"Kunika Women Are Always Sick": Views from Community Focus Groups on Short Birth Interval (Kunika) in Bauchi State, Northern Nigeria

"Your fellow women will be teasing you. They will say: Kunika women are lazy and dirty." - female focus group participant

Short birth interval is a well-recognised concept in Northern Nigeria, where the majority of the population is Muslim. Islamic teaching promotes birth spacing to protect the health of mothers and their children, though kunika (a word in the Hausa language describing a woman becoming pregnant before weaning her last child) is common in Nigeria. The study described here used focus groups to explore the views of men and women in Toro local government area (LGA) of Bauchi State about kunika and its consequences. The findings informed further work in the same communities to systematise local knowledge about causes and prevention of kunika.

Team members from Bauchi State, familiar with local customs and traditions, visited 6 communities to meet the village chief and council, and arranged to conduct the focus groups in a neutral venue, often the school. The training of the facilitators stressed the importance of not voicing their own views and neither endorsing nor challenging views expressed by focus group participants. The facilitators conducted 12 focus group discussions: one with men and one with women in each of the 6 communities. Forty-nine women and 48 men participated.

Participants explained their understanding of kunika, often in terms of pregnancy while breastfeeding. They described many disadvantages of kunika, including health complications for the mother and children, economic consequences, and adverse impact on men's health (e.g., depression, hypertension, and impotence) and family dynamics. The focus groups noted that kunika is not socially accepted in their communities. People make fun of kunika women, in part because people associate kunika with frequent sexual activity, which in a conservative society like Bauchi may be a matter of shame and embarrassment.

The groups concluded that some people still practise kunika, either intentionally (for example, in order to increase family size or because of competition between co-wives) or unintentionally (for example, because of frequent unprotected sex), and they explained the roles of men and women in this. Some women expressed the view that kunika was not something within their control: "Kunika is bad but if Allah gives you, there is nothing you can do."

In conservative cultures such as in Bauchi State, men are usually the main decision makers in a household, including decisions about the number and spacing of children. Discussing the health problems for men associated with kunika could be a way to draw men into the debate when seeking ways to reduce kunika.

In conclusion: "Women and men in communities in Toro LGA, Bauchi State, have a clear perception of what is meant by kunika. Their rich understanding of its adverse consequences goes well beyond the relatively narrow health concerns reported in quantitative studies. Including men in the discussions revealed their concerns about effects of kunika on men's health and wellbeing. In the Bauchi context men continue to dominate decision-making about reproductive health; the findings from these focus groups will help us to promote male involvement in seeking ways to reduce kunika."