Maternal health is not just a women’s issue – Q&A with Charity Maina
In the latest report on “Trends in maternal mortality 2000 to 2020” UN experts reveal that progress in reducing maternal mortality has stagnated and left the world off track to achieve the SDG target. This is the case in Nigeria which has the highest estimated number of maternal deaths accounting for 28.5% of all maternal deaths in 2020. The reality is most severe in the conflict-affected northern region where EQUAL is executing its research. These tragic figures are driven by a range of factors including gender which the World Health Organization recognizes as an important determinant of health seeking behaviors and outcomes.
In recognition of International Women’s Day – March 8, 2023 – EQUAL spoke with Charity Maina, a nurse and midwife now leading a robust portfolio of research at the Institute of Human Virology, Nigeria (full bio below). Charity joined EQUAL to help examine how gender impacts MNH outcomes in Nigeria and the importance of investing in women researchers and providers across the country.
You have had a diverse career path working as a nurse and midwife, in social work, and for the Ministry of Education leading health trainings. What led you to a career focused on women’s health?
Charity: When I was growing up, we had a neighbor who was a nurse and I admired everything about her – including her uniform! She came and spoke with my primary school about becoming a nurse or a midwife and the benefits of working in that profession. I was only 11 and yet I knew I wanted to be just like her. After secondary school I became a nurse and soon after a midwife and I really enjoyed it -- having this woman as a role model got me started and my passion for helping others kept me going and growing. Most of the work I’ve done – professionally and personally through volunteer work with my church and the community – has focused on improving health for women and adolescent girls, especially around their sexual and reproductive health. I spent a lot of time working on HIV education and awareness, adolescent awareness of menstruation, and now on maternal health with inclusion of pregnant Women With Disabilities -“Leaving No One Behind.” These are areas often silenced and stigmatized and I knew there was a lot of good I could do.
2. Why did you decide to transition to work in research on issues related to women’s health?
Charity: Similar to what led me to become a nurse, I found a mentor this time in Dr. Emilia Iwu -- who is now my supervisor at IHVN and part of the EQUAL consortium. Before I met Dr Emilia, I had rarely met such an accomplished woman, a nurse/ midwife with a PhD -- seeing her passion and expertise showed me that a PhD was also possible for me. She was patient in teaching me about methodologies like conducting in-depth interviews and focus group discussions to help answer questions and it excited me. What I like about research is the problem saving. That you can look at the most basic issue, collect information, analyze it, and then find a solution. Using that information to help other women brings me a lot of joy.
3. Why is it so important to have women working in science and research especially when studying topics related to women’s health (including MNH)?
Charity: SRHR is usually considered sensitive and personal so women often prefer to go to a health worker of the same gender. This is even more the case in the northern regions of Nigeria where gender norms are more strict. I think the same is true for research. When studying maternal and newborn health for example, I think it makes a big difference to have women leading the work because we can relate to the topics and experiences. That makes other women feel more comfortable and more likely to share openly and honestly. For example, I personally had a breech birth, so I know what it is like when talking about complications during pregnancy and childbirth. I think that also makes me a better researcher because my personal experiences drive my passion to find ways to prevent these types of complications for others.
4. Midwives can provide more than 80% of the essential care needed for women and their newborn babies. Despite this, there is a severe shortage of midwives around the world including in Nigeria where there are only six midwives for every 10,000 people. Recognizing that women account for ~90% of midwives globally, how does gender inequality impact midwifery in Nigeria?
Charity: Yes, like in other countries, midwifery in Nigeria is mostly women. Despite our ability as midwives to deliver the majority of MNH care, our work is undervalued. But because midwifery is made up of mostly women, the problem starts with education. Nigeria is a very dynamic country and things vary drastically not only between the different states but also between individual families in the same areas. My dad was the Commissioner for Education and my mother was a teacher so education was always a priority in my family -- my father was always pushing me to think about my future. Unfortunately, that isn’t the case for many young girls in Nigeria who don’t have the money or encouragement to get an education and the support to find a career they are passionate about. Things are more difficult in the northern part of the country where early and forced marriages are common and lead to school dropouts. With so many adolescent females not getting an education, it is difficult to recruit midwives. I think these women and young girls need the type of mentorship and role models that I had.
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5. Beyond the biological differences, gender roles, norms and behavior have an influence on how women and girls access health services and how health systems respond to their different needs. How do you gender dynamics, biases, and inequality impact maternal health access and outcomes in Nigeria?
Charity: We really can’t generalize because the answer varies depending on the region and the different cultural and religious practices. As I mentioned, in areas in the north, we see more early and forced marriage, poor education, and poverty. In these places, women are often voiceless and cannot make informed decisions about their own health – men make the decisions like if/when she goes to a health center and sometimes they even control what type of care she can receive – for example some adult women have to obtain permission from their husbands to get an HIV test. This is a contributing factor for why so many women give birth at home. I remember a time when I went to conduct a training at a hospital and there was a woman experiencing an obstructed labor. Even though the woman was of legal age for consent, the nurse felt the need to wait for her husband to give the consent before he could perform a c-section. All of this has been made worse in the northern states impacted by the conflict and a double tragedy for women living with disabilities. Over the years, we’ve seen health and education systems disrupted making it even more difficult for women to get an education and access good quality maternal care.
6. For International Women’s Day – March 8, 2023 – what is your call to action to help improve maternal health outcomes for women across Nigeria?
Charity: Every year, we celebrate international women’s day and it's a call for action to empower women and see more equity. It’s also an important time to remember that maternal health is not just a women’s issue. It is something everyone in Nigeria should care about and prioritize. Imagine a Gender Equal World. Collectively we can all #EmbraceEquity.
Charity Maina bio:
Charity has worked in public service for more than two decades as a Nurse and Midwife. She has also worked in the Education ministry to accelerate the sector’s response to HIV Prevention. She has a wealth of experience in curriculum development and implementation for both pre - service and in - service for Nurses, Midwives and Community Health Workers. Charity has worked with several non-governmental organizations, community-based, faith-based and civil society organizations. She has also interfaced with international organizations. As a Senior Training officer and Coordinator Health System strengthening at IHVN, she ensured that the right trainings are provided and aligned to meet the organizational goals. Charity who is also a Social Worker, has over the years, consistently developed herself for greater responsibilities in research and has also earned a PhD. She is Co - PI / Project Manager for EQUAL.