Ethical considerations in women's sexual and reproductive health care

No Abstract

A critic of maternal mortality reduction efforts in Nigeria

Context: Maternal mortality in Nigeria is high and occurs from direct and indirect medical causes together with non-medical causes which include socio-economic, religious, cultural and legal factors, reproductive healthfactors and health systems/health services factors. Government and Non-Governmental Organizations have over the years expended efforts towards the reversal of Nigerian's unacceptably high maternal mortality trends.Objective: This review examines major polices and programmes targeted at maternal mortality reduction in Nigeria as well as their possible outcome if any, identifies gaps attendant on these efforts, and suggests the wayforward towards a sustainable maternal mortality reduction in Nigeria.Maternal mortality reduction activities in Nigeria: Majority of these activities have been characterized by inherent poor design, lack of co-ordination with existing maternal health services and absence of sustainability mechanism, with an overall poor outcome. Amongst major maternal mortality reduction activities in Nigeria includes: Life Saving Skills (LSS) introduced by the American College of Midwifery in 1980 for emergencyobstetrics care and ultimately supported by UNICEF and WHO; White Ribbon Alliance developed by Centre for Development and Population Activities (CEDPA) in late 1990s; Prevention of Maternal Mortality Project (PMM) introduced by Columbia University in 1987 using funds from Carnegie corporation; The Making Pregnancy Safe Initiative introduced by WHO in 2000; Women and Child Friendly Health Services Initiative established in 2000 by the former Nigerian's First Lady — Late Mrs. Stella Obasanjo; United Nation Millennium Development Goals (MDGs) initiated in 2000; Women Sexual and Reproductive Rights Project initiated in 2002 by the International Federation of Obstetrics and Gynecology (FIGO) in partnership with Society of Obstetrics and Gynecology of Nigeria (SOGON) using funds obtained from Packard Foundation. Others include: Mentoring for Post Abortion Care (PAC) Services Delivery initiated by Ipas in 2007; The Integrated Maternal, New born and Child Health Strategy Initiative of the Federal Ministry of Health also initiated in 2007; and the Midwives Services Scheme (MSS) initiated by the Federal Government in 2009. Gaps identified to militate against maternal mortality reduction efforts include discontinuity and disconnect in government policies and programmes; legislation and other services emanating from change in government or between the executive and legislature within the same government; poor leadership of the health sector by the health ministries; poor coordination of maternal mortality reduction activities; poor development of human resources and health service infrastructure; inadequate funding of the health system, particularly of maternalhealth services; poor record keeping; and insufficient social mobilization activities.Recommendation and conclusion: Improving maternal mortality reduction efforts in Nigeria involves overhauling of the health system and services to render quality and affordable health care; adequate budgetary allocation and fund release for maternal health services; human resources development through recruitments, training and retraining; ensuring prudence in the development and siting of maternal health service infrastructure; ensuring program continuity between governments, and policy/legislative connect within government;developing effective record  keeping protocol for maternal health services; establishing effective socialmobilization outfits and harnessing health sector partnership for funding and other health services. Keywords: Critic; Maternal mortality reductionefforts; Nigeri

Knowledge and practice of universal precautions against blood borne pathogensamongst house officers and nurses in tertiary health institutions in southeast Nigeria

To examine the knowledge and practice, as well as factors influencing universal precautions practices amongstNigerianHouse officers andNurses. A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed usingEPI-info. Most Doctors, 66.6%,were aged 26-30 years while the Nurses, 41.1%,were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the Nurses were females. Knowledge of universal precautions measures was high for both categories of respondents - 97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p < 0.05. Themost important factor influencing universal precautions practice is the lack of provision of adequate protective equipments. Other factors, all of which show significant difference between the doctors and nurses (p < 0.05), include carelessness; lack of display of universal precautions guidelines; emergency nature of the procedure; insufficient water supply; patient perceived to be at low risk of blood borne pathogens; pressure of time; and universal precautions equipments interferingwith technical skills. Although knowledge of universal precautions is high for both house officers and nurses, practice is however better amongst the latter than the former. The effective knowledge and practice of universal precautions amongst hospitalworkers are of absolute necessity to prevent infections fromblood and body fluid pathogens.Keywords: Nigeria; knowledge and practice; universal precautions; healthcare workers; tertiary health institutions

Family planning in contermporary reproductive health and rights

Family planning is re-emerging as a foremost contemporary global reproductive health issue largely on account of its implication to world's population dynamics and it's perceived influence on several aspects of human development, most of which are linked with the economy. It refers to the control of world population in relation to the available food and economic resources. Despite its significance to human development it remains elucive to many women especially in developing countries. Family planning has profound sexual and reproductive rights implications which have been recognised over the years at several international conferences. Access to family planning is a major approach to maternal mortality reduction. Social and political factors, such as religion and politically-motivated funding restrictions for family planning services, negatively impact on availability and accessibility of such services, with often devastating effects to the most vulnerable and least privileged women,especially in underdeveloped countries. Family planning and its continued development is the collective responsibility of every individual, country, or organization. Key strategies to promote family planning include domestication of provisions of international conventions on family planning into state laws, and ensuring their implementation; development of community friendly family planning services; establishment of effective family planning commodities logistics management system; emphasising on the family planning needs of special groups such as adolescents, and members of some religious denominations; and the training of family planning counsellors and assistants

