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Advancing Equitable Access to Primary Healthcare for Women and Girls

Community Development, Female Roles in Nation Building, Gender, Gender Equality, Girl Education, Global warming, Health, Health Communication, Speak Wednesday, WHO, Women, Women Education, Women's Rights /

Access to quality primary healthcare is a fundamental human right, yet for millions of women and girls in Nigeria and across sub-Saharan Africa, this right remains far from reality. Despite global commitments to universal health coverage, structural inequalities continue to shape who gets care, when, and how. In Nigeria, nearly 52% of women report facing at least one barrier to accessing healthcare, with financial constraints, distance to facilities, and lack of autonomy among the most pressing challenges [1]. These barriers are not just statistics; they translate into preventable suffering and loss of life. Nigeria continues to carry one of the highest burdens of maternal mortality globally, with an estimated 145 women dying daily from pregnancy-related causes and a lifetime risk of 1 in 18 for women [2].

The roots of this inequity are deeply embedded in socioeconomic and cultural systems. For many women, especially those in rural and underserved communities, the cost of healthcare remains prohibitive. Out-of-pocket payments dominate the health financing system, and without adequate insurance coverage, seeking care often becomes a last resort rather than a first step. Even when services are available, geographic barriers such as long distances to health facilities, poor road networks, and inadequate transportation systems further limit access [3]. Compounding these challenges are entrenched gender norms that restrict women’s ability to make independent decisions about their health. Evidence shows that in some settings, more than half of healthcare providers still believe women should not independently choose family planning methods, reflecting systemic biases that undermine women’s agency [4].

Weak health systems further widen the gap. Many primary healthcare facilities lack skilled personnel, essential medicines, and functional infrastructure, making them unable to meet the needs of women and girls effectively. At the same time, the growing reliance on digital health solutions risks leaving women behind due to persistent gender gaps in digital access and literacy [5]. These overlapping barriers highlight the urgent need for a more inclusive and equitable approach to healthcare delivery.

Yet, evidence consistently shows that strengthening primary healthcare systems is one of the most effective ways to improve health outcomes for women and girls. Community-based healthcare models, particularly those that deploy trained community health workers, have demonstrated remarkable impact, contributing to reductions of up to 30% in child mortality by bringing essential services closer to households [3]. Beyond saving lives, equitable primary healthcare improves family planning uptake, enhances disease prevention, and strengthens the overall resilience of communities.

Recognizing these realities, the Nigerian government has introduced several interventions aimed at expanding access to primary healthcare. The National Primary Health Care Development Agency (NPHCDA) continues to play a central role in revitalizing primary healthcare systems and improving service delivery at the grassroots level [6]. Initiatives such as the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII) have been implemented to tackle high maternal mortality rates through targeted system strengthening and improved care delivery [2]. At the state, Centre for Family Health Initiative (CFHI)’s BIRTH Project have demonstrated promising results in improving maternal and child health outcomes by addressing malnutrition through community-based education, promotion of optimal infant and young child feeding practices, and strengthened linkage to quality primary healthcare services [9]. Community-Based Health Insurance Schemes have also emerged as a practical approach to reducing out-of-pocket expenses and improving access to care for vulnerable populations [7].

Beyond government efforts, international organizations and development partners have contributed significantly to advancing equitable healthcare. UNICEF’s Equitable Impact Sensitive Tool (EQUIST) has supported policymakers in identifying and prioritizing interventions that address disparities in maternal and child health outcomes [8]. The World Health Organization continues to advocate for decentralized, community-based healthcare delivery models and gender-responsive health systems that prioritize the needs of women and girls [3]. At the same time, partnerships leveraging digital innovation are opening new pathways for service delivery, although these must be intentionally designed to close, rather than widen, existing gender gaps.

Despite these efforts, progress remains uneven, and much more needs to be done. Advancing equitable access to primary healthcare for women and girls requires sustained investment in healthcare infrastructure, particularly in rural and underserved areas, alongside expanded health insurance coverage to reduce financial hardship. It demands policies that actively challenge gender inequality and empower women to make informed decisions about their health. Strengthening community health systems, improving health education, and ensuring inclusive governance with women represented in leadership and decision-making processes are equally critical.

