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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 12  |  Issue : 2  |  Page : 60-67

Socio -cultural and economic determinants of poor utilization of health facilities for child delivery among the Tarok in North -central Nigeria


Department of Sociology, Bingham University, PMB 005, New Karu, Nasarawa State, Nigeria

Date of Web Publication20-Jun-2014

Correspondence Address:
Titilayo C Orisaremi
Bingham University, PMB 005, New Karu, Nasarawa State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2384-5589.134892

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  Abstract 

Context: The study was informed by the poor state of maternal health especially in northern Nigeria and the inadequacy of the medically oriented approach that emphasizes health -facility delivery at the expense of certain traditional cultural practices of the various ethnic groups. Aims: The paper investigated and identified certain crucial socio -cultural and economic factors that inhibit health facility delivery among Tarok women in north -central Nigeria. Settings and Design: Data were collected from four Tarok communities in Langtang North local government area of Plateau State in north -central Nigeria. Qualitative research design was used to collect and to analyze data. Materials and Methods: Tools used to generate data were in -depth interviews (IDIs) and focus group discussion (FGD) guides. Sixteen key informants were individually interviewed and 24 FGD sessions were conducted for various groups of men and women of 15 years and above based on their socio -demographic background. Statistical Analysis Used: Tables were used to show the social background of the IDI and FGD participants. Results: Emerging evidence from the exploratory study showed the prevalence of risky traditional delivery practices rooted in the high value placed by the Tarok society on bravery; perception of heath facilities as places of last resort; low level of education among girls/women; and poverty; among other factors. Conclusions: Socio -cultural and economic factors are key determinants of the use of health facilities for child delivery. Addressing these factors is imperative toward achieving improved maternal and child health in Nigeria.

Keywords: Child delivery, cultural practices, health facility, maternal health, social determinants, and the Tarok
Key Messages: The importance attached to gallantry by the Tarok discourages many women from health facility delivery as they are expected to show bravery by having their babies delivered unattended and wherever child labor catches up with them.


How to cite this article:
Orisaremi TC. Socio -cultural and economic determinants of poor utilization of health facilities for child delivery among the Tarok in North -central Nigeria. Afr J Med Health Sci 2013;12:60-7

How to cite this URL:
Orisaremi TC. Socio -cultural and economic determinants of poor utilization of health facilities for child delivery among the Tarok in North -central Nigeria. Afr J Med Health Sci [serial online] 2013 [cited 2019 May 21];12:60-7. Available from: http://www.ajmhs.org/text.asp?2013/12/2/60/134892


  Introduction Top


Poor utilization of health facilities for child delivery is often associated with poor outcomes of maternal and child health both of which have contributed immensely to the high maternal morbidity and mortality rate especially in the north of Nigeria. It has become common knowledge in maternal health studies that Nigeria which constitutes only about 2% of the world's population accounts for as much as 20% of global maternal deaths. The mid -point assessment of the MDGs in Nigeria estimated that 872 women out of every 100,000 live births died in Nigeria in 2007. [1]

Indicators of maternal and child health often used by Nigeria and her development partners have been restricted to facility -related indicators such as antenatal care (ANC), place of delivery, and type of assistance during delivery. This is exemplified in the information contained in all National Demographic and Health Survey (NDHS) reports. For instance, the South West and the South East recorded 70% and 73.9% respectively in health facility delivery, North East and North West recorded 12.8% and 8.4% respectively, and the North Central region to which the Tarok belong had 41%. [2] Although using these indicators, the situation appears better in the North Central region compared to other regions in the North, it falls below average. Also, availability of emergency obstetric care (EOC) has been identified as a major challenge to maternal and child health across Nigeria, [3] where at least 15% of all pregnancies are expected to develop complications which require EOC. [4] Interestingly, even where facilities are available, more women patronize them for ANC than for delivery as only about 35% of deliveries are taken in health facilities nationwide. Sixty -two percent occur at home and only 25% of rural women in Nigeria deliver their babies in health facilities compared with 60% among urban women. [2]

There are thus questions about the adequacy of medically oriented and facility -based intervention programmes of the various tiers of the Nigerian Government and her development partners toward improving maternal and child health and attaining the Millennium Development Goals (MDG) 4 and 5. This is because this approach tends to undermine the fundamental non -medical socio -cultural beliefs and practices that permeate social relationships and are reflected in everyday practices in the Nigerian society. Even researches on social determinants of women's RH tend to focus primarily on education, socio -economic status, household wealth quintile, availability of and access to health facility for ANC and EOC. [5]

The International Conference on Population and Development (ICPD), [6] Article 12(2) of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), [7] as well as some other studies in Africa [8],[9],[10],[11],[12],[13] indicate the need to refocus attention from facility -based approach to maternal health to a more comprehensive and community based one that incorporates cultural, economic, and other vital social factors. Addressing medical or health institution -related issues without tackling the root cause of the problem amounts to tokenism.

