Social Inequalities In Relation To Reproductive Health Among Females In Lagos, Nigeria

Health Inequalities: Social Determinants & Female Reproductive Health

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Social Inequalities Among Females In Lagos, Nigeria Assignment Sample

Introduction of Social Inequalities Concerning Reproductive Health Among Females

The healthcare system can be referred to as the spectrum of people and established centers whose prime intention is to promote health. This also encompasses the restoration and maintenance of the health of the individuals. Thereafter, in the slums of Lagos, Nigeria, adolescent females are unwillingly facing inequalities regarding their sexual and reproductive health. Nigeria is a "lower-middle-income" country and thus, faces formidable challenges in the areas of development that implicates the healthcare system of the country. Being one of the most populous countries in the Sub-Saharan African borders, it fails to cater to the needs of the adolescent females dwelling in the slum areas of Lagos in Nigeria. Nigeria is considered a developing country among the 152 countries in the globe by IMF with the present human index ratio standing at 0.535 in Nigeria (Nhis.gov.ng, 2021). Additionally, access to a better healthcare system and social and cultural determinants are also deeply intertwined when it comes to the maintenance of sexual and reproductive healthcare. Therefore, presently, the thesis statement is focused on finding the deeply embedded inequalities that lie in many social factors that determine the overall well-being of female adolescents which would also highlight how it leads to inequalities in sexual and reproductive health in adolescent females of Lagos, Nigeria.

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Main Body - Inequalities In Reproductive Health Among Females

Nigeria, being a populous and lower-middle-income country in the Sub-Saharan African borders faces intimidating challenges to cater to the needs of female adolescents for their sexual and reproductive health which is determined by the socioeconomic status of the country and their population. This leads to inequalities in their well-being in the aspects of sexual and reproductive health. Social determinants of health can be referred to as the personal conditions that implicate their well-being and restoration of proper health conditions (Wado et al., 2022). Social determinants encompass the factors like income, education, access to healthcare facilities, awareness of specific causes, unemployment, residing and working environment, food facilities, and household facilities and amenities that eventually implicate the well-being of an individual (Nowshin et al., 2022). This also highlights the accessibility of these facilities and when the individuals have access, it questions the quality of these facilities that they are being accessible to implies to their well-being and restoration of health in Lagos, Nigeria.

Types of Social Determinants

The first social determinant to be considered is income and its stability in the families of adolescent females which leads to inequalities in the maintenance of well-being in sexual and reproductive health conditions (Akinyemi et al., 2021). As was highlighted in the above section that Nigeria falls into the category of a lower-middle-income country with a sub-category of developing country in the Sub-Saharan African borders, this also implicates the individuals whose income cannot provide the accessibility to better healthcare facilities and a better education system. The slums of Lagos, in Nigeria, are known for the devastating conditions for the families that live a very unprivileged life and are lesser acquainted with the facilities and amenities that are required for appropriate sexual and reproductive health for female adolescents. However, the families residing in the slums of Lagos have more than two children in each family yet they are not monetarily sufficient to support them in a proper way (Akinyemi et al., 2022). Female adolescents are subjected to poor sexual and reproductive as their earning members cannot give them access to a better healthcare system. Furthermore, the government cannot provide better healthcare facilities to these female adolescents residing in the slums of Lagos due to the huge population and lower income per capita (Health.gov.ng, 2021). Therefore, these aspects of income lead to inequalities in sexual and reproductive healthcare for female adolescents in Lagos, Nigeria.

The second determinant is education which implicates the income factor which is directly proportional to the determinants of sexual and reproductive health and well-being. The slums of Lagos have access to generic education but they do not have the facilities for high-quality education that the urban residents have as they are subjected to better income facilities compared to the slum residents in Lagos (Esan et al., 2022). Schools and universities with high-quality education are localized in the better areas of urban sectors of Lagos. The youth section, when they are not privileged to better education facilities and better educational quality leads to poor job facilities that might not suffice for running a household in the slum areas of Lagos. Additionally, the earning members of these families are employed in unskilled or semi-skilled jobs that do not fulfill the adequate requirements of wages that would be enough to provide better amenities to the members of the families (Sidze et al., 2021). Thereafter, inadequate educational facilities lead to insufficient employability and wages which implicates the situation of inequalities that pose a threat to their sexual and reproductive health.

