African Identities

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Personhood, human rights and health among the

Akan and Igbo of West Africa

Alex J. Wilson

To cite this article: Alex J. Wilson (2012) Personhood, human rights and health among the Akan
and Igbo of West Africa, African Identities, 10:4, 439-453, DOI: 10.1080/14725843.2012.730817

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African Identities
Vol. 10, No. 4, November 2012, 439–453

RESEARCH ARTICLE
Personhood, human rights and health among the Akan and
Igbo of West Africa
Alex J. Wilson*

Department of African Studies, University of Cape Coast, Cape Coast, Ghana

(Received 11 September 2011; final version received 12 June 2012)

Many African countries are now abreast with the need to link healthcare and human
rights, but the individual factor to ensure this is missing. It has become imperative that
health policy-makers reflect on the health of individuals within the community in order
to achieve a holistic healthcare delivery. Thus, the patients’ inputs and their cultural
values are invaluable for community health. This essay attempts to identify and
examine the relationship between healthcare and human rights based on the Akan and
Igbo (African societies) concepts of personhood. The main argument of this essay is
that the concept of personhood, as exists in the aforementioned indigenous societies,
provides the framework for understanding human rights and healthcare based on
cultural relativism. The essay identifies some of the discourses associated with human
rights and healthcare in the western world and those of the Akan and Igbo.
Keywords: human rights; health; indigenous knowledge; Akan and Igbo

The paradigm for the study of human rights and health has shifted from need-based to ways
of dealing with it (Gruskin et al. 2005). Consequently, human rights treaties and conventions
encompass the relationships between health and human rights. For example, the
International Covenant on Economic, Social and Cultural Rights (Article 12), the African
Charter of Human Rights (Article 16) and the Protocol on the Rights of Women in Africa
(Article 14) outline the rights to health and commit states to take the necessary steps to
uphold these. Many conferences and institutions have advocated the need to commit more
attention and resources into the implementation of health policies (Gruskin and Tarantola
2005). One of the best ways of doing this is to understand how people perceive health and
human rights in their cultures. African countries have embraced the international treaties
and rekindled their interest in linking healthcare and human rights. However, because of the
diverse ways by which people perceive human rights, the debate about universalism and
relativism needs to be addressed. The respect for differences and the right to be different with
regard to cultural, linguistic and religious identity need to be reconciled with universal rights
(UNICEF and UNESCO 2007, Himonga 2008). Furthermore, a rights-based approach
requires the development of laws, administrative procedures, practices and mechanisms to
ensure the fulfilment of peoples’ entitlements, as well as opportunities to address violations.
Mindful that the patients’ inputs, especially their cultural values, are very important, the
World Health Organization (WHO) calls for the translation of universal standards into

*Email: [email protected]

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440 A.J. Wilson

locally determined benchmarks in order to measure progress and enhance accountability

(WHO, 1979, 2008a, Stoskopf and Johnson 2010).
In this essay, I use content analyses to identify and examine the relationship between the
indigenous African healthcare systems and human rights based on the traditional Akan and
Igbo concepts of personhood. Based on poststucturalism’s and postmodernism’s arguments
that seek to disrupt the cultural hegemony of the west (Ahluwalia 2010) and the African
philosophy and thoughts about human rights advanced by Gyekye (1987), Wiredu (2002)
and Ikuenobe (2006) that the concepts of communalism and reciprocity form the bases and
principles underlying human rights among the Akan and Igbo, I argue that these principles of
human rights apply to rights to healthcare in the knowledge systems and philosophy of the
two ethnic groups. Furthermore, I argue that the principles of communalism and reciprocity
commit people to fulfil certain obligations so that they can enjoy their rights to good health.
I conclude that when policy-makers recognise the social and cultural rights of people, and
apply the principles of rights and obligations as understood by indigenous Africans, the
latter are likely to improve upon their level of participation in the healthcare delivery system
for a healthy environment. This essay will, therefore, create avenues for discussing political
and health issues among other indigenous groups in Africa for a better understanding of
concepts in human rights and health.

Similarities and differences between Akan and Igbo

Akan and Igbo, who constitute major ethnic groups in Ghana and Nigeria, respectively, have
been selected for this essay because they have similar philosophies about health and human
rights. The choice will help me to explain the ideas that indigenous societies have on themes
of this essay. As shown in the map below (Figure 1), the Akan live in the southern part of
Ghana whereas the Igbo live in the south-eastern part of Nigeria. Both experience similar
climates and vegetation.

