title: Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states.
abstract: BACKGROUND
  Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy.
  
  
  METHODS
  In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering.
  
  
  RESULTS
  The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5).
  
  
  CONCLUSIONS
  Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives--genital mutilation, domestic violence, and steep power gradients--is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.
authors.affiliation: Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Calle Pino, El Roble, Acapulco, Mexico. andersson@ciet.org
authors.forename: Neil
authors.initials: N
authors.lastname: Andersson
authors.forename: Khalid
authors.initials: K
authors.lastname: Omer
authors.forename: Dawn
authors.initials: D
authors.lastname: Caldwell
authors.forename: Mohammed Musa
authors.initials: MM
authors.lastname: Dambam
authors.forename: Ahmed Yahya
authors.initials: AY
authors.lastname: Maikudi
authors.forename: Bassey
authors.initials: B
authors.lastname: Effiong
authors.forename: Edet
authors.initials: E
authors.lastname: Ikpi
authors.forename: Etuk
authors.initials: E
authors.lastname: Udofia
authors.forename: Amir
authors.initials: A
authors.lastname: Khan
authors.forename: Umaira
authors.initials: U
authors.lastname: Ansari
authors.forename: Noor
authors.initials: N
authors.lastname: Ansari
authors.forename: Candyce
authors.initials: C
authors.lastname: Hamel
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D017579:Domestic Violence / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005783:Gender Identity; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008429:Maternal Welfare; D008875:Middle Aged; D015999:Multivariate Analysis; D009549:Nigeria / Q000453:epidemiology; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D012737:Sex Factors; D012938:Social Perception; D012941:Social Responsibility; D011795:Surveys and Questionnaires; D055815:Young Adult