Ethics in Perinatal Medicine

Background: The current trend in perinatal medicine addresses the challenge posed to newborn survival by newborn prematurity and other morbidities requiring neonatal newborn intensive care. These ethical concerns span through the spectrum of education, clinical practice and research, domicile in obstetrics and neonatology. Effective application of ethics to perinatal medicine requires basic knowledge bioethics in health care and medical research.Objectives: The objective of the article is to highlight the basic aspects of ethics, review research ethics and practical ethical issues in perinatal medicine and provide an analytical application of the principles involved in bioethics.Methodology: A search for the relevant literature available on the internet, journal publications, textbooks and monographs was conductedResult: The basics of ethics span through the definition of medical ethics, ethical codes and bioethics. It also includes the various bioethical orientations (historical, duty-based, utilitarian, feminist, casuistry, communitarian and virtue orientation), together with the guiding principles of modern bioethics and their levels of application (micro-ethical, macro-ethical, meso-ethical and mega-ethical level). Research ethics developed tremendously during the 20th century and it was boosted by a number of regulations such as Nuremberg code, CIOMS, Helsinki declaration, Belmont Report and the Nigerian National Code of Health Research Ethics. Ethics in perinatal medicine focus on medical decision making and foeto-maternal conflict as well as the concept of a foetus as a patient and medical futility. It includes prenatal diagnosis and interventions for severe congenital malformations of the foetus, safe mother hood and cord blood collection and newborn care.Conclusion: Bioethics is an important component of perinatal medicine. The consideration and application of bioethics in all aspect of perinatal medicine will undoubtedly improve the quality of care for obstetric patients and their newborn infants

Pain Relief in Postabortion Care Practiced by Healthcare Professionals in South Eastern Nigeria

Background: Postabortion care (PAC) is aimed at reducing maternal morbidity and mortality resulting from the incomplete abortion and abortion complications. The use of analgesia is an integral part of high quality PAC. Knowledge of the pattern of use of analgesia in PAC by healthcare professionals would help in planning group specific training programs for more effective PAC. Aim: This study is aimed at assessing the use of analgesia in PAC among healthcare professionals in South Eastern Nigeria.Subjects and Methods: This is a cross‑sectional questionnaire‑based survey carried out among healthcare professionals in Anambra State, Nigeria between June 1 and September 30, 2006.  Participants were chosen using a multistage sampling technique. Pretested questionnaires assessing the practice of postabortion counseling were then administered. The data were analyzed using SPSSversion 20.0 software. Frequencies were within 95% confidence limits.Results: A total of 437 health professionals were included in the study. The mean age was 38.2 (10.4) years. Formal PAC training influenced the use of analgesia positively (P &lt; 0.001). The use of analgesia in PAC was also significantly higher among professionals working in tertiary healthcare center and private specialist hospitals when compared with other facilities (P = 0.02). In general complications were more when analgesia was not employed. Older professionals were more likely to employ pain relief in PAC (P = 0.01). Furthermore, doctors were significantly more likely to employ pain relief in PAC when compared to nurses (P = 0.001).Conclusion: This study revealed a low level of use of analgesia in PAC among the healthcare  professionals. It also demonstrated a significant association between formal PAC training and use ofanalgesia in PAC. It is, therefore, recommended that increased PAC training and re‑training activities with emphasis on the need for analgesia should be conducted for healthcare professionals to improve the quality of PAC received by clients.KEY WORDS: Pain relief, post abortion care, Nigeri

Adolescent and pre-pregnancy nutrition in Nigeria

Good nutrition during adolescent and pre-pregnancy period is critical towards a healthy pregnancy and normal birth weight infant. This article is a review of Adolescent and pre-pregnancy nutrition in Nigeria. Undernutrition in adolescent girls aged 15–19 years in Nigeria has been variously reported to range between 23% and 57.8%. Undernutrition was more prevalent among the rural compared to the urban adolescent, and was attributable more to socio-economic, and dietary factors. A high proportion of energy amongst adolescent, was derived from carbohydrates such as rice, yam, and cassava. Proteins were derived mainly from legumes and pulses, while fats were derived mainly from palm and vegetable oil. Iron was mainly of plant origin and had low bioavailability due to the presence of absorption inhibitors – tannins and phytates. A high levels of vitamin A was prevalent due to consumption of red palm oil. Undernourished adolescent girl and pre-pregnant women are likely to give birth to undernourished infants with the risk of transmitting undernutrition to the future generation. The recommendation towards the implementation of adolescent and pre-pregnancy nutrition in Nigeria include – The establishment of a countrywide school-based nutrition programme; Integration of Nutritional counselling with primary health care services, targeting out of school adolescents; Development of dietary guidelines and IEC materials on nutrition; and Establishment of Preconception clinic to counsel women on family planning and appropriate diet as well as monitor their body weight prior to pregnancy.Key words: Adolescent; Nigeria; nutrition; pre-pregnancy

Where Do People in Nigeria Get Their Contraception?

Knowing where users obtain different contraceptive methods is useful for planning service delivery, argues Ladipo, who examines a new study on contraception in Nigeria