Pro-Chancellor and Chairman of Council, Federal University, Lokoja, Nigeria. February 2016
Member, Court of Governors, College of Medicine, University of Lagos, October 2015 for four years.
WOMEN’S HEALTH: A NATION’S WEALTH – A Valedictory Lecture By Nimi D. Briggs, JP, KSc, OON. MB, BS (Lag), MD (Lag), FMCOG (Nig), FWACS, FICS, FRCOG, FAS. PROFESSOR OF OBSTETRICS & GYNAECOLOGY, University of Port Harcourt on Monday, February 23, 2009
Public lectures are significant events in the life of a university: they educate the academic community on important issues as well as serve as vital links in the essential relationship between “town and gown”. Inaugural and Valedictory Lectures that are delivered by professors are established forms of public lectures within a university community.
Whereas the Inaugural Lecture gives the Professor the opportunity to announce his arrival on the intellectual firmament, and to define his subsequent trajectory in a prospective manner to the comity of scholars, the Valedictory Lecture, by nature, is retrospective and reflective. It invites the academic, out of his personal persuasion, to reminisce and to draw conclusions from his years of experience which should serve as a pointer to the community as well as to the nation on the way things should go.
So far, in its over 31 years of existence (October 1977- February 2009), the University of Port Harcourt has played host to 65 Inaugural Lectures. Consequently, it can be held that this form of public lecture is now firmly established at the university; besides, a vibrant social culture, as probably exists in none other, which helps to cement communal cohesion and comradeship, currently constitutes an important accessory of each Inaugural lecture. The same cannot be said of Valedictory Lectures, this being the first from my base, the College of Health Sciences and only the second in the university’s series – the first having been delivered on November 4, 2006 by Professor Emmanuel Anosike of the Faculty of Science..
May I therefore thank the Vice-Chancellor and the Senate of this university once again for having afforded me the opportunity to deliver my Inaugural Lecture in 1992 (the 1st from the College of Health Sciences of the University of Port Harcourt and 12th in the university’s series) on the topic, Cancer: Why are we so Helpless, on February 20, 1992. I also wish to express my deepest gratitude to the authorities of the university for granting me yet another opportunity – that of today – almost exactly 17 years to the date, to deliver my Valedictory Lecture which is on the subject of Women’s Health – a matter in which I have sustained an interest for over 30 years of my academic and professional life.
2.1 GENERAL REMARKS
The definition by the World Health Organization (WHO) that Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, entered into force on April 7,1948.The fact that the definition has not been amended ever since confirms that it is comprehensive and has stood the test of time.
This definition implies that Women’s Health in today’s lecture should not only be viewed through the periscope of the presence or absence of disease or infirmity – genital tract infections, diabetes mellitus, female malignancies, to mention just a few, but that such a view, should also incorporate issues which compromise the mental and social well-being of women including the abuse, violence, discrimination, neglect and the dependency that they suffer, as well as the extent of their poverty.
Similarly, the wealth of a nation should not only be interpreted in monetary terms – GDP per capita, foreign reserves, and balance of payments, but also in terms of the quality of life of its citizens and what ailment they commonly suffer and die from, as well as social and economic development in the country.
Within these premises, this Valedictory Lecture posits that women contribute substantially to national development and wealth creation in nations where they are regarded as important component of those societies, and where they do not suffer much discrimination or some other deficits on account of their gender, but are rather supported and their special needs, including those of health, catered for, satisfactorily. In such societies, women are usually assimilated into the mainstream of the body polity of the country. The lecture further argues that the corollary is also true: in societies where women are accorded lower status than men, extensively abused, discriminated against, and their special needs, including those of health, not amply met, women are not sufficiently empowered to contribute appropriately to national development and wealth creation as they are usually kept on the fringes of the society’s body polity. Such societies therefore lose out on the input of an important segment of their people to national growth, development and prosperity. Accordingly, the lecture makes a case for African societies and countries, including Nigeria, where these retrogressive and despicable actions against women are starkest, to embark on deliberate policies that would unbar their women and so enhance their contributions to the creation of national wealth.
2.2 ORGANIZATION OF THE LECTURE
The language and format of the lecture will be kept simple since the lecture is directed at a wide range of audience, including the general public. It will commence with some considerations on population issues – global and local, which are designed to show what an important numerical force that women constitute as well as the socio-cultural milieu in which many women live, especially in Africa. Then, some development matters will be examined and the critical role that a cultivated human capital of men and women plays in determining a nation’s financial buoyancy as well as its ability to provide those goods and services which delineate one country as developed (wealthy) and another as underdeveloped (poor), highlighted. Next, I will indicate some of the factors that weigh women down globally and locally, thus emasculating many of them and making them unable to contribute appropriately to national development; an attempt will be made here to rationalize the many forms of unfair treatments that women suffer as well as examining the dynamics of women, poverty and dependency. At this point, a brief examination of Women’s Health in the context of Nigeria’s current developmental efforts will be undertaken. I will then discuss some of the endeavours that I have made to promote the course and well-being of women and by extension, national wealth creation and development, in my academic and professional career over the years. My concluding remarks will counsel on steps that need to be institutionalized in order to ensure that women everywhere but especially in African societies are liberated from those forces that militate against them.
3. POPULATION ISSUES
The fact that the secondary sex ratio (number of males to 100 females at birth) in man is generally accepted as 105 would indicate that nature itself favours equality between men and women – a situation that appears to be reasonably maintained at all times. For example, by the close of 2008, the population of the world for all ages was estimated to be 6,706,992,932. Of these, 3,376,791,855 were males while 3,330,201,077 were females – the population was fairly equally divided between the two sexes. This almost equal representation by gender in national population figures was also noticed in examining population distribution in a number of countries (see Table 1).
Here in Nigeria, Africa’s most populous country, the last national head count was taken in 2006 and the results announced on December 29, 2006 as 140,003,542(total population), 71,709,859 (males), and 68,293,683 (females). Furthermore, a study on the trends of delivery of large babies at this university over a 10-year period, 1990-1999, showed that out of a total of 14,307 babies that were born during the study period, 7,111 were males, while 7,196 were females giving a sex ratio of 100 males to 101 females. There were no major differences in the numerical strength of the sexes.
Therefore it can be said that females constitute an important numerical force in the world and that they match men in their numbers almost on a one to one basis.