Equitable access to primary healthcare is not just a health issue; it is a matter of justice, dignity, and human rights. No woman should die while giving life, and no girl should be denied access to care because of poverty, distance, or discrimination. The time to act is now. Governments, civil society organizations, and development partners must intensify efforts to dismantle barriers, invest in inclusive systems, and prioritize women and girls in health policies and programs. By doing so, we can build a future where every woman and every girl can live a healthy, empowered life.

References

[1] https://en.wikipedia.org/wiki/Women_in_Nigeria
[2] https://articles.nigeriahealthwatch.com/iwd2025-accelerating-womens-access-to-quality-care-for-improved-maternal-outcomes/
[3] https://www.afro.who.int/sites/default/files/2017-06/report-of-the-commission-on-womens-health-in-the-african-region—chapter-6.pdf
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC7934485/
[5] https://gatesopenresearch-files.f1000.com/posters/docs/gatesopenres-208586.pdf
[6] https://en.wikipedia.org/wiki/National_Primary_Health_Care_Development_Agency_%28Nigeria%29
[7] https://womeningh.org/the-road-to-uhc-passes-through-gender-responsive-health-systems-the-case-of-wgh-nigeria/
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC7046112/                                                                              [9] https://www.cfhinitiative.org/news/promoting-maternal-nutrition-through-food-demonstration-at-adamawa-phc/

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Integrated Health and Sanitation Approaches for Tuberculosis Prevention

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Tuberculosis (TB) remains a major public health concern globally and in Nigeria, requiring a comprehensive and integrated approach that combines healthcare services with sanitation and environmental interventions. TB is caused by Mycobacterium tuberculosis and spreads through airborne droplets when an infected person coughs or sneezes. Globally, TB continues to be one of the leading infectious killers, with millions of new infections recorded annually. Nigeria is among the top high-burden TB countries, with an estimated incidence rate of 219 cases per 100,000 population and hundreds of thousands of infections reported yearly². Despite progress, gaps in early detection, treatment access, and environmental health conditions continue to drive transmission.

An integrated approach to TB prevention recognizes that the disease is not only a medical issue but also closely linked to living conditions, sanitation, and social determinants of health. Research shows that TB transmission is higher in overcrowded, poorly ventilated, and unsanitary environments, where airborne bacteria can easily spread⁷. In many communities, poor housing, inadequate waste management, and lack of hygiene practices contribute to increased exposure. Studies further highlight that weak implementation of infection prevention and control measures in health facilities also increases transmission risks among patients and healthcare workers⁷.

Effective TB prevention therefore requires combining health interventions with sanitation and hygiene (WASH) strategies. From a health systems perspective, early diagnosis and prompt treatment are critical. The World Health Organization emphasizes that starting TB treatment quickly after diagnosis significantly reduces transmission and improves outcomes¹. In addition, contact tracing and active case finding have proven effective. For instance, community-based screening interventions in Nigeria have shown that targeted contact investigation yields higher TB detection rates compared to general screening approaches, demonstrating the importance of integrated community health strategies¹².

Sanitation and environmental health measures also play a vital role in TB prevention. Improving ventilation in homes, schools, and health facilities reduces the concentration of infectious droplets in the air. Promoting good hygiene practices, such as covering the mouth when coughing and reducing indoor air pollution, helps limit transmission. Addressing overcrowding and ensuring access to clean and safe living environments are equally important. Furthermore, strengthening nutrition is essential, as malnutrition weakens immunity and increases susceptibility to TB infection.

Integrated interventions must also address vulnerable populations. TB is closely associated with HIV infection, poverty, and weak immune systems, making collaborative TB/HIV programs essential. In Nigeria, about 4.9% of TB patients are co-infected with HIV, highlighting the need for integrated service delivery that includes HIV testing, treatment, and TB care⁰. The global End TB Strategy also emphasizes patient-centered care, strong health systems, and community engagement as key pillars for reducing TB burden⁵.

