Speak Wednesday

Gender Inequality: A Threat to the Health, Safety, and Rights of Women and Girls in Nigeria

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Gender inequality remains a deeply entrenched threat to the health, safety, and rights of women and girls in Nigeria, undermining progress toward equitable development and directly shaping outcomes in health, education, economic participation, political representation, and freedom from violence. According to the United Nations Development Programme (UNDP), Nigeria ranks 147 out of 191 countries on the Gender Inequality Index, reflecting large disparities between men and women in reproductive health, empowerment, and labour market participation. ¹ These inequalities manifest in real and measurable ways that compromise the wellbeing and opportunities of women and girls across the country.

One of the most profound impacts of gender inequality in Nigeria is observed in health outcomes. The maternal mortality ratio remains unacceptably high at 512 maternal deaths per 100,000 live births, indicating that women are still at disproportionate risk during pregnancy and childbirth compared to global averages. ² Factors driving this include limited access to quality reproductive health services, lack of autonomy in health decision-making, and economic barriers that delay care-seeking. Research shows that women who lack financial independence or decision-making power are less likely to utilise antenatal care or deliver in health facilities, increasing the likelihood of preventable complications. ³

Education is another field deeply affected by gender inequality. UNESCO reports that girls’ school completion rates in Nigeria lag boys’, particularly at the secondary level, a gap that translates into reduced opportunities for advanced learning, better jobs, and informed health choices later in life. ⁴ Early marriage, still prevalent in many regions, significantly contributes to school dropout rates among girls. UNICEF estimates that 43% of girls in Nigeria are married before their 18th birthday, limiting educational attainment and exposing them to early pregnancy and increased health risks such as obstetric fistula and maternal mortality. ⁵

Gender-based violence (GBV) is another grave consequence of systemic inequality. The Nigeria Demographic and Health Survey (NDHS) reveals that around 30% of ever-married women aged 15–49 have experienced physical violence, with many cases going unreported due to stigma, fear, and weak legal enforcement. ⁶ Violence affects not only physical health but also leads to long-term psychological trauma, increased vulnerability to HIV infection, and reduced participation in economic and community life. ⁷

Political inequality further illustrates the scale of exclusion. In the current 10th National Assembly (2023–2027), women remain severely underrepresented in national decision-making. Out of 109 Senate seats, only 4 are held by women (approximately 3.7%), while 105 seats (96.3%) are held by men. In the House of Representatives, only 17 out of 360 seats are occupied by women (approximately 4.7%), compared to 343 men. Altogether, women hold just 21 out of 469 seats in the National Assembly, representing about 4.2% of federal lawmakers.¹⁰ This means that despite women making up nearly half of Nigeria’s population, their voice in shaping laws and policies that directly affect their health, safety, and rights remains below 5% — one of the lowest representation rates in the region.¹¹ Limited political participation restricts the advancement of gender-responsive policies and slows progress on critical issues such as maternal health funding, protection from violence, and equal economic opportunities.

Economic inequality further compounds these threats. Although women actively participate in Nigeria’s labour force, wage gaps, informal employment, and occupational segregation persist. The World Economic Forum’s Global Gender Gap Report highlights that women often earn less than men for similar work and remain underrepresented in leadership positions. ⁸ Without economic empowerment, many women are unable to afford essential health services, invest in their education, or break cycles of poverty and dependency.

These disparities are not inevitable; they are shaped by social norms, discriminatory practices, and gaps in policy implementation. Research consistently shows that gender-responsive policies including universal access to reproductive healthcare, enforcement of laws against child marriage, protection from gender-based violence, equal educational opportunities, and increased political inclusion significantly improve health, economic, and social outcomes. ⁹

Addressing gender inequality is therefore not only a moral obligation but also a public health, governance, and economic priority. When women and girls have equal access to education, healthcare, leadership opportunities, and economic resources, maternal and infant mortality decline, household incomes rise, communities become safer, and national development accelerates. Nigeria cannot achieve sustainable development while half of its population remains structurally disadvantaged.