Figure 1. Sketch map of west Africa showing the location of Akan and Igbo.
 African Identities 441

Akan and Igbo share similar concepts in their linguistic, social, political and religious
systems which influence their perception about health and human rights (Fortes and Evans-
Pritchard 1940, Busia 1968, Sarpong 1974, Mbiti 1990, 1991, Gyekye 1996, Agbasiere
2000, Wiredu 2002, Awedoba 2005, Ikuenobe 2006, Turaki 2006, Konadu 2007, Obiagwu
2008). By belonging to the Kwa sub-group of the Niger-Congo language family
(Williamson and Blench 2000), there is the high possibility for similarities in culture,
especially their world view on human rights and health as explained under the Sapir – Whorf
hypothesis (Wardhaugh 1992). With UNICEF and UNESCO’s (2007) call for the
importance of laws, administrative policies and mechanisms for addressing human rights
violations, it is imperative to identify the ways by which the two groups approach human
rights in their indigenous social and political systems. For instance, it is worthwhile knowing
how the concepts of personhood, individualism, communalism, kinship and inheritance
systems determine the sources of rights, and ways by which the political systems enforce
rules and regulations about human rights.

Theoretical and conceptual frameworks

I construct a theoretical framework based on postmodernism, poststructuralism and social
constructivism to explain the concepts of universalism and relativism in human rights.
Furthermore, I use these concepts to examine personhood, individualism and communalism
as exist in indigenous Akan and Igbo cultures to explain human rights in the healthcare
delivery system. Ahluwalia (2010) argues that colonialism’s ‘civilizing mission’ was linked
to notions of modernity which suggested a temporal separation, rapture with tradition and
rendering colonial peoples as non-modern. This made western powers see modernity as
contemporaneous with the idea of progress. Poststructuralist and the postmodernist
articulated the flaws of modernity. Postmodernism sought to deconstruct the logocentric
narratives of European culture by attempting to break the binaries of imperial discourse and
disrupt the cultural hegemony of the west. Based on this is the need to appreciate other
cultures and deconstruct western concepts of human rights.
The debate on universalism and relativism has increased global efforts to develop a body
of rights that all human beings could subscribe to. Some authors argue for universal human
rights as the guidelines for measuring the extent to which nations comply. Their opponents
argue that belief systems and history of groups differ, so human rights should be conceived
within the social, historical and philosophical systems of a group. In healthcare, the
culture of the patient influences the conception of diseases and health-seeking behaviour
(Sindiga 1995, Kreuter and McClure 2004, WHO 2008a). Therefore, it would be better for
Africans to reconsider issues of human rights and health within the framework of indigenous
African philosophies; considering that they are potentially underserved in biomedical
healthcare services.
Social constructivists challenge the familiar ways of constructing ideas. For example,
Blundo and Greene (2008) argue that cultural biases, myths, metaphors and political
contexts provide alternative perspectives on issues. Coupled with these is the different ways
by which people explain their experiences (Gyekye 1987). For instance, people interpret
what constitutes a disease and the acceptable interventions and treatments based on their
cultures (WHO 1979, 2008b, Njogu 2005, Rosal and Bodenlos 2009). Similarly, the culture
provides the spaces for communication on sensitive issues related to health and sexuality
and sets the conditions for best practices for any curative and preventive cure. Furthermore,
about 80% of Africans use traditional medicine (WHO 1979, 2008b). Therefore, it behoves
healthcare professionals to understand their clients, as individuals, as well as members of
442 A.J. Wilson

families or communities and be receptive to the patient’s culture by using indigenous

resources in the healthcare delivery system.
Ahluwalia (2010) identifies postmodernism as a theory of knowledge that deconstructs
the narratives of European culture. He notes that postmodernism is similar to the breaking of
binaries of imperial discourse, which postcolonialism addresses. One will agree with him
that postmodernism and postcolonialism are counter discourses that seek to disrupt the
cultural hegemony of the west. However, it is also worthwhile noting that postcolonialism
also identifies the situation in which elites in the society create a power system in which they
become the new colonialists and the African masses become the colonised (Fanon 2004).
Therefore, postcolonialism has the potential to create the impression that modernity
socialises people to accept everything European as the modern ways of doing things and that
the urban people have been acculturated into these ways of life.
In reaction, Mkhize (2004) states that the European ways of life cannot be used
exclusively to explain human needs across cultures and across time. He lamented that
psychology, in developing societies, tends to favour the modern sectors, but this has not
permeated the majority of people in rural settings. He, therefore, cautioned against the use
of imported conceptual categories and philosophical abstractions to explain the needs and
experiences of people in developing societies, and advocated indigenisation as the panacea
for transforming foreign models to suit local cultural contexts.
All the above statements point to the importance of the patients’ inputs in the healthcare
delivery systems. In the course of preparing the documents on Africa’s charter of human
rights, African leaders resolved that they would consider the virtues of their historical
traditions and values of civilisation in addressing the concept of human and peoples’ rights.
Though some people argue that at times culture prevents health interventions, a more
positive and accommodative view sees it in terms of its strengths and capabilities.