But in virtually all societies, that is where the equality between the sexes terminates as women are often considered somewhat inferior and so, not accorded the same opportunities as men to maximize their potentials. For instance, not one of the 44 elected presidents of the United States of America is a woman; since 1688, only one woman, Margaret Thatcher, has evolved as the Prime Minister of Great Britain; the same honour goes to only one woman, Angela Merkel, as Chancellor of Germany; Nigeria has not had a female Head of State/President since independence in 1960; only nine of the 100 scientists who shaped the world are women.
If this lack of acceptance of equality is only a mindset, subtle, covert and not backed by culture and formal regulations in developed countries, it is often overt; undisguised; largely accepted and even commonly backed by various cultures, which are not infrequently promoted by women themselves, as well as legislations in developing countries, where many women are subjected to lifelong discrimination and neglect (Fig.1). Not even the spectacular achievements of some women, Marie Curie – physicist and two times Nobel Prize winner, Mary Slessor of Scotland/Nigeria, the late Queen Amina of Zaria – “a woman as capable as a man”, Joan of Arc of the French army and Ngozi Okonjo Iweala of the World Bank, can convince such societies that given the right opportunities, many women are capable of carrying their well-acknowledged efficiency and success in child bearing and housekeeping into important decision making levels. So, since women in developed countries operate within a wider socio-political space, they more readily actualize themselves and consequently contribute better to national development. On the other hand, many women in developing countries are locked in a lurch by a number of factors which deny them the full range of opportunities for self actualization; their contribution to national development is accordingly compromised. It is to these factors that rob women of their full opportunities as well as their resultant effects that the direction of this lecture will now shift; but before then, some comments will be made on national development process and the factors that promote it.
4. NATIONAL DEVELOPMENT PROCESS
4.1. GENERAL REMARKS
National development here is taken as the totality of the issues involved in creating national wealth and prosperity, advancement of socio-economic progress and improvement in the quality of life of a people. In this respect, history teaches us that development arises as a need to meet the requirements of individual members of the society – food, health, education, transportation, shelter, among others.
What is needed to meet these requirements differs in accordance with the complexity of the requirements. Thus, where the requirements are confined to the basic needs of food and shelter, the economic base needed to respond to such a demand is usually a subsistence economy – characterized by low GDP per capita and requiring only the most basic of education in the operators. Such a development paradigm is weak, uncompetitive and is unable to support good quality of life. On the other hand, where the needs of the society are beyond the basics and involve complex and sophisticated desires like the feeding of teeming populations, rapid trans-global communications, speedy mass transportation of persons and goods across vast distances, complex construction works involving several components, enhanced quality of life as well as increased life expectancy, a more sophisticated and robust development paradigm like the technology economy is required.
Thus, nations in their growth processes evolve through development paradigms that are based on subsistence economy, commercial economy, emerging market economy and technology economy.
The technology economy is the competitive economy of the 21st century globalised world with enhanced GDP per capita. It supports a development archetype that is knowledge-based and driven by Science, Engineering, Technology and Innovation (SETI) and engenders rapid national growth as well as socio-economic development. For it to be successful, a large number of its operators have to have acquired knowledge, skills and expertise at tertiary level education. However, at all phases of the development of a globally competitive economy, the education of its citizens (number and quality) is prime because it is their capacity, capability and proficiency that constitutes the most crucial capital and asset that drives and upgrades the economy at each stage.
4.2. NIGERIA’S DEVELOPMENT.
For ease of reference, let us consider Nigeria’s recent developmental efforts as having commenced in 1999 when the country elected a democratic government into power, led by Chief Olusegun Obasanjo. Prior to that time, national development, other than during a brief interregnum in the 1970s had been characterized largely by failure due to a number of factors, including inept leadership, military adventurism and widespread corruption especially among its leaders. In the eight-year tenure of the Obasanjo’s administration, it can be said that some effort was made to pull the country away from its serious economic predicament which had marred developmental efforts. These involved using a number of fiscal and social engineering instruments, even though this effort was buoyed by a massive and unprecedented inflow of funds from the sale of crude oil. The instruments used included the National Economic Empowerment and Development Strategy (NEEDS), Bank Consolidation, Due Process, Poverty alleviation, Debt Reprieve, and Fight against Corruption. The GDP growth which had dipped to 3.5% annually rose to 6.9% with inflation rate remaining in the single digit. The country became a major player in the global banking sector and spectacularly so in Africa. In addition, some foreign currency reserve was built up even though major difficulties, especially those arising from a weak and undemocratic political base, the operations of a monolithic economy that is heavily dependent on the sale of crude oil and the unrest in the Niger Delta of the country from where the oil is extracted, remained unabated.
The present administration of Umaru Musa Yar’Adua (elected into office in May, 2007) wishes to enhance the nation’s development profile through insistence on the Rule of Law and the execution of a Seven Point Development Agenda Plus Two Special Issues which are aimed at transforming Nigeria into one of the world’s 20 largest economies by the year 2020 (Vision 20: 2020): Power and Energy, Food Security and Agriculture; Wealth Creation and Employment; Mass Transportation; Land Reform; Security; Qualitative and Functional Education; Plus Two Special Interest Issues…Niger Delta and Disadvantaged Groups.
For now however, the country still remains underdeveloped and poor. The UNDP Human Development Index (HDI – a measure of the quality of life and well-being of a people, with 1(one) as the highest possible HDI) which was updated for 2008 shows that Nigeria occupies the 155th position out of 180 countries and that it could not make the list of 10 countries in Africa with the highest HDIs, while more than 50% of its population live below the poverty line of 2 USD per day.
Thus it can be said that Nigeria’s developmental efforts have so far not been driven by an economy beyond a Commercial Economy. Predictions on the ability of the Seven Point Developmental Agenda of the present administration to meet their stated goals of leapfrogging the country to the likes of Germany, United Kingdom and Canada, have to be guarded. This is especially so in the face of the downward spiral of the benchmark price of crude oil from which over 80% of the foreign exchange earnings of the country is derived. Pointers to the need for caution include the fact that by December 2008, foreign reserves had fallen by $6 billion or 8.2% to $52.7 billion from a peak of $63 billion in September 2008. In order to shore up the value of the reserves the Central Bank of Nigeria (CBN) said it allowed the depreciation of the naira, the nation’s currency, which by December 2008, had dropped by 14%.In this respect, even the World Bank, through its chief economist, Justin Lin, recently predicted that on a per capita basis, world growth would be negative in 2009.
