced by elders and community expectations. This social pressure persists even where awareness of harm is increasing, illustrating how deeply family influence and social norms are intertwined. (acrl-rfp.org) In Mali, for example, prevalence rates of FGM remain high only dropping from 91% to 89% over two decades underscoring that legal change alone is insufficient without deep shifts in family and community norms. (ODI: Think change)

However, when families act as agents of change rather than enforcers of harmful norms, progress is possible. In Sudan in 2025, community committees that included family members mobilized against an FGM practitioner’s arrival, stopping the practice in its tracks, and demonstrating the power of collective family and community action to protect children. This local action, grounded in awareness about health risks and legal protections, helped shift attitudes and strengthen community resistance against harmful practices. (UNICEF)

Education is another critical lever. Families that value girls’ schooling and future potential are more likely to delay or abandon harmful practices, recognizing the long-term benefits of learning and opportunity. Research from UNICEF indicates that education can shift attitudes and reduce the transmission of harmful practices across generations, as families who understand the risks and benefits are better positioned to protect their daughters. (UNICEF DATA)

Promoting family engagement as a public health strategy also aligns with broader efforts to prevent violence and abuse. Evidence shows that family-based interventions reduce harmful behaviors such as bullying among children and adolescents by improving parenting, communication, and protective supervision. These family systems create environments where children feel supported, informed, and safer, reducing the likelihood of various forms of harm. (SpringerLink)

Yet meaningful change requires more than individual awareness it requires collective, sustained action that equips families with knowledge, resources, and support to challenge harmful norms. Governments, civil society, health systems, and community leaders must invest in education, legal protections, economic opportunities, and culturally appropriate outreach that reinforces families as protectors rather than perpetuators of harmful practices. As one advocate puts it, “Families who understand the suffering these practices cause is increasingly willing to resist, one conversation at a time.” (UNICEF)

Call to Action: Ending harmful practices such as FGM and child marriage depends on empowering families with evidence, support, and tools to reject harmful norms and champion girls’ rights. Invest in family-focused education and prevention, strengthen community support networks, involve elders and parents in advocacy, and ensure every girl’s health, education, and dignity are protected.

References

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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

  1. 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/
  2. 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
  3. 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
  4. 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/
  5. 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
  6. 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/
  7. 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
  8. 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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Breaking Myths, Ending Stigma, and Acting Against Cervical Cancer

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Cervical cancer is a major global health issue yet one of the most preventable forms of cancer. Almost all cervical cancer cases (about 99%) are linked to infection with high-risk human papillomaviruses (HPV), which are extremely common and transmitted through sexual contact. Persistent HPV infection can cause cervical cancer if left untreated, but early detection and prevention make this disease largely preventable. ¹

Despite this, myths and misinformation persist and contribute to stigma around cervical cancer screening and HPV. Studies show that many women feel shame, anxiety, and embarrassment when diagnosed with HPV or advised to get screened, often because HPV is incorrectly perceived as a sign of promiscuity or extreme risk. ² This stigma can deter women from seeking preventive care and early diagnosis, undermining efforts to reduce disease burden. ³

Globally, cervical cancer remains a leading cause of cancer deaths among women. In 2022, an estimated 660,000 new cases were diagnosed worldwide, with about 350,000 deaths many of which could be prevented through vaccination, regular screening, and early treatment. ¹ In Nigeria, cervical cancer is the second most common cancer among women and carries significant risk in the reproductive age group. ⁴

Despite proven benefits, uptake of cervical cancer screening and HPV vaccination remains low. Studies in Nigeria (2021–2023) show that fewer than 15% of adolescent girls have received the HPV vaccine and only about 10% of women have ever been screened, indicating slow progress compared to global targets.⁵ This low uptake is driven by limited awareness, misconceptions, stigma, and weak family or partner support, while reviews from 2022–2024 highlight persistent beliefs that screening is only for certain women or may cause harm, further discouraging participation.⁶

Myths about cervical cancer include beliefs that HPV always leads to cancer, that only women with symptoms should screen, or that screening itself causes harm. Evidence shows these are false HPV does not always cause cancer, early stages of disease often have no symptoms, and regular screening (Pap tests or HPV testing) is safe and effective in detecting abnormalities before they progress. ⁷

Stigma further compounds the problem. Surveys indicate that significant numbers of women experience emotional distress or feel ashamed after receiving abnormal screening results, which can delay follow-up care and discourage others from attending future screenings. ² Overcoming this stigma requires not just medical interventions but community education and open conversations about HPV and cervical health.