Concept of personhood
Many African societies conceive the individual within the concept of personhood, which
also links an individual with the community (Ikuenobe 2006). Among the Akan and Igbo,
the conception defines who is a person, including what makes up the individual and
what society expects of individuals as human entities (Gyekye 1996, Agbasiere 2000,
Wiredu 2002). These expectations help to define norms and set the basis for mores, laws,
policies and practices. The groups believe that three entities – blood, spirit and soul –
constitute an individual. At conception, a woman provides the blood whereas a man
provides the semen which fuse to form a human embryo. Both groups believe that the
human being is made up of a material and non-material entities, and acknowledge the
Supreme Being’s crucial role in the provision of the non-material aspect. The breath of
life is associated with the soul and destiny. Both Akan and Igbo have the maxim that
only the Supreme Being knows the destiny of a person (Sarpong 1974, Agbasiere 2000,
Wiredu 2002).
The authors mentioned above are silent on whether the Supreme Being provides the soul
at conception or childbirth. However, they state categorically that man and woman provide
their respective entities during conception. Some of the people with whom I discussed this
issue said the Supreme Being provides it during conception, whereas others said it is just
before childbirth. The best explanation that I gathered was that childbirth is a gift of the
Supreme Being. Therefore, He honours the couple by allowing the fusion of the sperm and
the ovum. This explanation seems to be ambiguous when viewed against the concept of
reincarnation, which both ethnic groups believe in.
 African Identities 443

Reincarnation buttresses the point that the birth of a child is the loss of a person in the
spiritual world and the vice versa. However, in as much as the newborn child is an ancestor
reincarnated, he or she is also unique (Agbasiere 2000). Mbiti (1990) explained this
phenomenon as partial reincarnation – not everybody is reborn, only some features are
reincarnated. Similarly, Sarpong (1974) stated that individuals have dual destinies – one that
they shape by themselves and the other by the Supreme Being. Therefore, individuals shape
their lives in line with what the Supreme Being has ordained. Among the two ethnic groups,
young children are named after the old or dead people to signify the probable reincarnation.
Dual destiny finds meaning in dual lifestyle. A person has an individual lifestyle and a
communal lifestyle (Gyekye 1996, Ikuenobe 2006). Gyekye (1996) supported the
ambivalent nature of communalism and individualism in a symbiotic relationship by
defining communalism as ‘the doctrine or theory that the community (or group) is the focus
of the activities of the individual members of the community’ (p. 36). Therefore, the cultural
communities in which individuals live are their foremost priority and not their selfish
interests. A balance between the two, where individuals realise their potential from the
community and the community recognises individuals’ achievements, is necessary. Thus,
the individual cannot develop outside the framework of the community and the community
too cannot dispense with the talents and initiatives of its individual members. Therefore,
the idea of communalism places emphasis on the wider society, not necessarily to the
detriment of the individual. The ethnic groups communicate these in a number of maxims
and proverbs.
The importance of personhood stems from the belief that both individualism and
communalism are important in the healthcare delivery system. The individual’s and the
community’s attitudes can lead to the outbreak of diseases as well as a healthy environment.
The communitarian features shape the attitudes of individuals. If the community’s interests
set the pace for individuals’ attitudes, the latter will perceive unhealthy practices as deviance
and advocate laws for healthy practices. This ensures success in public health.

Personhood and human rights

The interplay of universalism and relativism influences the ways by which laws are made
to ensure that individuals in a group enjoy their basic human rights. For instance,
universal human rights documents entreat nations to enact laws that ensure that citizens
enjoy their rights. However, in traditional societies like the Akan and Igbo, morality
endures more than the rule of law. The judicial systems examine the circumstances
surrounding an act that breaches the law in line with the moral laws of the community.
Therefore, the society examines every case on its own merit. The philosophical
foundations of many African societies shape their traditional worldviews and guide them
to establish the moral laws of the community based on the concept of personhood
(Turaki 2006). Therefore, the moral laws serve as the bases upon which the society
establishes human rights, human dignity, human well-being and health. Attesting to the
profound relationship between a society’s philosophy and theology, and the behaviour of
its people, Turaki (2006) identified four philosophical foundations associated with
African ways of life (holism, spiritualism, dynamism and communalism). He noted that
each of these finds expression in moral laws – holism, in law of harmony; spiritualism, in
the law of the spirit; dynamism, in the law of power and communalism, in the law of
kinship. These foundations establish the expected behaviours of people by conditioning
the rights and obligations that people must uphold to ensure human dignity and a healthy
environment for the growth of the community.
444 A.J. Wilson