While it is accepted that bad governance and systemic corruption are at the root of Nigeria’s paltry development and poverty despite its abundant natural resources, it is inconceivable that the nation would have made much of a progress while still keeping a huge section of its population – the women – outside the mainstream of activities with obnoxious practices, lack of adequate care and concern as well as inequity in social inclusion. Such an action is like playing the game of football (with which Nigerians are very familiar) with a team of five or six instead of eleven! Let us now examine these factors.
5.SOCIO-CULTURAL CONSTRAINTS AND HEALTH ISSUES OF WOMEN
So pervading, protean and grotesque are the constraints that women suffer in the course of their everyday lives on account of their gender that it is impossible to do justice to them in a time-bound lecture such as this valedictory one. Similarly the conspiracy of silence and nonchalance that surrounds the specific disease conditions from which women suffer or die, cannot be adequately described in this forum. What I will do therefore is to pick some examples of the social constraints under which many women live and discuss them briefly. I will also speak to some disease conditions which are doing so much damage to women just because society does not place sufficient premium on the lives of women. Accordingly, this section of the lecture will be presented under the subtitles of Discrimination, Abuse and Violence; Neglect and Lack of Sufficient Care; and Inequity in Education. A global perspective will be espoused where necessary but the emphasis will be on what happens in African societies especially those in Nigeria, where the problem, in many instances, is at its nadir.
5.1. DISCRIMINATION, ABUSE AND VIOLENCE
There are no societies in which women enjoy the same opportunities as men. But in many developed countries, such discriminations are faint and restrained. The “glass ceiling” phenomenon, to which Hillary Clinton made reference in her acceptance speech of Barack Obama’s candidature during the 2008 presidential campaign for the United States presidency, is a discrimination against the female gender for high positions in public office. The harsher forms of discriminations that are carried out even to the point of extermination are usually not seen.
On the other hand, in societies where the predilection for the male child has been taken to the extremes, female fetuses are selectively terminated in the womb and female newborns destroyed preferentially. Gender-selective killings which are known as gendercide, fetocide, or infanticide, though widespread, are commonest in China and India, the two most populous countries of the world and became most pronounced in the wake of their “one child per family” contraceptive policy. These sex-selective abortions, which target female fetuses almost exclusively, are, arguably, the most brutal and destructive manifestation of the anti-female bias that permeates many societies and have been considered akin to genocide.
A report from Bombay (Mumbai) in 1984 on abortions after prenatal sex determination stated that 7,999 out of 8,000 of the aborted fetuses were females. An estimated 1.7 million girl babies are “missing” each year in China just as several female children are abandoned in orphanages. Killing of female fetuses and infants is also practiced in Africa and Nigeria – the International Federation of Women’s Lawyers (FIDA) said that much during its 2008 Human Rights Day activities in Abuja, Nigeria. But probably not as ruthlessly and remorselessly as is the case in India and China.
Nor does the female child have a respite after birth – incidence of deliberate suffocation and even poisoning are all higher with the Girl Child. Additionally, gender-based allocation in the distribution of resources including food and even in the care of babies still persists. In many families in developing countries it is usual for girls and women to eat less than men and boys and to have their meal after the men and boys had finished eating.
Female education lags far behind male education in parts of northern Nigeria (girls net enrollment in school is 15% compared to 59% for boys – UNICEF) and about 30% of school age girls drop out to be given away in marriage, usually without their consent and so often commence childbearing before the age of 18. Also prevailing customs and norms are much harsher on women than they are on men. Oftentimes they are not expected to venture out of the confines of their homes. Another example is the celebrated case in 2002 of Amina Lawal, a 32-year old Nigerian woman who was sentenced to death because she bore a child outside wedlock. She was to be buried up to her neck in sand and stoned to death. Happily, the sentence was overturned by an Islamic court; nothing was said about the father of the child.
Other examples abound of women in parts of Eastern Nigeria who suffer some of the worst degrading discrimination within the ambit of marriage, especially as widows: some are made to drink of the water with which their husband’s corpses are washed; confined in seclusion for several months and compelled to wear sackcloth, with heads shaved. There are no corresponding measures for men who lose their wives.
Abuse (mainly sexual) and Violence (mainly physical) are directed against females, especially adolescent youths, who lack the economic and social status to resist or avoid them, more so in sub Saharan Africa – 81% of Nigerian married women are verbally or physically abused by their husbands, 46% in the presence of their children.
The World Bank estimates that rape and domestic violence account for 5% of healthy years, as well as suicide attempts, of life lost to women of reproductive age in developing countries where the threat of social stigma prevents females from speaking up about rape and other forms of sexual abuse.
It was all this that led the United Nations (UN) to choose the theme “Ending Impunity for Violence against Women and Girls.” as the focus for the 2007 International Women’s Day which was set aside as a day for a reflection on the health and lives of women and their progress in civil society. On that occasion, the UN urged gynaecologists everywhere to persuade civil society to respect and value women and to support their sexual and reproductive rights.
The message identified gender-based violence, which could have serious health consequences for women, including adverse outcomes of pregnancies, as a public health problem affecting girls and women in all social strata in all countries of the world. The message further stated that almost 50% of sexual assaults (rape) occur in girls under age 15 and that this may be a factor in the spiraling increase of HIV prevalence in young women aged 15-24.
In Nigeria, as is elsewhere, female gender-based violence is manifested in many forms, including physical violence, sexual abuse, genital mutilation, as well as trafficking of women and girls and child marriage.
Trafficking of Nigerian girls and women, usually between the ages of 17-20, to Europe for prostitution has become such a big business in recent times that the largest group of prostitutes in Western Europe from sub-Saharan Africa (about 60% overall – FIDA) comes from Nigeria (10,000-15,000 – FIDA) while Italy remains the country of first choice for would-be Nigerian prostitutes probably because prostitution is legalized in that country.
Female Genital Mutilation (FGM) or Female Genital Cutting (FGC), also known as Female Circumcision (FC), according to Mahmoud Fathalla, is widely practiced especially in East and West Africa and parts of the Persian Gulf. Estimates of the global prevalence of the practice range between 85 and 114 million girls, with about 6,000 undergoing the practice daily. In Nigeria, estimates obtained from the 1999 Demographic and Health Survey indicated that about 25.1% of women have had one form or the other of this surgical operation.
