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I know, I know. So okay, go ahead. Go ahead and go ahead. Favor bye.

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Lorretta Favour Ntoimo: Okay, thank you so much. All for one.

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Lorretta Favour Ntoimo: I'm so glad to to be here to join online.

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Lorretta Favour Ntoimo: And I'm going to make this pre first presentation, which is titled. Those Bride Wells. Give a man per or via a woman

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Lorretta Favour Ntoimo: conflict of culture and women's rights in Nigeria.

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Lorretta Favour Ntoimo: please the the outline of my presentation. I'll give you a brief introduction, then the research objectives in my thoughts, the results. a brief discussion of the findings and conclusions and references

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Lorretta Favour Ntoimo: by way of introduction. Brad Wells is a collection of gifts and money that is transferred from the groom to the Bright family before marriage in Nigeria. It is a cultural practice in many Nigerian communities.

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Lorretta Favour Ntoimo: bride wells the transfer of bride wells from the groom. Today. Bryce's family is what legitimizes marriage in Nigeria traditionally.

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Lorretta Favour Ntoimo: and

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Lorretta Favour Ntoimo: The return of Bradwell is also what is considered dissolution of marriage. Traditionally.

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Lorretta Favour Ntoimo: however, bread well as it is practice, it seems to reinforce imbalance in gender relations in the home.

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Lorretta Favour Ntoimo: There are some records of women who have outrightly resisted the custom, some who have how directly demonstrated against the custom of bride wells.

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Lorretta Favour Ntoimo: There are also records of states in Nigeria that have re legislated against it or tried to regulate it.

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Lorretta Favour Ntoimo: A number of studies also have tried to link Brideworth the practice of Bride wells to women's autonomy and and well being.

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Lorretta Favour Ntoimo: How about how Bride Wells defies gender relations, particularly in the home. How it reinforces the violation of women's rights, has actually remained largely undocumented in Nigeria to date.

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Lorretta Favour Ntoimo: Yeah, for this study investigates the cultural meaning of Brad Wells in Nigeria

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Lorretta Favour Ntoimo: we specifically sort women's and men's perception of the practice for bread wells in relation to what is considered women's rights in a marriage.

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Lorretta Favour Ntoimo: and then the implications of the findings are discussed in relation to women's rights gender apt and gender equality.

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Lorretta Favour Ntoimo: The study is conducted in Nigeria.

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Lorretta Favour Ntoimo: We used a qualitative design. and our study population, includes men and women in in a maritime union. The data we are collected through in depth interviews

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Lorretta Favour Ntoimo: with 4 key informants, elderly men and women who we call, who, I consider, custodians of of culture.

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Lorretta Favour Ntoimo: 25 men who are married, currently married. and 19 women who are also currently married.

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Lorretta Favour Ntoimo: The data were collected by using a students, actually, university students who are trained in the art of collecting qualitative data.

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Lorretta Favour Ntoimo: The interviews last stage

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Lorretta Favour Ntoimo: an average of 30 to 45 min. They were all tip record and transcribed.

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Lorretta Favour Ntoimo: Our clusty was used

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Lorretta Favour Ntoimo: for for the coding

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Lorretta Favour Ntoimo: 4 broad things in my from the narratives. Number one is Brad. Word legitimacy. Union to Bradworth is simply symbolic, for I mean straight bride, word, confess authority on a man over a woman, and for bride wells and rights for a woman in marriage.

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Lorretta Favour Ntoimo: I'll be presenting the results. According to this, 4 broad things, number one. Brad wells legitimizes a woman. There are a number of The participants who think that who actually believe, and their perception is that is a confirmation of the cultural meaning of the what should be the cultural meaning of Brideworth? That it is it legitimacy, union without bribe price. A woman is not considered to be married.

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Lorretta Favour Ntoimo: She's not actually accepted into their months family. She may be there having children and doing all the for them, I mean performing all the functions of a wife, but traditionally she is not considered a wife because her bride wealth has not been paid. One of the participants said.

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Lorretta Favour Ntoimo: It's it is significant because it is not only a cultural practice, but also a really just practice.

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Lorretta Favour Ntoimo: and one and one cannot be said to be legally married to a girl without paying this bread price, or bride wells which give surface in legal ownership a recognition to the Union and the entire family. We witness the occasion as a sign of approval. When Brad Wells is not paid, the woman is not accorded any rights. Culturally, when the man dies she is not considered. His wife.

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Lorretta Favour Ntoimo: and that she has no right to buy his his property, and any other thing that the man has.

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Lorretta Favour Ntoimo: So the interior asks what happens if you don't pay, it indicates, and they and they, the participants, said it. It indicates that there will be no, there will be no marriage, and that's

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Lorretta Favour Ntoimo: one is not 0. So prepared for marriage. Talking about the now No. Number 2 broad thing that a much is that Bradford is simply a symbolic.

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Lorretta Favour Ntoimo: All the items, all the materials that are transferred from the groom to the bread family. All of them are symbolic.

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Lorretta Favour Ntoimo: and that is it, that is all. Some of the participants saying that Bradford is just symbolic.

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Lorretta Favour Ntoimo: Each item represents something something like the union of the symbolic of the union of 2 families. Some items represent peace. Some some are meant to represent prosperity and fruitfulness just symbolic. It is not something that is meant to enslave a woman or take away her right as a person they are all symbolic.

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Lorretta Favour Ntoimo: This is the perception. One of the key information in time is actually described. His own marriage and the items he took to his wife's family, and what they all represent. Some of the act items actually represents a wish, a good wish of longevity for the couple.

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Lorretta Favour Ntoimo: The third broad team is Brad word confessed authority, and a man go by over a woman.

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Lorretta Favour Ntoimo: Many of the participants actually believe that the transfer of Wells. That's it, wells from the groom bride word from the groom to the the Bryce family, is, is it? It confers a level of authority on a man over the woman. In other words, it means that the man actually owns the woman.

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Lorretta Favour Ntoimo: and one of them said, men are women, women of quality that are that we are talking about is not in marriage

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Lorretta Favour Ntoimo: participants who wrote this view. Thing that look Bradford simply makes a man higher than the woman superior to the woman in the Union. Women or men can be equal in position, the participant continues.

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Lorretta Favour Ntoimo: we can be equal in in post. Women can be President. A woman can be a governor. Women can be anything, but women can not be husbands in the house that is, know how a woman will be in the he. We be the husband of the husband of a man

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Lorretta Favour Ntoimo: we can be equal in every other thing. But husband and wife should not be there, somebody you're married with your money.

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Lorretta Favour Ntoimo: Man and woman cannot be equally in the house, in your room. A woman you marry with, with money to your compound. You pay the bright price, do everything, and you say you are equal in the same house. You cannot give her an order. No, you can. This is a position of some of the participants. You think that the bread price, the payment of bread browse makes the woman in to them

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Lorretta Favour Ntoimo: in the Union, and she can be giving all that she can be commanded. She can be told what to do. She actually has got no rights in the Union. Really it is what the man gives her that she takes. It is where the man tells her to stay, that she stays because he married out with money. This is the position of some of the participants, others thing that's Brad word. No, particularly woman held this position. That Bradford

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Lorretta Favour Ntoimo: Bride well does not confer any authority on a man over a woman

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Lorretta Favour Ntoimo: One of the women said, No. in my community it is a no.

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Lorretta Favour Ntoimo: and in my opinion it is a no, no, to okay.

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Lorretta Favour Ntoimo: That you have paid the bread price does not mean you should take over the woman's to to life in a proper marriage in a proper room. Such things should not

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Lorretta Favour Ntoimo: even behead in the first place. So that you have spent this, don't this? It is just tradition. It is just a normal thing that does not mean you, you you own her life, or that you own her entirely. This is a position of some of the participants, a few men, and the majority were women who held this view.

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Lorretta Favour Ntoimo: Now the fox, broad theme is Brad Wells.

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Lorretta Favour Ntoimo: and right for a woman in marriage. The participants who are specifically asked whether Bradford, when Bradford has been paid in full and duly

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Lorretta Favour Ntoimo: does does a woman actually have the right in marriage, when her bright price has been.

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Lorretta Favour Ntoimo: All the participants actually said yes to this question, among the rights they mentioned by the participants, we arrived to the man's property rights, to participate in household decisions, certain household decisions and rights to care rights to care from the man. The man should also care for a woman whose bright pride he has paid.

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Lorretta Favour Ntoimo: One of them, said, one of the key informants said, the moment the bride price is paid on the, on the woman they have, they have complete. They have completed a legal marriage, she has the right to assume the property of the man. If he dies, the property belongs to the woman talking about property right now, when the man dies only for a woman who's right, whose bride price has been paid.

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Lorretta Favour Ntoimo: Then the another person says yes, she has several rights, such as

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Lorretta Favour Ntoimo: it is her right. The her husband was close her and feed her right. She also has right right over her her personal property or properties.

