CHAPTER ONE

INTRODUCTION

1.1         Background of the Study

Sexual and Reproductive Health and Rights (SRHR) are human rights applied to sexuality and reproduction. They form a combination of four fields that in some contexts are more or less distinct from each other, but less so or not at all in other contexts. These four fields are sexual health, sexual rights, reproductive health and reproductive rights. These four fields are treated as separate but inherently intertwined (Adebayo, Fahmeir, Seiler, & Heumann, 2011). Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (Speizer, Magnani, & Colvin, 2003).

Reproductive health, or sexual health, addresses the reproductive processes, functions and systems at all stages of life (Issues for Framework Health Service Providers, 2008). Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Women International Network in 2009 implied that men and women ought to be informed of and to have access to safe, effective, affordable and acceptable methods of birth control; also access to appropriate health care services of sexual, reproductive medicine and implementation of health education programs to stress the importance of women to go safely through pregnancy and childbirth that could provide couples with the best chance of having a healthy infant. On the other hand individuals do face inequalities in reproductive health services. Inequalities vary based on socioeconomic status, education level, age, ethnicity, religion, and resources available in their environment. It is possible for example, that low income individuals lack the resources for appropriate health

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services and the knowledge to know what is appropriate for maintaining reproductive health (Neumayer & Thomas 2007).

Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence (Baptiste, Kapungu, Khare, Lewis,

&   Barlow-Mosha, 2010). Sexual Rights unlike the other three aspects of SRHR, includes and focus on sexual pleasure and emotional sexual expression. One platform for this struggle is the World Association of Sexual Health (WAS) Declaration of Sexual Rights. The Platform for Action from the 1995 Beijing Conference on Women established that human rights include the right of women freely and without coercion, violence or discrimination, to have control over and make decisions concerning their own sexuality, including their own sexual and reproductive health (Baptiste, Kapungu, Khare, Lewis, & Barlow-Mosha, 2010).

The current population of Nigeria is 188,789,677 as of Monday, November 21, 2016, based on the latest United Nations estimates. Out of this number, women constitute 94,017,259 (Worldometers, 2016). In a country with such number of women, it is expected that the government of that country ought to pay particular attention to issues affecting the women folks. One of such issues is the right to choose provisions contained in the Convention on the Elimination of all Discrimination against Women (CEDAW) (Olatokun, 2014). Sadly, this Convention is yet to be domesticated and implemented in Nigeria, revealing that, Nigerian women are likely to be denied of three things which basically can be guaranteed by the right to choose as contained within CEDAW. Firstly, Nigerian women will be denied of the right to decide what to do with their bodies, in that, they will be denied of the right to choose and determine the timing of their pregnancies. Secondly, Nigerian women are likely to be denied

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of the right to health, in that, failure to be able to determine the right timing of pregnancies is injurious to both mother and the unborn child. Lastly, the Nigerian women are robbed of the opportunity of being self-determined in that, women in Nigeria will not have the opportunity to decide for themselves on issues of maternity. Aside these, the right to choose provision contained in CEDAW is capable of reducing the economic hardship presently faced in Nigeria to the barest minimum (Olatokun, 2014).

In the pre-independence era when formal education was first introduced in Northern Nigeria, the government through the Native Authority which transformed to Local Government Authority had to force parents to send the girl-child to enrol in formal schools. The Native Authority fully funded the education of these girls who were conscripted to various schools often located outside their province. However, the socio-cultural and religious practices that evolved later in Northern states, particularly the North East and North West changed with the highest number of girl-child not enrolled in school and those who drop out to get married. The majority of these girls never return to school to complete their education, learn a trade, or acquire vocational skills that would economically empower and make them self-reliant (Bala, 2003).

Every society and culture has some basic norms and beliefs that guide the people. In Nigeria for instance, specifically the Northern Nigeria (Hausa - Fulani dominated) allowed early marriage of the girl-child. Erulkar and Bello (2007) argued that the reason for acceptance of early marriages among Northern region is to preserve the value of virginity, fears about pre-marital sexual activity, to reduce promiscuity of the girl-child, and other socio-cultural and religious norms. However, due to the ignorance and selfish nature, more often than not they forget the effect it has on the girl- child as well as their community development. It is worrisome that the girl- child has no power to resist the offer. The effect of early marriage on the girl-child that affects her wellbeing and that of the society include education, lack of economic empowerment and lack of knowledge on reproductive health services which will

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enable them take informed decisions, enhance their ability to leverage resources and participate in community decision making (Isiugo-Abanihe, 2005). These translate into development of negative attitude towards sexual and reproductive health and the sexual and reproductive rights of the girl-child in later life which prompted the researcher to conduct the research on the knowledge, attitude, and practice of women about sexual and reproductive health rights in Kaduna state.

