THE USE OF GROUP COMMUNICATION AS A TOOL FOR CAMPAIGN AGAINST MATERNAL MORTALITY IN NIGER STATE

by CHRISTIAN GLORIA

INTRODUCTION
It’s easy to get people’s attention, what counts is getting their interest- Philip Randolph
Communication, particularly verbal, occurs when one person speaks and another person listens. Health workers uses range of verbal communication skills to respond to questions, find out about an individual’s problems or needs, contribute to team meetings, break bad news, provide support to others and deal with problems and complaints. According to MDG-DRG Funded Midwives Service Scheme (2009), despite the intervention of international organisation, gaps still exist. These gaps range from infrastructure, access to services and human resource needs in many health facilities across Nigeria, there is shortage of skill attendants and this has been reported to impact negatively on utilization of services by women. Group communication refers to the communication that exists between two or more people. This type of communication can be used in health and social care, particularly to improve maternal health.

In group communication, women for instance are likely to open up to a social worker about issues if they are around people of similar situations. Different languages, cultures and psychological factors exist so not every social worker can understand verbally what their patients are complaining about in a typical group communication; therefore, effective communication and interaction play an important role in the work of all health and social care professionals. In doing this, health practitioners can employ range of communication and interaction skills in order to:

1. Work inclusively with people of different ages and diverse backgrounds.
2. Respond appropriately to the variety of care-related problems and individual needs of people who use care services.
3. Enable people to feel relaxed and secure enough to talk openly.
4. Ask sensitive and difficult questions, and obtain information about matters that might be very personal and sensitive.
5. Obtain clear, accurate information about a person’s problems, symptoms or concerns.
Group communication is essential in enabling the health practitioner to establish a good rapport with women before, during and after childbirth. Respect can also be shown to these women by paying careful attention to their complaints in a group as well as communicating to them in a language that they all understand. Doing this may result in effective interaction between the health worker and the group.

STATEMENT OF THE PROBLEM

As part of Millennium Development Goals (MDGs), in order to reduce maternal mortality by three-fourths before 2015 and to achieve universal access to reproductive health, midwives were deployed to health facilities in rural communities to carryout community service aimed at facilitating reduction in maternal mortality. These midwives use various communication campaigns (like group communication, interpersonal communication and others) in carrying out this exercise in diverse communities within Nigeria. Yet, there is still low turnout of women in Niger state towards this communication campaign. Hence, maternal mortality remains an issue and women continue to encounter complications during childbirth at home. It is on this premise that this research was carried out empirically.

OBJECTIVES OF THE STUDY
Group communication may be common in the health sectors because care professionals tend to work in teams and in partnership with patients. Hence, this study would be guided by the following objectives:

1. To determine the use of group communication in the campaign against maternal mortality in Niger state.

2. To ascertain how effective this campaign is used in creating awareness among the community women.

RESEARCH QUESTIONS
This study will be guided by the following research questions;

1. How has group communication been used as a campaign against maternal mortality in Niger state?
2. How effective is this campaign in creating awareness among rural women within the community?

SIGNIFICANCE OF THE STUDY

One of the factors that prevent women from receiving or seeking care during pregnancy and childbirth is lack of information (WHO, 2012). Hence, Niger State women are not left out in this problem. There are low efforts in Niger state at curbing this societal menace. This study is geared towards suggesting ways through which group communication can be used to carry out this enlightenment among the rural women of Niger state.

LITERATURE REVIEW

Group communication

Group communication, according to Collins (2011), is seen as a process of giving, receiving, and interpreting information through verbal and non-verbal expression. Effective communication occurs in a group when the speaker speaks and the message is interpreted by the members of the group receiving the message in the manner that the speaker intended sending and receiving messages which often takes place simultaneously due to the dynamic process of verbal and non-verbal communication. Collins (2011) also said group communication is either adaptive or maladaptive. Adaptive may include clarifying goals and the sharing of ideas, experiences, and feelings. Group communication that is maladaptive may include seeking to control the group by controlling the channels of communication, and avoidance of specific issues or persons.

According to Wood (2003:274) a group must have, “three or more people who interact over time, depend on each other, and follow shared rules of conduct to reach a common goal”. Wilson (2002:14) defines a group as, “a collection of three or more individuals who interact about some common problem or interdependent goal and can exert mutual influence over one another”. He goes on to say that the three key components of a group are, “size, goal orientation, and mutual influence”. Interpersonal communication can also be aligned with group communication because individuals may communicate inter personally in pairs.