FGM is an assault on the dignity of its victim. It may compromise the ability of the woman from deriving pleasure from sexual intercourse and aside from the erroneous belief of promiscuity in uncircumcised females, the procedure is of no known value and may even be associated with serious life-threatening conditions.
These abuses, discriminations and violent actions, dehumanize women and strip them of their human rights, self esteem and respect. They make some women feel second-rate and so dissuade them even from aspiring to heights that are within their competence and capabilities especially if such heights have to be scaled through competitive contests with men. Ultimately, the nation loses because by its own act of demarcation of the sexes through discrimination and inequity, it has shut out a good number of its own persons from giving of their best to the nation.
5.2. NEGLECT AND LACK OF SUFFICIENT CARE
5.2.1. Maternal Deaths and disabilities
No other set of conditions depict the neglect and lack of sufficient care that women suffer than the circumstances that lead to maternal death (the death of a woman while pregnant or within 42 days of the expulsion of the fetus) and it is for this reason that maternal deaths are commoner in parts of the world where development is poor and the special needs of women, with particular reference to their health, are not adequately catered for. This is so, despite the fact that the process of child bearing from which these women die, is not in itself a disease.
Globally, 99% of all maternal deaths occur in underdeveloped countries. Of the 430 estimated maternal deaths per 100,000 live births that occur worldwide, the estimated ratios are 480 for underdeveloped countries and 27 for the developed countries. These ratios can be translated into women’s lifetime risks of dying from pregnancy/pregnancy-related causes as follows: 1 chance in 48 in the underdeveloped countries contrasted with 1 chance in 1,800 in developed ones. The highest maternal mortality ratios are found in parts of India, eastern and western Africa with some of the least developed countries of the world (800-1,000 per 100,000 live births in Nigeria); the lowest levels occur in northern Europe with some of the best developed countries of the world (<4 per 100,000 live births in Finland).
Our country, Nigeria, has some of the worse statistics relating to maternal deaths in the developing world. Worldwide, an estimated 529,000 women die each year from the complications of pregnancy and childbirth, essentially from 13 underdeveloped countries. Of these, an estimated 55,000 deaths (over 140 daily) occur in Nigeria alone. Thus, although Nigeria accounts for only 2% of the world’s population, it produces 10% of the global estimates of maternal deaths. The only country that has a higher absolute number of maternal deaths is India with 136,000 maternal deaths each year.
Surprisingly enough, as was stated by the Director-General of WHO in 1998, “the interventions that make motherhood safe are known and the resources needed are obtainable; the necessary services are neither sophisticated nor very expensive, and reducing maternal mortality is one of the most cost-effective strategies available in the area of public health.” But mothers still die in large numbers in some parts of the world on account of a number of factors including:
However, even in the face of severe complications in pregnancy and labour, not all women die; some escape, but, not infrequently, with some serious disabilities. Although these are many, mention will be made only of two, again, as a result of time constrains: obstetric fistulae and blockage of the fallopian tubes.
Obstetric fistulae are abnormal communications between the vagina and adjacent soft tissues – commonly the bladder (Vesico Vaginal fistula, VVF) and/or the rectum (Recto Vaginal Fistula, RVF). Each of these conditions arises as a result of prolonged, neglected and unrelieved obstructed labour. The disability is found mostly in illiterate, poor and deprived women with contracted pelves, either from having commenced childbearing too early in life when they had not attained their full growth potentials (including growth of the pelvic bones), or from a generalized stunting associated with chronic malnutrition, especially in childhood. The labour that is associated with obstetric fistulae formation often commences at home or in such similar circumstances like prayer homes, where informed and specialized care is often absent.
The magnitude of the condition worldwide is unknown but the WHO estimates that there are about 2 million untreated cases and that 100,000 new cases get formed each year mainly in sub Saharan Africa as well as in parts of South and Central Asia, Latin America, the Middle East and isolated parts of the former Soviet Union and Soviet dominated Eastern Europe. The incidence in one Nigerian hospital was given as 350 per 100,000 deliveries.
Obstetric fistulae result in continuous and uncontrollable leakage of urine and/or faeces from the vagina and they constitute some of the most dehumanizing ailment anyone can ever suffer as those affected get ostracized and abandoned as a result of the strong, pungent and offensive smell of urine and/or faeces; a number of those afflicted by the condition end up as destitutes and beggars.
As for the blocking of the fallopian tubes, the condition arises from tubal infections which occur commonly as a result of botched abortions or infections from the genital tract during poorly managed labours and puerperia. Such infections are responsible for the vast majority of cases of Secondary Infertility which are often seen in many Gynaecology Clinics in several parts of sub Saharan Africa.
Maternal death, together with the problems that surround it, has thus become a yardstick by which the quality of Women’s Health is appraised – the death rates, including the near misses, being highest in areas of the world where women are accorded low status by the society and their health issues not considered with any measure of priority. Improving maternal health and by extension Women’s Health, by drastically reducing the maternal mortality ratio is an important way of reacting to women’s special needs. Such an improvement will involve grappling with the wider concerns of female poverty and dependency, female illiteracy and ignorance as well as the harmful cultural practices and taboos that affect them, among many others. These, in the long run, are issues of lack of development which pave the path to maternal deaths. Indeed, maternal deaths have become a metaphor for lack of development (Fig. 2).
Apart from the deplorable problem of colossal maternal deaths and other related issues, let me quickly draw attention to two other sets of conditions – one set, malignant diseases (breast and cervical cancers) and the other, infection (HIV/AIDS), which further amplify the lack of societal concern for women and their problems.
5.2.2. Breast and Cervical Cancers.
Breast and Cervical Cancers are two common malignant diseases that affect women whose mortality rates and morbidity could be vastly improved if early detection mechanisms are in place for their quick identification and management.
Other than paying attention to preventive measures like the avoidance of cigarette smoking, adequate use of the breast to feed newborn babies, checking obesity, awareness campaigns, self breast examination which should be taught at school and regular mammography are some of the ways that many societies have used to cut down on the incidence of breast cancer. Through these measures also, the disease is usually detected early when present and appropriate measures instituted thereby leading to decrease in mortality and morbidity.
The same is true of cervical cancer where over 80% of mortalities occur in developing countries, often from advanced end-stage disease. Here again, early detection holds the key to improved five year survival rates.
