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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
One of the major health challengesof the world is improving the deplorable state of maternal and child health. Maternal health is the health of a woman during pregnancy, childbirth, and the postpartum period (WHO). It encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality. Child health on the other hand, is the care and treatment of children. It is the state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity. Maternal, infant, and child health are intertwined as they address a wide range of conditions, health behaviours, and health systems indicators that affect the health, wellness, and quality of life of women, children and families.This shows the close relationship between the well-being of the mother and the child, and justifies the need to integrate maternal, newborn and child health interventions. The health of mothers and children are threatened in developing countries as a result of pregnancy- related complications, which in most cases, have grave consequences.
Statistics available indicate that approximately three million newborn deaths, seven million under-five deaths, and 300,000 maternal deaths, occur globally every year. The United
Nations PopulationFund (UNFPA,2013) estimated that 289,000 women died of pregnancy or childbirth related causes in 2013. These causes range from severe bleeding to obstructed labour, all of which have effective interventions. It is worrisome that this health burden is unevenly distributed, with most deaths occurring in the poorest regions of the world; 87 percent of maternal deaths and 37percent of neonatal deaths, for example, occur in sub-Saharan Africa
(UNICEF, 2012). A woman’s chance of dying or becoming disabled during pregnancy andchildbirth is closely connected to her social and economic status, the norms and values of her culture, and the geographic remoteness of her home. This is a reflection of the maternal and child mortality disparities between wealthy and poor countries (UNFPA). This trend demonstrates the greatest disparity between the poor and the rich and has been referred to as the “largest discrepancy of all public- health statistics “(Mahler, 1987). A woman’s lifetime risk of dying as a result of pregnancy or childbirth is 1 in 39 in Sub-Saharan Africa, as compared to 1 in 4,700 in industrialized countries (UNFPA). During the 62nd World Health Assembly held in Geneva, in
May 2009, the Secretary-General of the United Nations, Mr. Ban Ki-moon acknowledged that maternal mortality is the slowest moving target of the Millennium Development Goals (MDG’S) and that it is an outrage in this century. In his words,
“There is no single issue that ties together the security, prosperity and progress of our world than women’s health…. Everywhere, especially in the poorest countries, women’s health affect the nation’s health….women, after all, care for the children, they often grow crops, and they hold families together and that “no woman should have to give her life to give life”, as is the scenario in many developing countries.”This statement indicates that maternal and child health is a yardstick for measuring a functioning health system as a nation’s development is tied and anchored on a strong health system.
Nigeria is a developing country where the poor health delivery system leads to high maternal and child mortality. As with many developing countries in Africa, Nigeria suffers high maternal and child mortality ratesdue to a variety of factors. The five biggest challenges for maternal, newborn and child health in sub-Saharan Africa are: “pregnancy and childbirth complications, newborn illness, childhood infections, malnutrition, and HIV/AIDS, and poor health services and health care facilities”(Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, 2010). According to the UNICEF Executive Director, Ann Veneman, “midway to 2015 deadline for MDGs, Nigeria continues to record unacceptably high maternal, newborn and child mortality”. Nigeria ranks as one of the 13 countries in the world with the highest maternal and child mortality rate and still has not been listed among the 10 countries seen to have made speedy progress toward achieving millenniumdevelopment goals. As the most populous country in the region and the eight most populous country in the world, Nigeria accounts for a quarter of all maternal, newborn, and child deaths in sub-Saharan Africa
(UNICEF, 2009). This has necessitated the greater attention given to Maternal and Child health.
Each year, more than 50,000 Nigerian women die from pregnancy- related complications(National Primary Health Care Development Agency(NPHCDA), 2012).According to the WHO/United Nations Children Fund (UNICEF), in 1995, Nigeria had the third highest number of maternal deaths in the world (approximately 45000 deaths). By the year 2000, for every 100,000 live births, about 800 women died in the process of child birth. Out of the 27 million Nigerian women of reproductive age, about two million did not survive either pregnancy or childbirth. In 2008, the maternal mortality ratio (MMR) was estimated at 545 per 100,000 live births, increasing to over 800 per 100,000 births in rural areas (National Population Commission
(NPC) [Nigeria] & ICF Macro, 2009).According to UN report, the figure stood at between 1000 and 1500 deaths per 100,000 live births. The State of the World Children Report 2009 stated that one out of nine global maternal deaths occurred in Nigeria.
Presently, Nigeria is stillthe second country with the highest maternal mortality rate in the world behind India with about 144 girls and women dying every day from complication of pregnancy and child birth. One in every 18 women die giving birth compared to one in 4800 in the US (Pitterson, 2010; Daily Independent, 2010). According to the survey conducted in February 2010, the record stands at between 165 per 100,000 live births in the South West and
1549 per 100,000 live births in the North East (Onumere, 2010).