Organizational communication might be thought of as a group that is larger than 12 people.
Group communication follows slightly different ‘rules’ to communication in one-to-one situations and can be seen as an extension of interpersonal communication. This is because information shared through interpersonal communication can be spread by an individual to a group and then the process continues. According to Collins (2011:6), group communication deals with a number of different people trying to speak, get their point across and their voices heard.
In the context of communication, Collins listed a number of benefits groups can have for participants:

1. A group can be an effective way of sharing responsibilities
2. Groups can improve decision-making and problem-solving because they draw on the knowledge and skills of a number of people
3. Groups tend to command more respect and have more power than an individual acting alone.
Furthermore, Collins (2011) highlighted a number of ways that can undermine the effectiveness of group communication if:
1. The power in a group is held by a single person or is misused by a small clique of people to dominate others and pursue their own agenda.
2. Power struggles and battles break out within the group, resulting in a loss of purpose and effectiveness.
3. The group loses sight of its main goal or purpose, drifting into a pattern of ineffective activity that doesn’t have a real benefit or outcome (holding meetings for the sake of meetings, for example) and people find it hard to speak and contribute effectively or to challenge aspects of the group’s thinking or practices. This can lead to poorly thought-out and unquestioned decisions being made.
Characteristics of Groups

1. Interdependence. To Lewin (1951), Cragon & Wright (1999) and Harris & Sherblom (2008) and, groups cannot be defined as a number of people simply talking to each other or meeting together. Instead, a primary characteristic of groups is that members of a group are dependent on the others for the group to maintain its existence and achieve its goals. In essence, interdependence is the recognition by those in a group of their need for the others in the group. For example, the group communication campaign in Niger state is interdependent when members of a group for maternal health recognise their needs from the needs of other members.

2. Interaction. For a group to be functional there must be interaction. Since communication is done on daily basis, there should be something that distinguishes group communication from other forms of communication and which is the issue of interaction. Cragon and Wright (1999:7) states that “the primary defining characteristic of group interaction is that it is purposeful. Furthermore, they break down purposeful interaction into four types: problem solving, role playing, team building, and trust building”. This means that without purposeful interaction, a true group does not exist. Pregnant women, for example, may want to interact with her fellow pregnant women or a nursing mother within a group. They might start by wanting to exchange their numbers, contact address and other information that may help in keeping them in touch.

3. Synergy. One advantage of working in groups, according to Harris & Sherblom (2008) is that it allows them to accomplish things they wouldn’t be able to accomplish on their own. For example, the group communication campaign carried out in Niger state gives room for pregnant women to be checked thoroughly by the midwives (like the heartbeat, position of the baby, etc) which ordinarily they wouldn’t have been able to do on their own.

4. Common Goals. Having interaction and synergy may be pointless in groups without a common goal. People who comprise groups are brought together for a reason or a purpose. While most members of a group have individual goals, a group is largely defined by the common goals of the group. In reducing maternal mortality, the group communication campaign carried out in Niger state has a common goal of reducing maternal mortality among women in rural communities.

5. Shared Norms. Because people come together for a specific purpose, they develop shared norms to help them achieve their goals. Even with a goal in place, random interaction does not define a group. Group interaction is generally guided by norms a group has established for acceptable behavior. Norms are essentially expectations of the group members, established by the group. The group communication campaign carried out in Niger state for example, has a norm that ensures every women (pregnant and nursing mothers) to be in attendance around 9: am on daily basis for health talk on maternal health.

6. Cohesiveness. One way that members understand the idea of communicating in groups is when they experience a sense of cohesiveness with other members of the group. When members feel like they are part of something larger, it creates a sense of cohesion or wholeness. It is the sense of connection and participation that characterizes the interaction in a group as different from the defined interaction among loosely connected individuals. In other words, when there is interaction, then participation is likely to occur. The group communication campaign in Niger state for example, enables women to participate by asking questions and contributions in the discussion.

Types of Groups
Not all groups are the same or brought together for the same reasons. Bilhart and Galanes (1998) categorize groups on the basis of the reason they were formed and the human needs they serve.