We call on the Federal and State Governments to strengthen and fully enforce laws protecting women and girls from discrimination and violence, expand access to quality healthcare services, promote girls’ education, and implement affirmative measures to increase women’s political representation. Development partners, civil society, and community leaders must intensify advocacy, scale up gender-responsive programming, and challenge harmful norms that sustain inequality. Every sector health, education, justice, governance, and economic development must mainstream gender equity as a foundational principle. The health, safety, and rights of Nigeria’s women and girls demand bold, sustained, and collective action.

References

  1. UNDP Gender Inequality Index
    https://hdr.undp.org/data-center/thematic-composite-indices/gender-inequality-index
  2. WHO Trends in Maternal Mortality 2000–2023
    https://www.who.int/publications/i/item/9789240068759
  3. Journal of Women’s Health – Decision-Making Power & Maternal Service Utilisation
    https://www.liebertpub.com/doi/10.1089/jwh.2020.8805
  4. UNESCO Institute for Statistics – Girls’ Education
    https://uis.unesco.org/en/topic/girls-education
  5. UNICEF – Child Marriage in Nigeria
    https://data.unicef.org/topic/child-protection/child-marriage/
  6. Nigeria Demographic and Health Survey (NDHS)
    https://dhsprogram.com/pubs/pdf/FR379/FR379.pdf
  7. WHO – Violence Against Women Prevalence Estimates
    https://www.who.int/publications/i/item/9789240022256
  8. World Economic Forum – Global Gender Gap Report 2023
    https://www3.weforum.org/docs/WEF_GGGR_2023.pdf
  9. Journal of Gender & Development – Gender-Responsive Policies
    https://www.tandfonline.com/doi/full/10.1080/13552074.2021.1952743
  10. The Nation Newspaper – Women in the 10th National Assembly
    https://thenationonlineng.net/meet-the-only-four-female-senators-in-10th-nass/
  11. The Guardian Nigeria – Women’s Representation in N’Assembly
    https://guardian.ng/news/national/only-4-5-of-nassembly-members-are-women-says-wilan-report/

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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

Creating a Safe Environment for Girls in Schools and Communities. Read More »

Gender-Bias Sustains Violence Against Girls

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Across the globe, gender bias fuels and sustains violence against girls, shaping social norms that devalue their rights, safety, and dignity. Gender bias refers to the systemic prejudice that privileges one gender over another, embedding harmful beliefs about power, control, and worth. These biases are not abstract they manifest in everyday interactions, institutional policies, cultural practices, and legal frameworks that indirectly condone or fail to protect girls from violence and discrimination. Gender bias is a root cause of many forms of gender-based violence, contributing to a world where nearly 1 in 3 women and girls experience physical or sexual violence in their lifetime, most often from intimate partners or family members. This stark reality reflects deep-seated inequalities and underscores how societal norms around gender perpetuate violence rather than prevent it. (UN Women Knowledge hub)

Gender bias does not only drive overt acts of violence; it also grows through socialization and cultural messaging that position girls as subordinate or less valuable. In many communities, girls are more likely to face early marriage with 1 in 5 women aged 20–24 first married before age 18 a practice rooted in beliefs that girls need male guardianship and are better suited to domestic roles than education or economic participation. These harmful norms create environments where violence against girls is tolerated or overlooked, and where girls themselves may internalize messages that diminish their sense of self-worth and agency. (violenceagainstchildren.un.org)

The consequences of violence sustained by gender bias are severe and far-reaching. Beyond physical injuries, girls and young women who experience violence are at greater risk of anxiety, depression, post-traumatic stress, unintended pregnancy, and sexually transmitted infections. The psychological impact can hinder education, employment, and social participation, trapping survivors in cycles of marginalization. When legal systems, communities, and institutions fail to protect girls or address the bias that underpins violence, they perpetuate impunity and signal that girls’ safety is negotiable rather than a human right. (UN Women Knowledge hub)

Efforts to combat gender-based violence must therefore confront the gender bias that sustains it. This means challenging societal norms that excuse controlling behaviour, silence survivors, or blame victims for the harm inflicted upon them. It requires that governments strengthen legal protections, enforce laws that criminalize domestic and sexual violence, and ensure survivors have access to justice and support services. It also means investing in community education that promotes gender equality, respectful relationships, and non-violent conflict resolution. Addressing gender bias is central to dismantling the conditions that allow violence against girls to persist. (UN Women Knowledge hub)

True change demands collective action from families, teachers, health workers, policymakers, and young people themselves to build cultures that respect girls’ autonomy, voices, and contributions. Eliminating violence against girls is not simply a matter of responding to individual incidents; it is a long-term effort to transform the biases that place girls at risk in the first place. Communities that challenge harmful gender norms and promote equality create safer, healthier, and more just environments for all children and future generations.