Organizations like the Centre for Family Health Initiative (CFHI) play a critical role in advancing integrated TB prevention efforts in Nigeria. Through community-based programs, CFHI supports TB awareness, screening, referral, and linkage to treatment services, particularly among vulnerable populations such as children, adolescents, and people living with HIV. The organization also promotes health education, hygiene practices, and community mobilization, helping to address both the medical and environmental factors driving TB transmission. CFHI’s work aligns with national and global strategies that emphasize integration of health services with social and behavioral interventions.

To strengthen TB prevention, several measures should be prioritized. First, expand community-based TB screening and early diagnosis services to detect cases early. Second, improve sanitation and housing conditions, especially in high-density communities. Third, promote WASH interventions, including hygiene education and environmental cleanliness. Fourth, strengthen infection prevention and control practices in health facilities to protect both patients and healthcare workers. Fifth, increase public awareness campaigns to reduce stigma and encourage timely healthcare seeking. Finally, ensure consistent access to free TB treatment and adherence support, as treatment success rates can reach over 90% when properly followed⁰.

The fight against tuberculosis requires a multi-sectoral and integrated response that goes beyond clinical treatment. By combining health services with sanitation, environmental improvements, and community engagement, it is possible to significantly reduce TB transmission and improve health outcomes. Individuals also have a role to play by seeking early testing when symptoms appear, maintaining good hygiene practices, and supporting affected persons without stigma.

 

Tuberculosis is preventable and curable, but only when detected and treated early. Communities, health workers, organizations, and policymakers must work together to strengthen integrated health and sanitation interventions. If you experience symptoms such as a persistent cough lasting more than two weeks, fever, or weight loss, visit the nearest health facility for testing. Together, through improved hygiene, better living conditions, and timely treatment, we can reduce the burden of TB and move closer to ending the epidemic.

References

  1. World Health Organization – TB Prevention and Infection Control
    https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023/tb-prevention
  2. CDC Nigeria TB Data and Statistics
    https://www.cdc.gov/global-hiv-tb/php/where-we-work/nigeria.html
  3. WHO Global Tuberculosis Programme – Nigeria Case Study
    https://www.who.int/docs/default-source/documents/tuberculosis/engage-tb-nigeria-case-study.pdf
  4. National Tuberculosis and Leprosy Control Programme (NTBLCP)
    https://ntblcp.org.ng/
  5. WHO End TB Strategy Overview
    https://afro.who.int/health-topics/tuberculosis-tb
  6. BMC Public Health – TB Burden and Treatment Outcomes in Nigeria
    https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09289-x
  7. BMC Infectious Diseases – TB Infection Control in Nigeria
    https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1453-y
  8. TB Preventive Practices Study (Nigeria)
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10262855/
  9. TB Infection Control Study (Enugu, Nigeria)
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9120735/
  10. WHO TB Case Finding Initiatives in Nigeria
    https://www.afro.who.int/countries/nigeria/news/intensifying-new-initiatives-tb-case-finding-nigeria

 

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Early Symptoms of Tuberculosis and Why Prompt Treatment Matters

Community Development, Female Roles in Nation Building, Gender, Gender Based Violence, Global warming, Health, Health Communication, Men's Health, Monday Health Burst, Nation Building, WHO, Women Education /

Tuberculosis (TB) remains one of the world’s most significant infectious threats, claiming approximately 1.25 million lives globally in 2023 alone 3. Despite being a preventable and curable bacterial infection, its ability to remain dormant makes early detection a critical challenge. The primary red flag is a persistent cough lasting three weeks or longer, often accompanied by chest pain and the coughing up of blood or blood-stained sputum 1. These early signs are the body’s alarm system indicating that the Mycobacterium tuberculosis bacteria are actively attacking the lung tissue, necessitating immediate medical evaluation to prevent permanent respiratory damage.

