Nigerian women ensure they get the best health care by managing the unequal power relationship with men

Nigerian women ensure they get the best health care by managing the unequal power relationship with men

Nigeria is a patriarchal society. Authority is held by men, who tend to exert power and control over women in various areas of life. This impacts women’s health and decisions about their health care.

Women’s health is not only affected by medical conditions and childbearing, but also by cultural attitudes and traditions. Social factors such as gender access to health services or employment also influence people’s capacity to lead healthy lives.

Nigerian feminist scholar Obioma Nnaemeka describes feminism in the African context as a matter of negotiation and compromise. She calls it “negofeminism”. It involves a “give and take” rather than a confrontational exchange.

This concept helps me, as a global health researcher, to understand what rural Nigerian women have to say about seeking health care during and after pregnancy.

For our research, my colleagues and I interviewed women and their partners in two rural communities in southern Nigeria.

Our findings describe the ways in which women negotiate authority by assuming a decision-making role for their male partners while retaining influence over their maternity health care decisions and actions. The concepts of alliance, community, and connectedness of negofeminism are highlighted through the constructive involvement of men in maternal health.

We found that women are not passive victims. Instead, they navigate the patriarchal environment to produce the best possible maternal health outcomes by gaining control over their health care decisions.

Recognizing this form of agency can assist in formulating policies and programs that recognize how women’s wider social environment affects their health.

Maternal health in Nigeria

In Nigeria, limited access to quality health services contributes to 556 pregnancy-related deaths per 100,000 live births. UNICEF reports that Nigeria accounts for 10% of the global burden of pregnancy-related deaths.

Some scholars argue that women can only seek health care if they can make their own decisions. However, this approach often ignores women’s realities, such as the fact that their social networks (mothers, grandmothers, spouses and community members) influence their use of health services.

However, as our research shows, the social dimension does not necessarily impede women’s autonomy.

Therefore, I believe that discussions about maternal health in the African context need to consider women’s experiences of being “African” and “woman”.


We studied two predominantly rural communities in Southeast Esan and West Etsako, local government areas of Edo State in southern Nigeria. We conducted five FGDs for women with a total of 39 women, and three FGDs for men with 25 men. Participants were selected from a database of women participating in a maternal health intervention.

We asked them which women consulted for antenatal care first, and who made the decision to seek maternal health care. We also asked about their experiences with men’s involvement in maternal and child health.

We categorized their responses as negotiation, collaboration, and maneuvering.

It seems that men are considered as decision makers at the household level. Participants said the woman’s partner should be the first to know about her pregnancy. Both men and women say men should make all decisions about health care during pregnancy, even though it’s clear that sometimes women influence decisions.

Describing her experience, one woman said:

In the maintenance aspect, I will tell my husband, so he will decide. After my husband finds out, I will go to the hospital to tell the doctor so he can tell me what to do.

Likewise, the men noted that women “couldn’t just go to a health facility without the husband’s decision”.

But they also make comments like:

My wife would tell me, ‘take me and see the nurse’. When I’m not around, he can go to the doctor himself. It is commonplace in our society.

Both men and women say it’s important to get skilled care, especially for complications.

The act of women informing men can be seen as a form of negotiation by women to influence decisions on access to maternal health care. First, he recognizes the patriarchal environment and gives decision-making authority to men. But he also exercised his agency in that environment.

The notion of male responsibility and collective action on maternal health is evident in this study. In these communities, a man’s job as a father-to-be is mostly financial support to cover expenses associated with pregnancy, including clinic visits, delivery costs, essential medicines and meals.

It can be said that in giving decision-making authority to men, women benefit from the duties and responsibilities of men to be breadwinners. Women say they cannot afford the high costs of maternal healthcare on their own. There is a “give and take”.

Some women show their rejection of male involvement in their pregnancies. They reported surreptitiously seeking maternal health care without informing their partners. In this they show control over their lives.

Why is this important

Our findings show that it is important to involve women’s communities and partners in maternal health programs.

We show that patriarchy gives men power over decision-making or financial resources. Women are not passive in this situation, they are actively looking for ways to ensure they have access to skilled health care during pregnancy.

This study shows that maternal health is not always the responsibility of the individual – it can be the responsibility of the women’s community and the nation. Ignoring this can undermine programs and policies aimed at improving women’s health.

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