Call to action: Governments, civil society, community leaders, educators, and individuals must work together to replace harmful gender stereotypes with norms that respect human rights and dignity. Strengthening legal frameworks, investing in prevention programmes, supporting survivors, and promoting gender-equal education are essential steps toward a future where girls can live free from violence and realize their full potential.

References

• UN Special Representative on Violence Against Children: Girls
https://violenceagainstchildren.un.org/content/girls (violenceagainstchildren.un.org

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Female Genital Mutilation as Gender-Based Violence: A Violation of Girls’ Rights

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Female Genital Mutilation (FGM) is a harmful traditional practice and a clear form of gender-based violence that fundamentally violates the human rights of girls and women. The World Health Organization defines FGM as all procedures involving the partial or total removal of the external female genitalia or other injury to female genital organs for non-medical reasons (1). The practice has no health benefits and causes lifelong harm, violating girls’ rights to health, bodily integrity, security, and freedom from cruel, inhuman, or degrading treatment (1).

Globally, more than 230 million girls and women alive today have undergone FGM, spanning at least 30 countries across Africa, the Middle East, and parts of Asia (1). Each year, an estimated 4 million additional girls remain at risk, most of them under the age of 15, highlighting the urgent need for accelerated action (1). These figures reflect not isolated incidents, but a sustained pattern of violence rooted in gender inequality.

FGM persists primarily because of unequal power relations and entrenched social norms that subordinate girls and women. In many communities, the practice is falsely justified as a cultural rite of passage, a prerequisite for marriage, or a means of controlling female sexuality. These beliefs reinforce the notion that girls’ bodies are subject to communal control rather than individual rights, a hallmark of gender-based violence (2).

FGM remains most prevalent in sub-Saharan Africa, with some of the highest rates recorded in Somalia (approximately 99%), Guinea (94.5%), and Djibouti (93%) among women aged 15–49 (3). In Nigeria, an estimated 19.9 million girls and women have undergone FGM, making it one of the countries with the highest absolute number of survivors globally (4). Prevalence varies significantly across regions, with higher rates reported in the South-East and South-West, including states such as Imo, where prevalence exceeds 60% in some communities (4). These statistics underscore how deeply embedded the practice remains at both national and sub-national levels.

As a form of violence, FGM is typically carried out without informed consent, often during childhood, and results in enduring physical, psychological, and social harm. Survivors frequently report anxiety, emotional distress, reduced self-esteem, and loss of bodily autonomy, which can persist throughout adulthood (5). The trauma associated with the experience often affects girls’ confidence, participation in education, and ability to form healthy relationships later in life.

Beyond psychological harm, FGM has serious implications for sexual and reproductive health. It increases the risk of complications during pregnancy and childbirth, contributes to maternal and neonatal morbidity, and places additional strain on already fragile health systems in low-resource settings (1). These consequences further affirm why FGM is recognized globally as both a public health crisis and a human rights violation.

Recognizing its severity, the international community has committed to eliminating FGM under Sustainable Development Goal (SDG) Target 5.3, with a global target year of 2030 (5). Agencies such as the World Health Organization (WHO) and UNICEF have led coordinated efforts focusing on legal reform, community engagement, survivor-centred health services, and prevention strategies that challenge harmful gender norms (6).

At the national level, progress has been uneven. In countries like Somalia, WHO and partners have supported health system reforms, professional training, and community-based interventions to address both FGM and broader gender-based violence (7). In Nigeria, UNICEF has supported community-led abandonment initiatives in high-prevalence states, mobilizing local leaders, families, and youth to protect girls at risk and shift social norms (4).