The third determinant is access to healthcare facilities which daunts the factors of inequalities in the case of sexual and reproductive health among female adolescents residing in Nigeria. As suggested, access to better healthcare facilities will only be possible when there is a better economic background of the families (Chawhanda et al., 2022). Quality healthcare amenities are only available to those who are privileged in their economic background. The government of Nigeria provides healthcare facilities that are free of cost like community health clinics, community hospitals, and medicine vendors that provide free life-saving medicines (Ncbi.nlm.nih.gov, 2020). The mortality rate is higher compared to urban areas as they are advantaged in the sections of obtaining better healthcare facilities. Furthermore, sexual hygiene and protectiveness are not accounted for when the government is providing healthcare facilities in the slums of Lagos (Health.gov.ng, 2021). However, reproductive healthcare is still accounted for while providing facilities for maternal care and childbirth in Lagos yet they are not adequate in keeping the health in a better circumstance for female adolescents.

Fourthly, awareness is another determinant that accounts for inequalities in sexual and reproductive health. Inadequate awareness of health issues like sexual and reproductive aspects leads to poor maintenance of sexual and reproductive health among female adolescents living in the slums of Lagos in Nigeria (Bacigale, 2022). Inadequate to no awareness in the areas of sexual and reproductive health leads to inequalities by the government toward female adolescents. Awareness campaigns on sexual hygiene and protection can hamper the health of female adolescents as it might subject them to various sexually transmitted diseases that might take a toll on their health (Uwadia et al., 2022). Additionally, female adolescents are subject to early marriage due to their poor education and unemployment, which accounts for lives that are not opinionated, which determines the inequalities in the healthcare system. Moreover, reproductive healthcare is also unprivileged, as they are subject to pregnancies and childbirth which were a result of poor healthcare amenities (Green et al., 2022). Furthermore, inadequate maternal care during pregnancy and childbirth can take a toll on the health of these female adolescents residing in the slums of Lagos. Awareness campaigns should be organized regarding these issues to obtain adequate healthcare facilities from the government and the family members.

The fifth determinant is unemployment and the working environment that adds to the inequalities that are accounted for in the sexual and reproductive health of female adolescents residing in the slums of Lagos, Nigeria. Poor education or no education at all leads the earning members of the family to unskilled or semi-skilled jobs that do not fulfill the wage requirements to run a household in the slum areas of Lagos (Ukonu et al., 2021). Additionally, the wage earned is spent mostly on providing food for the family and fulfilling the household requirements. The leftovers are spent on health and educational amenities. Unemployment can lead to inaccessibility to little or no healthcare facilities (Kunnuji et al., 2018). Moreover, the governmental facilities are not adequate at all to fulfill the requirements for sexual and reproductive health which leads to inequalities in obtaining and providing better healthcare facilities accounting for the sexual and reproductive well-being of female adolescents.

The sixth determinant is the poor resident environment that accounts for inequalities in sexual and reproductive health. Inadequate awareness of health issues like sexual and reproductive aspects leads to poor maintenance of sexual and reproductive health among female adolescents living in the slums of Lagos in Nigeria (Polis et al., 2022). Unhygienic living conditions and poor sanitation can lead to various diseases that can directly or indirectly implicate the sexual and reproductive health of the female adolescents living in the slums of Lagos, Nigeria. Lower-income strata cannot provide healthcare facilities (Jarke, 2018). Thereafter, additional diseases arising from poor and unhygienic living conditions may worsen the health of female adolescents in the slums of Lagos.