The purpose of this study therefore is to investigate and document some of the social and cultural beliefs and practices among the Tarok ethnic group that discourage and inhibit many Tarok women, particularly in rural areas, from institutional deliveries. It also seeks to make substantive recommendations on how to address the challenges posed by these practices in an attempt toward attaining improved maternal health in Plateau State and indeed, in Nigeria.


  Research setting Top


The study was undertaken in Tarok land in Plateau State, central Nigeria. Tarok men and women are traditionally agriculturalists who cultivate several kinds of cereal like guinea corn (Sorghum Bicolour), millet (Pennisetum Americanum), and sesame. They also keep some livestock. Men, women, and grown up children all take active part in farming while cattle herding is exclusively undertaken by boys or young men. Weekly markets in Tarok land are fora for buying and selling as well as for intense social activities.

The Tarok are organized around patriarchal system. They practice strict lineage exogamy and a mix of polygyny and monogamy with patrilocal mode of residence whereby each uterine family has a separate hut. [14] Authority, control, and inheritance lie with the male head of the family. The dominant religions in Tarok land are traditional religion and Christianity. The Christian missionaries brought Western education and medical services. The Tarok people embraced Western education and many upon completion sought paid employment in the large urban centers. They have taken to several careers but made the most impact in the Nigerian Armed Forces. In spite of the spread of Western education and the rapid growth of Christianity, beliefs and practices that are deeply entrenched in superstition and traditional religion abound. The Tarok have several traditional socio -cultural beliefs and practices in relation to pregnancy, labor, and child birth. For instance, Dashe [15] observed that Tarok women are forbidden from crying during their first labor to prevent them from doing same during subsequent deliveries and that deliveries are taken by traditional birth attendants (TBAs).


  Materials and Methods Top


This study was part of a larger research which was aimed at exploring how unequal gender relations influence the reproductive processes and the reproductive health of Tarok women in north -central Nigeria. The research utilized qualitative method for data collection and analysis. Fieldwork was conducted in four Tarok communities in Langtang North Local Government Area of Plateau State namely, Langtang, Gazum, Reak, and Pilgani in April -May 2008. Gazum and Reak are rural while Langtang and Pilgani are urban areas.

In -depth interviews (IDIs) and focus group discussions (FGDs) were used for data gathering. IDI participants in each community comprised a community leader, a religious and a woman leader as well as a senior modern health service provider from a public or private health facility who had worked in the community for not less than 3 years and was conversant with the socio -cultural practices of the Tarok. The focus groups consisted of female and male participants with a good knowledge of the mores, social norms, workings, and practices of the community in relation to the issues of interest. Participants were purposively selected to reflect the social differences in the communities. A structured questionnaire with ten simple questions on socio -demographic background such as age, gender, religion, marital status, highest level of education attained, and income earning activities was administered to each of the potential participants prior to the constitution of the focus groups. This was to enable an initial contact and to ensure homogeneity in the constitution of the groups for enhanced interaction.

The purpose of the research was explained to the selected participants and informed consent was verbally obtained from each of them prior to the IDI and FGD sessions. Four IDIs and six FGDs (three each for men and women) were conducted in each community. Female and male community members who participated in the FGDs were 15 years and above while the minimum age for the IDI participants was 38 years. On the whole, 41.5% of all participants were 50 years and above while those below 50 years made up 58.5%. Eighteen point six percent of all FGD participants were between 15 and 24 years and the 25 -34 age category constituted 28.5%. [Table 1] and [Table 2] below present the background characteristics and the distribution of the 16 IDIs and the 24 FGDs.
Table 1: Social background of IDI participants

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Table 2: Social background characteristics of focus groups

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With the aid of the three research assistants, interviews and discussions were conducted in Tarok, Hausa, and English languages and auto -recorded. These were transcribed and translated into English language. Key variables were examined and coded and thereafter, results were written from translated texts, coded master sheets, and researchers' memos to ensure that reported responses were contextual.