1. Primary Groups. Primary groups are ones we form to help us realize our human needs like inclusion and affection. They are not generally formed to accomplish a task, but rather, to help members meet their fundamental needs as rational beings like acceptance, love, and affection. The group communication campaign in Niger state for example, enables women (pregnant women) to feel loved, affection and acceptance in the society mostly when they interact with their fellow pregnant women.

2. Secondary Groups. Secondary groups are formed to accomplish work, perform a task, solve problems, and make decisions. Bilhart & Galanes; Harris & Sherblom; Cragan & Wright; and Larson & LaFasto (1989) state that secondary groups have a specific performance objective or recognizable goal to be attained; and coordination of activity among the members of the team is required for attainment of the team goal or objective. Bilhart and Galanes divide secondary groups into four different types.

i. Activity Groups. Activity groups are ones that are formed for the purpose of participating in activities. For example, the group communication campaign in Niger state enables women to participate in activities like strolling and walking as a recommended exercise enlightened by the midwife or nurses.

ii. Personal Growth Groups. Personal growth groups are formed to come together to develop personal insights, overcome personal problems, and grow as individuals from the feedback and support of others (Bilhart & Galanes). For example, the group communication campaign in Niger state on maternal mortality enables pregnant women to come together and share as well as overcome the problems they encounter during the stages of their pregnancy.

iii. Learning Groups. Learning groups are concerned primarily with discovering and developing new ideas and ways of thinking (Harris & Sherblom). For example, the Primary Health Care (PHC) in Niger state organise a group communication campaign solely for the purpose of educating the women on what to do and what not to do with the sole aim of reducing maternal mortality.

iv. Problem-Solving Groups. These groups are created for the express purpose of solving a specific problem. The very nature of organizing people into this type of group is to get them to collectively figure out effective solutions to the problem they encounter. In this type of groups, women for example, are brought together to collectively proffer solutions on how to prevent maternal mortality amongst women as well as establishing ways of preventing them.

For the purpose of this study, the category of group that is applicable in Niger State is the secondary group which is basically formed to accomplish work, solve problems and make decisions. That is to say that this category of group is formed in order to tackle maternal mortality among women of Niger state.

Importance of Group communication
When groups of like-minded people came together with shared commitments and goals, change may likely occur. Groups are used for social movement. For Bowers and Ochs (1971), without a sufficient group, the actions of individual protestors are likely to be dismissed. Group communication helps to unite people. The communication that occurs through the collective action of singing songs or chanting slogans serves to unite group members. The key to group success is the sustained effort of group members working together through communication.

Group communication plays an important role in one’s cultural identity and membership in the communicative choices and how the communication of others is interpreted. People may want to examine membership and communication in groups because different cultures emphasize the role of individuals while other cultures emphasize the importance of the group. For example, collectivist cultures are ones that place high value on group work because they understand that outcomes of their communication impact all members of the community and the community as a whole, not just the individuals in the group.

On the other hand, individualistic cultures are ones that place high value on the individual person above the needs of the group. For example, the group communication campaign in Niger state has both collective and individualistic culture. Collective because the outcomes of their communication impact on all members of the community, particularly those the information is spread to and Individualistic because each woman may place her needs above the needs of the group.

Power influences how an individual interprets the messages of others and determines the extent to which the person has the right to speak up and voice out concerns and opinions to others. For example, the group communication campaign in Niger state, an individual may harbor the following thoughts: Are some people essentially more powerful than I am? Do I consider myself to be a powerful person? The word “power” in this instance could literary mean “to be able”.
According to Starhawk (1987), he divided power into power-over, power-from-within and power-with. Power-over enables one individual or group to make the decisions that affect others, and to enforce control. Control can take many forms in the society.

Starhawk explains that power is wielded from the workplace, in the schools, in the courts, in the doctor’s office. It may rule with weapons that are physical or by controlling the resources needed to live like; money, food, medical care or by controlling more delicate resources: information, approval, love. People maybe accustomed to power-over that they may become aware of its functioning only when they see its extreme manifestations. If for example, in the group communication campaign in Niger state, someone dominates the group, makes all the decisions or controls the resources of the group such as money or equipment, this is known as power-over.