The relationship between personhood and community provides the framework of

rights and responsibilities within the society (Gyekye 1987, Wiredu 2002, Ikuenobe 2006).
Wiredu (2002) explores the question ‘what is it about [human beings] that makes [them]
entitled to human rights, within the Akan perspective?’ He linked the Akan conception of
personhood to why and how people obtain rights. He stated, ‘The Akan conception of
person has both descriptive and normative aspects that are directly relevant not only to the
idea that there are human rights but also the question of what those rights are’ (p. 299).
Using Aristotle’s maxim that human beings are naturally political beings, he situated the
political nature of humankind among the Akan within the context of the community, and
argued that as individuals and communal beings, people enjoy certain rights and are
supposed to render certain obligations to the community that they belong to. By having a
soul, everybody has an intrinsic value, which is the same in everybody because they do not
owe it to any earthly circumstance but the Supreme Being. Therefore, everyone is entitled
to equal measure of basic respect. Similarly, the Igbo conceptualise a person in terms of
his or her relationships with the group as conditioned by reciprocal rights and obligations
(Agbasiere 2000). This is not different from the explanations offered by Gyekye (1987)
and Wiredu (2002).
Donnelly (1982) provides a different perspective on the link between human dignity and
human rights. He noted that many authors treat human dignity and human rights as
equivalent concepts and argued that human rights present only an aspect of the realisation of
human dignity. Non-western societies handle human rights in terms of duties that are neither
derivative nor correlative to rights. They recognise the guarantee of human rights as
essential to human life and human dignity. Therefore, they have elaborate systems of duties
that ensure the protection of human rights. Donnelly (1982) posits that rights and duties do
not go together and that when the rights holders are compared to those obligated to ensure
that the rights prevail, the obligated acquires an advantageous position. He stated:
The duties imposed by rights do not only operate at different levels but in different ways. Both
what is demanded of the obligee and how those demands are imposed are crucially different;
depending on what sense of right is involved . . . . Human rights are conceived as naturally
inhering in human person. They are neither granted by the state nor are they the result of one’s
action . . . . To have human rights, one does not have to be anything other than being a human
being. Neither must one do anything other than be born a human being (p. 306).
He also argued that human rights are not absolute and that there are few circumstances
under which they might be justifiably overridden. Thus, Donelly’s arguments uphold some
of the principles outlined by the indigenous people, hence the idea of relativism, as would
be explained soon.
Donnelly’s arguments that human dignity is an aspect of human rights are in line with
the WHO’s outline of rights-based approach to health, which recommends the integration
of human rights norms and principles, including human dignity and accessibility of health
systems to all. However, the claim that duties are neither derivative nor correlative to
rights is an abstract that should be deconstructed. Like Wiredu (2002), Donnelly (1982)
argues that people enjoy rights because they are members of the human race. However, he
does not identify the source of the rights and who ensures that members of the human race
enjoy these rights. His argument that the state does not grant them raises some questions;
for example, what does the state consider before granting them? Who ensures that they are
there to be enjoyed?
On the contrary, Pearce (2001) states that the universalistic plans of the west targeted
every aspect of indigenous African way of life for change. He notes that the Universalists’
attack on the Relativists, particularly Africans, for focusing on the group and social rights,
 African Identities 445

makes human rights concepts removed a step away from the individual rights. Human rights
in African societies support communal values, which place rights within the collective
domain. Therefore, perpetual existence of rights goes with the support of resources.
With regard to health, Pearce (2001) states that Africans believe that a sickness has a
strong social component. It results from the breakdown of social relationships whose
imprints the individual’s personality bears. This challenges healthcare providers to examine
the effects of the collective on the individuals. He concludes that individualistic conceptions
of rights without regard for the collective or group dynamics, values and the environment,
lead to decontextualised approach to human rights. The dynamics of these value systems are
the basis for examining health and human rights in the discussions, which follow.