  Results Top


With the exception of the traditional rulers who were of the opinion that most pregnant women patronize health centers for delivery, most participants irrespective of age and gender reported that Tarok women prefer to deliver their babies at home to having them delivered in formal health facilities. The only few exceptions mentioned by participants are some of the educated women and some young first timers. Various reasons adduced by them for women's preference for home delivery are presented below according to how frequent these factors were mentioned.

High value attached by communities to bravery and audacity: Majority of female and male participants saw it is a thing of pride for a Tarok woman to display the sheer bravery of going through labor and delivery unattended. For them, it indicates courage and toughness. Thus, pregnant Tarok women in general keep on performing their usual functions until delivery. It is therefore not unusual for a Tarok woman to give birth on her way to or from farm; in the farm itself; in the marketplace; at the stream; in the bush while collecting firewood; while cooking; practically anywhere with or without any form of assistance. She would simply squat or kneel to deliver her baby. Although the practice was more common in the past, it is found among modern Tarok women. The following quotes illustrate this view:

Our women gave birth on the road, in the farm, anywhere. Even if she was walking on the street and she got into pains of labor she could deliver there . . . a girl delivered on the road is called Mowap, or Lohsel if it is a boy . . . our women delivered their babies on their own but nowadays they go to the clinic. My wives had all their babies at home {FGD, 70+, Male, Uneducated, Rural}.

She would simply squat if she was caught by labor and give birth wherever she felt labor pains. She gave birth on her own even in the market, in the farm . . . and the child would be brought home in a calabash {FGD, 70+, Female, Uneducated, Rural}.

A lot of our women give birth at home because they want to show that they are courageous women [FGD, 35 -45, Female, Primary, Urban].

If she delivers on her own, she will be congratulated for being a strong woman. The people will come and express their happiness over her action . . . for instance, I delivered even my first baby at home on my own . . . yes! [FGD, 50 -55, Female, Secondary, Urban].

Interaction with participants revealed some of the special names given to children born under the various circumstances listed above as shown in [Table 3].

A minority of young female participants however mentioned that some Tarok men regard facility delivery as repugnant, meant only for cowards and so they prevent their wives from engaging in the practice except for cases of complicated delivery.
Table 3: Tarok names showing circumstances of delivery

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Faith in the efficacy of amulak and ipun ikun

There was a general consensus that male and female herbalists are often consulted for (1) problematic pregnancies and (2) difficult delivery. Ipun ikun (an herbal mix given to pregnant women supposedly to keep them healthy and strong both before and during delivery) was usually given for the former case while the woman was made to take amulak (a slimy herbal mix used traditionally to ease delivery) for the latter. Both mixtures are administered orally. Amulak was however more commonly mentioned than ipun ikun. A modest majority of younger participants expressed faith in the herbal mixtures while most elderly participants attributed ease of delivery among Tarok women to both amulak and ipun ikun. This perception was confirmed by the explanations of experienced Tarok health service providers in the sampled communities:

There are certain concoctions that they take at home which they believe hasten delivery . . . and some other practices which the elderly women apply during labor. They believe that some of these things facilitate delivery. There is a woman here that we did a CS [Caesarean section] for on Sunday, she was in labor for about 3 days and she was attended to by these women at home. They gave her all manner of concoction and the thing couldn't help a multigravida who had delivered more than three or four times. They kept giving her concoction until the baby died and when they couldn't do otherwise, they had to rush her to the clinic so we had to do a CS on her . . . They call the concoction mulak. That concoction is multi -dimensional . . . made of all kinds of everything you can think of {IDI, 52, Male, Tertiary, Urban}.

Faith in the efficacy of the administration of nmok, afifyan or snuff

Interaction with older female participants revealed other traditional forms of assistance given to a woman in labor besides the use of herbal mix. Majority of them explained that for some difficult deliveries, experienced elderly women assist by: (1) making her inhale snuff, (2) administering nmok (guinea corn flour mixed with cold water), or (3) forcing afifyan (a wooden stirrer) down the woman's throat. Each of these processes according to them would force a heavy cough or sneeze out of her thereby helping her to expel the baby and or placenta as the case may be. The particular method to be used is left to the direction of the assisting elderly woman.