Finally, the last determinant is food facilities and household amenities that account for inequalities in sexual and reproductive health. Inadequate awareness of health issues like sexual and reproductive aspects leads to poor maintenance of sexual and reproductive health among female adolescents living in the slums of Lagos in Nigeria (Shantilwe et al., 2021). Inadequate income or no income at all subjects families to malnutrition and poor healthcare. Inadequate food and proper household amenities eventually subject female adolescents to inequalities regarding their sexual and reproductive health while residing in the slums of Lagos, Nigeria (Park et al., 2022). Additionally, inadequate food can hamper the health of the expecting mothers and the mothers post-childbirth. This will also lead to the malnutrition of newborn babies which can lead to ill health (Muluneh et al., 2020). Improper and inadequate household amenities can escalate the conditions of sexual and reproductive health in female adolescents in the slums of Lagos, Nigeria.

Social issues are a major factor in health problems in terms of sexual abuse and issues among females in adolescence. The unhealthy and unhygienic methods of living standards or livelihood have resulted in the arising of various diseases related to sexual health and well-being (Odimegwu & Adewoyin, 2022). The people residing in the slums of Lagos in Nigeria of Africa are known to have major issues with sexual health. Healthy well-being in the context of sexual health is an important factor of living that the slum people of Lagos lack (Aerts, 2018). The population residing in the slum of Lagos lack the knowledge of sexual health as well as hygiene thereby resulting in high incidences of health issues among the females of adolescent groups. The adolescent women population of the slums are observed to be living an unhealthy and unprotected life and lack basic education (Akinyemi et al. 2022). There is also a prevalence of gender inequality and other social problems in the urban slums of Nigeria in Africa. Social inequality, lack of education and poor employment status are major problems in the slums of Lagos in Nigeria (Wado et al. 2020). Social disparities are therefore major factors in the rising issues of sexual health in adolescents especially the female population of Lagos residing in slums.

Potential Solutions to the Social Issues

The issues can be solved by organising campaigns in the society of Lagos and involving the maximum participation of the slum population. The government as well as non-government organisations involved in the improvement of social health should focus on creating awareness among the population of the slums of Lagos in Nigeria (Akpabio et al. 2021). Social drawbacks that are prevalent in society should be discussed with the slum population and the remedies to improve the disparities should be acknowledged. Campaigns in different zones of slums of Lagos can help in educating the residents and induce a better understanding of healthy standards of living (Nowshin et al. 2022). It is important to educate the slum population so that they can be enlightened about the disadvantages of the prevailing sexual ill-being and the health adversity among women. Campaigns with health and medical facilities in the slums can aid the government of Nigeria to keep records of the sexually unhealthy as well as healthy adolescent women population (Liang et al. 2019). Non-government organisations should focus on educating women and female children from the groups of teenagers to adolescents about sexual well-being. Therefore campaigns along with education can help in the improvement of the knowledge of the women groups of the slums of Lagos in Nigeria.

The aforementioned education system organised by non-government organisations involves adult as well as adolescent women only. However, it is also important to include sexual education among school-going children in schools (Melesse et al. 2020). This can educate them about the problems of unhealthy sexual habits and the diseases that can be contracted by women. It is observed that the women adolescent population of the slums of Lagos suffer from a wide range of genital issues and sexual issues (George et al. 2020). The most commonly identified issues include excess vaginal discharge, vaginitis and cervical cancer. Cervical cancer is found to be malignant among females in Nigeria in urban slums (Prather et al. 2018). Bacterial “vaginosis” has increased the incidences of vaginal discharge as well as vaginitis. These adverse “sexually transmitted diseases (STDs)” have increased over time among the women population in Nigeria and especially in the urban slums (Chandra-Mouli, Neal & Moller, 2021). The slums of Lagos in Nigeria have therefore recorded an increase in “sexually transmitted diseases” among adolescent women. The diseases have resulted in an increased number of fatalities among adolescent females due to social unhealthy living and inequalities (Odimegwu & Adewoyin, 2022). Thus it is evident that the women of the slums of Nigeria have been highly prone to suffering from diseases which are sexually transmitted.