In addition to respiratory issues, the disease often presents with systemic symptoms that are frequently mistaken for minor ailments. Patients may experience unexplained weight loss, a total loss of appetite, and a persistent low-grade fever accompanied by chills 1. One of the most distinctive markers of the infection is the occurrence of heavy night sweats, where a person wakes up with soaked bedding regardless of the room temperature or weather conditions 2. Fatigue and a general sense of weakness also prevail as the body’s immune system is stretched thin while attempting to combat the bacterial load within the lungs.

Prompt treatment is a necessity for both individual survival and public safety because a person with active, untreated pulmonary TB can infect between 10 to 15 other people through close contact in a single year 3. When treatment is delayed, the bacteria have more time to multiply and potentially spread to other parts of the body, such as the spine or kidneys. Furthermore, delaying the start of the standard six-month medication course significantly increases the risk of developing Multi-Drug Resistant TB (MDR-TB). This strain does not respond to the most powerful first-line drugs and requires longer, more toxic, and significantly more expensive treatment regimens with lower survival rates 4.

According to the 2024 WHO Global Tuberculosis Report, while the global treatment success rate for drug-susceptible TB is a high 88%, a massive gap in funding persists. Currently, global investment stands at US$ 5.7 billion, which is far below the required US$ 22 billion annually needed to meet 2027 targets 3. This funding gap limits the availability of rapid diagnostic tools, such as GeneXpert machines, especially in high-burden regions. To mitigate this impact, communities must prioritize environmental ventilation to reduce airborne droplet concentration and ensure strict adherence to the Directly Observed Treatment Short-course (DOTS) strategy, where healthcare workers supervise medication intake 2.

Over the years, CFHI has established strategic partnerships with key stakeholders, particularly the National Tuberculosis and Leprosy Control Programme (NTBLCP), to facilitate community sensitization, mass screenings, and the delivery of essential TB services. Currently, CFHI provides these services in Imo State with support from relevant partners and stakeholders.

Ultimately, ending TB requires early action, community awareness, and the removal of social stigma. If you or anyone you know has experienced a persistent cough for more than two weeks, visit the nearest Primary Health Centre for a free TB test. TB treatment is free at government-supported health facilities, and completing the full course of medication ensures cure and prevents the spread of infection.

By recognizing symptoms early, supporting those undergoing treatment, and encouraging routine screening, we can protect our families and move closer to a TB-free future.

References

  1. Mayo Clinic: Tuberculosis Symptoms & Causes
  2. Centers for Disease Control and Prevention (CDC): Basic TB Facts
  3. World Health Organization (WHO): Global Tuberculosis Report 2024
  4. Stop TB Partnership: MDR-TB Factsheet

 

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Unsafe Water and Poor Sanitation: Hidden Threats to Community Health

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By Chiadika Emmanuel Chidera 

Unsafe water and poor sanitation remain major but often overlooked threats to community health. Access to clean drinking water and safe sanitation is a fundamental human right and a critical pillar of disease prevention. Yet millions of people around the world still lack these essential services. According to global health data, about 2 billion people do not have access to safely managed drinking water, while nearly 3.6 billion people lack safely managed sanitation services¹. These gaps create conditions where preventable diseases easily spread, particularly among vulnerable populations such as children and women.

Contaminated water often carries harmful bacteria, viruses, parasites, and toxic substances that can lead to serious illnesses. Diseases such as cholera, typhoid fever, dysentery, hepatitis A, and diarrhoea are commonly transmitted through unsafe water. Health estimates show that approximately 1.4 million deaths each year are linked to inadequate water, sanitation, and hygiene (WASH) services². Diarrhoeal diseases alone cause over 1 million deaths annually, with nearly 395,000 of these deaths occurring among children under the age of five². In Nigeria, the situation remains concerning, as reports indicate that over 100 children die daily from diarrhoeal diseases, many of which are connected to unsafe water sources and poor sanitation practices⁴.