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Lorretta Favour Ntoimo: We have personal wealth or properties right to practice her religion among orders. In other words, when a woman's bridew has been paid. She has some rights in the Union, such as right to practice her religion, rights to over her own property, of the husband's or the husband's property, and your mom also has the right to feed her. The man should feed her. And also

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Lorretta Favour Ntoimo: now for seeing this, for the

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Lorretta Favour Ntoimo: women would fully pay right price, have rights in their own union.

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Lorretta Favour Ntoimo: such as the rights to be cloted and fed by the man. We proceed this a bit further by acting by absent woman. How? Whether this is actually the case in the in the actual marriage, and the and that if this is actually a rights, the rights for a month to feed the woman and close her because he has paid bread price. Then some of the women aside in the negative.

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Lorretta Favour Ntoimo: For them they are called

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Lorretta Favour Ntoimo: primary bride. With breadwinners. Men are actually not feeding them on and closing them as they, as as as if it is as they are right.

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Lorretta Favour Ntoimo: So so one of them said the men. We ask the women to share the school fees of their children. The men we take half, and the women we take half, even before they come back from school. It is a woman that will struggle to look for food for the for the children. They don't that they they don't care. Referring to men. So this one is saying that

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Lorretta Favour Ntoimo: breadwinning is actually co-shared. It's shared in the home the woman provides, the man provides so that right word does not actually confer, Practically speaking, it's not. It does not. give a man I mean. There's no position a man to feed and close woman. Another person says men are not living up to expectation.

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Lorretta Favour Ntoimo: You find that it is some women doing what their husbands are supposed to be doing. For example, spend the children's fees struggling to buy clothes for yourself and for the and and the children. This is. This is by a man in one of the communities.

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Lorretta Favour Ntoimo: Okay, so summary of the findings.

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Lorretta Favour Ntoimo: we, we, the the 5, is generally so just a bride world legitimize the Union. Number one.

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Lorretta Favour Ntoimo: Every

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Lorretta Favour Ntoimo: material, every item in bribe world signifies something important, such as fruitfulness, longevity, peace, and so called.

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Lorretta Favour Ntoimo: However, there are different views on whether bread. Price, Bride Wells generally gives a man a right to via a woman, and what those rights are. According to some of the participants in Bradford simply integrates, incorporates a woman

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Lorretta Favour Ntoimo: into a man's family, makes her accepted into the man's family, and give all right today with her husband, whereas others believe that it grants a man authority over a woman and However, it prohibits my treatment. It does not mean a woman should be moderated.

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Lorretta Favour Ntoimo: and the orders perceive Brideworth as a proof of a man's superiority, and, in fact, justifies a husband dominance in the home.

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Lorretta Favour Ntoimo: We did this study highlights, notions of practice of bread with that could actually put a barrier to achieving sustainable development. Google 5 in Nigeria.

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Lorretta Favour Ntoimo: which is to achieve gender equality and empower women and girls in Nigeria

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and other countries. We're we're right.

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Lorretta Favour Ntoimo: we, we define. These are useful

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Lorretta Favour Ntoimo: for interventions. Any intervention that aims to advance women's fundamental human rights, particularly those that relate to gender equality and deputy

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Lorretta Favour Ntoimo: in the home, especially

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Lorretta Favour Ntoimo: the findings of this study are useful for such interventions. These are some of the references. Thank you for listening.

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Thank you very much.

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 we have time for one quick question.

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Thank you so much. That was very interesting. I wonder if you had any, if you noticed any distinction between older and younger participants?

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Did their thinking change regarding

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 you know, regarding the findings, and especially, you know, thinking about some of your participants were in their sixtys, or I think even so, one that was 80 years old. So was there thinking different than those who were from younger birth cohorts.

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Lorretta Favour Ntoimo: Yeah, we observed. We observed them.

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Lorretta Favour Ntoimo: We observed the some differences particularly for the woman.

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Lorretta Favour Ntoimo: Younger women we are, we are more likely to have views

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Lorretta Favour Ntoimo: that are more liberal views that tend to equality. And I think Bradworth is more of

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Lorretta Favour Ntoimo: is. It is just. It's just something that legitimizes a union traditionally and not something that's a confess authority on a man of a woman This notion, we observed, was,

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Lorretta Favour Ntoimo: was, mainly held by so many young women and the the younger men. The younger men that we interviewed tended to more towards tradition.

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Lorretta Favour Ntoimo: But you know the 80 year old man in this study is the one who held.

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Lorretta Favour Ntoimo: we we you know, I. We involved them 4 of them in this study because we considered them. They are elders.

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Lorretta Favour Ntoimo: rulers in their communities who, we think are custodials of culture. And that's 80 year old man actually said he's the one who who is founded, the fact of a bright word being symbolic.

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Lorretta Favour Ntoimo: and he get his own example and things. And then another elderly woman, who I couldn't cite in this presentation, said

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Lorretta Favour Ntoimo: They, the broadcast

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Lorretta Favour Ntoimo: does not in any way confer the right

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Lorretta Favour Ntoimo: on a a man to match with his wife, so I think it was a mixed thing. However, we noticed that most younger woman held a view, a more liberal view about transfer of bride world from the groom today today today to the brightest family.

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Thank you very much.

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Okay, okay, thank you. Favor. We'll see you so. And now we move on to Ana, because I'm a honest presentation.

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Ana Cristina Marques: Hi.

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Ana Cristina Marques: okay, just a minute.

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Ana Cristina Marques: Hey? Good morning for you all for me. Still night time.

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Ana Cristina Marques:  let me see almost 4.

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Ana Cristina Marques: So just to say that it's actually quite interesting coming from the first presentation to mine. since many of the women that are we talk to actually see the dowry as an insurance in case of divorce.

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All right. So let me just start to say that this project actually came from a an idea of a mammalian assigned. She's she's a British woman now, living in the Uk, and unfortunately she can be here with us.

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Ana Cristina Marques: and

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Ana Cristina Marques: So there was this panic, this idea of panic around divorce in the Kurdistan region, and everyone was talking about the consequences but mammal, and felt the need to understand sorry the the causes, but mammal, and felt they need to understand what happened to to women afterwards.

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Ana Cristina Marques: So myself. I'm a I'm an outsider Helen helped us with the interviews, and she also helped me, understanding many of the things that I I didn't know before. as not being Kurdish.

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Ana Cristina Marques: All right. So just to start with, I just.

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Ana Cristina Marques: I want to. I like this idea that Kurdistan is a multi-layer society. So yes, we still have these ideas associated to Kurdistan as being at the track of, particularly in the society where gender inequalities exist. But there's also been many changes. coming or having been a a happening in the last 20 years specially, and a lot that to do with the Krg general politics, the Kurdish regional government.

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Ana Cristina Marques: But also we, the presence of the non government organizations, government organizations, the the the return of a diaspora the technologies of information. let me just say that we are talking specifically about the Kurdish, the Kurdistan region of Iraq.

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Ana Cristina Marques: and not the other. Kurdish.

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Ana Cristina Marques: I will not going to have time to talk about this. But if you want to discuss, there's certainly a issues interesting in the in the personal status quo on the forcing the Kurdistan region, I just want to say that the talak is not allowed in the Kurdistan region. It is in Federal Iraq. The government is supposed to have some responsibility for women that need it. But there's a question mark on that.

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Ana Cristina Marques: And also the proof still need. The proof is still needed for the divorce

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Ana Cristina Marques: in courts.

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Ana Cristina Marques: I'm not going to talk about the numbers as well. I just wanted to say that one statistical one's fiscal study and graphic study on Kurdistan from 2,018. So the date is from 2,017, says it's only one of women that are divorced

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Ana Cristina Marques: mit Ctl. And but still there is this idea that divorce is normalized. Society failures are changing. So this is seen as a threat, one to family values, to marriage and society.

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Ana Cristina Marques: Sorry. let me just say we interviewed 20 divorced women in the different regions of the in the different reasons of Kurdistan.

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Ana Cristina Marques: Half of them, more younger than 30 years old, have more. Most of them are very high educated, most of them also employed. And I. We do think this makes a difference

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Ana Cristina Marques: almost half with children and Aah without. So the interviews took between 1 h and 2 h, and the experts were lawyers, social worker psychologists. Here the interviews took between more informal ones between like 15 min and 2 h as well.

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Ana Cristina Marques: This slide I I didn't want to. I I put this here for one specific reason. I'm not going to go for the reasons of divorce. I just wanted to highlight that different sources. Talk about different reasons for that divorce. So the official statistics of the region which

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Ana Cristina Marques: E. C.

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Ana Cristina Marques: this issue of technology is much to do with the fatality and the new technologies. They see it is a big problem. But if we go to the move, as, for example, the religious schoolers, they talk about people getting on getting married very young, not knowing each other so much. So. They just rushed into marriage because they find it so each other attractive.