Experience acquired after one or two deliveries (parity)

Participants were generally agreed that mothers or any experienced woman in the neighborhood attends to young inexperienced women during child delivery. Hence, many young women reportedly go back home to their natal homes to have their first babies under their mothers' tutelage. They equally mentioned that in modern times, those who cannot travel to their natal homes invite their mothers to their marital homes. A young woman's mother is expected to: show her love and understanding during labor; assist her at delivery; give her hot bath, give her the right kind of meals and all the necessary care including massaging her body; and also teach her how to provide maternal care. Interactions with participants show that the length of time she stays with her mother ranges from 2 weeks to 3 months. Majority of participants said that TBAs do not exist in their communities. Only a minority of participants in a community in Gani district mentioned the presence of two elderly TBAs. Overall, a Tarok woman is expected to deliver her baby unattended after one or two experiences of childbirth except if there are complications.

Preference for traditional squatting position

Not only were most elderly and middle aged female participants averse to the positioning recommended in health facilities during delivery (where they have to lie on their back and push), they equally expressed their preference for the traditional squatting position adopted at home which according to them is more effective, convenient, and less painful. A health service provider explained it thus:

The delivery at home is usually supervised by the elderly women and you know there are some positions they adopt at home which they think is more convenient than the one we apply in the clinic . . . they squat {IDI, 51, Female, Tertiary, Urban}.

Faith in the skills of native doctors and surgeons

A few participants mentioned that complicated deliveries are attended to by either skilled native doctors at home or service providers in modern health facilities. However, most said that while more women patronize health facilities for complicated cases now than before, native doctors are largely patronized by traditionalists and uneducated rural women. These native doctors are men skilled in handling complicated deliveries including surgery. Below is a description of the process:

The native doctors rub amulak on their hands, insert them and pull the baby out. They also use a small knife. If the baby is too big, they'll tear the woman a little before bringing it out. Sometimes, if the baby is not properly positioned they will use their hand to reposition it or if the baby is breech, they will adjust with bare hands like this (demonstrating with her hands). That is why some women do have these fungal infections . . . because their fingers are usually very dirty . . . if it is a dead baby, they use amulak and a small knife with which they cut the baby into pieces before bringing out the parts one by one. So with the native doctors, sometimes the baby comes out dead . . . but other times the babies do come out alive . . . [FGD, 50 -55, Female, Secondary/Tertiary, Rural].

Only skilled male native doctors, who according to participants are increasingly becoming fewer with the advent of Western medicine, perform the surgery described above. Participants identified causes of difficult delivery as: intake of sugary foods in pregnancy, narrow vagina, a pregnant woman's refusal to take ipun ikun, evil spirits, poison, infidelity on the part of the woman, curse placed on her by her parents or ancestral spirits, witchcraft, breech presentation, insufficient blood (anemia), and inexperience.

Perception of modern health facility as a last resort

Majority of the participants expressed the opinion that professional assistance from traditionalists or modern skilled health service providers is the last resort that should be sought only when complications arise in the process of self or home delivery. Thus, facility delivery or being assisted during delivery is not what many Tarok women look forward to as captured by the statements below:

. . . If she is lucky she will give birth at home, if not, she will deliver in the hospital [FGD, 30 -34, Male, Primary, Rural].

They mostly come to the clinic when they have complications. . . sometimes when you interact with them, they will tell you this is their fourth or fifth delivery and they have never delivered in a clinic so they were brought for the first time because of the complications that developed {IDI, 52, Male, Tertiary, Urban}.

Some men and very elderly women on the other hand, perceived the presence of health facilities as what encourages modern young Tarok women to be 'lazy':

Now because of the presence of clinics, even when a woman can deliver on her own she becomes reluctant to push the baby out just because she wants to be taken to the hospital . . . this on its own can lead to complication {FGD, 70+, Male, Uneducated, Rural].

However, some participants pointed out that the advent of Christianity, Western education, and white collar jobs in Tarok land changed some of these traditional practices as many educated women especially in urban areas now attend ANC and give birth in health facilities where they are given some health education on basic maternal care.