Discussions
The discussions focus on three areas, namely, the role of the indigenous family systems in
granting human rights, the obligations associated with the enjoyment of human rights and
the discourse associated with health and human rights. As noted earlier, the concept of
personhood explains the entities that make up a person and the moral expectations
expected of him or her as a member of the human community. It also explains the
underlying philosophies associated with why individuals have human rights. Therefore,
the discussions in this section examines the interplay of these concepts in the indigenous
knowledge systems of the Akan and Igbo to deconstruct human rights in terms of
postmodern and poststructuralism and reconstruct human rights, bearing in mind the social
constructivist idea that there are many ways of doing things.
The network of kinship, especially lineage, and the political systems generate a system
of rights and obligations for individuals within the kinship system and the community. This
is in line with Turaki’s (2006) moral foundation of communalism which, he argued,
explains the law of kinship. At birth, individuals are weak, defenceless and dependent,
so they have the right to be nursed by members of their kin group (Wiredu 2002). Because
the indigenous African societies build their political systems on the lineage systems
(Fortes and Evans-Pritchard 1940), the lineages in the community have the collective
responsibility to ensure that the members of the kin groups support their children to enjoy
their rights. Based on this, individuals enjoy rights from the Supreme Being and their
parents’ lineages, depending on the lineage system. As a matrilineal society, the Akan
obtain most of their jural, social, political and economic rights from the matrilineage,
whereas the Igbo, who are mostly patrilineal, obtain most of these from their patrilineage.
The Igbo maxim goes that agnates are one’s source of strength (Okere 1983). Therefore,
the Igbo are entitled to rights and privileges including healthcare from their patrilineage.
However, they are also privileged honorary members in their mothers’ lineage. Mothers’
brothers protect individuals’ jural rights in their fathers’ lineages. The mother’s lineage
home is a place for refuge for a person who gets into serious trouble and is exiled. A typical
example can be found in Achebe’s (1996) Things fall Apart, where Okwonko left his own
house and joined his mother’s relatives for 7 years after he had killed Ekedu’s son,
accidentally.
Among the Akan, a father has to provide his children’s basic needs until they are ready
to marry and be independent from parental control (Wilson 2011). He is obligated to
educate his children and guide them to acquire gainful livelihood to prepare them for the
future. After marriage, a person’s matrilineage becomes responsible for his or her rights
and privileges. The element of personhood that fathers contribute (the spirit) links the
offspring to their fathers, and the latter’s lineages permanently. The rights that one enjoys
446 A.J. Wilson

during one’s childhood transform into obligations when one grows up and has to reproduce
and take care of one’s children and parents.
The role of the Supreme Being in the perception of human rights is that through the soul,
which individuals obtain from Him, they become spiritual beings with religious and moral
obligations. The Akan and Igbo associate the soul with destiny (individual) and human
dignity (communal). Individual destiny means people have different abilities. Human
dignity implies that every human being is entitled to equal measure of basic respect, which
transmits into rights (Wiredu 2002). Individual ability and collective dignity mean that
individuals use their ability for the benefit of the society. In the spirit of communalism and
reciprocity, every member of the community has to give out something that other members
need, and in return take away some of the things that others have given, based on their needs.
This buttresses the Akan maxim ‘the individual is not a palm tree’. The symbolism
associated with the palm tree is that every part of it is used to produce something and the
residue serves as a by-product for another round of production. Therefore, it symbolises
self-sufficiency.
The dynamics of personhood and human rights begins from the clan level to the
community. The Akan have the maxim ‘The individual descended from the spiritual world
and landed in the clan (community)’, whereas the Igbo maxim goes ‘because the tortoise
has no family it has already made its coffin’. The state charges the clans to see to the
welfare of their members. With the clans as the main social and political units, they
organise their members as households and lineages. These subunits ensure a fair
contribution and distribution of resources among the members so that both the rich and the
poor enjoy their rights and human dignity.
It is pertinent that African culture is shaped within interdependence, communalism and
reciprocity. These transmit into rights and obligations that the states (societies) task the
traditional family structures to uphold. Rights are not in abstract terms. Therefore, the
possibility that the state, which has to see to the rights of the individuals, will be found to
be trampling on the rights of people, as happens in many modern societies, will be slim.
The clans take up the responsibilities of ensuring the rights of its members and, therefore,
put structures in place within the state to fulfil this.

Human rights, obligations and healthcare

Considering the importance of human rights in the healthcare delivery system, it is worth
understanding the relationship between each of them and the concept of personhood.
As noted earlier, the concept of personhood evolves from conception, through childhood
to adulthood until a person dies. Furthermore, the African Charter of the Rights and
Welfare of the Child (Article 31) and the African Charter of Human and Peoples’ Rights
(Articles 27 –29) state categorically that children have obligations to their families and
communities. Therefore, both children and adults have responsibilities to ensure that
human rights prevail in their communities. A child is weak and needs the support of the
parents for its survival. All children are entitled to basic needs such as nurturance, a safe
environment to live in, attention, food and nutrition, security, healthcare, education and a
hopeful future in order to grow into healthy and productive adults (Goonesekere 2007).
Thus, child survival, a public health concern, is upheld as a right among the Akan and
Igbo. Children enjoy this as inalienable right until they get to a stage in life that the society
expects them to provide certain obligations to reciprocate the gesture.
In order to ensure the high level of participation that the WHO advocates, society
needs to identify a health and human rights concept that evolves along the concept of
 African Identities 447