Power-from-within manifests when a person can stand, walk, and speak. That is, words that convey a person’s needs and thoughts (Starhawk, 1987). In groups, this type of power arises from a person’s sense of connection, bonding with other human beings and with the environment. As Heider (1997) explains that since all creation is a whole, separateness is an illusion. Power-from-within comes through cooperation, independence through service, and a greater self through selflessness. The group communication campaign in Niger state for example, while on the field, the researcher closely observed a woman who angrily sprang up and left the group discussion; probably because she wasn’t benefitting from the discussion.

Finally, groups manifest power-with, which is the power of a strong individual in a group of equals, the power not to command, but to suggest and be listened to, to begin something and see it happen (Starhawk, 1987). For this to be effective in a group at least two qualities must be present among members: first, all group members must command respect and equality for one another, and secondly, the leader must not abuse power-with and attempt to turn it into power-over. For example, been in a group where members do not treat each others as equals or with respect is a good example of power-with.

Why groups are formed
Communication maybe seen as the central activity of every group depending on how the group is formed, organised and maintained. Individuals may have both positive and negative stories to tell about being in groups, but how they are formed is an essential aspect to be considered. Sometimes, people join a group because they want to and not necessarily because they have an objective to attain. Either way, Lumsden and Lumsden (1986) gave three reasons why groups are formed.

First, groups are formed because people want to share similar interests or attractions with other group members. In health care, groups that share similar interests or attractions are being formed. For example, groups that campaign against HIV/AIDS discrimination, maternal mortality and other health related issues are formed to share similar interests or attractions. These groups may share similar interest and attraction when it comes to touching and affecting people’s life.

A second reason a group is formed is called drive reduction. People may join groups so that their work with others may help them to fulfill their needs. As Maslow (1970) explains, people have drives for physiological needs, security, love, self-esteem, and self-actualization. Working with others may help in achieving these needs thereby reducing their obligation to meet these needs themselves. For example, using the group communication campaign in Niger state, an individual within a group may decide to carry out a campaign against women victimization, if she accomplishes the task successfully for the group, it’s likely her group members may compliment her work, thus fulfilling some of her self-esteem needs.

A third reason a group is formed is for reinforcement. We are often motivated to do things for the rewards they bring. Participating in groups provides reinforcement from others in the pursuit of goals and rewards. For example, a group of women may successfully carryout a campaign against maternal mortality and other prevailing health issues, the group may likely be rewarded by NGOs, government, international organisations as well as other operating organisations. By this, the group fulfills the purpose of reinforcement.

Group stages
Most groups go through series of stages as they come together. These stages as listed by Tuckman (1977); Fisher (1970) and Harris & Sherblom (2002) are called forming, storming, norming, and performing. Groups formed to achieve a task may go through a fifth stage called termination which may occur after a group accomplishes its goal.

1. Forming: For a group to exist and work together its members must first form the group. During the forming stage, group members begin to set the parameters of the group by establishing what characteristics identify the members of the group as a group. During this stage, the group’s goals are made generally clear to members, initial questions and concerns are addressed, and initial role assignments may develop. This is the stage when group norms begin to be negotiated and established. For example, when the group communication campaign in Niger state was at the forming stage, it started gradually with interpersonal communication approach, then some women became aware of the campaign and the benefits before the group began to form.

2. Storming: The storming stage maybe used to compare the “first fight” of a romantic couple. After the initial politeness passes in the forming stage, group members begin to feel more comfortable expressing their opinions about how the group should operate and the participation of other members in the group. Given the complexity of meeting both individual goals as well as group goals, there is constant negotiation among group members regarding participation and how a group should operate. For example, using the group communication campaign in Niger state, after the forming stage, there were controversies among the women as regards to the topics to be treated. This is the storming stage.

3. Norming: As soon as a group survives a first fight, they may emerge on the other side of the conflict feeling stronger and more cohesive. That is to say that if a group is able to work through the initial conflict of the storming stage, there is the opportunity to really solidify the group’s norms and get to the task at hand as a cohesive group. Norming signifies that the members of a group are willing to abide by group rules and values to achieve the group’s goals. For example, using the group communication campaign in Niger state, rules were set that every community woman (pregnant and nursing mothers) should be in attendance every day at around 9.am and no talk will be repeated if she misses out.

4. Performing: Performing is the stage associated with the defining characteristic of groups. This stage is marked by a decrease in tensions, less conscious attention to norm establishment, and greater focus on the actual work at hand in order to accomplish the group’s goals. While there still may be episodes of negotiating conflict and re-establishing norms, performing is about getting to the business at hand. For example, using the group communication campaign in Niger state, immediately the group ‘kicks off’ its activities, it means it is at the performing stage.

