A critical analysis of the extent to which social determinant of health explains health inequalities regarding maternal mortality in Nigeria

Abstract

This article critically analyzes and quantified the extent to which social determinants of health explains health inequalities regarding maternal mortality in Nigeria. Evidence suggests that maternal mortality is predominant in developing countries. This formed the rationale in using Nigeria as a case study for critical analysis. This study showed the relationship between social status/determinants, health inequalities and maternal mortality outcomes in Nigeria. Using a critical analytical approach, this study shows that access to a good health care by maternal patients depends on a number of social determinants (such as education/awareness, income level/unemployment, cultural beliefs, insecurity, environmental conditions and healthcare decline/lackadaisical attitude displayed by some health workers in some parts of Nigeria) which can be linked to explain health inequalities that results in maternal mortality in Nigeria. To tackle inequalities, this study recommends targeted social policy reforms and maternal program/education for affected populace in Nigeria.

A Scoping Review on Influence of Socioeconomic Status on Antenatal Care Utilization and Pregnancy Outcomes in Sub-Saharan Africa

“…The situation in South Sudan is similar to that of Chad whereby enabling resources, such as the household wealth index, were significantly associated with non-use of ANC services [31]. For instance, a study found that women from the top two household wealth quintiles had an increased utilization of the recommended number of four or more ANC visits compared to their counterparts from the lowest two quintiles [43]. Also, women of lower socioeconomic status and who specifically cannot afford to pay the transport fare to the health facility did not utilize ANC.…”

“…Women in polygamous households typically worked in the fields for little pay and received little financial support. Their spouses and other family members did not relieve them of their pregnancy-related domestic duties [43].…”

“…In addition to the possible impact of these unhealthy behaviours, being unemployed may have a negative impact on one’s ability to pay for high-quality medical care. The budget on such income, for example, could encourage a limited healthy diet or underuse of healthcare during the vital period of pregnancy, raising the likelihood of an unfavourable outcome if a spouse depends on it to provide nutritious foods and adequate prenatal care [43].…”

“…Somalia has limited and understaffed health care centres that works only a few hours per day, an inadequate payment system of salaries has made it difficult for mothers to pay right bills limiting their access to these antennal services [41]. Another study in Somalia found that women whose monthly household income was below $50 did not attend ANC [42,43]. In Chad an increase in wealth index increases the chances of ANC utilization [30].…”

“…However, women working in the informal sector, such as traders, may find it challenging to access ANC services due to the nature of their work and the lack of social protections. Several studies have shown that women in low-income occupations, such as agriculture and informal sector workers, have lower utilization of ANC services compared to those in high-income occupations, such as civil servants and professionals [43]. Furthermore, rural women tend to have lower utilization of ANC services compared to urban women, regardless of their occupation [14,44].…”