Distance to health facility and transportation

Urban -based participants especially those that are resident at district headquarters expressed satisfaction with the number of health facilities in their various communities which are largely privately owned. Participants in rural communities especially in Gazum (a very rocky and remote community) however complained about non -availability of functional health centers and maternity homes as well as transport -related difficulties like inadequate means of transportation, very high cost of available transportation, and bad roads.

Poverty and insufficient financial commitment of some husbands

This was mentioned by a few participants in both rural and urban areas. Some of them explained how difficult it is for many women to pay medical bills especially in rural communities due to widespread poverty. They were also of the opinion that poverty forces some husbands to neglect their roles and financial commitment to their wives even in emergencies. A male service provider explained that some husbands who cannot afford to pay medical bills especially for complicated deliveries that cost above N3000 (about USD 20), abscond and abandon their wives and new born babies in hospitals.

Attendance of ante natal clinic

A minority of participants mentioned that some women who attend ANC and are told about the well -being of the fetus perceive such information as a clean bill of health for them to engage in home or self -delivery.

Low female education

Some educated middle -aged female participants recognized low female education especially in rural areas as a major factor that prevents young women from seeking appropriate health care services. They further linked this to women's poor access to economic resources and to decision making.


  Discussion Top


The study reveals that many young women experience their first labor under the guidance of their mothers. This is largely borne out of the belief that mothers are more inclined to showing empathy. This practice encourages home delivery especially since most non -literate elderly participants were found to be ignorant of the need for specialist obstetric care. Rather, they perceived pregnancy as a normal condition; whereas every delivery ought to be regarded as an emergency that calls for skilled attendance. The implication of this is poor outcome of maternal and child health. While this attitude is capable of encouraging pregnant women to be strong and carry -on with their lives as usual, it can discourage them from seeking health care (whenever the need arises) out of fear of reproach by other women; their husbands; or members of their communities; thereby placing their health and that of their unborn children at risk. Although most first timers (prima gravida) are expected to be supervised by their mothers or at least any experienced woman in the neighborhood, some engage in self -delivery so as to be recognized as brave women and so share in the social rewards attached to such open display of courage.

This may be related to the relatively mature age at which most Tarok girls marry, at the same time, the practice poses much danger to women especially in remote areas where access to ANC is lacking. Lack of access to adequate ANC implies lack of information on the well -being of the fetus prior to delivery. [16] Other risky practices found by the study are: women going into labor literally anywhere and unprepared; and women's perception of ANC as a clean bill of health for home and self -delivery. These findings corroborate those of an earlier study in the north of Nigeria. [16] Complications of child delivery are however not always predictable and trying one's luck in matters of child delivery until certain complications become worse can, and indeed, do result in maternal or infant morbidity and mortality. This is particularly true of communities that lack good and accessible roads, adequate transport, and health facilities or where poverty denies them access to available EOC. [4]

Although only a few participants mentioned poverty as one of the inhibiting factors to health facility delivery, it is a very vital and recurrent element in any discussion on access to maternal health in Nigeria as it is a key determinant of each of the three levels of delay. [12],[13] Most rural and urban poor women can ill -afford charges even for normal delivery. Besides societal expectations of show of courage, poverty is also a crucial factor in the reluctance of some Tarok men to allow their wives to deliver in health facilities. Apart from user -fee, they are often expected to provide basic items needed by midwives during delivery especially in public maternities. Although service provision is cheaper in public health facilities, these facilities are grossly inadequate and largely inaccessible to most rural dwellers in terms of their physical location and the ability of the rural poor to pay for health services. Thus, contrary to Article 12(1) of CEDAW that calls for an end to discrimination against women in health care, user -fee amidst poverty limits the ability of many women to access maternal health care. This is significant because maternal mortality is higher in rural than urban areas in Nigeria. For instance, MMR in Nigeria for 1999 was reported as 351 (urban) and 828 (rural). [1] These conditions compel many to patronize herbalists and native doctors. Although traditional medicine and medical skills are very useful especially in the absence of modern health and medical care, the issue of drug composition, accurate dosage, hygiene, etc that is taken for granted portends great danger for maternal and infant health.

Contrary to the assertion by Dashe, [15] findings in this study revealed that rather than TBAs, any woman experienced in child birth can provide assistance to a young woman in labor who needs help except in complicated cases that call for skilled intervention after "trial and error". The unhygienic surgical process of traditional doctors can lead to infection thereby compounding the problem. Furthermore, the fact that most elderly and middle -aged participants have faith in the traditional herbal mixtures implies that many young women who have to rely on the experiences of the former are exposed to the risk of infection from the mixture and from the procedure of home delivery.


