Maternal and child health
Underneath the statistics lies the pain of human tragedy, for thousands of families who have lost their children. Even more devastating is the knowledge that, according to recent research, essential interventions reaching women and babies on time would have averted most of these deaths.
Although analyses of recent trends show that the country is making progress in cutting down infant and under-five mortality rates, the pace still remains too slow to achieve the Millennium Development Goals of reducing child mortality by a third by 2015.
Preventable or treatable infectious diseases such as malaria, pneumonia, diarrhoea, measles and HIV/AIDS account for more than 70 per cent of the estimated one million under-five deaths in Nigeria.
Malnutrition is the underlying cause of morbidity and mortality of a large proportion of children under-5 in Nigeria. It accounts for more than 50 per cent of deaths of children in this age bracket.
The deaths of newborn babies in Nigeria represent a quarter of the total number of deaths of children under-five. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery reflecting the intimate link between newborn survival and the quality of maternal care. Main causes of neonatal deaths are birth asphyxia, severe infection including tetanus and premature birth.
Similarly, a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. Although many of these deaths are preventable, the coverage and quality of health care services in Nigeria continue to fail women and children. Presently, less than 20 per cent of health facilities offer emergency obstetric care and only 35 per cent of deliveries are attended by skilled birth attendants.
This shows the close relationship between the well being of the mother and the child, and justifies the need to integrate maternal, newborn and child health interventions.
It is important to note that wide regional disparities exist in child health indicators with the North-East and North-West geopolitical zones of the country having the worst child survival figures.


Low coverage of life-saving interventions

The tragedy behind this lack of progress in child survival is that two-thirds of the under-five deaths could be avoided, since life-saving interventions are well known and can be implemented on a large scale, even in settings where resources are constrained.
Reduction in under-five mortality rates can be obtained by major increases in the use of insecticide-treated nets, Vitamin A supplementation, immunisation, oral re-hydration therapy, and treatment of malaria. Apart from Vitamin A supplementation, however, many of these interventions still have a low coverage among the Nigerian population.
Access and utilisation of quality health care services by women and children remains problematic because of the weak Primary health Care system. Also parents and care-givers lack the relevant knowledge on proper child healthcare practices.
For example, while breastfeeding is recognised worldwide as one of the most effective way of improving the health status of children, only 17 per cent of infants are exclusively breastfed up to 6 months in Nigeria. Only 6 per cent of children under-five in Nigeria sleep under a mosquito net. Routine immunisation coverage rates are still very low. Only 18 per cent of Nigerian children between 12-23 months can be considered fully immunised according to the recommended schedule of vaccination.
In addition, the lack of access to safe water and adequate sanitation combined with insufficient hygiene practices impact negatively on children’s health. Only about half of the population uses improved drinking water sources and adequate sanitation. Diarrhoea continues to account for many deaths of children under-5.
Not only is the child at high risk of not living beyond his/her fifth birthday, but those who survive serious illnesses often do not reach their full physical, intellectual and social potential due to the effects of poor health care and nutrition.
As the weakness of the country’s primary health care system continues to pose a major challenge to child health, poverty and illiteracy also hinder people’s access to health care. Primary healthcare centres usually lack skilled and motivated staff, drugs and equipment. It is hoped that the Integrated Maternal Newborn and Child Heath strategy – recently adopted by the Federal Government of Nigeria- will address these issues by improving supply management, enhancing the capacity of health personnel and supporting high impact intervention packages that can significantly improve maternal and child health in a short period of time
Birth registration
During the very first month of children’s life, birth registration is another important aspect for their protection because it gives them an identity, name and nationality for their lifetime.
In Nigeria, however, about 70 per cent of the 5 million children born annually are not being registered at birth. The value of birth registration as a fundamental human right is often overlooked due to the continuing lack of awareness that registration is a critical measure to secure the recognition of any person before the law, to safeguard his or her rights and to ensure that any violation of these rights does not go unnoticed.

Early childhood care and education

Pre-school age corresponds to a critical period of rapid physical, cognitive and psychosocial development of the child. The quality and intensity of care, nutrition and stimulation a child receives during this period determines to a large extent the level of physical and cognitive development a child can attain.
Though appreciable progress has been made in early childhood care and education in the past four years due to government policy requiring every public school to have a pre-primary school linkage, the proportion of children enrolled in pre-primary Early Childhood Care Centres still remains low at approximately 2.3 million children. This represents about 21 per cent of the population of children in this age group.
The caregivers of these centres are generally unqualified: about 85 per cent do not possess basic qualifications and more than half have no formal education. Another major issue in Nigeria’s early childhood care and development is the poor state of the infrastructure, equipment, facilities and learning resources. Essential learning resources are lacking in most facilities while the national curriculum is not yet widely operational. Mainstreaming of the early childhood education course into pre-service teacher training from the 2008/2009 session is expected to provide strategic solutions to some of the itemised problems.
Primary school years
In Nigeria, millions of children are still out of school. In addition, poor learning environment does not provide the quality education that would allow students to achieve their full potential.
Many children of primary school age also continue to experience physical and psychological violence both in schools and within the family environment while child labour continues to be a real source of concern; depriving many children of opportunities for schooling and development.
Children living on the streets, orphans and other groups of vulnerable children are also deprived of their right to basic primary education, face stigmatisation, encounter violence and are vulnerable to many dangerous situations.

Adolescence
Adolescent children need to acquire more sophisticated life skills to help them deal with the challenges of social relationships and entry into adulthood. This is usually achieved through education and training. However in Nigeria many adolescents are not in schools and do not benefit from such training.

