ANALYSIS OF THE LEGAL AND CULTURAL PERSPECTIVES
4.4 CONSTITUTIONAL, LEGISLATIVE AND POLICY FRAMEWORK FOR THE PROTECTION OF THE REPRODUCTIVE HEALTH RIGHTS OF WOMEN IN
4.4.4 Reproductive Health and Population Policies in Nigeria
Apart from the various pieces of legislation that forbid any infraction of the reproductive health rights of women by prevailing cultural practices in Nigeria, the government has adopted policies relating to the reproductive health rights of women. Reproductive health rights are a subset of the right to health. As noted earlier, the right to health is not expressly recognised as a fundamental human right in Nigeria. The Constitution only recognises the duty of the state to direct its policies to ensure adequate medical and health facilities for all persons, and encourages the evolution and promotion of family life.191 This particular section alludes to both health and reproductive health rights. The Federal Ministry of Health formulates health policies for the Nigerian health sector. Issues relating to health are on the concurrent legislative list of the Nigerian Constitution. This means that each state is at liberty to decide on its health policies and its way of implementing the national health policy.192
187 Enugu, Edo, Bayelsa, Delta, Cross-River and Ogun states, among others, have enacted laws on the elimination of FGM. As at April 2011, 24 states had adopted Child Rights Acts. Most of the states that have adopted the Act are from southern Nigeria.
188 Edo State Female Circumcision and Genital Multilation Prohibition Law (1999) Cross River State Girl – Child Marriages and Female Circumcision (Prohibition Law) 2000, Rivers State Abolition of Female Circumcision Law (2001) , Ogun State Female Circumcision and Genital Mutilation (Prohibition ) Law 2000, Ekiti State Gender – Based Violence (Prohibition) Law of 2001, among others.
189 Enugu State Prohibition of Widows and Widowers Fundamental Rights Laws (2001) , Oyo State Widows‟
Empowerment Law, 2002, Anambra State Malpractices against Widows and Widowers Prohibition Law, 2004 among others.
190 An example is the Prohibition of Early Marriage Law Kebbi State, Retention in School and against withdrawal of Girls from School Law, Kano State, and Violence against Women Law Lagos State. As at April 2011, 24states had adopted Child Rights Acts. Most of the states that have adopted the Act are from southern Nigeria.
191 Section 17(3) (d), 1999 Constitution.
192 Gbadamosi, note 48 (above).
137 (a) The National Health Policy
Nigeria‟s health policy recognises the importance of good health to social and economic development – as well as social justice and national security. It aims to achieve good health for all citizens by the year 2000 and beyond.193 According to the policy, the level of health envisaged is one in which all Nigerians will achieve socially and economically productive lives.194 The national health policy emphasises primary health care (PHC). In line with World Health Organization guidelines, PHC encompasses basic treatment, maternal and child health, and family planning services – as well as the prevention and control of infectious diseases and the provision of essential drugs and supplies.195 In light of this background, it is obvious that PHC does not make comprehensive provision for the reproductive health rights of women; t is limited to maternal and child health, as well as family planning services. This is insufficient to combat the wide range of health concerns of Nigerian women, which impede their reproductive health rights.
(b) The National Adolescent Health Policy
The National Adolescent Health Policy is another national policy germane to the realisation of the reproductive health rights of women. The policy caters for the special status of adolescents and applies to persons aged 10 to 24 years. It aims to address the different areas of the life of an adolescent – such as nutrition, education, career development, and reproductive health, among others. In terms of sexual and reproductive health rights, the policy focuses on preventing unwanted pregnancies and sexually transmitted diseases, because the average age at first intercourse has declined and unprotected sexual intercourse is more prevalent among this age group.196 However, the policy falls short of recognising the various cultural practices that impede the realisation of the reproductive health rights of young people and adolescents.
193 The National Health Policy, 1988, 1998, and revised in 2004.
194 Ibid.
195 M.T. Ladan “Review of the existing reproductive health policies and legislations in Nigeria”. Available at:
www.gamji.com.
196 Federal Ministry of Health, National Reproductive Health Policy and Strategy to Achieve Quality Reproductive and Sexual Health for all Nigerians, May 2001.
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(c) The National Strategic Framework for the Elimination of Obstetric Fistula in Nigeria 2011-2015
In 2002, the Federal Government of Nigeria committed itself to combatting the deadly effects of Obstetric Fistula (OF) – which is abnormal communication between the vagina and bladder as a result of obstructed labour during child birth – on the reproductive health rights of Nigerian women.197 The government felt that OF should not be treated in isolation, but should be seen as part of the government‟s overall efforts to improve women‟s sexual and reproductive health rights. Various efforts to combat OF led to the development of the National Strategic Framework for the Eradication of Fistula in Nigeria (2005 to 2010) – which aimed to implement OF interventions, including prevention, treatment and care, as well as rehabilitation and reintegration.198 During this five-year period, the federal government developed Standards of Practice for doctors and nurses involved in the management of OF. Surveys revealed that 2 000 to 4 000 patients suffering from OF were repaired each year. Despite these efforts, OF persists in Nigeria.199 Hence, the policy was extended for another five years (2011-2015).
