Why Nigerian women shy away from family planning
Despite the Federal government of Nigeria’s commitment in 2012 to enhancing access of voluntary family planning services to an over 120 million women and girls in Nigeria, four years down the line, achieving the goal of a contraceptive prevalence rate (CPR) of 36 percent by 2018 looks bleak as low demand of family planning services and commodities remain significant barriers to increasing CPR. LARA ADEJORO reports
Aside misconception and the information gaps required to increase the number of Nigerian women and girls using family planning methods, the cost of consumables, distance of health facility are some of the reasons women shy away from family planning, some Nigerian women who spoke with Daily Times reveal.
Recall that in July 2012, the Federal Government announced a total financial commitment of US$33.4 million (N5.2104 billion) towards ensuring availability of reproductive health services and family planning commodities, over the next four years.
The then Minister of State for Health, Dr Muhammad Ali Pate made the announcement at the London Summit on Family Planning co-hosted by the UK Government’s Department for International Development and the Bill & Melinda Gates Foundation.
Dr Pate said Nigeria was fully committed to meeting unmet needs for reproductive health services and commodities, including family planning while speaking at the global event on behalf of President Goodluck Jonathan.
His words: “In addition to our current annual commitment of US$3 million for the procurement of reproductive health commodities, we are now committing to provide an additional US$8,350,000 annually over the next four years, making a total of US$33,400,000 over the next four years. This is an increase of 300 percent.”
However, findings show that there are still unmet needs for reproductive health services, including family planning as the country’s CPR is as low as 15.1 per cent and this means that less percentage of women use any contraceptive methods while the use of the modern method is 10 per cent, which is said to be low compared to Ethiopia, the second largest African country with 40 per cent.
A woman waiting to be attended to at Family Planning Clinic at Sango-Agege PHC
If any client visits the newly renovated Family Planning Clinic by the Nigerian Urban Reproductive Health Initiative (NURHI) at the Primary Healthcare Centre located at Sango-Agege, one would feel at home.
Reasons: The health officials are friendly, the environment is welcoming and almost everything looks new.
But, a client who struggles to make ends meet for the family would immediately frown when she hears the Counselling Nurse tell her that, the method of family planning one chooses will determine the amount one will spend.
Narrating her experience to a counseling nurse at the family planning unit when Daily Times Correspondent visited, Mrs Blessing Uyobong, 34, said, she came for the implant method since the injectable methods hadn’t been suitable for her body system.
Our Correspondent was paired with Mrs Uyobong for counseling when she went for family planning enquiries and counselling.
“I already have four kids and I had done family planning before. I had used the injectable ones at a private clinic before (the one for 2 and 3 months consecutively) but the last time I tried it, I bled throughout a whole month and when I told the nurse, she recommended that I go for the coil (Intrauterine device (IUD) but she said it’s N6000.
“Apart from the cost, I’m scared of the method because I’ve heard some people say it could be ineffective.”
Even though, the nurse tried to douse her fears, she further confided in Daily Times that, her neighbour said, it’s not effective.
“When my neighbor used the coil, she eventually became pregnant and during delivery, the baby came out with the coil but my sister-in-law uses the implant and became fat. Though, she told me it depends on my body system, so I’m going for the implant and see how it works for me.”
When Daily Times made further enquiries, the Counselling Nurse said, when coming for any of the family planning method, one would come along with N200 for pregnancy test.
“When coming, you’ll come along with N200 for pregnancy test, the test can be done here or in any other centre because we can’t place you on any method without being sure that you’re not pregnant at the moment.
“For implant or IUD, you’ll also need at least N500 because you’ll need spirit, cotton wool, surgical gloves and you’ll have to go buy them because it’s not sold here and you’ll pay N50 for registration card but the procedure is free.”
Speaking with Daily Times during the NURHI training for the Ward Health Committee recently, the WHC Chairperson for Sango-Agege ward, Mrs. Fausat King said, apart from ignorance, people believe in visiting herbalists for the safety of their children.
On the issue of consumables, she said, “the money they collect from them is reasonable and it’s just for the card and it depends on what they will use. If what they will use is not available here, they can write it for you to go and buy it, they are not selling it here.
“Though people complain that when they come for family planning, they tell them to buy consumables and that is why some women don’t come for family planning but we have to keep convincing them.
“We can’t keep depending on government alone to provide everything but once our people hear that anything is free, they assume everything from A to Z is free but they must realize that everything cannot be free, so we have to keep convincing them about the essence of family planning.”
This is however contrary to the statement of the Commissioner for Health, Dr Jide Idris that said earlier in the year that there must not be any user fee for consumables.
Other women speak on family planning
Other women also aired their minds on why most Nigerian women shy away from family planning.
Mrs Blessing Ubah-Ekeghalu said, “Some say it’s against their belief and for some women, their husbands do not give them the consent to do family planning.”
The Social Media Personnel at Ben Bruce Foundation, Ademidun Oladipo Abimbola said, “most people are afraid of the long term effect and some say it’s against their belief.”