  Conclusion Top


Overall, an average Tarok woman faces a lot health risks during child birth due to the value attached to bravery; the prevalence of traditional modes of maternal care; user -fee; distance to modern health facilities; poor girl -child education; poverty; insufficient support from some men; etc. All of which are social, cultural, and economic factors that serve to discourage and prevent women from seeking modern skilled assistance for delivery and thus affect modern health facility utilization and maternal health. This is particularly true of the rural population which constitutes over 60% of the Nigerian population. [17]

 
  References Top

1.Federal Republic of Nigeria. Mid -Point Assessment of the Millennium Development Goals in Nigeria 2000 -2007. Abuja: The Office of the Senior Special Assistant to the President on the MDGs, 2008.  Back to cited text no. 1
    
2.National Population Commission (Nigeria) and ICF Macro. Nigeria Demographic and Health Survey 2008. Maryland: National Population Commission and ICF Macro, 2009.  Back to cited text no. 2
    
3.United Nations Population Fund. National Study on Essential Obstetric Care Facilities in Nigeria. Abuja: Federal Ministry of Health and UNFPA 2003.  Back to cited text no. 3
    
4.United Nations Children's Fund, World Health Organisation. Guidelines for monitoring the availability of and use of obstetric services. New York: UNICEF; 1997.  Back to cited text no. 4
    
5.Moyer CA, Dako -Gyeke P, Adanu RM. Facility -based delivery and maternal and early neonatal mortality in sub -Saharan Africa: A regional review of the literature. Afr J Reprod Health 2013;17:30 -43.  Back to cited text no. 5
    
6.United Nations Population Fund. ICPD At Ten, The World Reaffirms Cairo: Official outcomes of the ICPD at ten review. New York: UNFPA; 2005.  Back to cited text no. 6
    
7.Convention on All Forms of Discrimination against Women [Internet]. New York: United Nations. Available from: http://www.CEDAW 29th Session 30 June to 25 July 2003.html. [Last cited on 2011 July 6].  Back to cited text no. 7
    
8.Sai FT, Measham DM. Safe motherhood initiative: Getting our priorities right. Lancet 1992;339:478 -80.  Back to cited text no. 8
    
9.Hove I, Siziya S, Katito C, Tshimanga M. Prevalence and associated factors for non -utilization of postnatal care services: Population based study in Kuwadzana peri -urban area, Zvimba district of Mashonaland West province, Zimbabwe. Afr J Reprod Health 1999;3:25 -32.  Back to cited text no. 9
    
10.Berhane Y, Högberg U. Prolonged labour in rural Ethiopa: A community based study. Afr J Reprod Health 1999;3:33 -9.  Back to cited text no. 10
    
11.Okaro J, Umezulike A, Onah H, Chukwuali L, Ezugwu O, Nweke P. Maternal mortality at the University of Nigeria Teaching Hospital, Enugu before and after Kenya. Afr J Reprod Health 2001;5:90 -7.  Back to cited text no. 11
    
12.Roth D, Mbizvo M. Promoting safe motherhood in the country: The case for strategies that include men. Afr J Reprod Health 2001;5:10 -21.  Back to cited text no. 12
    
13.Okonofua FE. The role of health in national development the status of maternal and child health in Nigeria. In: Details of Proceeding of Nigeria National Health Conference 2006. Abuja: Health Reform Foundation of Nigeria; 2007.  Back to cited text no. 13
    
14.Shagaya JN. Taroh History. 2005.   Back to cited text no. 14
    
15.Dashe SC. Childbirth and naming ceremony. In: Lannap AL, editor. The Tarok Woman. Jos: University Press Limited; 1999. p. 28 -37.  Back to cited text no. 15
    
16.Wall LL. Dead mothers and injured wives: The social context of maternal morbidity and mortality among the Hausa of Northern Nigeria. Stud Fam Plann 1998;29:341 -59.  Back to cited text no. 16
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17.Federal Republic of Nigeria. National Policy on Population for Sustainable Development. Abuja: National Population Commission; 2004.  Back to cited text no. 17
    



 
 
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