5. Terminating: Groups that are assigned a specific goal and timeline may experience the fifth stage of group formation which is termination. Some groups terminate immediately they achieve their required assignment and earn a award. This is not to say that they do not continue relationships with other group members. But, the defining characteristics of the group established during the forming stage have come to an end and so has the group. For example, using the group communication campaign in Niger state, if the group decides to terminate its existence after attaining the goal of reducing maternal mortality to, let’s say 5%, then, it may decide to terminate operation.

Group roles
People participate differently in a group so; group communication is the focus on the roles that is played in groups. Knowing the various roles played in groups can help in understanding how to interact with various group members. Twenty five commonly played roles in groups exists, according to Sheats & Benne (1948) and it is further divided into three types—group task roles, group building and maintenance roles, and individual roles. In later research, Ketrow (1991) uses only two categories of group roles—task and social/emotional roles, while Jensen and Chilberg (1991) describe thirty-four roles in groups.

For the purpose of this study, Sheats & Benne (1948) and Ketrow (1991), group roles are categorized into four: task, social-emotional, procedural, and individual. Task roles are those that help or hinder a group’s ability to accomplish its goals. Social-emotional roles are those that focus on building and maintaining relationships among individuals in a group. The focus is on how people feel about being in the group. Procedural roles are concerned with how the group accomplishes its task.
People occupying these roles are interested in following directions, proper procedure, and going through appropriate channels when making decisions or initiating policy. The final category, individual roles, includes any role ‘waves off’ from group goals and emphasizes personal goals” (Jensen & Chilberg, 1991). When people come to a group to promote their individual agenda above the group’s, they do not communicate in ways that are beneficial to the group. It is important for group members to understand what kinds of roles they play in groups in order to engage in positive roles and to achieve their objectives.

Maternal mortality
World Health Organisation (2010) revealed that the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75% between 1990 and 2015. This will require an annual decline of 5.5%. The 34% decline since 1990 translates into an average annual decline of just 2.3%. Hence, 100 still die a day and more needs to be done to achieve sets targets. According to Umar (2012), the chairman of the National Population Commission (NPC) Mr. Eze Festus stated that maternal morbidity and mortality rate are most commonly associated with high risk pregnancies and births and these includes too early pregnancies and birth by mothers under 18 years, too many or more than four previous births and too late pregnancies after the age of 35 years.

The number of women dying due to complications during pregnancy and childbirth has decreased by 34% from an estimated 546 000 in 1990 to 358 000 in 2008, according to a new report, Trends in maternal mortality, released by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank. The progress is notable, but the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75% between 1990 and 2015. This will require an annual decline of 5.5%. The 34% decline since 1990 translates into an average annual decline of just 2.3% (WHO, 2010).

The new estimate shows that it is possible to prevent many more women from dying. Countries need to invest in their health systems and in the quality of care. “Every birth should be safe and every pregnancy wanted,” says Thoraya Ahmed Obaid, the Executive Director of UNFPA. “The lack of maternal health care violates women’s rights to life, health, equality, and non-discrimination. MDG5 can be achieved,” she adds, “but we urgently need to address the shortage of health workers and step up funding for reproductive health services.” (WHO, 2010)

UN agencies, donors and other partners have increasingly coordinated their assistance to countries. WHO, UNICEF, UNFPA and the World Bank are focusing on the countries with the greatest burden and help governments to develop and align their national health plans in order to accelerate progress in maternal and newborn health. “Maternal deaths are majorly caused by poverty. The costs of childbirth can quickly exhaust a family’s income, bringing with it even more financial hardship,” says Tamar Manuelyan Atinc, Vice President for Human Development at the World Bank. “Given the weak state of health systems in many countries, we must work closely with governments, aid donors and agencies, and other partners to strengthen these systems so that women gain significantly better access to quality family planning and other reproductive health services, skilled midwives at their births, emergency obstetric care, and postnatal care for mothers and newborns.” “We still need to do more to strengthen national data collection systems,” says Dr Margaret Chan, the Director-General of WHO. “It is vital to support the development of complete and accurate civil registration systems that include births, deaths and causes of death. Every maternal death needs to be counted,” she adds.