Apart from healthy living, expanded national cervical cytology screening through pap smears seems to be the way by which developed countries have succeeded in bringing down deaths from cervical cancers. It is therefore unfortunate that in many developing countries, there are no national cancer screening services.
In Nigeria, some state governments, and in particular wives of state governors, have tried to establish cervical cancer screening on a number of occasions. For instance, on December 13 last year, the First Lady of the Federation, Hajia Turai Yar Ardua was in Yenegoa to commission one such centre which was established by the wife of the state governor – Mrs.Alayingi Timipre Sylva. In the past, such efforts had been uncoordinated and unsustained and this had negated whatever benefits that were derivable from the exercise.
More recently, a vaccine (Gardasil Vaccine) is being propagated which is effective against infection with types 16 and 18 Human Papilloma Virus (HPV) which constitutes one of the risk factors for the disease.
The Human Immunodeficiency Virus (HIV) and the Acquired Immune Deficiency Syndrome (AIDS) which it causes, arise from an infection with a retrovirus which attacks the natural immune system of the body, thereby making it possible for many different infectious diseases, including those called opportunistic infections that are usually only able to strike when the body’s defenses are weakened, to take hold of the affected individual.
There is currently no cure for the disease and in the absence of proper care and medication, many affected persons die quickly. As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the WHO estimate that AIDS had killed more than 25 million people since it was first recognized on December 1, 1981, and that 40 million persons, from all over the globe, now live with the virus. This makes HIV/AIDS one of the most destructive pandemics in recorded history.
Over time however, the disease has become essentially an African, and in particular, a sub-Saharan African problem where more than a third of those dying from the disease are found, retarding economic growth and deepening poverty. Africa with just over 10% of the world’s population carries well over 75% of the burden of the disease and in 2005 lost 2.4 million adults and children to AIDS.
Rather unfortunately, women bear a greater portion of the burden of the disease especially in sub-Saharan Africa where almost 57% of all individuals living with HIV/AIDS are women. For Africans of ages 15-24 living with HIV/AIDS, women account for 76%. Specifically, in South Africa, Zambia and Zimbabwe, young women ages 15-24 have rates of infection that are between three and six times that of their male peers; while in Nigeria, the National Reproductive Health Survey of 2003 showed that young girls have a twice higher risk of contracting the HIV than boys of their age.
This feminization of HIV/AIDS is sequel to some issues of gender disparities, including poverty, cultural and sexual norms which care very little for the woman, lack of education, men’s predatory sex behaviour and violence directed at women – sexual assaults on women are often carried out in the belief that intercourse with a virgin cures HIV/AIDS as well as haematuria (blood in the urine). Prevention strategies must therefore address the wide range of gender inequalities that promote the dissemination of HIV especially among women.
5.3. INEQUITY IN EDUCATION
The importance of education as a tool for social emancipation and for determining the quality of life of an individual and indeed of a nation is underscored by the fact that it is a key component of HDI which defines human well-being in various countries.
Furthermore, education is an important determinant of health seeking behaviour of individuals including pregnant women as pregnancy outcome between educated and non-educated mothers is starkly incomparable. By educating the female child therefore, society is directly investing not just in the health of one of its mothers-to-be, and the outcome of her pregnancies but also in her ability to bring up her offspring to become responsible members of the community who would contribute to its development, among many other benefits.
Unfortunately, illiteracy is commoner in females than males in many communities. UNESCO reported that in 2005 about 785 million adults – some 17% of the adult population in the world – were illiterate, the majority of whom were girls and women. It further stated that in Europe, for every literate man then, there were two illiterate women. In 1979, UNICEF reported that 72.9% of urban girls and 80.08 % of rural girls in Nigeria were not attending school; currently, 42% of women in Nigeria (about twice the proportion of men – 22%) have never attended school.
But in some developed countries women have surpassed men at many levels of education. For example, in the United States of America in 2005/2006, women earned 62% of Associate degrees, 58% of Bachelor’s degrees, 60% of Master’s degrees, and 50% of doctorates. In comparison, at the University of Port Harcourt, even with its avowed policy of equal opportunities, males outweigh females in acquiring tertiary education – only 34% of the recipients of the degrees awarded at the 2008 Convocation Ceremony of the university were females.
So, by not doing enough to stem this injustice of social exclusion through gender inequity in female education, Nigeria and indeed many African countries are shooting themselves in the foot and precluding a good number of their citizens from potentially making their own useful contributions to national development and wealth creation. For, as Anya O. Anya pointed out at his Valedictory Lecture at the University of Nigeria in 2007, “ What is evident is that studies of such emerging countries like Brazil, South Korea, Taiwan and Singapore indicate firmly that educational expansion (for both boys and girls – my words) is essential for labour productivity , higher wages, reduction of poverty and inequality, enhancement of equity and mobility, increase in efficiency as well as reduction in population growth, increase in growth rate of exports, reduction of infant mortality and increase in school enrolment of the next generation…”
5.4. RATIONALIZING UNFAIR TREATMENT OF WOMEN
In attempting to bring the many unfair treatments that are meted out to women in accord with some reasoning, one immediately runs into a paradox. All men were born of women and without women, no man could have been born; yet men are at the fore front of the discriminatory actions against women. In many African societies, women, often as mothers-in-law, themselves encourage, insist on and propagate the obnoxious cultural practices that so badly dehumanise their fellow women especially those that become widows: denying them access to their late husband’s property, encouraging their remarriage to their late husband’s relations, and many others.
In some instances, the bias against females is related to the fact that men often provide the family income as well as being the ones that plow the land thereby providing the much needed manual labour. In this way sons are looked upon as a type of insurance and social security against the vicissitudes of the future. The practice in some countries of payment of dowry of enormous sums of money by prospective brides to the families in which they will live after marriage also helps in enhancing female rejection. Though formally outlawed, the practice is still pervasive.
Sadly, this unbridled prejudice against the female gender is having some serious collateral consequences in a number of communities, like China and parts of India where the secondary sex ratio has been so mutilated through the practice of gendercide, that there is now an imbalance in the sexes as women are no longer available in sufficient numbers for marriage and procreation. Women are therefore being kidnapped and forced into contrived marriages for the purposes of childbearing.
But all this need not be anymore. Modern progressive societies that are competitive are knowledge based. They are not built on the macho ability to use hoes, machetes and cutlasses and happily, in the business of knowledge acquisition and synthesis, females have proved not to be inferior to males, once given the appropriate opportunities.