Acting against cervical cancer involves three key strategies: vaccination, screening, and treatment. The World Health Organization’s global strategy targets HPV vaccination of 90% of girls by age 15, screening 70% of eligible women twice in their lifetimes, and ensuring 90% of women with pre-cancer or invasive cancer receive appropriate care. ⁴ Countries such as Pakistan have demonstrated wide vaccination coverage, with campaigns reaching millions of girls despite resistance fueled by misinformation.

Breaking myths and ending stigma is essential to increase screening uptake and vaccine acceptance. Community education campaigns, trusted health messaging, and culturally sensitive outreach can help shift perceptions, build trust, and empower women to take preventive action. We urge communities, health workers, and families to actively support women in accessing screenings and vaccinations, speak openly about cervical health, and challenge harmful myths whenever they arise. When women understand the facts and feel supported rather than judged, lives can be saved, and the stigma that hinders progress can be dismantled.

References

  1. World Health Organization (WHO). Cervical cancer prevention, diagnosis, screening.
    https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/
  2. Sheena Meredith. HPV stigma leads to shame for women with diagnosis. Medscape.
    https://www.medscape.com/viewarticle/HPV-Stigma-Leads-Shame-Women-Diagnosis-2022a10004lc
  3. BMC Public Health. Barriers to cervical cancer screening in Africa.
    https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17842-1
  4. WHO Africa. Cervical cancer early detection saves lives (Nigeria context).
    https://www.afro.who.int/countries/nigeria/news/cervical-cancer-early-detection-saves-lives
  5. BMC Women’s Health. Cervical cancer screening and HPV vaccination knowledge in Nigeria.
    https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02345-9
  6. PubMed Central. Cervical cancer stigma—a silent barrier to elimination.
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11869935/
  7. Thomson Medical. 9 common myths about cervical cancer debunked.
    https://www.thomsonmedical.com/blog/myths-about-cervical-cancer

 

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Silent Reproductive Health Struggles

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Women’s reproductive health is fundamental to their overall well-being, yet millions of women globally and in Nigeria face persistent, often silent challenges that compromise their health, autonomy, and quality of life [1]. Despite progress in some areas, vast inequities remain in access to services, information, and rights leaving many women vulnerable to preventable health problems [2].

One of the major silent struggles is limited access to essential reproductive health services, including family planning, maternal care, and safe delivery support. In sub-Saharan Africa, one in four women who wish to delay or stop childbearing do not use any contraceptive method, reflecting gaps in availability, choice, and quality of reproductive care [1][5]. These shortfalls contribute to high rates of unintended pregnancies, unsafe abortions, and increased maternal morbidity and mortality. Globally, about 800 women die each day from pregnancy-related causes, many of which are preventable with proper services and support [1].

In Nigeria, reproductive health disparities are stark. A survey of reproductive health concerns found that sexual health, contraception, infections, fertility issues, and reproductive cancers were among the most pressing worries for women, indicating broad unmet needs across the reproductive spectrum [3]. Despite various policies, only a few Nigerian states meet benchmarks for women’s participation in decisions about their sexual and reproductive health, reflecting systemic barriers rooted in socio-cultural norms and limited autonomy [4]. Economic challenges also contribute, with millions of women lacking access to modern contraceptives and comprehensive family planning services due to cost, misinformation, fear of side effects, cultural opposition, and weak health systems [5][6].

Another under-recognized struggle is infertility, which affects a significant portion of women yet remains stigmatized and poorly supported. Recent WHO guidance highlights infertility as a major public health concern, with more than one in six people of reproductive age affected [7]. Access to affordable fertility evaluation and treatment is limited in many countries, forcing women to choose between financial hardship and their desire for children [7].

Maternal health remains a critical issue. Globally, approximately 287,000 women die yearly from complications in pregnancy and childbirth, with nearly all these deaths occurring in low- and middle-income settings where health systems are weak and resources scarce [1]. In areas affected by conflict or economic strain, such as parts of northern Nigeria, women face even greater risks due to disrupted services, insecurity, and collapsed care infrastructure [8].