The UN maternal mortality estimates are developed in close collaboration with an international expert group and use all available country data on maternal mortality, as well as improved methods of estimation. The intensive country consultation carried out as part of the development of these estimates has been instrumental in identifying increased data collection efforts in recent years including the special systems to capture data on maternal deaths (WHO, 2012).

Pregnant women still die from four major causes: severe bleeding after childbirth, infections (such as Obstetric fistula), hypertensive disorders, and unsafe abortion. Every day, about 1000 women died due to these complications in 2008. Out of the 1000, 570 lived in sub-Saharan Africa, 300 in South Asia and five in high-income countries. The risk of a woman in a developing country dying from a pregnancy-related cause during her lifetime is about 36 times higher compared to a woman living in a developed country. “To achieve our global goal of improving maternal health and to save women’s lives we need to do more to reach those who are most at risk,” says Anthony Lake, Executive Director of UNICEF. “That means reaching women in rural areas and poorer households, women from ethnic minorities and indigenous groups, and women living with HIV and in conflict zones.” (WHO, 2010)

Theoretical Framework
The social judgement theory was used to explain this study. Social Judgement Theory was propounded by Muzafer Sherif and Carl Hovland in 1961. It is a communication theory that explains when a persuasive communication message is most likely to result in attitude change. The theory specifies the condition under which this change takes place and predicts the direction and extent of the attitude change. This theory is also known as Latitude of Acceptance and Rejection (Jonge, 2012).

Persuasion is a process by which people use messages to influence others. While persuasion typically uses information, the emphasis in a persuasive message is on influencing the receiver (rather than merely providing information and letting the receiver make up his/her own mind). Persuasion attempts to change minds or get people to act. According to Sherif (1961), the essence of this theory is to explain how attitudes (the stands the individual upholds and cherishes about objects, issues, persons, groups, or institutions) may change in the communication process. He added that the attitude change will be less likely to occur if the gap between an attitude a person already has and the attitude advised by the message is big.
Using this theory to explain this study, messages related to the need for women to visit health centers for obstetric care are communicated by the midwives (and nurses) to the women in group format or by a friend. Therefore, attitude change will occur if the woman (the message is being communicated to by midwives and nurses) accepts the message that concerns her maternal health.
The theory holds that any person hearing a message will position it on an attitude scales based on his/her personal judgment. Furthermore, Sheriff (1961) composed three different latitudes known as:

1. Latitude of Acceptance. This consists of opinions, beliefs and stands that are perceived as acceptable. In other words, it is the range of positions a person is ready to accept or agree the content of the message. In this latitude, change occurs. For example, messages that fall within this latitude can induce an attitude change in a pregnant woman to visit health centers for constant check up either for antenatal and postnatal care or to abide by the rules outlined by the midwife, nurse or a friend.

2. Latitude of Non-Commitment. It contains the range of ideas and opinions which is neutral or the person feels undecided or indifferent to the individual’s mindset. For example, messages that fall within this latitude can position the woman at the state of neutrality. That is, the woman may or may not accept the messages on the dos and don’ts during pregnancy being presented by the midwife, nurse or a friend-positioning her on a neutral state.

3. Latitude of Rejection. This is the area where an individual finds all ideas, beliefs, stands and opinions objectionable or unacceptable. The greater the rejection latitude, the more uninvolved the individual is in the issue and thus will be harder to persuade. Due to the contrast effect, idea present in this area tends to be perceived as more hostile then they really are. In this latitude, attitude change is therefore unlikely. Some women of Niger state, for example, may not accept the messages as to regards the needs to visit the hospital for antenatal and postnatal checkup or to abide by the outlined rules communicated by the sender (who is either the midwife, nurse or a friend whose attitude may have fallen within the latitude of acceptance) no matter how hard the sender tries to persuade the receiver.
O’Keefe (1990) affirms that only understanding the person’s latitudes of acceptance, rejection and non-commitment will permit one to understand the individual’s reactions to persuasive messages on the issue.