The impact of FGM on confidence and well-being cannot be overstated. Many survivors live with lasting psychological effects, including post-traumatic stress, fear, and diminished self-worth, which influence education, employment, and social participation (5). These invisible scars are often overlooked, yet they shape the life chances of millions of women and girls.

Ending FGM requires decisive, multi-level action. Governments must strengthen and enforce laws that criminalize the practice. Communities must be supported to challenge harmful norms through dialogue and education. Health systems must provide survivor-centred care, including mental health services. Men and boys must be engaged as allies in promoting gender equality, while robust data systems are needed to monitor progress and guide policy decisions. Only through sustained, coordinated action can FGM be eliminated, and girls’ rights fully protected.

FGM is not culture it is violence. Ending it is not optional; it is an urgent moral, public health, and human rights imperative.

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

References

  1. World Health Organization (WHO). Female Genital Mutilation.
    https://www.who.int/health-topics/female-genital-mutilation
  2. WHO Regional Office for Africa. Female Genital Mutilation.
    https://www.afro.who.int/health-topics/female-genital-mutilation
  3. UNICEF. New Statistical Report on Female Genital Mutilation.
    https://www.unicef.org/png/press-releases/new-statistical-report-female-genital-mutilation-shows-harmful-practice-global
  4. UNICEF Nigeria. FGM on the Rise Among Young Nigerian Girls.
    https://www.unicef.org/nigeria/press-releases/unicef-warns-fgm-rise-among-young-nigerian-girls
  5. UNICEF DATA. Female Genital Mutilation Statistics.
    https://data.unicef.org/topic/gender/fgm/
  6. World Health Organization. New Recommendations to End Medicalized FGM.
    https://www.who.int/news/item/28-04-2025-who-issues-new-recommendations-to-end-the-rise-in–medicalized–female-genital-mutilation-and-support-survivors
  7. World Health Organization. Addressing FGM and GBV in Somalia.
    https://www.who.int/about/accountability/results/who-results-report-2020-mtr/country-story/2023/improving-maternal-health-outcomes-by-addressing-female-genital-mutilation-and-gender-based-violence-in-somalia

 

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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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Stolen Childhoods Through Early Marriage

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Child marriage, also known as early marriage, refers to any formal marriage or informal union where one or both partners are under the age of 18. Despite laws and global commitments to end this practice, it remains widespread and continues to rob millions of children especially girls of their childhoods, education, health, and future opportunities. Globally, one in five young women aged 20–24 was married before age 18, compared to one in four a decade ago, showing slow progress but not enough to meet international targets. ¹

Every year, about 12 million adolescent girls are married before the age of 18, which translates to roughly 23 girls every minute entering unwanted, early partnerships.² This practice is not evenly distributed; it is more common in low- and middle-income countries, particularly in sub-Saharan Africa, where up to 41% of girls marry before 18, and in South Asia0ttwd- .³ Nigeria, for example, has one of the highest rates of child marriage in the world: an estimated 44% of girls are married before the age of 18, although recent reports indicate this may be declining nationally to around 30% as efforts to address the issue increase.⁴

The consequences of early marriage are profound. Girls who marry as children are far more likely to drop out of school, which severely limits their future economic opportunities and perpetuates cycles of poverty and dependency. Early marriage also exposes girls to higher risks of intimate partner violence, early and risky pregnancies, maternal health complications, and poor mental health outcomes. ⁵ Research shows that child brides experience worse health and social outcomes than their unmarried peers, and these effects often extend to their own children, undermining intergenerational well-being. ⁶

The prevalence of child marriage is influenced by multiple factors including poverty, lack of education, gender inequality, social norms, and in some regions, insecurity, and conflict. Data from Nigeria’s northern regions where poverty is high and educational outcomes are low shows early marriage remains particularly entrenched, with cultural practices and limited access to schooling contributing to higher rates. ⁷ The COVID-19 pandemic and other crises have also exacerbated these risks, as school closures, economic stress, and reduced social protections have increased vulnerability to early marriage in many communities. ⁸

Efforts to reduce child marriage require a multifaceted approach. Policies and laws that set the minimum age of marriage at 18 without exceptions must be enforced; girls’ access to quality education and economic opportunities must be expanded; and communities must be engaged to shift harmful norms that condone child marriage. Programs that empower adolescent girls with information, skills, and social support have been shown to delay marriage and improve life outcomes. International commitments, such as the Sustainable Development Goal target to eliminate child marriage by 2030, emphasize the importance of sustained action, yet projections suggest that without accelerated progress, child marriage will continue for decades in many countries. ⁹

Efforts by governments, civil society, families, and communities are essential to protect children and uphold their rights. Ending early marriage is not only a matter of legal compliance, but a moral imperative to ensure that every child can grow, learn, and contribute to society as an empowered adult.