In Nigeria, there is a high prevalence of social inequalities in addition to discrimination in the slums in terms of education and employment. There is an occurrence of inequalities in the education system of the children of the slums of Lagos in Nigeria still today (Aerts, 2018). Even in the present-day world, the females in the slums of Nigeria lack education and health well-being. The lack of education has resulted in the lack of basic knowledge of health issues and social issues caused due to unhealthy standards of living (Akinyemi et al. 2022). The lack of education has resulted in the lack of employment among the women of the slum population. High incidences of gender inequalities have caused an increased presence of sexual unawareness and knowledge among women (Wado et al. 2020). Most women lack knowledge of sexual health and healthy sexual practices to prevent themselves from being contracted “sexually transmitted diseases (STDs)". The diseases that are transmitted through sexual practices have resulted in poor health among adolescent women and also sometimes death at an early age (Akpabio et al. 2021). In the slums of Lagos in Nigeria, there are increased incidences of death among young adolescent women caused due to sexual illness.

In order to ward off the inequalities in education among the population of the slums in Nigeria the government of Nigeria should focus on introducing education facilities for the female population. The government should introduce schools for female children in the slum and educate them with basic knowledge of social well-being in addition to sexual well-being (Nowshin et al. 2022). The healthy practices to be followed at the time of copulation by women are necessary for their health and safety. The knowledge of transmissible diseases due to sexual intercourse should be widespread among the women population, especially the adolescent groups (Liang et al. 2019). The adolescent group of females should be specifically enlightened with the knowledge of sexual health and diseases that can easily affect their life expectancy. Both the non-government and government agencies should organise seminars and spread knowledge of various adversities and unhealthy living standards and their impact on the health of women (Melesse et al. 2020). Programmes should be launched by health service providers and government officials to keep track of the female adolescent groups who are pregnant and their health status. The prevalence of the number of adolescent pregnant women in the slums of Lagos are to be recorded and regular check-up must be provided by the health agencies and officials.

There are also incidences of low income among the groups of families residing in the slums of Lagos in Nigeria. The records have shown that the population of the urban slums is mainly prone to high incidences of “poverty" (George et al. 2020). The women groups of the slums in Nigeria are known to lack employment facilities due to the lack of education. The lack of employment is noticed also due to the prevalent inequality between males and females in the residents of the slums of Lagos (Prather et al. 2018). Among the Nigerian population, women are highly prone to be employed in discriminative low wages or unpaid employment even today. Females are mostly employed with low wages which have resulted in increased occurrences of low economic standards in the families of the slums (Chandra-Mouli, Neal & Moller, 2021). Sometimes the females are also discriminatively employed in the category of unpaid employment which shows high rates of prevailing discrimination. These incidences show discriminative actions in the workplace and also the high bulk of low-income levels among women (Odimegwu & Adewoyin, 2022). The existence of inequalities has resulted in sexual abuse as well as sexual harassment among women both adults and adolescent.

The above abusive factors have increased their lack of safety in the workplace and contracted sexual diseases as well as unwanted pregnancies. The safety of women both adolescents and adults should be increased by the government of Nigeria and NGOs through strict regulations and enactments on the safety and equality of women in urban slums (Aerts, 2018). Therefore the policies of the government should include education and employment of women with special reference to the slum population and sexual health and well-being.

Conclusion

The above information has revealed the presence of sexual ill-health among the residents of the slums of Lagos in Nigeria. The information has highlighted the unhealthy sexual practices and the diseases prevalent among women in the slums in Nigeria. There are occurrences of “sexually transmitted diseases” among most of the women of Nigeria and a lack of proper treatment for women. The inequalities are observed in terms of both employment and education among slum residents of Lagos. There are incidences of early death among adolescent women of Lagos because of “sexually transmitted diseases” especially “cervical cancer”. The occurrence of “Cervical cancer” is known to be high in number and most women are contracted malignant cancer. Employment discrimination has shown low income and unpaid categories of employment for women. It is advisable for the government to provide good quality amenities for healthcare to the residents of the slums of Lagos in Nigeria. There is also a need to increase awareness among the adolescent as well as the adult population of Nigeria about sexual health and hygiene.