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Ana Cristina Marques: And that's sometimes answering divorce. And they also talk about economic reasons, whereas many women interviewed, they talked about participants in the research they talk about leaving with the the families of family into the interference interference. So

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Ana Cristina Marques: another important issue would be that

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Ana Cristina Marques: divorce the process of divorce both by the because the force process is not just, he always has to go to court.

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Ana Cristina Marques: But sometimes the people do do news traditional sources, let's say so. Traditional leaders or religious leaders

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Ana Cristina Marques: mit Ctl, and and they do tend to slow the process down, and this is the same for the court as well. Sometimes the lawyers themselves pressure

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Ana Cristina Marques: the couple to slow the out the process to see if they touch, if they can, reconcile, especially when their children involved. When they see this is not the case, then yes, then they they go for the, for the divorce. And again, this is the the same case in court.

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Ana Cristina Marques: What happens is let me just say another thing, so the the family is always present. The family is present before. the

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Ana Cristina Marques: the divorce starts, the divorce process starts. Try and do the family members try to reconcile the couple, and they will go with the men and women to either the religious leaders or to the court, or with a large talk to lawyers, and they can to intervene.

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Ana Cristina Marques: But what I was trying to say in terms of the delay of the the divorce process in trying to reconcile the family. Is that what happens? Is that sorry?

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Ana Cristina Marques: Oh, sorry. What happens is that the the divorce the force process can take until one year if it's done with within the court with the or

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Ana Cristina Marques: if the process is so for followed we properly, with lawyers going to court and everything. And this is complicated in terms, emotionally especially, but also financially, because many women do a a a a use private lawyers, and they can be very expensive. So what they do many times the ones they can that can

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Ana Cristina Marques: they give up the dowry. And they they basically give up their rights

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Ana Cristina Marques: so that the divorce process can be accelerated or they don't lose their children.

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Ana Cristina Marques: And this is a very big cost for women.

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Ana Cristina Marques: so for women that have children. Just to say there are problems. There are many problems, sometimes with the children, especially for all the children that get a negative impact of not having the father present. But

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Ana Cristina Marques: the majority of women that had children. Funny enough, said that there was no difference between having the father or not, or that they are now mother, mother, and father, and that's like some kind of super women. And they feel children work for. And again, the family here. And I like this quote very much. So Mina talks about her mother, and she says she's conceding my kids are children

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Ana Cristina Marques: If and I always consider my shield, I I always tell on my Chili conceiv you consider as a mother more than me.

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Ana Cristina Marques: Because Grand grandmother's many times when the mother is working, take take care of their children, and and grandfathers

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Ana Cristina Marques: are seen as fathers, so they are the the masculine figure, let's say.

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Ana Cristina Marques: but it is also very, very common, not for all women, but many women did say they were actually better off being divorced

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Ana Cristina Marques: so they can their freedom. they don't have to. like. Maria says I had to tolerate someone I did not like any aspect of from his behavior, talking arguments, mindset and way of life. And on top of that we can provide for us. So basically, being divorced meant that she got the freedom back.

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Ana Cristina Marques: that she was in control of her life, and, like Sabar, says, you can finally breathe some fresh share. So there's games. There's games in terms of socialization there's gonna be in terms of autonomy, even financial financial kind, especially when the women can can work, whereas before they couldn't or their families, the family of origin is actually better off than their ex husband's work.

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Ana Cristina Marques: However.

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Ana Cristina Marques: there is the the negative sides. From the majority of the women the

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Ana Cristina Marques: positive compens for the negative, but for the majority of the women for best for but for even for those women for which the the good sites compens for the bands, they do a knowledge of social pressure. And

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Ana Cristina Marques: There is this expression, they have to be a widow and this carries suffering and negativity for some, for for others is not pleasant. Some of them can deal with it by getting away from

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Ana Cristina Marques: the negative people in their life. But there's this idea. That community that tells you when you get divorced will be a window. So this is some kind of loss. You can't do things, and importantly, he as well is the idea that the divorce woman is a sexualized woman. So the idea you are divorced. I can actually arrest you because you are going to be you married before you. Your sexuality began.

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Ana Cristina Marques: So you are available, basically And again, if on for women that are actually happy with the de force. This is an issue that it's complicated.

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Ana Cristina Marques: All right. So changing the making, is it changing, is it not? It's both, is both. There is this idea that an divorce is normalizing.

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some people accept it. Some people are very supportive. Some family members are immensely supportive.

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Ana Cristina Marques: of the this divorce women, and this makes a big difference for the way they deal with the divorce process. And after. So it makes the the process much more positive where the other way around also

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Ana Cristina Marques: fits in this case. but there's also still this idea. that the the divorce process like Sahara says is negative, especially for one to go through. It's like a a weak point, a rejection of a person. So it's basically the the woman wasn't good enough. It's their fault. That's the the divorced intake that divorce that took place. So there's still very much this differentiation on people's attitudes.

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Ana Cristina Marques: So just some final ideas. We can discuss some more things afterwards if we have time for it. Divorce is considered here as a process from marriage

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Ana Cristina Marques: to the the court or the going to the tradition is, and then the courts, and then singlehood, or remarried some to most of the times, going back to the family of Orange. There are very few women that can actually leave alone some of them remarry, and then they get out again. He's also very much a collective endeavor. So it's not just a woman's, the family that is involved with the children when there is, but also the communities, the religiously. There's some time, many times the tribal leaders of the and the courts.

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Ana Cristina Marques: But women do have strategies to go through through it and to build their lives. We it's negative cool. the idea of just

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Ana Cristina Marques: giving up their dowry. this one and this one that women tend to not regret when they do it so. Yes, family is supposed to be preserved, but not at all costs.

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Ana Cristina Marques: So

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Ana Cristina Marques: there are games and costs in the divorce project. A a divorce process. so the depression, the time, is important to you, the reputation. There's some some of human. There's actually some loss of control as well when they have to go back to their parents. the divorce process the costs in terms of the force process, but they also many gains in terms of freedom control of their own life in terms of social abilities.

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Ana Cristina Marques: So let me just that we also do believe that we, my social positioning the the the impacts on the divorce. Very important is their economic independence also having are not having children makes an impact for our women. Leave the divorce

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Ana Cristina Marques: And there is also, of course, some different, the original differences and their bill. And we money that are more urban areas are a bit different than, for example, a lot that is a bit more conservative.

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Ana Cristina Marques: So there's this kind of mixed idea that he has some, especially the medium. Some people talk about this normalization of the divorce. But this panic on the divorce keeps happening. So we will also have support for the divorce women. But,

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Ana Cristina Marques: The attacks on reputation still continue. So the idea that women do become with those okay, thank you very much

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thank you

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Ana Cristina Marques: to have any question.

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 so

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 okay, thank you, Anna, for your presentation.

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that was a very wonderful one. insightful. Oh, okay,

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From what you presented

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the angle from cultural cultural issues.

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How does it impacts on on the women without divorce

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and how to do? Because you said it. At the community level they they find a way to

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just ties this woman a come off

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visualizing their status and all that.

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How how do women cook?

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with such cultural issues that come out of time being divorced.

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Thank you.

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Ana Cristina Marques: Okay. thank you very much for your question. So yeah, the cultural issues are still very strong because of the reputation of the divorce. Women are still here strong, but there are

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Ana Cristina Marques: But first of all, this is interesting because of, I think I'd set this in with business meeting because divorce is not new. In Islam I was raised Catholic, and in my country, until 1,974, divorce wasn't even allowed because of the Catholic Church. So this is quite interesting. but yes, the difficult divorce is actually seen as a a new thing and a problematic thing, and the reputation is

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Ana Cristina Marques: complicated.

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Ana Cristina Marques: the community. The thing is, it's especially the community. Because you do have.

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Ana Cristina Marques: Okay, let me. It's not exactly like that. So there are women that do not get the. So there are women. And this is another part that needs to be research more. So there are women that probably if they didn't have the scooter constraints, but also the financial independence. And if they actually had other solutions they would get out of problematic now.

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Ana Cristina Marques: but for these women they actually do get out. And this is not representative. So and these are highly qualified women, most of them working Most of these women had support from their families, and it was when they didn't have the support from their families where things become more problematic. So the support from their families, help them cope with the divorce their jobs, help them, their sense of independence, help them code.

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Ana Cristina Marques: And what they do many times is

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Ana Cristina Marques: they start choosing the people they talk to. So they see these people are harming me by commenting on my behavior. So they are not really my friends. So they get away from these people, and they stay with the people that they feel are good for them.

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Ana Cristina Marques: And so they managed to do this, I think. Oh.

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Ana Cristina Marques: I would say that we all do it at some point in our lives with, for different reasons, but they have the the capacity, the agency, of course, in condition ways to

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Ana Cristina Marques: create their own or to maintain their own networks, the the the networks of people that are significant to them, and that made it, that are good to them, especially outside for the women that have economic independence

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Ana Cristina Marques: and support of the families.