5.5. WOMEN, POVERTY AND DEPENDENCY
A study of the eight Millennium Development Goals (MDGs) – a set of global development priorities agreed upon at the turn of this millennium by 189 Heads of State for the sustainable improvement in the quality of life of all citizens of the world) indicates that the eradication of poverty in vulnerable groups is the plank on which the achievements of the lofty ideals of the MDGs can be rationally based. This is so because poverty was identified as a core issue either directly or indirectly in most of the goals. Unfortunately, a number of circumstances have brought about a situation where females are the poorer of the two sexes globally but especially so in many developing countries and with special reference to sub Saharan Africa.
Women carry the burden of two thirds of the total hours of the work performed, largely in the informal sector of the economy. For this they earn 10% of the world’s income, slightly more than 50% of what men earn in comparable positions, and own but 1% of global property. Women, especially those in developing countries, Nigeria inclusive, constitute the vast majority of the over 1.2 billion people who live on less than one dollar a day, making poverty to “carry a woman face”.
Furthermore, although poverty affects households as a whole, women bear a disproportionate load of the problem as they attempt to manage household consumption and production even under conditions of scarcity as mothers, wives and workers.
Poverty, therefore badly affects all aspects of women’s lives; it enhances their dependence on men, who consequently take advantage of women and compromises their health, especially, their reproductive and sexual health. Women are, for these reasons, unable to contribute sufficiently to national development and wealth creation in a manner that they should have.
6. WOMEN’S HEALTH AND VISION 20: 2020
In a presentation that he made in January 2007, titled Nigerian Economy: Can We Achieve the Vision 20: 2020? in which he reiterated his notion of Nigeria soon becoming the China of Africa, Chukwuma Charles Soludo, in his capacity as the Governor of CBN, was upbeat on the ability of the Nigerian economy to achieve Vision 20: 2020.Citing the nation’s average GDP growth of 7% since 2003 (it was 2.8% in 1990), its abundant human and natural resources (population in excess of 140 million, large arable land, 8th world’s largest producer of oil and 6th largest deposit of gas) as some of Nigeria’s forte , the Governor was of the opinion that Nigeria has enough growth reserves to sustain the high growth rate that is required to make the vision a dream come true.
But this prediction was before the current global financial crisis which is not sparing Nigeria, let alone the tailspin of crude oil benchmark prices which is also affecting the nation’s economy. Furthermore, many would express reservation with the optimism of the Governor on the ground that the recorded economic growths have so far, not improved the well-being and quality of life of the citizens of the country in any appreciable manner – a factor, which indeed should constitute the very essence of sustainable democracy. For instance, the proportion of (the poor) those living on <$USD 2 per day has increased from 28.1% in 1980 to 50% in 2007 and the country now harbours some of the worst health indices not just in sub Saharan Africa, but indeed in the global context. The Federal Ministry of Health (FMoH) indicates that the country’s life expectancy at birth among Nigerians is 45.5 years; infant mortality rate, 103 per 1000 live births; under five mortality, 197 per 1000 live births; maternal mortality, 800 per 100,000 live births; crude birth rate, 43 per 1000 live births; crude death rate 14 per 1000 and full immunization coverage of children, 18%. It is these persistently dismal health indices that made the WHO in a recent report on the performance of health systems of member nations, to place Nigeria 187 out of 197. It has also made some individuals and organizations like the Health Reform Foundation of Nigeria (HERFON) to express dismay at the allocation of only 5% in the 2009 budget of the Federal Government to the health sector. This is against the minimum recommendation of 15% by WHO, since in widely held opinions, inadequate funding has been the bane of the health sector in Nigeria.
It is instructive that Health did not as much as receive a mention in the Seven Point Agenda of Vision 20: 2020. But if the overall intent of the vision is that of uplifting the living conditions and well-being of Nigerians to the standards of persons in the world’s 20 largest economies, then, to be successful in the health sector, Vision 20: 2020 must do the following: It must take steps to ensure that in the remaining eleven years, the quality of life of Nigerians as well as their health indices are sufficiently improved as to migrate them to the likes of those seen in the countries with the world’s 20 largest economies. The areas, in which these improvements would have to be assured, would include: HDI, (it is 0.935 for Germany and 0.470 for Nigeria); life expectancy at birth, (it is 82 years for Japan and 45.5 years for Nigeria); maternal mortality (it is < 4/100,000 live births for Finland and 800/100,000 live births for Nigeria); infant mortality, (it is 5.4/1000 live births for Canada and 103/1000 live births for Nigeria); and children’s immunization coverage, (it is 97% for Hong Kong and 18% for Nigeria). Whereas this is not an impossible task, all would agree that it is a tall order.
Access to the health care delivery system has to be improved so that even the poor can access it; an important reason for the success of the National Health Service (NHS) of the United Kingdom is that it is free and so accessible by all who require its services irrespective of the ability to pay. Funding of the system has to improve so that its operators can obtain, install and maintain the items that are required for the delivery of a reliable and effective health care system. In addition they would be able to innovate and research on issues that are of local relevance. Management of the system must also be better so that a properly functioning Referral System that will enable a patient who is seen at a Health Centre in the remotest village of the country, to ultimately benefit from the expertise that is available at an apex health institution which may be located several kilometres away from his village, without undue hassle.
As some initial steps, the Federal Government has embarked on a number of reforms in the health sector to enable it rise up to the demands of a dream as noble as Vision 20: 2020. These include the revamping and resuscitation of teaching hospitals through the Vamed Programme, to address the near collapse of the nation’s apex hospitals; the establishment of a National Health Insurance Scheme (NHIS), to obviate the difficulty of payment for health care when ill health strikes unexpectedly; the substantial appropriation of Debt Relief Funds to the health sector (N15.3 billion out of N109.5 billion) to meet health related issues in the MDGs and the reorganization of Primary Health Care (PHC), which is the foundation on which the health care delivery system is based as 70% of aliments from all the citizens of the country is expected to be satisfactorily addressed at that level. Additionally, Government responded swiftly to the HIV/AIDS pandemic, which has the potential of stopping and even reversing whatever developmental gains the country had made over the years, by establishing the National Aids Control Agency (NACA) and charging it with the responsibility of taking all appropriate steps to ensure that HIV infection is under check in Nigeria.