References

Books

Aerts, J. (2018). Shaping urbanization for children: A handbook on child-responsive urban planning. Unicef. ISBN: 978-92-806-4960-4

Odimegwu, C. O., & Adewoyin, Y. (Eds.). (2022). The Routledge Handbook of African Demography. Routledge. DOI: 10.4324/9780429287213

Journals

Akinyemi, A.I., Erinfolami, T.P., Adebayo, S.O., Shah, I., Elewonbi, R. & Omoluabi, E. (2021). Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria. PloS one, 16(11). https://doi.org/10.1371/journal.pone.0260588

Akinyemi, A.I., Ikuteyijo, O.O., Mobolaji, J.W., Erinfolami, T. & Samuel, A.O. (2022). Socioeconomic inequalities and family planning utilization among female adolescents in urban slums in Nigeria. Frontiers in Global Women's Health. DOI 10.3389/fgwh.2022.838977

Akpabio, E. M., Wilson, N. A. U., Essien, K. A., Ansa, I. E., & Odum, P. N. (2021). Slums, women and sanitary living in South-South Nigeria. Journal of Housing and the Built Environment, 36(3), 1229-1248. DOI: 10.1007/s10901-020-09802-z

Bacigale, R.M., (2022). What is the Level of Knowledge of Birth Control among Women of Reproductive Age in Bwaise Slum? A Cross-Sectional Study. Student's Journal of Health Research Africa, 3(9), pp.11-11. DOI: https://doi.org/10.51168/sjhrafrica.v3i9.228

Chandra-Mouli, V., Neal, S., & Moller, A. B. (2021). Adolescent sexual and reproductive health for all in sub-Saharan Africa: a spotlight on inequalities. Reproductive Health, 18(1), 1-4. DOI: https://doi.org/10.1186/s12978-021-01145-4

Chawhanda, C., Levin, J. & Ibisomi, L. (2022). Factors associated with sexual and reproductive health service utilization in high migration communities in six Southern African countries. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13308-4

Esan, O.T., Maswime, S. & Blaauw, D., (2022). A qualitative inquiry into pregnant women’s perceptions of respectful maternity care during childbirth in Ibadan Metropolis, Nigeria. Sexual and Reproductive Health Matters, 30(1). https://doi.org/10.1080/26410397.2022.205697

George, A. S., Amin, A., de Abreu Lopes, C. M., & Ravindran, T. S. (2020). Structural determinants of gender inequality: why they matter for adolescent girls’ sexual and reproductive health. bmj, 368. DOI: 10.1136/bmj.l6985

Green, G., Swartz, A., Tembo, D., Cooper, D., George, A., Matzopoulos, R., Leal, A.F., Cabral, C., Barbosa, R. & Knauth, D., (2022). A scoping review of how exposure to urban violence impacts youth access to sexual, reproductive, and trauma health care in LMICs. Global public health. https://doi.org/10.1080/17441692.2022.2103581

Jarke, H., (2018). mHealth–Friend or Foe in Reducing Inequality? A Systematic Literature Review. doi: 10.3389/fgwh.2022.838977

Kunnuji, M.O., Eshiet, I. & Nnorom, C.C. (2018). A survival analysis of the timing of onset of childbearing among young females in Nigeria: is predictors the same across regions? Reproductive health, 15(1). https://doi.org/10.1186/s12978-018-0623-3

Liang, M., Simelane, S., Fillo, G. F., Chalasani, S., Weny, K., Canelos, P. S., ... & Snow, R. (2019). The state of adolescent sexual and reproductive health. Journal of Adolescent Health, 65(6), S3-S15. DOI: https://doi.org/10.1016/j.jadohealth.2019.09.015