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Last question.

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Hi, Anna, this is Walter? This was a really interesting question. Sorry a presentation.

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 you said that participating in the labor market is a strong factor for getting divorced.

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 what's

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how is participation in the labor market of women in Iraq? And how did it develop?

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Ana Cristina Marques: Okay. so

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Ana Cristina Marques: I'd I do think I we cannot say for sure that he's a a, a, a, a, a reason, especially because he and women. This is actually the difference I was thinking about because of the question that was done to the previous presenter.

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Ana Cristina Marques: Young women get divorced much easier than all the women, because again, it's seen as more acceptable for them, and many of them don't have children saying that the the question in the labor market does make a difference

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Ana Cristina Marques: all right.

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Ana Cristina Marques: In Southern time, especially in the seventies and the eighties there was a big push for the participation of women in the labor market, and this was not for the goodness of his heart is, for instead of like other Middle Eastern countries, instead of using migrants

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Ana Cristina Marques: Saddam used women

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Ana Cristina Marques: 2 for the 2

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Ana Cristina Marques: feel the needs they heads for the labor mark.

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Ana Cristina Marques: he created, actually, kindergarten transportation. So basically it, it's several things that we actually considered in Western society as positive in terms of social fair to to support to him, and again, not for the good as well for August hard. And this was rapidly changed.

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Ana Cristina Marques: With the run. Iraqi war especially with the sanctions in the Second Gulf War. because he needed the support for the tribes from the tribes. Iraqi did Iraq. There's this idea that he didn't get much better after the intervention.

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Ana Cristina Marques: But this is larger Federal where we rock in the Kurdist region

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Ana Cristina Marques: women, if

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Ana Cristina Marques: being participating more and more since 1,991, especially after the recognition as of the faculty stage. But again, it's very low. The

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Ana Cristina Marques: formal participation in the labor market is very enough. It's I'm not

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Ana Cristina Marques: between 11 and 13% of we are in the labor market. These are highly qualified women, most of them, and specially, and this is to do with what is consider acceptable mess, mostly in a governmental jobs, saying that women always participate in the formal labor market always, if you rural women working in the fields.

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Ana Cristina Marques: I'm of course, doing the housework and taking care of children and the elderly, but at least it feels if you consider that as work.

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Ana Cristina Marques: Okay, thank you.

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Thank you very much.

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Then. Now we move on to

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what do you know?

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Presentation of a person.

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Thank you all for staying just late in the conference on Saturday, and for coming today. My name is Robert Hummer. I'm from the United States of America and the University of North Carolina at Chapel Hill.

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And today I'm going to talk to you about a study that my colleagues and I are are doing, focused on.

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Whether or not people lose

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have a parent, or a child, or a sibling, or a spouse die

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when they're young.

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and what happens internally in their bodies? Do they age more quickly

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in comparison to people who don't

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have someone die early on.

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So just as a a little bit of story about this, most of my career. I focused on

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what are the determinants of mortality and a lot of population studies that that's what we do. So this but this particular presentation, my colleagues and I are starting to look at, what are the consequences of mortality when someone in your family dies. What does that do to to you? as a person? And to this sample of people in the United States. So that's the research question here is.

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if you have someone who in your family who dies when when you're young.

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do you age more quickly? Does your body age more quickly?

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And let's see.

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yeah, okay.

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okay, so this is not a new idea. this. These are 2 old papers, one from the 18 hundreds. in the British Medical Journal.

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That suggests a a, a small paper that suggests that a tenants at funerals in during implement weather and in time when nervous system of the mourners and others is depressed. This is bad for your health. Okay, this is, this is a long time ago, and then toward the bottom of of the pages, while there was a an article from the Lancet back in the 1970 s. That suggests that when someone dies

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there.

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Immune system. May may be depressed for a short time after. So this again, the only point here is that these are this is not a new area of research. This has been, People been thinking about this for a long time.

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one of my colleagues who does is a co-author of this presentation. Her name is Deborah Emerson, and she she developed a model for to think about, how does life course exposure to death? And how does that influence the individual's health?

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And the big idea in this particular framework here is that if you look toward the left of the diagram, it says, life course, exposure to death, the timing of that death and the number of deaths this could influence your psychological health.

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your behavior, for example. Maybe people drink more alcohol to cope with a death in the family.

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it could influence your social relationships and these kind of pathways, if you will, could cause people who experience deaths early in their life to have worse biological health

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mit Ctl, and and even then themselves to die earlier in life. So the idea. Here is this exposure. Exposure to death may influence of a psychological, behavioral and social pathways that influence your own health. 150.

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Okay. Most recently there was one paper in this area by lawn at all in in a journal called Human Molecular Genetics, 5 years ago, that used data from the U. K.

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And it used this, this what's called the Horvath biological clock.

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And you may have heard of these things in the popular media. You can send a little bit of your blood to a company, and they can test your blood to see like, how old is your body? Not necessarily. How old are you? Chronologically. But how old are you? Biologically?

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And Horvath has developed one of these biological clocks? I'll show you 3 others that we look at as well. And in this particular study from the Uk. using the harvest biological clock, they found no

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association between people. If you had a a death in the family earlier in your life, and those people did not age more quickly than people who did not. And so we thought this was kind of

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odd, because the pathways we would think that that would suggest that you're experiencing a loss is very stressful and could impact your your body. So the questions we developed from this paper.

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we should look at more. there's been more of these biological clocks being developed in more recent years. We have blood samples from the people in our survey that we can send and and get get their biological age. So we're going to test for biological clocks. Here we have data from the Us. as a whole, a nationally representative sample of people. and we can also look at

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types of loss like? Did they have a loss, or very earlier in their life, like when you're a child? Did you experience the loss of a parent?

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or and how many losses did you experience loss of more than one person, for example, or in your earlier in your life? So we're going to? answer these questions about types of loss and quantity of loss. Using the data that I'll talk about here.

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Okay, the data come from a study that I run at the University of North Carolina, at Chapel Hill, called the National longitudinal study of adolescent to adult health or add health

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at health is a cohort study of over 20,000 individuals in the United States who were adolescents in 1,994, and 95. So they were in The ages 12 to 19, back

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in the mid 1,900 ninetys. And now they're in their fortys. We have followed them over all of these years, and we continually survey these these people. And then eventually, we collected blood samples from them as well. So it's a very large cohort study.

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we collect survey data on their social life, their health their families, and so forth, and And then you could see at the bottom of the screen we collect data on whether or not they've lost

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loved ones. Did they lose a parent? Did they lose a child? And so forth? And then we. We now have data on there. We have blood data on them. And we can test for their biological aging as well.

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Okay, so the methods we use here is that we have the survey data we have. We have 5 waves of survey data starting when they were adolescents, and then about every 5 years we conduct a survey on these these people.

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and we asked them about whether they've experienced a loss

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from the time they were first in the study in wave one to the time. More recently did they did one of their parents die? Did both parents die? Did one of their siblings die? Did their spouse or partner die, or did they unfortunately experience the death of a child which is unimaginable?

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And so, then, if they did experience the loss, then we asked them, When did they experience that loss? Did you experience that loss when you were young yourself, or when you were an adult?

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And so we know that you know the type of loss they had, and when that that loss occurred, And then we have a lot of covariates in the analysis, too, that we control for other kinds of neighborhood characteristics, their individual characteristics and so forth. So we're trying to understand what's the association between experiencing a loss and their biological age.

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So in 2,016 to 18, we collected blood on some of the participants in this study. It's very expensive to do this. And so we have blood data on 4,468 of them.

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And these we we've got a brand new Now we've got data on 4 of these biological clocks, the horvath clock, the grim age clock, the phenotype clock. And this done, even paste clock. I'm not a biologist myself. sociologists? but so the but my understanding is that the difference in these kind of clocks is just how do they use? What? What kind of cellular damage are these clocks looking at? And they're all looking at something somewhat different.

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They're correlated with one another. But these are not exact, replicate, replicate biological hawks. We don't know which ones are better than the others right now, there's like a just this is out there in the literature. And they they're all these new clocks being developed. so we tested all 4 of these in our models here to see what may be working and what would not be

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okay. So first, to look at loss again, our cohort members, right as of at at this point, are in their late thirtys. On average, they're 38 years old. Okay? And if you look on the far left of your screen right now for females

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and for males. Almost 40% of them have experienced a loss of a close family member by the time they're on average 38 years old, meaning that they've experienced loss of a parent

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or more or both parents, a sibling, a spouse or a child.

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the light gray bars down below suggest that not quite 10% of them experienced a loss when they themselves were children. So they experienced that loss

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early in their life

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on the right side of your screen, by race and by education. You can see just the the height of the bars that in the United States the black participants have experienced more loss than the white or Hispanic, or other participants.