Infants also experience poor health outcomes. An estimated 250,000 newborns die annually in Nigeria, the neonatal mortality rate is 48 per 1000 live births (FMOH and NPHCDA,
2009, Shettima, 2007; Amankwah, 2009). Nigeria loses about 2,300 under five years old and 145 women of childbearing age, making it the second largest contributor to the under-five mortality and maternal mortality rate in the world. Some of the contributory factors to infant mortality
Nigeria include malnutrition, poor environmental hygiene, low access and utilization of quality health care services.
Nigeria also has about 260,000 neonatal deaths annually, 13 percent of which can be prevented with live saving interventions such as provision of required maternal health medicines and supplies. The deaths of new-born babies in Nigeria represent a quarter of the total number of deaths of children under-five. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery reflecting the intimate link between new born survival and the quality of maternal care. Main causes of neonatal deaths are birth asphyxia, severe infection including tetanus and premature birth”, states UNICEF.
On Tuesday the 27 October 2015, during the ministerial screening by the Federal House of Representatives, a ministerial nominee, Prof Isaac Adewole, who was the Vice Chancellor of the University of Ibadan, advocated the need to consciously improve the health status of women and children. He disclosed that no fewer than 40,000 women lose their lives to maternal mortality every year and that the nation loses, at least, 800,000 children to infant mortality annually.With this scary figure, Nigeria occupies the second place in the list of countries with the highest maternal, infant and child mortalityrates in the world.
According to the United Nations, “Maternal and child mortality constitutes a severe violation of the reproductive rights of women” because most maternal deaths can be prevented with early and appropriate care. Almost every maternal death is an event that could be avoided and should never have been allowed to happen.”“Even more devastating is the knowledge that, according to recent research, essential interventions reaching women and babies on time would have averted most of these deaths.”
Although analyses of recent trends show that the country is making progress in cutting down infant and under-five mortality rates, the pace still remains too slow to achieve the Millennium Development Goals (MDGs) of reducing child mortality by a third by 2015”,states
UNICEF.
Avoiding maternal deaths is possible even in resource poor countries, but it requires the right kind of information on which to base programmes. (Lewis, 2003).
The priority of averting maternal death and child death was put on global front when reducing the maternal and child mortality was considered among the eight crucial Millennium
Development Goals to which each and every World Health Organization signatory country should abide. For Nigeria to achievethe MDG’s, the target of reducing the mortality among children younger than five years old, by two thirds, and reducing the maternal mortality, by three quarters in Nigeria, must be attained.
Although various programmes have been formulated and executed by successive administrations in Nigeria, women and children still lose their lives daily. This shows that the nation still lags behind and is yet to meet the millenniumdevelopment goals 4 and 5.Various intervention programmes have been executed with the view of improving maternal and child health, including the National Safe Motherhood Programme, the SURE-P Midwife Services Scheme, the free maternal and child health care programme and recently enacted National Health
Act. Effective and regular monitoring and evaluation, at all levels, are required to judge the effectiveness of these policies and programmes (WHO, 2009). It is necessary to evaluate these programmes in order to achieve targeted goals and, if necessary, design more effective policies and programmes to address these problems in a timely fashion (Lozano et al., 2011). Manandhar and Osrin (2004) reported that “community-based participatory interventions significantly reduce neonatal and maternal mortality”(p 970-979). .Proposed health interventions targeted to poor people and/or universal coverage as potentially promising approaches to the improvement of health equity. They further suggested regular monitoring of inequalities and use of the resulting information for education, advocacy, and increased accountability among the general public and decision-makers (Victoria et al., 2003). Reliable data on maternal and child health is necessary in order to evaluate progress. In order to achieve the objectives of MDGs 4 and 5, effective health promotion activities, institutional capacity strengthening through human resource development in terms of knowledge, skills, commitment and leadership, and organizational system/structural development play pivotal roles.
This brings us to the potentiality of the mass media in its effort at raising issues and creating awareness on issues that affect the society. Mass media provide information about health and make people aware so as to prevent the spread of various diseases. Communication scholars are in agreement thatit is the responsibility of the mass media to monitor, analyze and report development trends and issues in the society. Ndolo(2005) explains the information role of the mass media as providing “information about local, national and international events and conditions”. He adds that the mass media, through their informative role “facilitates innovation, adaptation and progress”(p.21). Dominick (2009)divided the surveillance function of the mass media into two, namely warning or beware and instrumental surveillance.This explains why Dominick(2008) says that surveillance refers to what we popularlycall the news and information role of the media. Policy makers also obtain considerable amount of information from the media as Bryant and Thompson (2002) have suggested that news coverage of health matters take on considerable significance that has the potential to shape the impression of average citizens and powerful policy makers alike.