The health hazards associated with unsafe water and poor sanitation are wide-ranging. These include (1) the rapid spread of waterborne diseases such as cholera and typhoid, (2) severe diarrhoeal infections that cause dehydration and malnutrition, (3) parasitic infections like intestinal worms that affect about 1.5 billion people globally³, (4) long-term malnutrition and stunted growth among children due to repeated infections, and (5) exposure to chemical contaminants that can lead to organ damage and developmental problems. Poor sanitation practices such as open defecation further worsen these risks by contaminating water sources and the surrounding environment.

Beyond the health effects, unsafe water and poor sanitation also create social and economic challenges. Families often spend limited resources on treating preventable diseases, children miss school due to illness, and communities experience reduced productivity. Research shows that improving water, sanitation, and hygiene services can reduce diarrhoeal diseases by 30–40 percent³, making WASH one of the most cost-effective public health interventions.

Addressing this hidden crisis requires coordinated action from governments, communities, and development partners. Expanding access to safe water infrastructure, improving sanitation facilities, and promoting hygiene education are critical steps toward protecting public health. Individuals and communities can also contribute by (1) using safe or treated drinking water, (2) practicing proper sanitation and avoiding open defecation, (3) washing hands regularly with soap, and (4) protecting local water sources from contamination.

Improving water, sanitation, and hygiene services is essential for building healthier communities and preventing avoidable diseases. By prioritizing safe water and proper sanitation, societies can protect lives, strengthen public health systems, and ensure a healthier future for all.

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. UNICEF & World Health Organization Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP). https://washdata.org
  2. World Health Organization. Global Burden of Disease Attributable to Water, Sanitation and Hygiene. https://www.who.int/health-topics/water-sanitation-and-hygiene-wash
  3. Centers for Disease Control and Prevention. Global Water, Sanitation, and Hygiene (WASH) Data. https://www.cdc.gov/healthywater/global/index.html
  4. Nigeria WASH and diarrhoeal disease statistics. https://washnigeria.com

 

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

Community Development, End FGM, Female Genital Mutilation, Female Roles in Nation Building, Gender, Gender Based Violence, Gender Equality, Girl Education, Global warming, Health, Health Communication, International Day of Rural Women, Mental Health, Monday Health Burst, Reproductive Health, SDG, Speak Wednesday, Special Events, Stop FGM, Uncategorized, WHO, Women, Women Education, Women in Leadership, Women's Rights /

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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Maternal Health – Access to Care

Climate change, Community Development, Cultural practices in Africa, Gender, Gender Based Violence, Gender Equality, Girl Education, Global warming, Health, Health Communication, Hygiene, Monday Health Burst, Reproductive Health, Special Events, WHO /

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

Attention Deficit, Child Labour, ChildNotBride, Community Development, Cultural practices in Africa, End FGM, Events, Female Genital Mutilation, Female Roles in Nation Building, Gender, Gender Based Violence, Gender Equality, Girl Education, Global warming, Health, Health Communication, Mental Health, Monday Health Burst, Nation Building, Reproductive Health, Women, Women's Rights /

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.

Child Trafficking, ChildNotBride, Community Development, Cultural practices in Africa, End FGM, Female Genital Mutilation, Female Roles in Nation Building, Gender, Gender Based Violence, Gender Equality, Girl Education, Global warming, Health, Health Communication, Mental Health, Postpartum Depression, Reproductive Health, Speak Wednesday, WHO, Women, Women Education, Women in Leadership, Women's Rights /

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 »

Families as Frontline Defenders Against Harmful Practices.

Community Development, Cultural practices in Africa, Female Genital Mutilation, Female Roles in Nation Building, Gender, Gender Based Violence, Gender Equality, Girl Education, Global warming, Health, Health Communication, Mental Health, Monday Health Burst, Reproductive Health, Women Education, Women in Leadership, Women's Rights /

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

Families as Frontline Defenders Against Harmful Practices. Read More »

Gender-Bias Sustains Violence Against Girls

Community Development, End FGM, Female Genital Mutilation, Female Roles in Nation Building, Gender, Gender Based Violence, Gender Equality, Girl Education, Global warming, Health, Health Communication, Speak Wednesday, Special Events, Stop FGM, WHO, Women, Women Education, Women in Leadership /

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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