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and then low-educated people have experienced more loss than people who have who are more highly educated. So these, unfortunately, have this kind of social stratification of loss in in the United States.

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Okay. So now I'm going to start to show you a few graphs of the the associations between loss and biological aging

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on these crafts, you'll notice 0 point 0 on the X-axis

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that so at 0, it means that there's no difference between those who experience loss and those who have have not experienced loss. Anything to the right means that the bars to the right suggest that people who have experienced loss are aging more quickly.

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then the group who have not experienced loss. So this, this particular graph looks like this, any loss

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related to biological aging.

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So on the 2 graphs, these estimates suggest that

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the green, the red, and the purple for 3 of these 4 biological clocks, people who have experienced a loss are aging more quickly than people who have not experienced a loss by age 38,

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controlling for a lot of other factors. So these basic associations suggest that yet loss is doing something internally to us, to our biological age, which is different than our chronological age, but doing something within our body to

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speed up our aging process. Okay, does that make sense?

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Okay? All right.

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Yeah.

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0 is no effect.

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Both, please.

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Right? On the right side means that there the those estimates suggest that those people that those groups are experiencing for more rapid biological aging than those who didn't have not experienced a loss at all.

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One of the hmm.

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yeah, because the don't even pay the the the, the the scale is different. So we just and and so that that's the only reason why.

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Okay? So this looks at this graph looks at, when did people experience a loss if they experienced one?

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So at the on the top. Those people who have experienced a child loss that 3 of the 4 clocks suggest that they probably are might be aging more quickly, but the air bars are very wide, because, fortunately, relatively few people experience childhood loss. This is a good thing, so the air bars are wide, but it's suggestive that there there could be more rapid biological aging

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on the bottom. People who experience a loss during adulthood, so say when they're between the ages of 18 and 38, and in our sample, so they're experiencing losses in a relatively young age of a parent, a spouse.

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a few of them with a child.

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for 2 of the 4 clocks. It suggests that there there those groups experiencing more rapid aging than those people who have not experienced a lost during adulthood. and third one. The pheno age also is suggestive of more rapid aging as well. So several of these clocks suggesting that experiencing a loss during adulthood means these, these groups are aging more rapidly.

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Okay, this next graph, and looks at what about losing a parent? Specifically because parents are the ones. Again, think about people. These are the people who are most likely to be dying is they're older. Okay? And so do people who experience a parent lose a parent during childhood? Do they? Are they biologically aging more rapidly than people who don't experience a loss of a parent during during childhood, and the results here suggest that that's not the case.

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this is, we were surprised by this but losing a parent during during childhood. these, these air bars all cross the 0 and suggest that these these groups are not aging more rapidly than people who do not experience a loss of a parent during childhood. Now, one of the things to keep in mind here is that because these our cohort members are now in their late thirtys.

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These losses occurred quite a while ago during the life course they occurred, you know, at least 20 years ago, maybe 30 years ago or more. So they're they're one of the questions that we have here is maybe what happened in the interim. Did they get more social support? Did the parents remarry someone else, or or you know what what happened there

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the bottom row looks at. Did you experience a loss of a parent during adulthood?

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Can this be more recent.

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This happened to many of us, you know that experienced parent loss of appearance when they were in our twenties or thirties, and 3 of the 4 estimates again suggest here that there is more rapid biological aging among people who experienced loss of a parent during adulthood compared to people who did not lose a parent during adulthood.

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Just the horvath. Estimate that. And the Harvath clock is acting very strangely, and in all of these we're not sure what's what's going on with the Horvath clock here? But 3 of the 4 estimates suggest that a more recent loss of a parent is taking its toll biologically on our bodies.

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Finally, I'll show you 2 graphs here that looks at numbers of losses, and you can see at the bottom it's just 0 losses, one loss or 2 or more losses. Again, the horvath clock is acting very strangely. we're not sure what's going on there. Big air bars. But on the next slide I'll show you the other 2 for 3 of the 4 clocks. It clearly suggests that experiencing one loss. kind of

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is associated with more rapid biological aging, and especially experiencing 2 or more losses, either both parents or parent, and a sibling or parent and child, and so forth, is really taking its toll biologically inside our bodies. Here's the second picture as well. You can see

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in all cases. you know, confirming that hypothesis that that experiencing losses of a loved one is very difficult, not only psychologically, behaviorally, but is operating within our bodies as well to to in terms of cellular aging

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in in our bodies.

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Okay? So in terms of summary and next steps summary our results to date so far suggest that especially loss in adulthood associated with higher worse biological aging.

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We didn't see this with the Horvath clock. I don't know enough about these clocks to know kind of what's exactly the distinction between them. But we're gonna look further into what distinguishes the Horvath clock from the other 3 clocks to see what might be causing the the strange results. For for Harvard Corvath

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we don't see significant associations with loss in childhood and biological aging that age in the late thirties. This could be because those losses occurred a long time ago, but also we have less power. We have fewer losses that occurred during childhood, as well with bigger, bigger air bars.

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the quantity of loss is associated with with higher biological age for 3 of the 4 clocks. So what might be your you know your prior suggesting that, hey? Losing loved ones is difficult. It is. It suggests that very clearly in these data for 3 or 4 clocks.

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we have plenty of limitations here.

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for example, we got no information on type of loss like, for example, were they sudden deaths like a car accident?

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a homicide? Or was it a long drawn out loss, like someone had cancer for 10 years? And then they they passed away. these, you know, people may diff deal with those kind of losses differently, and that's something we we can look at further as well. We don't know exactly when these losses occur as well. We know, if they occurred

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during childhood or during adulthood. But you don't know the exact age at which the losses occurred. So some of the next steps that we're going to take here is to examine loss.

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for particular subgroups of the population, by race, by ethnicity, by education. We want to look at the buffering, too. What? How do people overcome loss, for example, through social support.

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through religion, so forth to so that their bodies are less likely to experience aging, and we want to assess other traumas as well. for example, of parents or siblings being incarcerated. For example, do those kind of losses which don't necessarily mean that someone died, but they were maybe lost within the house of are those associated with rapid biological aging as well, so there's a lot we can. We can do here.

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the add, health data are available. we collect these data for the for the public. if you're interested in the data, please visit the website there. People all over the world uses data. And we there's about one publication every single day. being produced. based on these data.

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And then, thanks, thank you to a lot of collaborators on this work as well. So really appreciate it. Thank you.

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I don't know how many of you

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are aware of the late sixtys and early seventeenth concept of life events.

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So we were looking at life treatment, and of course, dressing the family is one of life events.

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 I want the we we all.

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if you are talking about death in the family

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depends on our age, but we are all going to experience it. Of all those siblings, and all their parents, and all the when parents, this is more

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considered, nature younger siblings and children.

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So I think that it's very important to make the differentiation there. I don't know if you have enough death among this young population to do that. But this will be very useful.

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Can I? Can I come up? Thank you for that comment. We we unfortunately do not have data on loss of grandparents. We have so some of the limitations here that we have

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good data on the loss of of parents, spouses. children.

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and siblings, but not on grandparents. And then again, fortunately.

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erez agmoni, it's it's so sad to see in these data that some people do lose children, but fortunately there's not too many of them. So it's really difficult to get good estimates here on loss of child. No, I'm just sort of imagining 150

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a curve instead of mortality of aging curve

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that will go steeper

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as people get older because they accumulate accumulate more losses. Yeah.

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thank you, I know I know.

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thank you. Fascinating

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your approach to looking at this

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as a demographer, I would define aging

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at least past the age of 10

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as an increasing probability of dialing.

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So

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2 questions are obviously aged 30, you just no real data on

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mortality of the individuals, have these measures of biological aging being validated in terms of the probability of dying.

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 Secondly, do you have any? I mean there have been some stuff

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and widowhood, and more powerful, and so on with that reach. The second question.

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which is recorded the decay of the effect.

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believe one can have a strong and immediate effect.

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but we learned to live with it.

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Right?

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Thank you for 2 2 great questions. So I would describe the validation of these clocks right now as

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what we would describe in the United States is the Wild West. These these are so they, to my knowledge, have not been validated with large scale mortality studies. But there, the people who have developed these are looking at kind of kind of cross sectionally.

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Do do these? measures of biological aging, do they cross-sectionally? so associate with other kinds of reports of poor health.

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for example. And they do. But they're again they, the people who are developing these. They're they're all different. and so it's it's very difficult to know right now. kind of exactly what what we have here. We're admittedly experience experimenting with these measures of biological aging.

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and they're being developed all over the world by different scientific groups. And you can send away a little bit of your blood to all kinds of companies for a hundred bucks and get some estimate of your biological age. But if you send it to her to. You're going to end up with a different estimate. for for all of these. So

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so it's somewhat comforting in the sense that we're seeing parallel results for 3 of the 4 clocks that we have.