It is the responsibility of the Nigerian media to keep the citizens abreast of what happens in the society. Newspapers, are generally known for their daily, current, timely information reportage and their easily accessible storage factors. They shape perceptions of key events through the act of “framing”.Frames in media are essential components in the study and interpretation of news, Lippmann(quoted in Papacharassi & Oliveira,2008:5). Through their roles of informing, educating and entertaining the people, the media set ‘frames of reference’ that their readers and viewers can use to interpret and discuss public events. The press, therefore,play a critical role in awareness and education on public issues and influence decisions about health policies andissues amongst which are maternal and child health issues. This study looked at the inherent frames employed by the Nigerian Newspapers in reporting stories on maternal and child health issues. It also attempted to assess the extent to which media select news and shape its contents on maternal and child health in Nigeria.
1.2 Statement of the Problem
Since the world leaders assembled in New York to sign ‘‘the most widely ratified set of development goals ever signed by every country’’, the Millennium Development Goals, several efforts have been made by successive governments, medical practitioners, non-governmental organizations, international organizations to nip the menace of maternal and infant mortality in the bud. Unfortunately, these efforts and interventions of maternal and child health welfare services have not yielded the desired results as incidents of maternal and child mortality in
Nigeria,still remain unacceptably high as the country is still amongst the worst rated. It is even more disheartening considering the fact that a total eradication of maternal and child mortality is the top most priority of the Millennium Development Goals.(MDGs).
For this reason, stakeholders are concerned as to why infant and maternal deaths have lingered probably as a result of poor communication of the issues involved, especially the right mass-media use to attain the objective of maternal and child health. It is against this backdrop that the study sought to know the extent to which newspapers have been able to utilize their coverage to bring theseissues to the fore through the attention given to the issues as well as the implications of the contents presented in the stories. This necessitated this study on newspaper content analysis of maternal and child health issues in Nigeria. It is important to ascertain what role the media play in ensuring adequate comprehension of maternal and child health issues in order to ensure the elimination or reduction of maternal and child mortality in Nigeria. The study will broaden our understanding of media effects by focusing on the frames newspapers thematise maternal and child health issues in Nigeria.
1.3 Objectives of the Study
The objectives of the study were as follows:
- To ascertain the frequency of maternal and child health coverage in selected Nigerian newspapers.
- To determine the prominence given to maternal and child health issues in the selected Nigerian newspapers.
- To ascertain the slant or direction of coverage of maternal and child health reports in the selected newspapers.
- To determine the sources of maternal and child health reportage in the selected Nigerian newspapers.
1.4 Research Questions
The research attempted to find answers to the following research questions:
- What is the frequency of coverage given to maternal and child health issues in the selected dailies?
- To what extent did the selected newspapers give prominence to maternal and child health issues.
- What direction of coverage did the selected newspapers take in their coverage of maternal and child health issues.
- What are the sources of maternal and child health reportage in the newspapers selected.
1.5 Significance of Study
The study would be relevant to the publicsince they rely on the media to disseminate accurate and relevant information. The public health community looks to the media for support, and attention and are considered as a primary source of information. It will also be beneficial to journalists and media practitioners as they will be made to understand that certain frames used in reporting events can have an effect on audience perception of the issue. More so, this work will serve as an addition to the existing literature to other researchers who would like to carry out research on related topics. The study will be of importance to health professionals, policy makers and the government as coverage of such issues as maternal and child health has the potential of shaping the impressions of average citizens and influencing government’s policies.
1.6 Scope of Study
This work employed the content analysis method used by the Nigerian Press in their reportage of maternal and child health issues in Nigeria. The content analysis is limited to the manifest content of four Nigerian Newspapers; The Sun Newspapers,The Vanguard,The Nation
Newspapers and The Guardian Papers, representing the Southern Eastern Nigeria. They were purposely selected for the study spanning from August 1st, 2014- July1st 2015. Only contents relating to maternal and child health will be analysed.
1.7 Definition of Basic Terms
- Analysis: According to Oxford Advanced Learner’s Dictionary of Current English 7th
Edition (2005), analysis is “the detailed study or examination of something in other to understand more about it. This analysis will involve newspaper framing of maternal and child health issues.
- Maternal Health: Is the health of women during pregnancy, childbirth and the postpartum period. It encompasses the health care dimensions of family planning, preconception, and prenatal care in order to reduce maternal morbidity and mortality.
- Child Health: Is the care and treatment of children.
- Newspaper: A newspaper “ is a publication issued at regular and usually close intervals, especially daily, weekly, and commonly containing news, comments, features and advertising”(dictionary.com). In this research, the term newspaper will be used to address the selected for the study.
- Framing: Framing as defined by Scheufe and Tewksbury (2007) “is based on the assumption that how an issue is characterized in news reports can have an influence on how it is understood by the audience”. It also focuses on how issues are selected for coverage and on the particular way those issues are presented by the mass media.
