LOCAL GOVERNMENT LEGISLATORS' AWARENESS, PERCEPTIONS AND IDENTIFIED POLITICAL STRATEGIES FOR REDUCING MATERNAL MORTALITY IN IBADAN, NIGERIA

Abstract

Nigeria has one of the highest Maternal Mortality (MM) ratios in the world, yet the political commitment needed to reduce its magnitude is low. Local Government legislators (LGLs) have important role to play in formulating policies and enacting laws for ameliorating this public health problems. However, the awareness and perceptions of LGLs regarding the burden of MM have not been adequately documented. This study was therefore designed to determine the awareness and perceptions of LGLs in Ibadan relating to MM and political strategies for its reduction. A cross-sectional study was conducted in the five metropolitan and six peripheral Local Government Areas (LGAs) that constitute Ibadan. Eleven legislators who were Chairman of House Committees on Health (CHCH) were purposivley selected and interviewed using an in-Depth Interview (IDI) guide while 110 consenting Legislators out of 113 were interviewed using a semi-structured questionnaire to collect information on awareness, perceptions and strategies for reducing MM. Perceptions of MM were determined using an 11-item perception scale. A positive perception attracted a score of 2 points while a negative perception was zero making a total of 22 points. A total score of < 12 and ≥12 points were considered negative and positive perceptions respectively. Descriptive statistics and Chi-square were used to analyse the quantitative data and the qualitative data were subjected to thematic analysis. Mean age of respondents was 36.5 ± 7.2 years, 81.8% were males and 91.8% were married. Many (41.8%) had either Ordinary National Diploma (OND) or National Certificate of Education (NCE) and 34.5% had Secondary School Certificate (SSC). Some (39.1%) were not aware that MM is high in Nigeria. Majority (60.9%) were aware of women who died during pregnancy or childbirth in their LGAs. Most respondents (91.8%) were not aware of any existing policies for reducing MM. Respondents mean perception score was 10.6 ± 4.4 and 54.5% were of the perception that a legislation on compulsory use of antenatal care would not reduce MM. The perception of 78.2% was that abortion should not be legalized inspite of its association with MM when done illegally. The opinion of 60.9% was that legislators should not finance maternal health projects from their consistuency allowance. The mean perception scores of respondents with first degree, OND/NCE and SSC were 10.6, 9.9 and 9.4 points respectively (p<0.05). proffered political strategies for reducing MM included training workshop for political leaders (100%), involvement of party leaders in maternal health programmes (88.2%) and provision of evidence to show political leaders that MM is a public health problem (87.3%). The CHCH suggested establishment of rapport with political leaders and involvement of traditional leaders. In-depth interviews also revealed that HIV/AIDS, Immunization, Tuberculosis and Leprosy control were the top priority health programmes in the LGAs and unsafe abortion was identified as the main cause of MM in their consistencies. Negative perceptions of maternal mortality existed among the legislators, Advocacy and the integration of their suggestions into control efforts have potential for ameliorating the problem.