The impact of these struggles extends beyond physical health. When women cannot access respectful, quality reproductive care, the consequences ripple into social and economic domains limiting educational opportunities, reducing workforce participation, and perpetuating cycles of poverty and inequality [2].

Improving women’s reproductive health requires a holistic approach that ensures affordable and accessible services such as contraception, antenatal care, skilled delivery, and emergency support reach even the most underserved communities [1][5], while also equipping women with accurate, culturally sensitive information to make informed choices about their bodies and health [2]. At the same time, policies must actively protect women’s autonomy and reproductive rights by challenging harmful norms and discrimination [2][4], supported by strong, well-funded health systems with trained personnel to guarantee continuity of care, especially in fragile settings [1][8]. Integrating affordable infertility care and psychosocial support into routine reproductive health services is also essential to address the often hidden emotional and social burdens many women silently endure [7].

Speak Wednesday is an initiative of CFHI to address issues around gender-base violence and gender-bias.

References

  1. WHO Regional Office for Africa. Women’s Health. Available from: https://www.afro.who.int/health-topics/womens-health
  2. United Nations Population Fund (UNFPA). New UNFPA report finds 30 years of progress in sexual and reproductive health has mostly ignored the most marginalized communities. Available from: https://www.unfpa.org/press/new-unfpa-report-finds-30-years-progress-sexual-and-reproductive-health-has-mostly-ignored
  3. Sa’adatu TS, Dieng B, Danmadami AM. Reproductive health issues of concern among Nigerians: an online survey. Int J Community Med Public Health. Available from: https://doi.org/10.18203/2394-6040.ijcmph20234114
  4. Premium Times Nigeria. Only eight Nigerian states meet women’s health benchmark – Report. Available from: https://www.premiumtimesng.com/news/top-news/830200-only-eight-nigerian-states-meet-womens-health-benchmark-report.html
  5. World Health Organization. Sexual and Reproductive Health and Research (SRH): Family planning and contraception. Available from: https://www.who.int/teams/sexual-and-reproductive-health-and-research-%28srh%29
  6. Ballard Brief. Barriers to Family Planning for Women in West Africa. Available from: https://ballardbrief.byu.edu/issue-briefs/barriers-to-family-planning-for-women-in-west-africa
  7. WHO releases first global guideline on infertility care. Reddit; 2025. Available from: https://www.reddit.com/r/EmbryologyIVFSupport/comments/1pcjrzh/who_releases_first_global_guideline_on/
  8. AP News. Pregnancy has become a nightmare for many women in Nigeria’s conflict-hit north. Available from: https://apnews.com/article/c5846961ed87cddd8a24d1c2b04564a0

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Cervical Cancer: What Every Woman Should Know

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Cervical cancer remains a significant public health concern for women both globally and in Nigeria, yet it is largely preventable and treatable when detected early. Understanding its causes, risk factors, prevention strategies, and interventions is critical for improving women’s health outcomes. Cervical cancer develops in the cervix, the lower part of the uterus that connects to the vagina and is one of the most common cancers affecting women worldwide. In 2022, an estimated 660,000 new cervical cancer cases were reported globally, with about 350,000 deaths attributed to the disease, largely in low- and middle-income countries due to disparities in prevention and care access [1].

Almost all cervical cancers, over 99%, are caused by persistent infection with high-risk types of Human Papillomavirus (HPV), a sexually transmitted virus. While most HPV infections are naturally cleared by the immune system, persistent infection with oncogenic HPV types, particularly HPV 16 and 18, can lead to abnormal cell changes and eventual cancer over many years if not identified and treated [2]. Beyond HPV infection, several factors increase the risk of cervical cancer in women. HIV infection and weakened immunity accelerate cancer progression [1]. Smoking impairs immune response and promotes cellular changes [3]. Early onset of sexual activity, multiple sexual partners, and long-term use of certain hormonal contraceptives also contribute to heightened risk [4].