However, as important as these Vertical Actions may be, the point must be made again that the overall level of development of a country plays a crucial role in determining the level of efficiency of its health care system as well as its health indices. I am here referring, among others, to the level of ignorance and poverty which preclude some individuals from passing a life style that promotes good health; the absence of good and all-season roads and other avenues for movement which make it difficult for the sick to be quickly transported to where help can be obtained; the presence of a poor environment which rather than supports good health, encourages the propagation of ill health and disease through the existence of dilapidated and poorly ventilated homes, massive heaps of refuse on streets, blocked drains with stagnant dirty water and sewage, polluted rivers and other sources of drinking water; epileptic supply of basic needs like electricity and pipe borne water, which make it difficult for health institutions, such as there are, to function properly, resulting in the postponement or even cancellation of life saving operations, and storage problems with vital drugs like vaccines, to mention just a few. These issues which depict a lack of intersectoral collaboration must be properly addressed if Vision 20: 2020 is not to remain a pipe dream.
As for the specific matter of Women’s Health, the point was made earlier in this lecture that reducing maternal deaths by improving maternal health, is the gate way to improving women’s health. This is so because, among others, such a process would tackle the crucial issue of female poverty and dependency which contributes to women’s inability to cater for their own needs. It will seek to eradicate female illiteracy and its associated ignorance which makes women vulnerable to all kinds of manipulation, neglect and unfair treatment. Above all, it will foster national development which will uplift the well-being and quality of life of all women. In this respect, instituting free maternal and child health services in all public health institutions in the country should be seen as an urgent requirement. These are not just the tenets of Maternal Health; they are the essentials of Women’s Health.
7. MY ROLE IN ENHANCING WOMEN’S WELL-BEING
In my citation which was read earlier, my academic and profession path was defined but here, I wish to draw attention to some specific aspects of my contributions to the overall well-being of women.
During my brief stint in the Nigerian Army in 1970 as a Field Captain at the height of the Nigerian civil war, that is, even before the commencement of my formal training as an Obstetrician and Gynaecologist, I established a special clinic for women and children on both sides of the fratricidal conflict, at a site very close to the present day location of the Catholic Cathedral in Owerri, Imo State of Nigeria. Although there are no records, it is possible that the services that were rendered in that clinic saved the lives of some women and children.
As an academic staff in two universities (ABU Zaria and Uniport) and a consultant Obstetrician and Gynaecologist to their teaching hospitals, in over 30 years of my career (1975 to date), I have trained hundreds of medical doctors, a good number of whom are females and attended to the health needs of thousands of women and their children especially in the areas of maternal health and oncology. At some point during that period, I served as an external examiner to 11 of the 12 medical schools that existed then and one in Ghana and so my contribution to the training of medical practitioners for national development, was not confined to my employing institutions of Ahmadu Bello University, Zaria and the University of Port Harcourt.
As the pioneer Head of the Department of Obstetrics and Gynaecology at the University of Port Harcourt, I established the post graduate programme of the department in 1980 which has now turned out scores of qualified persons, some of whom have risen to the levels of Professors and Consultants. At least one third of those who have passed through the department in this manner are women. Furthermore, I have served as an Examiner at all three parts of the Fellowship Examinations of the National Post Graduate Medical College and the West African College of Surgeons and in this respect, I have helped to produce specialised manpower in Medicine for national development not just in Nigeria but also in the West African sub region.
Through my research activities, I have improved and saved the lives of women all over the world. In this regard, I and members of my team along with colleagues from the University of Liverpool reactivated the health facilities at kegbara Dere in Ogoni land as a major research centre for reproductive health studies. The results of many original prospective research that are designed to find solutions to women’s health problems that emanated from that centre, have been published in a number of world renowned medical journals, including the Lancet in 1995. Additionally, that health facility in Kegbara Dere is now functioning as a fully fledged hospital which attends to the needs of everyone including women.
I served as Secretary-General of the Society of Gynaecology and Obstetrics of Nigeria (SOGON), the professional umbrella body that embraces most Obstetricians and Gynaecologists in Nigeria with affiliation to the International Federation of Gynecology and Obstetrics (FIGO) between 1982 and 1988. That body, during my watch, furthered the course of women through scholarship and insistence on sound professional practice; it was instrumental in getting the WHO to launch the current Safe Motherhood Programme in 1985 which is specifically designed to make motherhood safer for all women, including those in sub Saharan Africa where maternal deaths are highest.
As Chairman of the Faculty of Obstetrics and Gynaecology, of the National Post Graduate Medical College of Nigeria, member of Senate and later the Treasurer of the College, I joined in 2005 in approving the election of one of the only two female College Presidents so far in the over 30 years life of the college and also supervised the training of several specialists in the discipline, many of whom were women.
As Provost of the College of Health Sciences of the University of Port Harcourt in 1994, I led the presentation to the Senate of the university which resulted in the establishment of the Doctor of Medicine (MD) Degree programme from which men and women stand to benefit.
Furthermore, as Vice Chancellor of the university (2000-2005), my colleagues and I ran an administration that offered equal opportunity to all and one that was deliberately female friendly. Little wonder that:
I was Chairman of the Board of the National Hospital, Abuja, between 2006 and 2007 and during that period, the board, under my chairmanship, effected the promotion of all deserving staff of the hospital – an exercise that had been pending for eight years prior to my assumption of office. The bulk of those who benefited from the exercise were females who were in the service of the hospital either as nurses or medical officers. Additionally, the Board under my chairmanship, in 2006, approved and financed the establishment of an Invitro Fertilization –IVF- (popularly known as Test Tube Baby) Unit. This was the first of its kind in a public health facility in Nigeria, where charges are only a fraction of those in private health facilities. At the last count at the end of December 2008, 17 babies had been born through this highly sophisticated technique with eight on-going pregnancies at the National Hospital. That decision of the Board during my tenure as Chairman has thus brought satisfaction, succour and happiness to a number of women with infertility.
In recent times, I have been involved in micro enterprise schemes for the improvement of the lot of women in Rivers State, especially widows, under the auspices of New Dawn Africa as well as Mankind Survival Project.
In sum, Mr. Vice Chancellor, distinguished Ladies and Gentlemen, I have dedicated my life to two aspects of human endeavour which impact most profoundly on women’s well-being – Education and Health – I have thus contributed to enabling women to assert their human rights, improve their living conditions, enhance their literacy and guarantee their happiness. This is not to say that I could not have done better and that some of my actions and decisions may not have inadvertently hurt the overall interest of women.