1.2         Statement of Problem

Violations of women‘s sexual and reproductive health rights are often deeply engrained in societal values pertaining to women‘s sexuality. Patriarchal concepts of women‘s roles within the family mean that women are often valued based on their ability to reproduce. Early marriage and pregnancy, or repeated pregnancies spaced too closely together, often as the result of efforts to produce male offspring because of the preference for sons, has a devastating impact on women‘s health with sometimes fatal consequences. Women are also often blamed for infertility, suffering ostracism and being subjected to various human rights violations as a result.

Women seemly lack awareness and knowledge of their sexual and reproductive health rights which is one of the causes of problems and complications (female genital mutilation, lack of sexual pleasure and satisfaction, uterine rupture, infertility, and so on) women face when it comes to sexual and reproductive health and in turn the development of negative attitude. In Nigeria, women may shy away from exercising their rights due to cultural, religious, and moral values because it is frowned upon in the society. Young women of reproductive age who are married are prevented from accessing sexual and reproductive health care which they rightfully deserve because they are expected to give birth to as many children as possible without family planning. Whereas single women of reproductive age who are sexually active

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also shy away because they fear how the society will treat them and the shame they will have to feel while tending to their sexual and reproductive health, thereby leading them to practice unsafe sex because room was never created to have positive attitude. This would result in unwanted pregnancies, which if they try to abort may result into serious complications such as sepsis, uterine rupture, etc. The researcher observed that a lot of women present at health facilities with complications resulting from sexual and reproductive health problems. Therefore, the present study aims at assessing the knowledge, attitude, and practice of women towards sexual and reproductive health rights.

1.3         Purpose of the Study

The purpose of the study is to assess the knowledge, attitude, and practice towards sexual and reproductive health rights among women in Kaduna State. Specifically, the study is to:

1.      assess the knowledge of women on sexual and reproductive health rights.

2.      assess the attitude of women towards sexual and reproductive health rights.

3.      investigate the practice of sexual and reproductive health rights among women in Kaduna state.

4.      examine the effect of marital status on the knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna state.

5.      examine the effect of educational level on the knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna state.

6.      examine the effect of occupation on the knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna state.

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1.4         Research Questions

The research questions were designed to specifically assess the knowledge, attitude, and practice of women towards sexual and reproductive health rights, thus:

1.      Do women have knowledge on sexual and reproductive health rights in Kaduna state?

2.      What is the attitude of the women towards sexual and reproductive health rights in Kaduna state?

3.      Do women practice sexual and reproductive health rights in Kaduna state?

4.      Does marital status have effect on knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna state?

5.      Does level of education have effect on knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna state?

6.      Does occupation have effect on knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna state?

1.5         Significance of the Study

The findings from this study will uplift the standard of Health education on sexual and reproductive health rights in the following ways:

i.            The study would add to the existing body of knowledge in Health Education, especially with regards to the knowledge, attitude, and practice of sexual and reproductive health rights among women in Kaduna State by making it available on the internet and in libraries for use. This would acquaint health educators with information and knowledge to use while carrying out their roles.

ii.             This study would provide health workers with information and knowledge of sexual and reproductive health rights as they are the ones that the women

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come across first when they have complications resulting from sexual and reproductive health problems, hence they can refer them appropriately thereby treating the underlying cause of that problem.

iii.             This study would make the government aware of the existence of sexual and reproductive health problems and help the government in legislations and policy making that will ensure the implementation of the laws of sexual and reproductive health rights already in the Nigerian constitution.

iv.            The study would make women aware of the existence of sexual and reproductive health rights. It will enlighten them by giving them in-depth knowledge on sexual and reproductive health rights. It will change the attitude of women positively towards sexual and reproductive health rights. The study will also enlighten women on safe practice on sexual and reproductive health rights via the use of health talks, mass media, social media, discussions, lectures, and conferences at health facilities and Non-Governmental Organisations (NGOs) to disseminate information to women in Kaduna state.

1.6         Basic Assumptions

The following basic assumptions were made for the study:

1.      Women would have knowledge of sexual and reproductive health rights in Kaduna state.

2.      The attitude of women towards sexual and reproductive health rights would change after having been exposed to enlightenment campaign programs on sexual and reproductive health rights in Kaduna state.

3.      The women would practice sexual and reproductive health rights in Kaduna state after the enlightenment campaign program on sexual and reproductive health rights has

impacted on them positively.

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