METHODOLOGY
Key informant interviews method was used for this study. Key Informant Interviews, according to Johanna (2013) are interviews conducted with key individuals within the community, schools, etc. Key Informant Interviews provide a researcher with detailed, qualitative information about impressions, experiences and opinions. In the course of this study, the researcher interviewed four stakeholders-one midwife, a nurse, a pregnant woman and a nursing mother. The interviews were conducted at Comprehensive Primary Health Centre at Paikoro local government area of Niger State.
This Primary Health Center is the only health center covering the whole wards and the population of attendants was ranging from 15-20 women within the 7days this research was conducted. This local government was chosen based on balloting. The questions were posed to them at different occasions and each reacted in her own way. Since this study concerns women, the researcher deemed it necessary to interview women on the issue. The questions were drawn from the research questions, as posed by the researcher earlier in this study.

In addition, participatory observation was used by the researcher. Participatory observation, according to Macionis & Plummer (2005), refers to a form of research methodology in which the researcher takes on a role in the social situation under observation. The social researcher immerses herself in the social setting under study, getting to know key actors in that location in a role which is either covert (the social researcher participating fully without informing members of the social group of the reasons for her presence mainly in secret) or overt (the researcher being open about the reason for her presence in
the field of study since the researcher is given permission by the group to conduct her research).
The aim is to experience events in the manner in which the subjects under study also experience these events.
Macionis & Plummer (2005) added that researchers who employ participant observation as a research tool aim to discover the nature of social reality by understanding the actor’s perception, understanding and interpretation of that social world. Whilst observing and experiencing as a participant, the researcher must retain a level of objectivity in order to understand, analyse and explain the social world under study. In carrying out this research, both the covert and the overt type were used. That is, the researcher sat amongst the women as a covert participant observer after informing the management the purpose of the research. The essence of using this methodology was to detect some information that the respondents were shy to talk about or may not want to divulge at all.

Analysis
A skilled health worker (doctor, nurse or mid-wife) at delivery is critical to reducing maternal deaths (Okeibunor, Onyeneho & Okonofua 2010). Using group communication campaign as a tool against maternal mortality in Niger state, in fulfilling the goals of MDG5, midwives were assigned to various primary health cares, particularly in rural communities to assist women with obstetric aimed at reducing maternal and child mortality. Midwives assigned to these rural areas educate the women on the need to visit the health centers for checkup so as to avoid complications during and after delivery. A midwife was observed by the researcher addressing them in English while a nurse stood beside her, interpreting in Gwari and Hausa language. Maternal health issues were discussed and educated by the midwife on duty. Issues like; what to eat, what to wear, exercise to embark on and how frequent they should visit the health center for antenatal and postnatal care were critically discussed.

Another topic raised (in concise sentences) by the midwife (named Vivian) that made the women to observe a total silence and a display of self pity was ‘Obstetric Fistula’. The midwife read from a sheet of paper kept on the table. The researcher quotes:
Obstetric fistula is one of the major causes of death among pregnant women. Obstetric fistula is a hole in the birth canal caused by obstructed labour. Every year, between 50 000 to 100 000 women worldwide develop obstetric fistula. Women who experience this condition suffer constant urinary consistence which often leads to social isolation, skin infections, kidney disorders and even death if untreated.
But it can be prevented by: delaying the age of your first pregnancy; avoid using traditional methods in delivery and always come for check up so that we can dictate it on time.

There are other causes like; bleeding after childbirth, infections, unsafe abortion and hypertensive disorder. If you don’t want to experience all these things I mentioned, try to come for check up when you are pregnant and after delivery. Avoid delivering at home because if complications occur, we may not be there to assist you which can lead to your death. Also try to inform others whom you know have never visited the hospital to also come for check up so as not to experience these things.
While the midwife educated them, the women were attentive. They asked questions relating to the topics discussed, which the midwife answered. During the course of the study, the researcher also asked questions (as a participant observer) which was answered by the midwife.

Interviews
Aside the participatory observation, interviews were conducted. A nurse, the midwife and two women were interviewed.
Nurse
How do you think group communication have been used as a campaign against maternal mortality in your community?

Sarah spoke:
We try to gather them in one group here in the health center. We talk to them by teaching them what they should know and what they should do including the need to come here for checkup. We also remind them to inform their friends and loved ones who have not visited here to come as well. On our own part, we the nurses, we organise health talk for them on daily basis either by us or the midwives posted to us.
How effective is this campaign used in creating awareness among the uninformed women?
Women are responding to this campaign, but not much. We try to inform the women on attendance to inform and invite their friends and relations, including their neighbours. On market days, we don’t hold this meeting because we don’t want to be the cause of any woman not fending for her family.
Midwife
How do you think group communication have been used as a campaign against maternal mortality in your community?