In this connection I once again wish to thank the Rumuosi Community in Akpor kingdom of Ikwerre Land for building a Library last year and naming it after me in appreciation of my contribution to the education of their sons and daughters and also to the kegbara Dere Community of Ogoni Land for making me a Chief in 2003 (Menelale – the chief that does good) in recognition of my efforts at resuscitating medical services in their community.
Mr. Vice Chancellor, it is my wish to continue with this tradition of contribution to women’s well-being and by extension, to national development and wealth creation. So, on this occasion, I wish to institute a prize for the best graduating female student with a first class degree or its equivalent to be known as the NIMI BRIGGS PRIZE and I hereby handover a cheque for the sum of one million naira to the Vice Chancellor, to endow this prize in perpetuity.
I will do more as the Almighty God gives me strength and resources.
Let me commence my closing remarks by quoting Article 1, Universal Declaration of Human Rights, 1948, of the United Nations which says “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood’.
Most of the issues that have been canvassed in this lecture as militating against women – the abuse/discrimination/violence (infecting them with the deadly HIV virus through rape), neglect (not minding sufficiently about how many of them die needlessly and are maimed from pregnancy related causes) and inequity in social inclusion (preferentially educating males) – are attitudinal and stem from society’s inability to accept that women are born free and are equal to any other and so their dignity and rights should be respected at all times. For indeed “women’s rights are Human Rights”.
To condemn and change this deplorable attitude of society, there has been a plethora of conventions, conferences, and seminars by multilateral bodies, Non-Governmental Organizations, academic and professional institutions – Convention on the Elimination of All Forms of Discrimination Against Women (1993), International Covenant on Economic, Social and Cultural Rights (1966), Convention on the Rights of the Child (1989), the World Declaration on Education for All (1990, 2000), Beijing Conference On Women (1995) and Beijing plus 5 (2000), Beijing plus 10 (2005) – urging that the situation is unacceptable and making recommendations on remedial measures.
In the light of all this, it will be correct to observe that some progress has been made and that societal attitude to women is indeed changing – globally and locally. One can surmise that the massive support Barack Obama had at the last presidential election in the United States, was in part due to his wife – Michelle – her carriage, charisma and immense contribution to the electioneering process. But the change in attitude is not occurring at the same pace in all parts of the world: it is most rapid and strongest in developed countries where women had, over the years, already secured respectability and are literarily in the main flow of all societal activities – pursuit of knowledge, politics, leadership, economics and others. On the other hand, the pace of change is slowest, if at all, in developing countries like many in Africa, where women remain mired in prejudice and some go through all manner of hardship just because of their gender.
It is for all these reasons that today’s Valedictory Lecture on Women and the travails that some of them suffer in our society is being delivered before this august university audience – universities have always served as conscience of society and their inmates, strong advocates for change.
Nevertheless, it is gratifying to note that women everywhere, including those in Africa, are not just lying prostrate and accepting the situation as a fait accompli. Only recently Vital Voices, an NGO operating in Africa, reported that “the women of Africa are sending the world a clear message – they represent the potential of their continent, they stand ready to make progress, and they are poised to lead”. Happily again, this is becoming truer by the day. On January 16, 2006, the continent of Africa was blessed with its first elected female president – Ellen Johnson Sirleaf of the Republic of Liberia. Over 30% of elected positions in Angola, Mozambique and South Africa are now held by women. The newly elected Speaker of the Ghanaian Parliament is a woman – a former Justice of the Supreme Court of Ghana. In Nigeria, the number of women who get elected into the upper House of the National Assembly – the Senate, is rising, even if slowly. Of the 90 members, there were 3 females in 1999, 4 in 2003 and 9 in 2007 (8.26%). Three women have become vice chancellors of Nigerian universities in recent times and for the first time, there is now a female among the serving Nigeria’s Supreme Court Judges.
Furthermore, girls’ primary school enrollment is surging in Kano State – a prominent part of Northern Nigeria (VOA News December 31, 2008) and early this year, the Hon. Minster of Women Affairs, Hajiya Salamatu Suleiman, stated that her priority “is women and girl child education”. In yet another development, a Nigerian Women Leadership Conference and Exhibition has been scheduled to hold on April 3-5, 2009, at Washington, DC – USA, with the theme “Nigerian Women, the Asset of Our Nation”. At that conference, the achievements of diverse groups of African Women Leaders will be presented.
What is required now is for society to massively throw its weight behind the education of the Girl Child and the elimination of all the discrimination that she suffers. For Education remains the quintessential tool for economic, social and political emancipation and empowerment. In addition, education avails its recipients with the necessary knowledge, skills and expertise with which to contribute to national development and wealth creation especially in the globalised world of today.
Distinguished ladies and gentlemen, I am done and so what is left is for me to thank you all for your presence and also to express my deep indebtedness to all those who have contributed in one way or the other to making me what I am today. You are far too many for names to be mentioned but even at that, two women stand out – my mother – for the awesome sacrifice she made as well as her tenacity even in the face of palpable hopelessness in ensuring that I did not have a wasted life and my wife, Lady D, as she is popularly called, for being the gem of inestimable value whose radiance and incandescence glow brightest when tribulations strike.
Many of you here have told me at various times that I have had a successful career; I agree with you and also confirm that I enjoyed it even though the career was almost untimely truncated by some unknown gunmen – all young boys, none hardly 25 by my reckoning, whom I have forgiven and I now call my 13 new sons, when they invaded the official residence of the immediate past Vice-Chancellor of this university on Thursday 13 December, 2007 and kidnapped me. But it has been said that to be successful, you need to know more than other; work more than other and expect less than other (Shakespeare). In my case, I am not sure I know more than other nor do I feel I have I work(ed) more than other. But I accept that I have received more than other and that one thing has been glaringly evident and that is that God’s abundant grace has been profuse in my life. And it is on account of all this that I now sing:
Such goodness, Lord, and constant care
I never can repay;
But may it be my daily prayer,
To love thee and obey
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WOMEN’S HEALTH: A NATION’S WEALTH – A Valedictory Lecture By Nimi D. Briggs, JP, KSc, OON. MB, BS (Lag), MD (Lag), FMCOG (Nig), FWACS, FICS, FRCOG, FAS. PROFESSOR OF OBSTETRICS & GYNAECOLOGY, University of Port Harcourt on Monday, February 23, 2009