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Fourth one. Horvath, is that acting very strangely in in our case. But there's more and more of these to be being developed. So I would not

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take this this. Take these as like hard and fast right now, until there's much more validation done here.

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The time that bereavement affects. you know I think we may be, seeing that in the case of the folks here who lose Someone during childhood

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that this is a long time ago for them. They're there again on average 38 years old. Here the range is like 33 to 43. So losing someone in child is at least 15 years ago for the youngest people in our cohort, and it could be

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2025, 30 years for some

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 mit Ctl. And humans are adaptable. We have great social relationships and and ways of dealing with social stressors through our friends, our family, our religion, our work, and so forth. So 250,

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you know we see some of that in the widowhood mortality that there seems to be some kind of shock right away, and that people can and do adapt later on. Not that you don't ever end up missing that person and and but in terms of statistically what this may be doing with health. there could be

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mit Ctl and people adapting and overcoming these losses with time as well. We don't know what those mechanisms are yet we. We have some of the data that we may be able to sort that out. But we do see some evidence here to suggest that what you what you're saying maybe maybe right? 101.

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It uses the question of invasibility.

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Yeah.

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 yeah. So

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thank you very much. Let's give it over to our C. 11. So search of aging very interesting paper, I kind of first time looking into this. And and this is by no means any scientifically written. And I hope you will follow these people even longer. Is that the case to plan? Okay? And now I'm just been frame back again to this like popular thinking about early traumas come reappearing as we were saying cumulatively, much later in life.

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So I wonder if you will be also later on being able to follow these very early childhood traumas that right now in their 30 s. Are kind of covered, reappearing with, you know, later midlife crisis.

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Thank you for your question.

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Yeah.

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we're in the field right now for the the sixth wave of the at health data collection. The the participants are 44 years of age on average. we're doing both web-based surveys and in-person surveys. one of the really interesting things we're doing. This wave is collecting a lot of

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cognitive data.

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so people, you know, like, even in their fortys, some people, their their memory.

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their kind of brain health is, is not as good as it was just a few years ago. So and we're also collecting early. These are still relatively young people

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compared to me. but we're collecting physical functioning data as well. Things like how hand strength, sensory smelling, hearing in sight.

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So our our goal here is to collect a battery of health information for this cohort through the whole life course.

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Obviously that depends on funding and being successful with with with grant proposals. But so the goal here is to be able to follow these people until they're they're old, and then, you know, we can reassess some of the things that happen to them during childhood. How does it play out in terms of their cognitive health, their physical functioning, maybe their biological aging, their own mortality, and so forth.

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We also, you know. Again the first wave of data collection occurred when they were in there adolescents or ages 12 to 19. So we have a lot of information about their schooling as well. Like, what kind of schools did they go? To? What kind of courses did they take? Did they have a lot of friends? Did they have no friends? Were they socially isolated? And and so forth. So the the goal here is really to have a a cohort based data set that follows people for the rest of their lives, to, to

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to answer some of the questions that you're suggesting.

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One problem is that to him the vulnerable and studies

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we tend to improve our scales with time away from Harris, and mental health

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scales change in the old scale stone are not considered to be valid or as valid anymore.

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So this is the risk. It's it's always attention. I you know. I I became director of this study 3 years ago.

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It's an amazing study, and but the biggest one of the biggest dilemmas we always have is

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what we call longitudinal integrity.

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insane versus innovation, I mean, because you know, to do longitudinal analysis. You need the same

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measures, but

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we improve our measure so and so that is a really difficult thing that we have in in putting the instruments together. Yeah.

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that just a full pop to watch it, just because I know that it's very challenging. Yeah, it's something I will want to know more.

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because of

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if

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I want to replicate this kind of study.

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in the gym.

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what? What am I expected to

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that to? Because so

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of them? Not. We don't see the traditional studies because of the challenges

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of maintaining the skills of over time. And you get a lot of data

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for 19 and different ways.

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I'm living in your money since you it's like an experiment, because we are. We are comparing those

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who did not experience this. And those are the speakers. It's like, probably one of these.

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 I.

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It's very expensive for one that the Us. Government pays tremendous amount of money for a study like this.

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 so we're very fortunate scientists to have have such resources available to us.

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One of the things that the

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 that we continue to do and that was done early on was that

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we collected as much identifiable information as possible

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from people at every wave like.

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So we have

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names, people change names. We have, you know, if they, if they're willing to give us in the Us. Their social security number that really helps us to find them. Over time.

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We?

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We ask them not only for their own identical information, but you know who's a close contact. Can you give us the name of your parent or sibling, so that if we can't find you, can we go to them to help us find you?

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 we spend lots of time and money trying to find people over time. We've been successfully our retention rate so far has been about 70% over nearly 30 years. But it's very

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time intensive and expensive to do that. We we have.

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We have a lot of staff that that do computer searches and and to to try to keep keep track of people. We also send our code. There's about 20,000 cohort members. We send them newsletters

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from the study. We try to keep in touch with them. We try to thank them continually. We are fortunate to be able to offer them small monetary incentives

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to to keep them in the study.

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 and so it's it's a tremendous

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set of of

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of strategies we use. because it's it's it's very difficult to find people because of the mobility. People move around all all over.

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Okay, thank you very much. A very interesting work.

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And we move on

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your less presentation.

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Lorretta Favour Ntoimo: Can I share from here?

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Okay. can you?

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Lorretta Favour Ntoimo: Yeah. Sure, I can.  this

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Lorretta Favour Ntoimo: stop sharing. stop the last presentation. Good. Okay.

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Here you are.

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Lorretta Favour Ntoimo: Okay. Thank you.

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01:17:20.410 --> 01:17:23.340
Now, you can show your presentation with us.

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Lorretta Favour Ntoimo: Okay.

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lovely.

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So this is our last presentation.

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Lorretta Favour Ntoimo: Okay, thank you so much. back again a second time to present the results of our research.

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Lorretta Favour Ntoimo: across the experimental research that is conducted in Nigeria

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Lorretta Favour Ntoimo: and

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Lorretta Favour Ntoimo: for secondary hospitals in Nigeria. The title of this presentation is outcome of interventions to improve the quality of an intrapart. Some care in Nigerian referral hospitals.

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Lorretta Favour Ntoimo: It was the experimental research design I

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Lorretta Favour Ntoimo: wish to acknowledge my co autos at this point and the funders of these projects alliance for health policy and systems, research.

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Lorretta Favour Ntoimo: By where of introduction Nigeria has one of the highest number of maternal debts in the world.

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Lorretta Favour Ntoimo: Currently.

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Lorretta Favour Ntoimo: the the most recent report puts the number of debt in Nigeria at 67,000 per annum

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01:18:56.560 --> 01:19:00.580
Lorretta Favour Ntoimo: in 2,015 Before the current reports.

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Lorretta Favour Ntoimo: the in Nigeria was 814,

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Lorretta Favour Ntoimo: 400,000 life bits

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Lorretta Favour Ntoimo: and major causes of the high maternal mortality in Nigeria include a a primary and number one course is hemorrhage.

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Lorretta Favour Ntoimo: a obstructed label, malaria and linear and other courses. The mortality ratio varies, of course, across the different geographical regions and of Nigeria.

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Lorretta Favour Ntoimo: we have the highest ratio. Maternal mortality ratio is in the North and not East specifically, and then, of course, variation exists between the rural and the urban locations.

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Lorretta Favour Ntoimo: The high maternal authority rates in Nigeria is primarily primarily attributed to events around child best in.

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Lorretta Favour Ntoimo: and the a major factor that is attributed to it is

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Lorretta Favour Ntoimo: the the, the limited use of skill, better attendance in the country, and late presentation to hospitals.

448
01:20:25.060 --> 01:20:34.830
Lorretta Favour Ntoimo: Use of skilled best attendance in the country is ranges from a low low of 0 point less than 1% in in particular States.

449
01:20:34.970 --> 01:20:58.760
Lorretta Favour Ntoimo: and then a high rate of close to 70 72% in in some states in the country. and a major regime woman and people give for not using skate. Better attendance in the country is dissatisfaction with what they with intrapat and care experience of people during during child best

450
01:20:58.800 --> 01:21:00.350
Lorretta Favour Ntoimo: during delivery.

451
01:21:00.420 --> 01:21:28.090
Lorretta Favour Ntoimo: So we conjecture that when people are satisfied with their experience during child delivery, it will increase the their tendency to use antennato care, and I mean skilled intrapaton care skilled, and to to care and postpartum care also, and that we ultimately decrease

452
01:21:28.770 --> 01:21:34.510
Lorretta Favour Ntoimo: this particular study. is conducted in 2

453
01:21:35.010 --> 01:21:53.029
Lorretta Favour Ntoimo: rejo. In Nigeria. Nigeria has 6 geopolitical zones, also called regions. and the we conducted this study in 2 of the regions, one in the north, central, and another one is er the South south.