personhood. For the Akan and Igbo, these evolve from the individual through the family to
the community. For instance, they perceive a person as an individual with personal values,
and a member of the community with communal values. Furthermore, they perceive that
traditional concepts of health have both an individual and communal dimension, and that
the individual’s well-being or health depends on a balance between his or her mind
(conscience), body and the spirit (Appiah-Kubi 1981). Therefore, if people do things
contrary to their conscience, they will be overburdened by their conscience and fall sick.
The interplay between individualism and communalism makes traditional healers
admonish patients to confess their sins to maintain the balance between themselves and
other people so that patients will get healed (Appiah-Kubi 1981). Families are obligated to
create the environment for their members to participate in politics and enjoy their basic
human rights including effective healthcare delivery. The relationship between a person’s
health and that of the community (public health) calls for a balance between individuals
and their environment (social, physical, biological and religious). The society ensures
success of public health by placing the responsibilities of enjoying a healthy environment
on the people. The Akan share this in the maxim ‘unstable conditions within the states
begin from individual households’. They use this in politics. However, it can also be
applied in health because as individuals participate in politics, their inputs provide the
framework for the policies that condition health as human rights. Therefore, high level of
health among individuals in the community translates into a healthy community. While the
individuals ensure their personal health, they also show concern for other people’s health.
The community ensures this by organising communal labour, public education and
religious rites, and making rules and regulations for efficient public health systems.
The concept of personhood provides the impetus for effective reproductive health
systems in which everyone participates. Unity among the three entities of a person (body,
spirit and soul) is necessary for conception and birth. A husband ensures that his wife lives in
a healthy environment for her survival and that of her foetus. The woman’s responsibility is
to endow the foetus with its bodily characteristics, or to ensure that the foetus is formed well.
She does this by disclosing any pregnancy to her husband and demanding the best of
healthcare provision, including performance of the necessary rituals, provision of antenatal
care from a renowned medicine man or woman. She is obliged to take her medications,
observe pregnancy taboos and many more (Christensen 1954, Agbasiere 2000). Translating
these traditions into modern life means that both husband and wife have roles to play in
antenatal and postnatal care. The role of the Supreme Being is couched in the belief in his
omnipotence and omnipresence. He is not visible but believed to be present always and
everywhere (Mbiti 1990). Therefore, his roles are delegated to the community and hence the
need for the community to ensure that individuals in the community are in good relationship
with their environment. The indigenous people believe that if the community fails to do this,
it will experience a calamity or a plaque, thereby making the individuals and community
suffer; and hence the community’s challenge to families or households in the form of laws,
rituals and customs.

Health and human rights discourse

The way people perceive health influences the discourse of human rights under
universalism and relativism. Understanding the discourse helps to establish the essence
and roles of individuals in the society. Under universalism, I examine inalienability of
rights and equity whereas for relativism I examine rights in relationship with religion.
Should society concern itself with equity when the impact of an action differs by gender,
448 A.J. Wilson

and equality is detrimental to the health of an individual or community? Second, do men

and women in Akan and Igbo societies have reproductive rights or obligations?
Universalism argues for the inalienability of human rights and creates the impression
that rights must always be exercised. Therefore, if the intended results are not being
achieved, then somebody must be preventing someone from enjoying those rights.
However, relativism of human rights under the Akan and the Igbo emphasises that one
performs obligations in return for one’s rights. Where individuals exercise their rights
without recourse for communal solidarity, the community will condemn their actions.
A typical example is that the society may uphold gender equality, but when smoking is very
harmful to the foetus the society is likely to criticise pregnant women for smoking. This may
be seen as gender discrimination, but for the sake of the health of the foetus and that of the
future generation, a biased intervention will be worthwhile.
Many authors, including Hartmann (1995) and Fathalla (2004), state that African
women do not have reproductive rights. This is a typical modernists and structuralists
argument which the postmodernists and poststructuralists should deconstruct. However,
this status quo remains for the fear that one will be labelled an anti-feminist or
anti-development because population dynamics have become apolitical. Therefore, society
must make efforts to reduce population. Furthermore, reduction in population has been tied
to women’s empowerment thereby creating the impression that men hold women’s power.
The binary situation created in the case of reproductive rights is that men seek to increase
population, whereas women do otherwise. Therefore to be modernised, men should reverse
that power to women to ensure a decreased or stable population.
One of the discourses in reproductive health between modern societies and the
indigenous Akan and Igbo societies is that modern societies associate reproductive health
with rights, whereas the latter associate reproductive health with both rights and
responsibilities. The modernists argue that because the reproductive rights of women in the
developing world are vested in their husbands, they can best be described as ‘reproductive
wrongs’. Hartmann (1995) and Fathalla (2004) advocate that societies should vest such
rights in women who bear the chunk of reproduction. Furthermore, childbearing should be
made freely based on informed choice. It becomes a ‘reproductive wrong’ if fertility control
by women is turned into fertility control of women. The impression creates a binary situation
in which women are often not informed but men are informed. Therefore, men become
victims of the blame game in reproductive rights.
Okonjo’s (1991) caution to scholars to jettison the male super ordination and female
subordination dichotomy in their analyses of the position of women in African societies
and Njogu’s (2005) that scholars should use the positive and accommodative view of
culture as a resource for care and social support system will suffice here for critical
analyses. Hartmann’s catalogue of complaints from women about their inability to access
their reproductive rights and autonomy gives the impression that men always ‘demand’
sex and women have to yield. Akan and Igbo cultures spell out rights and obligation of
couples. Married women have rights to sexual satisfaction from their husbands in return
for fidelity (Agbasiere 2000, Nukunya 2003, Awedoba 2005). These mutual rights and
obligations are communicated to initiates and newly married couples (Sarpong 1971,
1974). One may wonder if women refuse to exercise these rights. In a research conducted
in Ghana by Awusabo-Asare et al. (2004), many women claimed that they did not consent
to their first sex experience. Upon further questioning, they admitted that sex has always
been presented as a man’s business, so a woman will hardly accept that she consented to
her first experience. Probably, this may influence the people’s perception about sexual
rights and hence men are seen to be on the offensive in matters of sex and sexuality.
 African Identities 449

