Shifting Gender Norms through Women Empowerment Group for Improved Health-Seeking Behaviors in Northern Nigeria

Summary:

Nigeria is the second largest contributor to maternal mortality worldwide. Key factors that contribute towards this are poor health-seeking behaviors including restrictive gender norms such as lack of spousal support, high level of social tolerance for violence against women and girls and women's lack of agency to make decisions related to their reproductive health and household finances. Using a human-centered design approach, Breakthrough ACTION Nigeria integrated research, behavioral science, and communication into a cohesive flexible approach to co-create possible solutions address this challenge. Women's empowerment groups emerged through this process as a promising solution for women to identify opportunities to increase their agency through income generation and increased knowledge to improve health-seeking behaviors around maternal and child health in three northern states in Nigeria. Through a pilot of one woman empowerment group per State between April and August 2019, with each group conducting weekly meetings embedded with structured health conversations and financial contributions, nearly two-thirds of the women are now managing their own businesses. Also, almost all the women reported increased spousal communication, the ability to contribute to their household finances, and influence decisions that affect their health and that of their children. Additional qualitative evidence indicates that the initial engagement of the husbands helped to increase their buy-in while, the co-design process enabled a broader understanding of leverage points to improve women's financial agency, efficacy to communicate and participate in household decision making and improve health outcomes for themselves and their households.

Background/Objectives:

As the second-largest contributor to maternal mortality worldwide, Nigerian women face several challenges that affect health-seeking behaviors, including restrictive gender norms such as lack of spousal permission/spousal disapproval, high levels and social tolerance of violence against women and girls, womenду»s lack of decision-making power related to their reproductive health and household finances. 

Breakthrough ACTION - Nigeria utilized the SBC Flowchart (a flexible design process that integrates several behavioral sciences). Co-designing a series of women's groups in Northern Nigeria emerged as a way a woman could generate income, learn about priority MNCH+N behaviors, and gain new skills.

Description of Intervention and/or Methods/Design:

The women's groups intended to build women's confidence to discuss health and social issues. The co-design process began in December 2018 and included interviews with women, their families, religious and community leaders to outline the aims, structure, and design of a womenду»s empowerment group. The prototype brings together up to 25 women in a group and provides a safe space to generate discourse on social and gender norms, deepen knowledge on MNCH+N, and influence decisions and practices that affect their health and that of their children. Based on community feedback, the Women Empowerment Groups now include elements such as microfinance opportunities, uniforms, and social fines. Each group is led by a trained community facilitator and a gender Desk Officer from the State Ministry of Women Affairs (SMOWA). On a weekly basis, a trained consultant collected qualitative and quantitative data points on the women's groups.

Results/Lessons Learned:

It was observed during the group meeting that the women could recall MNCH+N key messages and explain specific behaviors they carry out with their families during the meeting. They formed a local song with the key messages and as part of their rules and regulation, take turns to recite and explain each key message. Also, women self-reported increased spousal communication, ability to contribute to their households, and influence decisions that affect their health and that of their children. 

Many women involved during the pilot phase of this activity initially reported limited access to income-generating activities. Following weekly meetings, structured health conversations, and mandatory financial contributions, now nearly two-thirds of the women in the pilot are managing their own business. Initial community outreach to husbands increased spousal support for the women's group activities as almost all women in the group reported some level of spousal support and communication.

Discussion/Implications for the Field:

Bringing women together can create safe spaces for different groups of women to discuss economic empowerment, MNCH+N priority behaviors, and other issues in community spaces outside of the home. The groups encourage self-empowerment while creating a strong network of women who are interested in and invested in opportunities for self-improvement. Surplus income - coupled with improved health knowledge and sharpened life-skills - leads to financially empowered women who are actively engaged in household decision-making and confident enough to lead meaningful conversations on health topics with their spouses. Women Empowerment Groups can be easily replicated across Nigeria.

Abstract submitted by:

Chizoba Onyechi - Breakthrough ACTION Nigeria
Fatimah Nasir - Breakthrough ACTION Nigeria
Lindsey Leslie - Johns Hopkins Center for Communication Programs
Shittu Abdu-Aguye - Breakthrough ACTION Nigeria