454
01:21:53.380 --> 01:22:13.590
Lorretta Favour Ntoimo: they we. It's a quite experimental study. We had control sites one and and intervention sides one intervention sites in the North Central and one control sites in the North Central, one intervention site in the South south, and the

455
01:22:13.810 --> 01:22:20.629
Lorretta Favour Ntoimo: one control site in the South South, and the hospitals are similar in many respects

456
01:22:20.740 --> 01:22:37.589
Lorretta Favour Ntoimo: they all secondary health facilities. Nigeria operated 3. A health system that starts with primary health care, which is actually entrance to the the countries her system. they offer mainly basic care.

457
01:22:37.590 --> 01:23:03.339
Lorretta Favour Ntoimo: And then at the second, here we have the secondary hospitals, and these are the hospitals we use for this intervention. It's secondary facilities. Hospitals offer both basic and secondary care. And then we have at the apex is the tertiary hospitals, also called the Teaching Hospitals. They also offer all the basic and comprehensive emergency health care

458
01:23:03.370 --> 01:23:13.159
Lorretta Favour Ntoimo: and the but this intervention took place at the second year. Secondary hospitals, 4 of them 2 in the North and 2 in the South.

459
01:23:13.850 --> 01:23:36.679
Lorretta Favour Ntoimo: The project started with formative research where we use multi methods qualitative and quantitative to collect baseline data and based on the baseline data. We designed multi-faceted interventions which includes designing we work with the hospital management

460
01:23:36.680 --> 01:23:44.870
Lorretta Favour Ntoimo: to develop strategic plan for to improve in and delivery care and the hospitals

461
01:23:44.880 --> 01:24:09.219
Lorretta Favour Ntoimo: in the intervention hospitals and the the help provide us in the in the of Citric and the Gynecology section specifically, where the trend We also provided protocols and and remind us on optimal interpret and care. And there was also clinical review of of of of delivery care.

462
01:24:09.280 --> 01:24:11.660
Lorretta Favour Ntoimo: and and that's too.

463
01:24:11.670 --> 01:24:20.179
Lorretta Favour Ntoimo: And then we had series of health education provided to her pregnant women and their policies.

464
01:24:21.240 --> 01:24:43.570
Lorretta Favour Ntoimo: The intervention is took place in 3 facilities. We had a pre intervention which was between October and December 2,017. The intervention phase was between January 2,018 to June 2,018, at any post integration phase between July 2,018 and June 2,019,

465
01:24:44.180 --> 01:24:49.280
Lorretta Favour Ntoimo: the primary outcome. For this part of this study is

466
01:24:49.310 --> 01:24:50.360
Lorretta Favour Ntoimo: and

467
01:24:50.370 --> 01:24:52.570
Lorretta Favour Ntoimo: quality indicators.

468
01:24:52.670 --> 01:24:57.930
Lorretta Favour Ntoimo: and in many explanatory variables where the sites and the the research period

469
01:24:58.200 --> 01:25:24.199
Lorretta Favour Ntoimo: intervention period was, of course we we we fragmented again into segmented period, 7 periods specifically made up of 3 months from baseline to the end of the term. We wanted to see what happened over time. We actually collected data over 21 months. Starting from the baseline to the end of the of the

470
01:25:24.200 --> 01:25:31.000
Lorretta Favour Ntoimo: of to the post intervention period. We collected data every month, using exit interview.

471
01:25:31.010 --> 01:25:39.860
Lorretta Favour Ntoimo: using exit interview from women who who have used the hospitals for intrapat and care.

472
01:25:40.620 --> 01:25:46.470
Lorretta Favour Ntoimo: These are the interpret and care policy indicators.

473
01:25:46.550 --> 01:25:52.819
Lorretta Favour Ntoimo: We. This we are selected from the Wh. Recommended recommendation

474
01:25:52.840 --> 01:26:22.759
Lorretta Favour Ntoimo: and include delivery assistance. What I was skilled, or who who delivered the woman who took the child best mode of delivery, clean delivery park used to management. What was I applied to it. Baby was dried before Place Center was delivered. They'd be placed on bed, belly, breast before plus center delivery. Baby buffet. First time before 20 within 24 h, or after 24 h.

475
01:26:22.760 --> 01:26:51.619
Lorretta Favour Ntoimo: information on baby care giving to the woman whether the woman felt well attended during level, whether she had a PC. Atomy, and then to this, at 1010 indicators, we had 2 soap indicators. To one is whether for those who had a Pciotomy was it repaired promptly, and then those who said they experience pandering level where they happy with the management of the plan. During during level

476
01:26:51.830 --> 01:26:59.890
Lorretta Favour Ntoimo: we collected the data over a period of 21 months from exit interviews.

477
01:27:00.020 --> 01:27:29.490
Lorretta Favour Ntoimo: 752 women we are successfully interviewed out of. It's 800 that we initially plan using a sample sampling, sampling technique. and the 3 90, we are successfully achieved 3 night interviews. We are successfully achieved in the control side, making a total of 752 out of the 800 we planned

478
01:27:29.490 --> 01:27:42.919
Lorretta Favour Ntoimo: from the beginning and 12 wi-fi indicates your indicators like I said, we are used and we aggregated 10 of the

479
01:27:43.050 --> 01:27:49.109
Lorretta Favour Ntoimo: quality indicators to generate a single index of quality of interprets in care.

480
01:27:49.470 --> 01:27:52.820
Lorretta Favour Ntoimo: higher scores indicating better quality of care.

481
01:27:53.320 --> 01:27:57.690
Lorretta Favour Ntoimo: and then the 2, the remaining 2, were so

482
01:27:57.810 --> 01:28:06.489
Lorretta Favour Ntoimo: so for so for the soap population of the Sam, of the of the of the study population. So that is why we did not include it in the aggregation.

483
01:28:06.770 --> 01:28:31.809
Lorretta Favour Ntoimo: And then we conducted a number of analysis which includes the poison, regression, logistic regression analysis to compare it to of quality and dedicate, or at the intervention versus the control hospitals. We also conducted properties call marching to see the average treatment effects. on the the average effect of the intervention

484
01:28:31.810 --> 01:28:39.750
Lorretta Favour Ntoimo: on the the primary outcome and the individual to of indicators

485
01:28:42.540 --> 01:28:44.320
the results now

486
01:28:44.810 --> 01:29:06.870
Lorretta Favour Ntoimo: overall. There was 6% increase in policy of care at intervention hospitals compared to the compared to the control hospitals. 5 of the 10 signal functions were better at intervention. Hospitals after the intervention. Specifically they were there were less Cs

487
01:29:07.260 --> 01:29:15.010
Lorretta Favour Ntoimo: section at the intervention. sites compared to the control settings.

488
01:29:15.040 --> 01:29:30.319
Lorretta Favour Ntoimo: Babies. We are also buffet after 24 h, which is double your recommendation. We're after more babies. Your budget. After 24 h of death at intervention, hospitals compared to the control hospitals.

489
01:29:30.320 --> 01:29:54.129
Lorretta Favour Ntoimo: Well, women were also better. Women also said they were better women at intervention side. It's also said they were better treated. They were better treated, and they they were also. We also had more women reporting that they were happy with. Had a pen. Was manager level More of them reported this at integration side than the control side and for the and then prompt.

490
01:29:54.380 --> 01:30:03.239
Lorretta Favour Ntoimo: it was more reported, reported more in the intervention sites than at them

491
01:30:03.270 --> 01:30:05.710
Lorretta Favour Ntoimo: and control sides

492
01:30:05.960 --> 01:30:18.369
Lorretta Favour Ntoimo: overall. The quality means cause of higher scores of in quality was higher at intervention than at the control side.

493
01:30:20.040 --> 01:30:24.850
Lorretta Favour Ntoimo: These are the specific. the 12

494
01:30:24.930 --> 01:30:35.160
Lorretta Favour Ntoimo: in policy indicators I had mentioned India. 5 were actually better at intervention sites than at the control

495
01:30:35.340 --> 01:30:37.209
Lorretta Favour Ntoimo: how to control sides.

496
01:30:39.230 --> 01:30:47.750
Lorretta Favour Ntoimo: We, our findings indicate that aggregate assistance of intrapat and care qualities was actually higher.