Universalism is about individual choice as it is framed in the United Nations Declaration

of Human Rights. However, an individual’s choice will likely be based on the community’s
values. In the African situation in which individualism is good if only it is used for the benefit
of the collective or community, building a local premise on a universal one may not augur
well. With reproduction perceived in terms of obligations and rights, the indigenous Akan
and Igbo societies encourage high fertility among their women. Among seven things that the
typical Akan prays for is fertility (Warren 1986). ‘For the traditional Igbo community,
marriage must be fruitful. Its fruits are children . . . without children . . . marriage is
incomplete’ (Obiagwu 2008, p. 59). Furthermore, Obiagwu (2008) espoused Mbiti’s (1990)
assertion that marriage is a religious obligation through which individuals propagate and
eschew the extinction of humankind. He attributed this to the Igbo as well and emphasised
Mbiti’s point that despising these sacred obligations would not augur well in an indigenous
Igbo society.
Attributing fertility to women in the field of demography and health demonstrates the
need for women to have a voice about it. In both traditional Akan and the Igbo cultures,
women’s voices on fertility manifest in the rituals for fertility. The people present fertility in
feminine terms. They vest it in a goddess – Akuaba among the Akan and Isia (in the Ohofia
area) and aja-ani (in the Nri area) among the Igbo (Agbasiere 2000). In Ihofia, women
perform rituals to Isia to supplicate for increase in fertility. It is a taboo for men to go pass
them on the way to or from the shrine. In Nri both women and men perform the rituals,
but women offer the ritual gifts of the community. Women pour libation in this particular
ritual but in other rituals men do that. In the aja-ani rituals, women pray for their personal chi
(soul or goddess) to ensure fertility for their female descendants and their husbands. Among
the Akan, women perform rituals for bragoro (puberty rites). Most of the prayers offered
during this time are for fertility (Sarpong 1971, 1974, Warren 1986). These show that
fertility and reproductive rights are matters for both men and women but more of the
women’s power and their rights to invoke the supernatural.
Some of the rights that the universal documents provide do not conform to traditional
Akan and Igbo cultures, for example, the right to abortion. It is very difficult to talk about the
rights to abortion because the indigenous peoples perceive it as an anti-social practice, and
probably a taboo. African women’s rights advocates such as Dolphyne (1995) and Sofola
(1998) detest western feminism because it advocates foreign ideas such as rights to abortion,
and lesbian and gay rights while the average African woman perceives rights in politics of
survival – a situation in which women will rather exert their energies in ensuring the welfare
of their family members, especially children. For instance, they have played effective roles
in ensuring food sufficiency in the mist of policies such as the Structural Adjustment
Programme which brought about situations like those where their husbands were laid off and
they could not access maternal and child healthcare services.
In contrast to universalism, which often considers abortion as a right, both indigenous
Akan and Igbo societies conceive it as bloodletting. Blood is sacred to them so shedding it
pollutes the earth and violates the covenant between the earth and humankind. Therefore,
they abhor it unless it is a command from the deities or in war. They even consider accidental
death as an abomination for which the community must be purified (Obiagwu 2008).
Agbasiere (2000) stated that there seem to be no definite view about when a foetus becomes
imbued with life, other than the biological; but her discussions with Igbo women on the
causes of miscarriage suggested that the moment a pregnancy is determined, there is life in
the foetus. Among the Akan, once a woman detects that she is pregnant, she conceives the
development of another person’s life within her and observes taboos, including those of her
450 A.J. Wilson