Child rights and participation
In 2003, Nigeria adopted the Child Rights Act to domesticate the Convention on the Rights of the Child. Although this law was passed at the Federal level, it is only effective if State Assemblies also enact it. To date, only 16 of the country’s 36 States have passed the Act. Intense advocacy continues for the other 20 States to pass it.
This explains that this landmark legislative achievement has not yet translated into improved legal protection throughout the Federation. Nigeria has been unable to deal with several issues hindering the protection rights of children such as children living on the streets, children affected by communal conflict, drug abuse, human trafficking and the weaknesses of the juvenile justice system amongst others.
Children conflict with the law for a variety of reasons. Poverty, social inequality, failed educational system, family problems, peer pressure, social and religious conflicts in which children are used as the foot soldiers are some of the factors that account for the number of children in conflict with the law. Unfortunately these child offenders are often treated like adults and mixed with adults in prisons. Many are convicted and jailed without making contact with a social worker or getting the opportunity to be heard.
The most recent report to the African Union on the rights and welfare of the Nigerian child showed that about 6,000 children are in prison and detention centres across the country. Girls make up less than 10 per cent and they mainly come into contact with the law as a result of criminal acts committed against them such as rape, sexual exploitation and trafficking.
Child rights and participation Increased participation of children in issues affecting their lives can have positive and far reaching effects on their health and socio-economic conditions. When children participate in decision making, they tend to be more creative, positive and energetic, offering ideas devoid of prejudices and stereotypes.
The Federal Government inaugurated the Children’s Parliament in 2003 to enhance children’s participation. Since then, 26 States have inaugurated children’s parliaments. The main challenge is to make these Parliaments truly representative of the broad categories of Nigerian children, including the most vulnerable and disadvantaged.
There is also an increased participation of children in the media and their opinion at the public domain is now sought and publicized to give them some measure of participation and responsibility.

Education
The Universal Basic Education scheme adopted by the Federal Government of Nigeria provides for a nine year continuous basic education comprising six years of Primary education and three years of Junior Secondary education. This nine-year cycle is free and compulsory for all children. However, as at 2006, only 22 per cent of the over 10.5 million eligible children between 12 and 14 years of age were enrolled in Junior Secondary Schools. Over the last 10 years, the enrolment ratio improved only marginally.
Many adolescents do not attend school because their parents are unable to afford the monetary cost of schooling. For others, they have to start working to support their family. Figures also show that there are higher proportions of boys in junior secondary school as compared to girls.
Transition rates from primary school into junior secondary school are low compared to the 100 per cent transition rate envisaged under the country’s education scheme. Although there has been a slight increase in transition rates, opportunities for entering into junior secondary schools are limited. National data shows that more than half of the children who would have been admitted are denied admission due to unavailability of space.
This can be explained by the lack of adequate schools. In many cases, the great distance to schools is a major obstacle to enrolment. In addition, those who enrol in school either drop out or attend irregularly. In 2006, only 33% of the pupils completed Junor Secondary School. The lack of adequate sanitation in schools also contributes to poor school attendance of the girl child.
The quality of education at this level is low. Evaluations show that students perform poorly in core subjects.

HIV/AIDS
The present generation of young people is the largest in the country’s history. Coincidentally, the highest rate of HIV infection is constantly recorded among this group. Young people are one of the most vulnerable groups to the disease.As Nigerian adolescents begin to engage in sexual relations at a much earlier age than in the past, cases of HIV/AIDS infection are being reported among pre-teenage youths in schools.
The occurrence of new infections is highest among young people aged 15-24 years, accounting for 40 per cent of new infections in 2006. Having multiple sex partners continues to be recognised as a persistent problem driving the epidemic in the country, especially among adolescent and young people.
A recent HIV/AIDS school-based survey shows a low risk perception among school pupils towards contracting the HIV virus, a high tendency to discriminate and stigmatise HIV positive persons and some level of misconception about the mode of transmission of the HIV virus. For instance 26% of respondents thought that mosquitoes could transmit the virus.
In response to this situation, the Government has developed the Education Sector Strategic Plan on HIV/AIDS and has included HIV-AIDS in the public school health curriculum.
In many parts of the country, traditional values promoting female submissiveness make adolescent girls more vulnerable because it is difficult for them to refuse sexual relationships. In addition, early marriage for girls remains a common practice in some communities, particularly in the Northern part of Nigeria. In 2005, the median age at marriage for women in Nigeria was 17 with some regional variation. Marriage of girls as young as 12 or 10 years is still common in some areas.
This is particularly worrisome given the implications on the child bride. Consequences of child marriage include obstetric fistula, infections, HIV, infertility, limited social support and high infant and maternal morbidity and mortality.

Child trafficking
The trafficking of children for the purpose of domestic service, prostitution and other forms of exploitative labour is a widespread phenomenon in Nigeria. Children and women are recruited with promises of well-paid jobs in urban centres within the country or abroad, realising too late that they have been lured into a debt bond. Violence, coercion and deception are used to take victims away from their families. Regretfully, Nigeria is a source, transit and destination country for trafficked women and children. Prostitution, domestic and exploitative labour continues to fuel this modern from of slavery.
There is yet no reliable estimate of the number of children trafficked internally and externally primarily because of the clandestine nature of the phenomenon. The causes of children and women trafficking are numerous. They include poverty, desperation to escape violence, corruption, unemployment, illiteracy and ignorance.
To fight human trafficking, the Government passed the Trafficking in Persons Prohibition and Administration Act and established the National Agency for the Prohibition of Trafficking in Persons and Other Related matters (NAPTIP) in 2003. Since then, investigation of cases, prosecution of criminals, rescue and rehabilitation of victims have been successfully carried out by the Agency.