497
01:30:47.790 --> 01:30:58.669
Lorretta Favour Ntoimo: At the control. Compared to the intervention sites, however, the intervention sites were better in 5,

498
01:30:58.980 --> 01:31:00.829
Lorretta Favour Ntoimo: 5 out of the 10

499
01:31:00.870 --> 01:31:03.409
Lorretta Favour Ntoimo: individuals should

500
01:31:03.710 --> 01:31:08.059
Lorretta Favour Ntoimo: little or no little or no effect on 5 quality indicators

501
01:31:08.510 --> 01:31:34.219
Lorretta Favour Ntoimo: incomplete it. The implementation and for integration of intervention activities into the the the care system in intervention hospitals is what we think may be responsible for the limited effect we see in 5, in. In the, in the, in the 5 major quality indicators that we where we saw no effect

502
01:31:41.030 --> 01:31:52.209
Lorretta Favour Ntoimo: by the conclusion, we. despite the fact that we only saw 6% improvement in in

503
01:31:52.290 --> 01:31:56.210
Lorretta Favour Ntoimo: in the comp and the intervention side compared today

504
01:31:56.760 --> 01:32:09.929
Lorretta Favour Ntoimo: control sides, we still we, we conclude the multiple interventions that address the different components of quality of and Nigerian refer hospitals

505
01:32:10.390 --> 01:32:13.009
Lorretta Favour Ntoimo: actually demonstrated some effects.

506
01:32:13.340 --> 01:32:24.240
Lorretta Favour Ntoimo: He may not be as high as we expected, but we saw some positive effect. The proposal is so much, and also confirmed that our intervention had that effect.

507
01:32:27.330 --> 01:32:33.810
Lorretta Favour Ntoimo: This method that we used we think would be quite useful.

508
01:32:33.940 --> 01:32:39.480
Lorretta Favour Ntoimo: quite informative, for for the studies in Nigeria and other sub-saharan African

509
01:32:39.610 --> 01:32:42.250
Lorretta Favour Ntoimo: countries. Thank you.

510
01:32:43.920 --> 01:32:44.999
Thank you.

511
01:33:00.230 --> 01:33:01.600
One of

512
01:33:05.660 --> 01:33:08.920
thank you so much. I have one question.

513
01:33:09.110 --> 01:33:09.850
what

514
01:33:10.270 --> 01:33:19.599
if you had to give recommendations for? How to better implement the intervention? What could your top recommendations be

515
01:33:21.390 --> 01:33:36.350
Lorretta Favour Ntoimo: like? We said we we had looked at this overall. And we think that's The major reason why we saw the minimal improvement we saw is the

516
01:33:37.170 --> 01:33:51.840
Lorretta Favour Ntoimo:  The hospitals did not integrate the interventions fully into their system. We concentrated more in the O. And G section.

517
01:33:52.370 --> 01:33:56.579
Lorretta Favour Ntoimo: of course, with the cooperation and support of the of the management.

518
01:33:56.680 --> 01:34:00.579
Lorretta Favour Ntoimo: However, we also noticed that they

519
01:34:00.590 --> 01:34:06.149
Lorretta Favour Ntoimo: they they did not, of course, they supported, and they they worked with us all through.

520
01:34:06.190 --> 01:34:19.250
Lorretta Favour Ntoimo: but the integrating, the the interventions into the care system, the normal care system day to day system of the hospitals would have made a lot of difference.

521
01:34:19.330 --> 01:34:45.710
Lorretta Favour Ntoimo: So instead of just seeing this as, okay one of projects. This is a project we are doing when you, when we're doing it at this time. But then, for order? it is not a part of our system. Instead of just seeing the innovation as just a project, it should actually be seen as part of it should be incorporated into the system and be seen as a part of the system. And this is what we think

522
01:34:45.870 --> 01:34:55.209
Lorretta Favour Ntoimo: should be done better next time, if we have the opportunity to do this again. And this is what we also recommend in in, in our, in our study.

523
01:34:55.670 --> 01:34:56.870
Thank you so much.

524
01:34:57.490 --> 01:34:58.540
Okay.

525
01:34:59.730 --> 01:35:07.369
thank you, Robert, for your wonderful presentation, as always.

526
01:35:07.480 --> 01:35:15.569
My name is. I'm from Nigeria and all the State University of Science and Technology.

527
01:35:15.770 --> 01:35:23.380
my question. it's one in terms of methodology.

528
01:35:23.430 --> 01:35:32.239
But what justification do you give to the way you selected your study? Yes.

529
01:35:32.440 --> 01:35:34.850
because I, from what I had said

530
01:35:34.940 --> 01:35:40.340
from the geopolitical zones. you select that from

531
01:35:41.030 --> 01:35:43.189
the South, come from the not

532
01:35:43.360 --> 01:35:58.510
 Don't systematically. What is the probability? Or that you use in selecting some, you know. Study area. that is one Secondly,

533
01:35:58.780 --> 01:36:07.799
yes, you've complained about. the hospital management not integrating. this particular strategy.

534
01:36:07.890 --> 01:36:15.620
But you also mentioned that at the beginning you people had a meeting where you develop a strategic plan.

535
01:36:15.860 --> 01:36:29.400
I don't know if if it's with the hospital. So that because I know certificate plans are and laid out activities and ways. What I mean long term or shock them on how things

536
01:36:29.470 --> 01:36:32.969
can be done to achieve particular indicators of goals.

537
01:36:33.090 --> 01:36:43.059
 I wouldn't know if it was for a formality for them to have that paperwork and not translating it into their

538
01:36:43.070 --> 01:37:07.009
and daily, everyday activities or programs that we would do so in the outcome of your intervention. So I wouldn't know if you want to talk around that because I've actually worked in both of them. Child health intervention over time. working with the partnership for transforming her system past to where we also this kind of intervention?

539
01:37:07.040 --> 01:37:27.680
What's a more or less community base trying to enlighten the women of the dentist science that are you to maternal health, and also finding a way to increase utilization of scale path. So coming from that angle, do you also have plan of sustainability?

540
01:37:27.810 --> 01:37:51.689
yes, the hospital tool is not incorporating, but at the other we you think we can lay out

541
01:37:51.730 --> 01:37:59.919
intervenue variables that you think would have posted. What is the capacity.

542
01:38:00.950 --> 01:38:05.000
Okay, okay, okay, let me stop here. Thank you. Thank you.

543
01:38:08.120 --> 01:38:12.730
Lorretta Favour Ntoimo: Okay. thank you. the

544
01:38:12.900 --> 01:38:18.869
Lorretta Favour Ntoimo: I. The hospitals were selected for, possibly.

545
01:38:19.760 --> 01:38:22.750
Lorretta Favour Ntoimo: And then based on the

546
01:38:22.840 --> 01:38:27.469
Lorretta Favour Ntoimo: the the the number of maternal death reported

547
01:38:27.520 --> 01:38:31.350
Lorretta Favour Ntoimo: in those hospitals in the years before the project.

548
01:38:31.800 --> 01:38:39.639
Lorretta Favour Ntoimo: And we decided to it. The formative research. Actually, I should explain at this point.

549
01:38:39.750 --> 01:38:44.369
Lorretta Favour Ntoimo: well included.

550
01:38:45.190 --> 01:38:55.180
Lorretta Favour Ntoimo: the formative research was actually conducted in 4 regions out of the 6 in Nigeria. and that was also progressive.

551
01:38:55.350 --> 01:39:07.980
Lorretta Favour Ntoimo: The not East. Some part of Nigeria, you know, has this. He's a is a is a is experienced, a lot of crisis arising from terrorism.

552
01:39:08.030 --> 01:39:16.690
Lorretta Favour Ntoimo: And so we excluded the origin, and then we decided to possibly exclude the south eastern region.

553
01:39:17.010 --> 01:39:22.479
Lorretta Favour Ntoimo: So the 2 eastern region, not, and the start were excluded in the formative research.

554
01:39:22.530 --> 01:39:33.909
Lorretta Favour Ntoimo: But when we go to the intervention stage. the hospital in in this, in the North, West, and the hospital in the Southwest.

555
01:39:34.840 --> 01:39:47.199
Lorretta Favour Ntoimo: We're also possibly dropped out of the intervention. They we're not ready to continue with intervention. So we continued with the North Central and the South South.

556
01:39:47.920 --> 01:39:56.759
Lorretta Favour Ntoimo: This. That is how we selected the hospitals. And then, of course, you you your long comment. You also.

557
01:39:56.920 --> 01:40:24.049
Lorretta Favour Ntoimo: It's it's it's The hospitals like, I said earlier, if they seriously integrated, which is one of the problems we have with funded interventional projects in Nigeria at the time the project is going on. People see it? Oh, okay, project is going on, but integrating it into the system, which is what we bring to us. 10 is sustainability. How is it is a big problem, not just in our project, but in many other projects.

558
01:40:24.050 --> 01:40:33.390
Lorretta Favour Ntoimo: So I wish to stop at this point because of time, so that but we can chat more if you need to know more about the project. Something.

559
01:40:34.860 --> 01:40:36.510
Thank you very much.

560
01:40:39.990 --> 01:40:45.090
So we conclude, I think this is the last session of the Rc. 41,

561
01:40:45.450 --> 01:40:47.170
and we can all go home.

562
01:40:48.030 --> 01:40:53.960
Lorretta Favour Ntoimo: My favor.

563
01:40:54.020 --> 01:40:58.619
Lorretta Favour Ntoimo: Yeah, I hope so. Zoom.