husband’s ntoro or egyabosom (patrilineal cult) to ensure the well-being of the foetus
(Christensen 1954, Wilson 2011).
Though the Akan and Igbo cherish high fertility, they abhor situations that are likely to
endanger the health of mothers and/or children. Therefore, they cherish birth-spacing and
long period of breastfeeding (Nukunya 2003, Awedoba 2005). Elderly women encourage
nursing mothers to breastfeed their children very often and stay away from postpartum sex
until the child is weaned. This helps to space the intervals between childbirth. The kin group
and community support nursing mothers by offering to do the routine strenuous chores such
as fetching water and sweeping, and encourage them to abide by good traditional practices
that ensure good health for mothers and their children. Furthermore, the Protocol to the
African Charter on Human and Peoples’ Rights on the Rights of Women in Africa provides
for rights to abortion only if keeping the pregnancy will endanger the health of the expectant
mother or it resulted from rape or incest [Article 14(c)]. Where the rights that people
advocate oppose cultural values they evoke cynicism and prevent other people from that
culture from joining in such advocacies.
On the contrary, some traditional belief systems may also interfere with upholding
human rights. They do not encourage people to seek knowledge. Therefore, the system
creates a congenial environment for socio-political and religious power holders to trample
upon people’s right to sex education and healthcare. For instance, in times past, the
indigenous Akan attributed difficulty in childbirth to infidelity on the part of the woman
(Christensen 1954). This often led to maternal mortality because women were not referred to
competent healthcare providers who could have saved the situation. The Igbo considered
multiple births as reducing the human race to that of animalistic instincts, or human beings
taking the form of nso ani, and therefore an abomination which should be eradicated before it
polluted the rest of the society (Bastian 2001). Therefore, the society allowed such children
to perish.
The situations above raise a number of questions. For example, prayers are not always
answered. Therefore, why should difficult childbirth be attributed solely to offending one’s
husband, because he has prayed for safe delivery for her? If the people believe that the
Supreme Being’s role to conception is exerted in the concept of personhood, and he is
infallible, why should humankind even think of multiple births as reducing humankind to
animalistic instincts? Ironically, whereas the Igbo abhorred women associated with multiple
births, the Akan rewarded such women. They were also associated with powers to heal pains
and fractures and, therefore, played important roles in the healthcare delivery system.

Conclusion
Human rights have become a major component of the healthcare delivery system. Because
rights-based approach calls for the participation of the patient in the treatment process, and
the way patients perceive health is influenced by their culture, there is the need for
human rights to go beyond universalism. Communities have different practices and beliefs
about health and human rights. For instance, differences exist in the ways people perceive
diseases and good health including reproductive health. In indigenous African societies
like that of the Akan and Igbo, human rights go with the obligations to uphold other
people’s rights and ensure that all contribute their quota to provision of resources for
attaining the rights available. The African Charters on the various human rights documents
state this clearly.
Incorporating the beliefs and value systems of a group in the design, delivery and
evaluations of targeted interventions and programmes in the healthcare delivery system is
 African Identities 451

very important. Because the history and culture of peoples differ and effective participation
is likely to be influenced by the history and culture of a group, universalism cannot be
holistic. The universal documents should serve as guidelines for local phenomena since
countries have different situations and experiences. Therefore, knowledge of indigenous
human rights systems such as those for the Akan and Igbo is worth examining. These
can serve as a framework for analysing other indigenous groups for effective and efficient
provision of healthcare in which the beneficiary is involved in making the policies,
in the design, implementation, monitoring, and evaluation of health-related policies and
programmes.
Where the universal practice frowns upon something because it does not follow
universal principles and that is not detrimental to the health of indigenous people, the
indigenous culture can be upheld instead of treating it as primitive. On the other hand, where
the culture is detrimental to human rights, healthcare providers should be sensitive to the
culture as they impress upon the people to change their ways. To be able to do this
effectively, policy-makers and service providers must have a clear understanding of the
relationship between the traditional practices and beliefs of the communities and the
conventional methods of doing things.

Notes on contributor
Alex Wilson is a lecturer in African Social, Political, Health and Educational Systems in the
Department of African Studies, University of Cape Coast, Ghana. His article, Women’s Power in the
Socio-Political Organization of the Fante of Ghana: The Case of Asafo Companies was published in
UMOJA Vol 1 Issue 2 of 2007.

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