Cervical cancer is highly preventable and much more treatable when detected early. HPV vaccination, administered to girls typically aged 9 to 14, is highly effective at preventing infections that cause most cervical cancers [1]. Regular screening through Pap smears or HPV tests allows for the detection of precancerous changes before they progress to cancer, significantly improving treatment outcomes [2]. Despite these preventive measures, in Nigeria, cervical cancer remains the second most frequent cancer among women and a leading cause of cancer-related death [5]. Awareness and screening uptake are low, particularly in rural areas, due to financial barriers, limited access to screening facilities, and insufficient information about prevention [6].

To further reduce the burden of cervical cancer, it is essential to scale up HPV vaccination campaigns targeting adolescent girls before exposure to the virus, expand the availability and affordability of cervical cancer screening at primary healthcare levels, and strengthen health education to promote understanding of cervical health through sustained community engagement. Addressing gender and social barriers that limit women’s access to preventive care is also critical. Cervical cancer should not be a life sentence. With knowledge, preventive action, and supportive community health services, every woman can protect her health and future.

References

  1. World Health Organization. Human papillomavirus (HPV) and cervical cancer fact sheet. Dec 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-%28hpv%29-and-cervical-cancer
  2. World Health Organization. Cervical cancer prevention, diagnosis, and screening overview. Available from: https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/
  3. Centers for Disease Control and Prevention. Cervical Cancer Risk Factors. Available from: https://www.cdc.gov/cervical-cancer/risk-factors/index.html
  4. National Cancer Institute. Cervical Cancer Causes, Risk Factors, and Prevention. Available from: https://www.cancer.gov/types/cervical/causes-risk-prevention
  5. World Health Organization Regional Office for Africa. Cervical cancer early detection saves lives (Nigeria). Available from: https://www.afro.who.int/countries/nigeria/news/cervical-cancer-early-detection-saves-lives
  6. The Guardian (Nigeria). Screening, awareness gaps slow cervical cancer elimination. Available from: https://guardian.ng/features/health/screening-awareness-gaps-slow-cervical-cancer-elimination/

 

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When Healthcare Costs Become a Form of Bias

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When healthcare costs rise beyond the reach of ordinary people, they silently become a form of bias one that decides who lives, who suffers, and who is forced to endure preventable pain. In Nigeria today, access to quality healthcare is increasingly determined not by need, but by ability to pay. For millions of women and girls, especially in low-income and underserved communities, the cost of care has become a cruel barrier that denies them their most basic right: the right to health. This hidden injustice affects lives, futures, and communities.

The impact of this bias is devastating. Pregnant women delay antenatal care because consultation fees are unaffordable, adolescent girls are denied reproductive health services, and survivors of gender-based violence cannot access timely medical attention due to cost. These barriers fuel inequality, worsen health outcomes, and perpetuate cycles of suffering. When healthcare becomes a privilege instead of a right, women and girls bear the heaviest burden, trapped in a system that marginalizes them and ignores their dignity.

The financial strain of out-of-pocket spending is crushing. Families are forced to choose between food, education, and medical care, often at the expense of women and girls. This reality exposes a health system that has failed to protect those most vulnerable, leaving them at risk of illness, neglect, and further gender-based harm. A functional, responsive healthcare system should uplift women and girls, not push them into vulnerability. Every woman and girl deserve care, respect, and protection regardless of income.

The Nigerian government must act decisively. Investing in maternal, reproductive, and gender-sensitive health services, strengthening primary healthcare, implementing effective insurance schemes, and ensuring accountability at every level are not optional, they are urgent obligations. Health must be treated as a national priority, because no society can prosper while its women and girls remain unwell, unprotected, and underserved. A fair and just society is one where access to healthcare is based on need, not income. Ending cost-driven bias in healthcare requires collective action from policymakers prioritizing women’s health financing, to institutions delivering quality care, to communities demanding equitable systems.

The call to action is clear: the government, stakeholders, and citizens must commit to ensuring healthcare is affordable, accessible, and equitable for all. Healthcare should heal, protect, and empower women and girls, and not discriminate against them. Until costs no longer determine who can access care, gender-based bias will continue to persist quietly, unfairly, and at an unacceptable human cost.

Speak Wednesday is an initiative of CFHI to address issues around gender-base violence and gender-bias.

