Navigating reproductive health and societal pressures

In Ayobami Adebayo’s Stay with Me, the narrative revolves around Akin and Yejide, a young Yoruba couple grappling with the challenges of childbirth and navigating their careers and emotional turmoil within their relationship. This story provides a poignant lens through which to examine reproductive health issues in Nigeria.

According to the 2021 MICS/NICS report by the National Bureau of Statistics, 69.60 per cent of pregnant women attended antenatal care and were seen at least once by skilled health personnel. Additionally, 18.20 per cent of women who are currently married or in union use any modern method of contraception for pregnancy prevention and family planning, while 21.70 per cent use any method. However, 78.30 per cent do not use any method at all. This data underscores the critical state of reproductive health in Nigeria, a country where the future literally lies in the wombs of women.

Moreover, the World Health Organisation defines reproductive health as “more than just the absence of illness; it involves a comprehensive approach to physical, mental, and social well-being, ensuring that individuals have the resources and freedom to make choices about their reproductive lives.” This definition highlights that only a small number of women are fully engaged in managing their reproductive health from puberty to menopause. For instance, consider the teenage girl unable to afford menstrual pads due to high living costs. Similarly, think about the mother suffering from perinatal or postnatal depression, yet perceived as fine because she appears physically healthy.

In Stay with Me, Yejide resorts to mystical methods to conceive, ignoring scientific options, revealing the social stigma and isolation faced by childless women in society. This aspect of the story illuminates how societal pressures and cultural beliefs can impact women’s health decisions.

While literature and storytelling can illuminate the world of the unborn, they also prompt us to consider the harsh realities of reproductive health in Nigeria and Africa as a whole.  Economic burdens still hinder the acceptance and utilisation of comprehensive reproductive health resources in Nigeria. Many individuals, particularly women in low-income communities, face significant financial constraints that prevent them from accessing essential healthcare services. For example, the cost of transportation to healthcare facilities is expensive, even just moving from Iyana Ipaja to Ikeja with the recent hike in transport fares. Additionally, the direct costs of reproductive health services, such as consultations, diagnostic tests, and treatments, are often beyond the reach of those living in poverty. This financial barrier is further increased by the high cost of medical supplies and medications, including contraceptives and menstrual hygiene products, which are essential for maintaining reproductive health. Furthermore, economic instability and widespread unemployment mean that many households must prioritise immediate basic needs, such as food and shelter, over healthcare expenditures. As a result, women may forego necessary reproductive health services, leading to adverse health outcomes and perpetuating cycles of poor health and poverty.

Furthermore, consider men with erectile dysfunction who mask their condition under the guise of purity. For example, an anonymous member of a Facebook community group shared how her husband pretended to endorse “no sex before marriage.” Yejide reflects on this in Stay with Me, writing: “What did I know? I knew that I was once invested in his lies as he was, probably more than he was – I imagine he at least admitted the truth to himself. I could not do that until Dotun had spoken the words; I could not allow him to be flawed. So I bit my tongue when customers talked about sex and I let him hold my hand when he told the doctor our sex life was absolutely normal. I told myself I was respecting my husband. I convinced myself that my silence meant I was a good wife. But the biggest lies are often the ones we tell ourselves. I bit my tongue because I did not want to ask questions. I did not ask questions because I did not want to know the answers. It was convenient to believe my husband was trustworthy; sometimes faith is easier than doubt.”

This excerpt illustrates the complex interplay between personal beliefs, societal expectations, and health issues. It emphasises that only through a collective investment in advancing women’s reproductive health can we move towards promoting methods like artificial reproductive technology, empowering women to feel confident in their health.

As stated in the International Conference on Population and Development Programme of Action, 7.3, “[P]ractically speaking, it [the indivisibility of rights] has to do with the real-life fact that a woman cannot avail herself of her ‘right to decide freely and responsibly the number, spacing, and timing of her children”

In conclusion, if a woman lacks financial resources for reproductive health services or transportation to access them, cannot read package inserts or clinic posters, works in environments contaminated with harmful substances, or is harassed by a husband or in-laws who scorn or abuse her for using birth control, her ability to manage her reproductive health is severely compromised. Therefore, addressing these barriers is crucial for ensuring comprehensive reproductive health and well-being for all women. This is crucial for improving the acceptance and utilisation of comprehensive reproductive health resources, ensuring that all individuals, regardless of their financial status, can make informed and autonomous decisions about their reproductive health.

Adenuga is a graduate student at the Indiana University of Pennsylvania