Submission ID 131361
| Issue/Objective | Nigeria records one of the world's highest maternal mortality ratios, at 993 deaths per 100,000 live births, while Pakistan's burden - at 155 per 100,000 - conceals severe sub-national disparities. In both contexts, TCI's MNCH scoping studies reveal that mortality is not simply a function of health system capacity; it is a consequence of power. Male gatekeeping over women's health-seeking decisions, early marriage, adolescent pregnancy, cultural misconceptions about facility delivery, and the social stigmatisation of women who access reproductive health services operate as upstream determinants of maternal death - yet they are rarely captured in health system data or addressed in programme design. |
|---|---|
| Methodology/Approach | This paper synthesises qualitative and quantitative findings from TCI's 2025 MNCH scoping studies in Adamawa and Gombe States (Nigeria) and Punjab and Sindh provinces (Pakistan), including community dialogues, stakeholder consultations, demand-side barrier assessments, and routine service uptake data across supported facilities. |
| Results | In northern Nigeria, male consent requirements delayed or prevented ANC attendance for a significant proportion of women, particularly in communities with high rates of early marriage and low female literacy. Facility delivery rates in Adamawa (24.4%) and Gombe (37.9%) - compared to 84.9% in the South West - reflect not infrastructure deficits but gendered decision-making hierarchies and deeply rooted misconceptions about skilled birth attendance. In Pakistan, health system restructuring in Punjab disrupted staff morale and documentation quality, disproportionately affecting women's access to postnatal care. Social and Behaviour Change Communication (SBCC) that engaged male household decision-makers and religious leaders as advocates for maternal care produced measurable improvements in ANC attendance in pilot geographies. |
| Discussion/Conclusion | Reducing maternal mortality in high-burden settings requires treating gender inequity as a clinical variable. MNCH programmes that engage households, communities, and cultural authorities as sites of intervention will outperform those that conflate service provision with equitable access. TCI's evidence from Nigeria and Pakistan makes a compelling case for embedding gendered power analysis into MNCH programme design, monitoring, and evaluation. |
| Presenters and Affiliations | Victor Igharo Johns Hopkins University, W.H Gates Institute for Population and Reproductive Health Victor Igharo Johns Hopkins University, W.H Gates Institute for Population and Reproductive Health Taiwo Johnson Johns Hopkins Centre for Communication Programs (JHCCP) Ghazunfer Abbas Greenstar Social Marketing, Pakistan |