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

 

References

  1. UNICEF. Child marriage prevalence and trends (global). https://www.unicef.org/protection/child-marriage (UNICEF USA)
  2. UNICEF Innocenti. What works to prevent child marriage. https://www.unicef.org/innocenti/innocenti/innocenti/what-works-prevent-child-marriage (unicef.org)
  3. UNICEF West and Central Africa. Child marriage in West and Central Africa. https://www.unicef.org/wca/child-marriage (unicef.org)
  4. UNICEF Nigeria. Child marriage rates and trends in Nigeria. https://www.unicef.org/nigeria/press-releases/nigeria-takes-bold-steps-end-child-marriage-and-protect-rights-children (unicef.org)
  5. Prevention Collaborative. Child, early, and forced marriage harms and impacts. https://prevention-collaborative.org/about-violence/child-early-and-forced-marriage/ (Prevention Collaborative)
  6. PubMed systematic review. Prevalence and factors associated with child marriage. https://pubmed.ncbi.nlm.nih.gov/37817117/ (PubMed)
  7. International Health (Oxford Academic). Spatial distribution of child marriage in Nigeria. https://academic.oup.com/inthealth/article/15/2/171/6589585 (OUP Academic)
  8. Early marriage and teenage pregnancy literature review (COVID-19 impacts). https://pmc.ncbi.nlm.nih.gov/articles/PMC8411836/ (PMC)
  9. UNFPA / UNICEF global programme and SDG targets. https://www.unfpa.org/child-marriage (unfpa.org)

 

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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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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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Removing Gender Barriers in Healthcare Access

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Removing gender barriers to healthcare is not only a matter of equity it is a moral and practical necessity if societies are to survive and thrive. Women and girls face layered obstacles to care: constrained mobility, financial dependence, harmful social norms, and health systems that are under-resourced and sometimes discriminatory. The World Health Organization highlights that gender norms and discrimination systematically limit access to services for women and girls, reducing their ability to obtain timely information, preventive care, and lifesaving treatment (1). These barriers are compounded by grim facility gaps: recent WHO/UNICEF data show billions are treated in health settings that lack basic water, sanitation, hygiene, and reliable electricity conditions that make safe maternal care and emergency treatment precarious (2). At the same time, progress toward universal health coverage (UHC) has slowed, leaving significant groups especially women in rural and low-income communities exposed to out-of-pocket costs and unmet needs (3).

The consequences are measurable and stark. Nigeria, for example, continues to bear a disproportionate share of global maternal deaths, a reality linked to regional inequalities in access, weak infrastructure, and funding shortfalls (4). Globally, analyses of health inclusivity reveal that refugees, displaced women, women with disabilities and other marginalized groups are far more likely to be denied or excluded from care in some cases by more than twenty percentage points compared with non-marginalized groups (5). These are not abstract injustices: they translate into delayed antenatal visits, unattended deliveries, untreated complications, and endless cycles of preventable suffering. Removing gender barriers means addressing the social drivers that prevent women from seeking care as urgently as fixing the physical gaps in facilities.

Civil society organisations and local actors are essential partners in closing these gaps. The Centre for Family Health Initiative (CFHI) works at the community level to confront both practical and cultural barriers to care: we run health education and rights-awareness campaigns that equip women and families with knowledge about available services and how to claim them; we strengthen linkages between households and primary health centres through referrals and case management; we support WASH and menstrual hygiene programmes so women can access services with dignity; and we provide capacity building for community health workers and facility staff so that care is both accessible and respectful (6). Where infrastructure is missing, CFHI has partnered with donors and initiatives to deliver pragmatic solutions for example installing solar birth kits in underserved PHCs to ensure safe night-time deliveries while simultaneously training Healthcare Professionals and Community Health Extension Workers (CHEWs) to enhance their competencies in clinical care, documentation, counselling, and emergency response, ensuring that PHCs can deliver reliable and respectful services across all essential health areas