Melesse, D. Y., Mutua, M. K., Choudhury, A., Wado, Y. D., Faye, C. M., Neal, S., & Boerma, T. (2020). Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?. BMJ global health, 5(1), e002231. DOI: 10.1136/

Muluneh, M.D., Stulz, V., Francis, L. & Agho, K. (2020). Gender-based violence against women in sub-Saharan Africa: a systematic review and meta-analysis of cross-sectional studies. International journal of environmental research and public health, 17(3). https://doi.org/10.3390/ijerph17030903

Nowshin, N., Kapiriri, L., Davison, C. M., Harms, S., Kwagala, B., Mutabazi, M. G., & Niec, A. (2022). Sexual and reproductive health and rights of “last mile” adolescents: a scoping review. Sexual and Reproductive Health Matters, 30(1), 2077283. DOI: 10.1080/26410397.2022.2077283

Park, J.E., Kibe, P., Yeboah, G., Oyebode, O., Harris, B., Ajisola, M.M., Griffiths, F., Aujla, N., Gill, P., Lilford, R.J., & Chen, Y.F., (2022). Factors associated with accessing and utilization of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature. BMJ open, 12(5). http://dx.doi.org/10.1136/bmjopen-2021-055415

Polis, C.B., Biddlecom, A., Singh, S., Ushie, B.A., Rosman, L. & Saad, A., (2022). Impacts of COVID-19 on contraceptive and abortion services in low-and middle-income countries: a scoping review. Sexual and Reproductive Health Matters, 30(1). https://doi.org/10.1080/26410397.2022.2098557

Prather, C., Fuller, T. R., Jeffries IV, W. L., Marshall, K. J., Howell, A. V., Belyue-Umole, A., & King, W. (2018). Racism, African American women, and their sexual and reproductive health: a review of historical and contemporary evidence and implications for health equity. Health equity, 2(1), 249-259. DOI: 10.1089/heq.2017.0045

Shatilwe, J.T., Kuupiel, D. & Mashamba-Thompson, T.P., (2021). Evidence on access to healthcare information by women of reproductive age in low-and middle-income countries: Scoping review. PloS one, 16(6), p.e0251633. https://doi.org/10.1371/journal.pone.0251633

Sidze, E.M., Wekesah, F.M., Kisia, L. & Abajobir, A., (2021). Inequalities in Access and Utilization of Maternal, Newborn and Child Health Services in sub-Saharan Africa: A Special Focus on Urban Settings. Maternal and child health journal. https://doi.org/10.1007/s10995-021-03250-z

Ukonu, M.O. & Ajaebili, N.C., (2021). Socio-cultural determinants of women’s health information opportunities in Nsukka, Southeast Nigeria. Asian Women, 37(1). doi: 10.3389/fgwh.2022.838977

Uwadia, R.C., Oloruntoba, E.O., Wada, O.Z. & Aluko, O.O., (2022). Menstrual hygiene management inequalities among school girls in Badagry, Nigeria. Tropical Medicine & International Health. https://doi.org/10.1111/tmi.13817

Wado, Y. D., Bangha, M., Kabiru, C. W., & Feyissa, G. T. (2020). Nature of, and responses to key sexual and reproductive health challenges for adolescents in urban slums in sub-Saharan Africa: a scoping review. Reproductive Health, 17(1), 1-14. DOI: 10.1186/s12978-020-00998-5

Websites

Health.gov.ng, (2021), Federal ministry of Health, Retrieved on 30 December 2022, Retrieved from: https://www.health.gov.ng/

Ncbi.nlm.nih.gov, (2020), The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems, Retrieved on 30 December 2022, Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249694/

Nhis.gov.ng, (2021), National Health Insurance authority, Retrieved on 30 December 2022, Retrieved from: https://www.nhis.gov.ng/

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