By Eze Onyekpere
Nigeria is under obligation to use the maximum of available resources for the progressive realisation of the right to health. This includes the obligation to ensure effective maternal, new born and child health (MNCH) within its territory. This obligation is encapsulated in national and international standards. The right to health is an integral and inextricable part of the right to life, for without good health, the right to life may be extinguished. All that the authorities need to do to violate the right to life is to deny health supporting facilities and conditions to a group of persons to the point of abrogation.
MNCH is a component of the right to health. It is a component that Nigeria has underperformed in over the years leading to high infant mortality and morbidity rates, high under-5 mortality rate and high maternal mortality rate. According to the World Health Statistics 2014, our immunisation coverage is poor and improvements in the sector have not been sustainable. As at 2012, immunisation coverage for 1 year olds is 42% for measles, 41%, 41% and 10% for DTP3, HepB3 and Hib3, respectively.
Nigeria’s infant mortality rate dropped from 126 per 1000 live births in 1990 to 112 per 1000 live births in 2000, and lowered to 78 per 1000 live births in 2012. Nigeria’s maternal mortality rate was 1200 per 100,000 live births in 1990, 950/100,000 in 2000 and “improved” to 560/100,000 in 2013. This is far higher than the numbers of peer countries.
These are not statistics and figures of cows and poultry dying from foot and mouth disease or bird flu, but figures of our mothers, sisters and daughters. Are these persons who lose their lives expendable or we now live a heartless society? Should getting pregnant to reproduce the future generation of Nigerians be a death sentence? These poor indicators should be pitched against S.33 of the 1999 which states: “Every person has a right to life and no one shall be deprived intentionally of his life, save in the execution of the sentence of a court in respect of a criminal offence of which he has been found guilty in Nigeria”.
The above provision makes exception to this general rule when it states that a person who dies as a result of the use, to such extent and in such circumstances, as are permitted by law, of such force as is reasonably necessary for the purpose of suppressing a riot, insurrection or mutiny or in order to effect a lawful arrest or to prevent the escape of a person lawfully detained. It also recognises that life may be taken away following the above proviso in defence of property or in defence of any person from unlawful violence. Similar provisions are found in the African Charter on Human and People’s Rights and other international standards binding on Nigeria. Mothers, newborns and children dying as presented in these statistics did not die under the cognizable exceptions to the general protection of the right to life. The state had a role to play but it let them down when it mattered most. Thus, their death could to a great extent be traced to our poor governance system.
Nigeria further made a commitment under the Millennium Development Goals 4 and 5 to reduce child mortality- reduce by two-thirds, between 1990 and 2015, the under-five mortality rate with indicators such as under-five mortality rate, infant mortality rate and proportion of 1 year-old children immunized against measles.
There was a commitment to improve maternal health by 2015; reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio with indicators such maternal mortality ratio, proportion of births attended by skilled health personnel, contraceptive prevalence rate, adolescent birth rate, antenatal care coverage (at least one visit and at least four visits) and unmet need for family planning. As usual, this is over fifteen years since this commitment was made and we are in the terminal year of 2015 with not much to show.
This brings us to the minimum core obligation of the state in terms of the rights to life and health including MNCH. According to the United Nations Committee on Economic, Social and Cultural Rights (UNCESR), the minimum core obligation is the threshold below which no state will be allowed to descend.
It is an obligation which must be met regardless of resources available to the state. It is the minimum core content of a right and in this instance, the rights to life and health. Nigeria has a core obligation to ensure the satisfaction of, at the very least, minimum essential levels of each of these rights including essential primary health care. The UNCESCR confirms the following as minimum core obligations (a) to ensure reproductive, maternal (pre-natal as well as post-natal) and child health care; (b) to provide immunization against the major infectious diseases occurring in the community. (To be continued)
Onyekpere is the Lead Director, Centre for Social Justice, 17 Yaounde Street, Wuse Zone 6, Abuja. Follow me on Twitter @censoj