(d) National Policy on Women
The national policy on women – adopted in 2001 – covers all issues relating to women. It emphasises the important roles played by women in the family and the community at large, and as the primary health-care provider notes social and cultural aspects of life such as harmful cultural practices, high illiteracy levels, women‟s low status, and the neglect of their health. The policy aims to improve women‟s status in the community in order to enhance their involvement in community development. It sets out health objectives which centre on encouraging women to participate in health development, supplying information, services and technical advice on women‟s health issues and family life, legislation on various issues that relate to maternal health services, and protecting women from VVF, FGM, and other harmful practices. The policy on women is however vague on practices such as FGM; furthermore, while it refers to the
197 Federal Ministry of Health, National Strategic Framework for the Elimination of Obstetric Fistula in Nigeria (2011-2015).
198 Idem 13.
199 Ibid.
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elimination of harmful traditional practices that affect the health of girls and women, it fails to explicitly state that legislation will be enacted to eliminate such practices.200
(e) National Reproductive Health Policy and Strategy
In May 2001, the Federal Ministry of Health inaugurated a new policy for the promotion of the reproductive health rights of women. The policy entitled „National Reproductive Health Policy and Strategy to Achieve Quality Reproductive and Sexual Health for all Nigerians‟, sets the following objectives and targets, among others:
1. Reduce maternal morbidity and mortality due to pregnancy and childbirth by 50%.
2. Reduce prenatal and neonatal morbidity and mortality by 30%.
3. Reduce the level of unwanted pregnancies in all women of reproductive age by 50%.
4. Reduce the incidence and prevalence of sexually transmitted infections, including the transmission of HIV infection.
5. Limit all forms of gender-based violence and other practices harmful to the health of women and children.
6. Reduce gender imbalances in the availability of reproductive health services.
7. Reduce the incidence and prevalence of reproductive cancers and other non- communicable diseases.
8. Increase knowledge of reproductive biology and promote responsible behaviour among adolescents regarding the prevention of unwanted pregnancies and sexually transmitted infections.
9. Reduce gender imbalances in all sexual and reproductive health matters.
10. Reduce the prevalence of infertility and provide adoption services for infertile couples.
11. Reduce the incidence and prevalence of infertility and sexual dysfunction in men and women.
12. Increase the involvement of men in reproductive health issues.
13. Promote research on reproductive health issues.
200 Ladan, note 195 (above).
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The provisions of the National Reproductive Health Policy and Strategy are all encompassing.
They deal with issues relating to the reproductive rights of all Nigerian citizens. The policy takes into cognisance the significance of reproductive health to the enjoyment of the various fundamental human rights of Nigerian citizens. To this end, it highlights the various reproductive challenges and needs of citizens, and strategies on various ways to address these. Above all, it emphasises the need to promote research on reproductive health issues.
(f) Nigeria’s Population Policy
Nigeria is the most populous country in Africa, with an estimated population of about 179 million, as at 1 July 2014.201 The country‟s population policy was developed to curb rapid population growth. The population policy first came into effect in 1988. At this time, the population of Nigeria was below 100 million, with a growth rate of about 3%. However, given population growth, and its consequences for the welfare of the citizens of Nigeria, coupled with its effect on socio-economic development, the Federal Government felt there was a need for a population policy.202 The goal of the population policy of 1988 was to improve the standard of living, promote health and welfare, reduce population growth, and ensure even distribution of the population. The policy also acknowledged the right of couples and individuals to decide on the number and spacing of their children – and the means to exercise such rights.
Nevertheless, the policy encouraged women to adhere to the four-child limit, while men were only obliged to limit their number of wives and children to what their resources could cater for.
The policy set out various objectives aimed at reducing Nigeria‟s population growth rate.
However, it failed to achieve its set objectives for several reasons. Reasons relevant to this study were that the policy disregarded male reproductive motivation203 and that current concerns in family planning and reproductive health (HIV/AIDS) were not considered. This policy was formulated before the 1994 International Conference for Population and Development, in Cairo.
Nigeria‟s population policy has been revised to take into consideration the objectives of the Cairo Conference. At its Federal Executive Council meeting on 27 January 2004, the Federal
201 Worldometers. Available at: www.worldometers.info/world-population/nigeria-population.
202 O. Obono “Cultural diversity and population policy in Nigeria” (2003) 29(1) Population and Development Review 103.
203 O. Adegbola “Population policy implementation in Nigeria, 1988-2003” (2008) 47(1) Population Review 56, 57.
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Government of Nigeria approved a population policy named “National Policy on Population for Sustainable Development”. This is designed to improve the lives and standard of living of Nigerians, by achieving the following targets:
1. A national population growth rate of not more than 2% by 2015.
2. Check population growth by means of voluntary fertility regulation methods and the availability of modern contraceptives.
3. Reduce infant and maternal mortality rates.
These targets did not fully incorporate the provisions of the Cairo Conference of 1994.204
In addition to the above policies, Nigeria has adopted other policies relating to the protection of the reproductive health rights of women. These include the revised National Policy on HIV/AIDS adopted on 10 June 2003; the Maternal and Child Health Policy, 1994; the National Gender Policy, 2007; and the National Policy on the Elimination of FGM, 1998 and 2002. All these policies were adopted by the Federal Government of Nigeria to ensure that women enjoy their reproductive health rights.
However, given the country‟s tripartite legal system and the nature of these rights – these policies had to be implemented by all three tiers of government. Consequently, there are geographical disparities in the implementation of these policies, as states or local governments that are not well disposed to such policies may not implement them. While recognising that it is the duty of the state to direct its policies towards these issues, the Constitution does not make provision for the enforcement of policies that seek to further the social order envisaged by the Constitution. In a bid to protect these rights, two or three policies may be directed towards the same issue: hence there is a proliferation of policies in Nigeria.