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Ensuring Health Services Reach Everyone

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Ensuring that health services reach everyone remains one of the world’s most urgent development challenges, especially as global progress toward Universal Health Coverage (UHC) continues to slow. Worldwide, more than 4.6 billion people still lack access to essential health services, leaving millions at risk of preventable illness and financial hardship [1]. Although the global service coverage index has risen from the mid-50s in 2000 to around 71 in 2023, the gains remain uneven and fragile [2]. In Nigeria, persistent gaps in primary healthcare, maternal and newborn services, limited staffing, shortages of essential supplies and unreliable electricity continue to restrict access for many communities, particularly in rural and underserved areas [3,4].

Electricity is one of the most basic requirements for safe and functional health care. In many low-resource settings, including parts of Nigeria, frequent power interruptions limit the ability of facilities to conduct safe night-time deliveries, sterilize equipment, store vaccines, or run lifesaving laboratory tests. Evidence shows that roughly one-third to two-fifths of Nigeria’s primary health care centres still lack stable electricity, forcing some to rely on kerosene lamps, phone flashlights or fuel-powered generators that often fail when needed most [5,6]. Without reliable light and power, both mothers and newborns face heightened risks, and health workers struggle to provide the standard of care for which they are trained.

These structural challenges contribute to persistent health inequalities. Nigeria retains one of the highest maternal mortality ratios globally, despite substantial global declines since the early 2000s [2,7]. Skilled birth attendance an essential determinant of maternal and newborn survival has improved in some regions but still varies widely across northern states, where many young women remain unable to access skilled care at birth [4]. Preventive services such as immunisation have also fluctuated, with pandemic-related disruptions causing setbacks. Although recovery efforts are ongoing, routine immunisation coverage remains below global and regional benchmarks, leaving children in remote communities at disproportionate risk [3,8].

Nonetheless, evidence from recent interventions demonstrates that targeted, practical investments can quickly strengthen essential health services. Solar electrification of primary health care facilities, particularly through durable systems designed for maternal and emergency care, has been shown to improve night-time service delivery, stabilize cold-chain systems and increase overall service availability [6,9]. When paired with training and continuous supervision, such interventions support proper equipment use, routine maintenance and long-term sustainability an approach consistently endorsed by global health experts and backed by facility-level assessments [7]. Furthermore, integrating community engagement, leadership participation and strong referral mechanisms encourages service uptake and strengthens public trust.

To accelerate progress, policymakers, donors, and community leaders must prioritize primary healthcare revitalization, commit to electrifying facilities, invest in continuous staff training, and support service delivery models proven to work. Ensuring that health services reach everyone is both achievable and urgent. With collective action, equitable investment and strengthened partnerships, Nigeria can move closer to a future where every individual regardless of geography or socioeconomic status receives the essential care needed to live a healthy and dignified life.

 

References

  1. World Health Organization. Universal health coverage (UHC) fact sheet. 2024 [cited 2025 Dec 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-%28uhc%29
  2. World Bank. Tracking Universal Health Coverage — 2025 Global Monitoring Report. 2025 [cited 2025 Dec 12]. Available from: https://www.worldbank.org/en/topic/universalhealthcoverage/publication/2025-global-monitoring-report-gmr
  3. WHO. Nigeria Country Health Profile — Health System Performance, Immunisation & Primary Care Indicators. 2024 [cited 2025 Dec 12]. Available from: https://www.who.int/countries/nga
  4. Afape AO, et al. Prevalence and determinants of skilled birth attendance among young women in Northern Nigeria. 2024 [cited 2025 Dec 12]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11389318/
  5. World Health Organization. Electricity in health-care facilities. 2023 [cited 2025 Dec 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/electricity-in-health-care-facilities
  6. Sustainable Energy for All. Powering primary healthcare in Nigeria. 2024 [cited 2025 Dec 12]. Available from: https://www.seforall.org
  7. World Bank. Maternal mortality ratio — Nigeria. 2024 [cited 2025 Dec 12]. Available from: https://data.worldbank.org/indicator/SH.STA.MMRT?locations=NG
  8. UNICEF. Immunisation data and analysis. 2024 [cited 2025 Dec 12]. Available from: https://data.unicef.org/topic/child-health/immunization/
  9. Nigeria Health Watch. Solar power solutions for primary healthcare centres. 2024 [cited 2025 Dec 12]. Available from: https://articles.nigeriahealthwatch.com/a-solar-power-project-is-keeping-primary-healthcare-centres-running-in-abuja/

 

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