To remove gender barriers at scale, governments, donors, and health systems must act on several fronts. First, finance primary health care adequately and ensure that essential services are free or financially protected at the point of use, so women are not forced to choose between care and survival. Second, invest in facility infrastructure WASH, electricity, cold chain and privacy provisions because dignity and safety are prerequisites for access. Third, embed gender-responsive policies across health programming: mandate respectful maternity care, train providers on implicit bias and discrimination, involve women and adolescent girls in service design, and expand targeted outreach for marginalized groups. Fourth, strengthen data systems to capture gender-disaggregated indicators and unmet needs so resource allocation can follow the evidence. Finally, create accountability mechanisms community scorecards, patient charters and independent oversight so promises become measurable action.

Change requires more than policy papers; it requires citizens, health workers, NGOs and governments to demand it and to act. We call on policymakers to prioritise gender responsive UHC financing and facility upgrades, on donors to fund long-term health system strengthening rather than short-term projects, on facility managers to adopt respectful care protocols today, and on community leaders to champion women’s right to health. If we truly value half our population, we will remove the gender barriers that deny women the healthcare they are owed.

References

  1. World Health Organization. Gender and health. Available from: https://www.who.int/health-topics/gender.
  2. World Health Organization; UNICEF. Countries making unprecedented efforts but billions still lack basic services in health-care facilities — WHO-UNICEF report warns. WHO website. 24 Sep 2025. Available from: https://www.who.int/news/item/24-09-2025-countries-making-unprecedented-efforts-but-billions-still-lack-basic-services-in-health-care-facilities—who-unicef-new-report-warns.
  3. World Health Organization. Universal health coverage (UHC) fact sheet. Available from: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc).
  4. The Guardian. ‘Difficult choices’: aid cuts threaten effort to reduce maternal deaths in Nigeria. 21 May 2025. Available from: https://www.theguardian.com/world/2025/may/21/aid-cuts-threaten-effort-reduce-maternal-deaths-nigeria.
  5. Economist Impact. Understanding health inclusivity for women. Available from: https://impact.economist.com/projects/health-inclusivity-index/inclusivity-topics/articles/understanding-health-inclusivity-for-women.
  6. Centre for Family Health Initiative (CFHI). Who we are / What we do. Available from: https://www.cfhinitiative.org.

 

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Beyond Stigma: Community-Led Support for Women and Girls Living with HIV

16DaysOfActivism, Gender, Gender Based Violence, Gender Equality, Health, Health Communication, HIV/AIDS, Hygiene, Men, Mental Health, Speak Wednesday /

Stigma remains one of the greatest obstacles to ending HIV: globally, according to the latest UNAIDS estimates, about 40.8 million people were living with HIV as of the end of 2024, with women and girls accounting for approximately 53% of all infections [1]. Despite progress in expanding treatment access bringing lifesaving antiretroviral therapy to over 31 million people worldwide millions still face stigma, discrimination, and social exclusion, which continue to limit their ability to seek testing, care, and long-term support [1].

Evidence shows that stigma discourages people from testing, delays linkage to treatment, and undermines adherence; pooled analyses across African surveys and facility studies find that people who experience stigma are significantly less likely to know their status or remain engaged in care, which in turn reduces chances of viral suppression and worsens health outcomes [2,3]. The scientific consensus that “U=U” (Undetectable = Untransmittable) underscores why ending stigma is also a prevention strategy: people on effective antiretroviral therapy (ART) who achieve and maintain an undetectable viral load do not sexually transmit HIV [4]. Despite these advances, gaps remain UNAIDS reports that while millions are on treatment, about 31.6 million people were accessing ART in 2024, leaving a substantial number still unreached by life-saving services [1].