Vivian spoke:
Just like you saw, they are really responding. We started with one person who came the next day with three women and subsequently. Before you know it, this place became a group of over ten women both pregnant and nursing mothers.
How effective is this campaign used in creating awareness among the uninformed women?
With time, I hope that women within this community will respond rapidly to this intervention. We usually have inconsistent number of attendance either on the increasing side or on the decreasing side. This is the central and only primary health care in this local government and some women live very far from this place so it might not really be easy for them to come over here.

Woman A
How do you think group communication have been used as a campaign against maternal mortality in your community?
Mariam, a pregnant mother of one spoke:
We started with small number of people. We sit together and share our problems and fears. I learn from a problem shared by a colleague and once the midwife answers the question, I learn from it so I might attend this meeting more than two weeks without asking any question because my problems had been solved with frequent questions and answers that may concern me. Before now, I never attended this even for once. I had my first child at home and it wasn’t easy and I am hoping to have my second child soon. But now, I see the benefit and I have invited more than five women here…
How effective is this campaign used in creating awareness among the uninformed women?
Creating awareness is another thing and the response of women is entirely another thing. I don’t see the effectiveness of this campaign to the fullest because for those that don’t have the money, not every woman can afford to trek the distance and for those that have little, they cannot afford to waste it on transport. This place is too far to organise this type of campaign.

Woman B
How do you think group communication have been used as a campaign against maternal mortality in your community?

Grace, a nursing mother spoke:
Through this campaign, the risk involved in pregnancy is reduced and women try to gather here every day for this health talk.
How effective is this campaign used in creating awareness among the uninformed women?
In fact, I was invited and I invited two other women. I was invited when I was pregnant and I had my baby here. To some extent, it is effective because some women are becoming aware by the day. But you know Ninja…well. This health clinic is far from where some women reside so this campaign may not really be effective to them because they are not carried along.

Findings
From the participatory observation and the interviews gathered, it was discovered that:
1. the only group communication campaign available is the gathering done by women in the central primary health center (which is far from the main town) and addressed by midwives and nurses on shift,
2. the attendance record fluctuates on daily basis, that is, high attendance in a day and low attendance on the next day,
3. though the campaign was aimed at creating awareness for the women to visit the health centers for proper care before, during and after delivery, the turn up of women were low in most cases-these group of women fall under the latitude of rejection as stipulated by the theory,
4. the campaign seems strenuous on the part of the midwife particularly when she has to speak and wait for her statement to be interpreted by the nurse and vice versa,
5. the women in attendance showed interest, attention, acceptance and some level of conviction during the discussion exercise-these group of women fall under the latitude of acceptance,
6. to some extent, group communication campaign is not effective for the fight against maternal mortality. Since the gathering is done in the central primary health center situated miles away from the main town and villages, not all women are reached out-these group of women fall under the latitude of non commitment.

RECOMMENDATION
Below are the recommendations of this study:
1. Dr Margaret Chan, the Director-General of WHO stated; “It is vital to support the development of complete and accurate civil registration systems that include births, deaths and causes of death. Every maternal death needs to be counted,” hence, there is need for accurate and daily statistical documentation of data on maternal mortality in Nigeria.
2. Other communication campaigns (like midwives visiting homes for interpersonal contact, contacting the women on phones and posting of adequate midwives to other health centers and not necessarily the primary health care within the community) should be put to place in communities to enable those women (pregnant and nursing) who are far from the primary health center to acquire the basic attention, assistance and information needed for their health.
3. Much importance should be placed by health personnel on the use of group communication in curbing maternal mortality because it can be seen as an easy way of dialoguing with more than one person at a time.

CONCLUSION
Group communication approach to maternal mortality can assist the midwife to meet the needs of more than two women at the same time. In a group communication, women are able to learn from other women’s experience through discussions, questions and answers as well as contributions shared from experience. To some extent, group communication may be disadvantageous because it may give little or no room for privacy since women are gathered in group. Incorrect ideas maybe shared amongst themselves in a group and the ideas may cause havoc to some women because they feel shy to raise their fears and desperation openly. With the efforts of international organisations, there is still more work to be done if the goal of MDG5 is to be achieved. More serious campaigns need to be carried out and various communication approaches needs to be put in place to curb this menace.

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