Mrs Opeoluwani Akintayo Ogunjimi said, “women shy away from family planning for fear of the process being irreversible, which may lead to barrenness or lateness in getting pregnant.”
Toyin Olusa who lives in Akure, Indo State said, “honestly, it’s not expensive but the aftermath effects scare people, especially the increase in weight and prolonged menstruation.”
Mrs Titilayo Adetunji who is a teacher Dutse Model International School, Jigawa State who spoke on her experience said, “the side effects are too many. There is also constant headache.”
A journalist, Mrs Desola Afolabi said, “No time to go for family planning. Plus, is the information/education really out there? Matrons and nurses take time to lecture expectant mothers before birth. But after birth, nobody wants to know anything again. In other words, life continues.”
Bukola Ajayi for Bukola Ajayi, a caterer and a mother of one, “most women shy away from family planning because of ignorance.”
According to the Lagos State Family Planning Co-ordinator, Mrs Juliana Okanlawon said, some of the challenges in the state are “insufficient staff in all the health facilities to render family planning services. The materials used to carry out the services such as cotton-wool, iodine, plaster are not available even though the services are rendered for free. Before now, people pay for the consumables but earlier this year, the commissioner for Health, Dr Jide Idris has mandated that nobody should collect money for consumables.”
Okanlawon said, by 2018, Nigeria is expected to reach 36 per cent blueprint of family planning. “To reach that goal, Lagos state is put at 74 per cent because of the population and if we are able to reach that goal, maternal mortality will reduce.”
According to her, the rate of maternal mortality in Nigeria is alarming “and family planning is about having our children by choice, not by chance and that’s why you can’t talk about maternal mortality without talking about pregnancy or child birth related problems. Once the family is planned, the issue of abortion or complications will not arise.”
Despite the widely acclaimed benefits of family planning, only 1 in 5 married women in Lagos are using any modern method of family planning, and 1 in 4 do not have access to the family planning supplies and services they need, according to Pathfinder International Nigeria.
Among women in Lagos who use family planning, majority rely on short-term methods, such as the pills, injectables and condoms. These methods are less effective at preventing unintended pregnancy than the long-acting reversible contraceptives (LARCs), such as the IUD and implant, which are very effective for many years. This reliance on shorter-term and less-effective methods leaves women at risk of unintended pregnancy.
Family planning and reproductive health services save lives by allowing women to decide the timing and spacing of their children; this lowers maternal mortality, increases the chances of children’s survival, saves government funds.
The Lagos State Team Lead of NURHI said, if the state Lagos State is able to achieve its family planning blueprint by 2018, “we’ll be saving 8000 women from dying and 1003 children.”
Prof Ojedengbe
Speaking on the assessment of family planning in Nigeria, the Director Centre for Reproductive Health Programme, University College Hospital (UCH), Ibadan, Professor Oladosu Ojengbede said, there are some people who want to do family planning, but there is no access to it either because the facility is not close by or financially, they can access it and it could be the both.
“Some of the providers are not responsible enough because government is not paying salaries regularly, there are slack actions by healthcare providers and the people have lost confidence in healthcare service delivery in this country.”
He further said, “the FG made a commitment after the London summit to provide commodities but even the system at the service delivery point is hindered significantly. The service providers are not committed to it the way it should be, there are a lot of under-the-table charges, people are claiming that government provide commodities but do not provide consumables such as gloves and they have to charge the patient.”
The Don said, the government needs to respond to the need of the people either by providing more money “but as it is now, there is a challenge in the economy, then they should redistribute the money committed to buying some commodities to buying the consumables required that will enable provision of free services to clients.”
On the benefits of family planning, Ojendegbe said, “a woman who has delivered ought to space for at least two years to be able to recover from the stress, so the health comes back to normal before she gets pregnant again, this is one of the major benefits of family planning. Family Planning is not just to prevent women from getting pregnant but it is also to restore health back to the women.
“The household is healthier and the wealth is better managed and distributed when the couple space pregnancy. With less children, one is able to care for their children and school drop-out is lower. Family planning prevents under-five mortality, neonatal mortality and maternal mortality.”
Statistics
With reference to the United Nations Children’s Emergency Fund (UNICEF), Nigeria loses about 2,300 under-five year olds every day and 145 women of childbearing age. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world.
Recent research shows that essential interventions reaching women and babies on time would have averted most of these deaths.
The deaths of newborn babies in Nigeria represent a quarter of the total number of deaths of children under-five. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery reflecting the intimate link between newborn survival and the quality of maternal care.
Similarly, a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. Although many of these deaths are preventable, the coverage and quality of health care services in Nigeria continue to fail women and children. Presently, less than 20 per cent of health facilities offer emergency obstetric care and only 35 per cent of deliveries are attended by skilled birth attendants.
This shows the close relationship between the well-being of the mother and the child, and justifies the need to integrate maternal, newborn and child health interventions.
It is important to note that wide regional disparities exist in child health indicators with the North-East and North-West geopolitical zones of the country having the worst child survival figures, UNICEF says.