Community-led support is central to bridging those gaps for women and girls. Practical, evidence-based community interventions peer support groups, community health worker follow-up, safe disclosure spaces, integrated mental-health services, and targeted outreach to adolescents have been shown to increase testing uptake, improve retention on ART, and reduce internalized stigma [5,6]. In Nigeria and other countries, facility-level and community studies link stigma with lower adherence and higher loss to follow up, highlighting the need for local, culturally sensitive responses that engage families, faith leaders, youth networks, and women’s groups [3,7]. Gender-sensitive programming is particularly important: women and girls face intersectional stigma driven by gender norms, economic dependence, and the risk of gender-based violence barriers that require combined social protection, livelihood support, and confidential clinical services to overcome [5].

At the Centre for Family Health Initiative (CFHI), community-led support is operationalized through sustained activities that go beyond one-day events. CFHI provides community HIV testing and counselling, adolescent-friendly education, psychosocial support, and peer navigation to link women and girls to care and keep them on treatment [8]. The organization integrates stigma-reduction messaging into gender-norms dialogues, trains community health volunteers in respectful care, and runs livelihood and empowerment sessions that reduce economic vulnerability an important factor that often forces women to remain in situations where disclosure is dangerous. CFHI’s community outreach also emphasizes U=U messaging to demystify treatment and encourage adherence and last year’s community testing and sensitization activities in Imo State reached hundreds with counselling and referrals, reinforcing the role of sustained local engagement in improving outcomes [8].

Ending HIV stigma requires action across sectors. Health facilities must adopt anti-discrimination policies and provide confidential, quality services; community leaders and faith institutions must publicly reject harmful narratives; schools and youth groups must deliver age-appropriate HIV education; and social protection programmes should prioritize women and girls so economic dependence does not block access to care. Donors and governments must sustain funding for community-led responses, which evidence shows are cost-effective and essential for reaching the UN targets to end AIDS as a public health threat [5,6].

Now is the time for communities to move from awareness to durable action. Support people living with HIV by learning and sharing accurate facts, joining, or starting peer support groups, encouraging friends and family to test, demanding respectful care at clinics, and supporting empowerment programmes that reduce vulnerability. CFHI and partners stand ready to work with communities, faith groups, schools, and health services to build safe, supportive environments where women and girls living with HIV can thrive. Together we can make stigma a thing of the past because when communities lead, lives change.

 

References

  1. Global HIV & AIDS statistics — Fact sheet. Geneva: Joint United Nations Programme on HIV/AIDS; 2025.
    Available from: https://www.unaids.org/en/resources/fact-sheet
  2. Doyle CM, Kuchukhidze S, Stannah J, Flores Anato JL, Xia Y, Logie CH, et al. The impact of HIV stigma and discrimination on HIV testing, antiretroviral treatment, and viral suppression in Africa: a pooled analysis of population-based surveys.
    Available from: https://www.researchgate.net/publication/391079137_The_Impact_of_HIV_Stigma_and_Discrimination_on_HIV_Testing_Antiretroviral_Treatment_and_Viral_Suppression_in_Africa_A_Pooled_Analysis_of_Population-Based_Surveys
  3. Mahlalela NB, et al. The association between HIV-related stigma and health-seeking behaviour, testing and adherence: a systematic review. J Public Health. 2024.
    Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896802/
  4. UNAIDS / IAS / Prevention Access Campaign. Undetectable = Untransmittable (U=U) consensus and evidence. Geneva: UNAIDS; 2018–2024.
    Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable
  5. World Health Organization. Eliminating stigma and discrimination in HIV responses: evidence and interventions. Geneva: WHO; 2022.
    Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics
  6. Community-led monitoring / Community-led responses — evidence and good practice. Geneva: UNAIDS; 2023.
    Available from: https://www.unaids.org/en/resources/documents/2023/community-led-monitoring-in-action
  7. Okunola A, et al. The impact of stigma on ART adherence in Ondo State clinics: cross-sectional evidence. Int J Res Innov Social Sci. 2025.
    Available from: https://rsisinternational.org/journals/ijriss/articles/the-impact-of-stigma-and-discrimination-on-adherence-levels-in-hiv-positive-patients-evidence-from-ondo-state-clinics/
  8. Centre for Family Health Initiative (CFHI). Community HIV services, stigma reduction and outreach report. Owerri: CFHI; 2024–2025.
    Available from: https://www.cfhinitiative.org

 

 

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