Efforts to slow down population growth and reduce maternal and child mortality rate in Nigeria through family planning are not yielding the desired result, studies have shown.
Nigeria is the most populous country in Africa and the seventh globally. The National Population Commission estimates the country’s population at 198 million. The United Nations’ publication, World Population Prospects, predicts Nigeria is on course to become the third most populous country in the world by 2050.
To curtail the unsustainable population growth, especially through procreation, the federal government at the 2012 London Summit on Family Planning made a commitment to scale up promotion of family planning to Nigerians.
This was to be done by making contraceptive consumables available to those who need them and when they need them. As part of the efforts, the government launched “Green Dot” to help people identify family planning facilities in the country. Though there is still a huge gap of unmet needs for those willing to use them, many sexually active women are simply reluctant to embrace contraceptives.
Contraceptives are methods, devices or drugs used to reduce or prevent unwanted pregnancy and unsafe abortion.
Contraception comes in three broad forms: the long-acting reversible contraception, the short-acting reversible contraception and permanent methods.
The long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs) and subdermal contraceptive implants. On the other hand, the short-acting contraceptives (SARC) have to be used in short time intervals such as in case of condoms, and daily intake of pills.
In spite of advocacy by government and development partners on the benefits of family planning, acceptance of modern contraceptives has remained very low in Nigeria.
The benefits of family planning are obvious: it allows women to space child birth and replenish vital nutrients lost during the process. It also allows the organs of mothers to return to normal.
In spite of these obvious merits, 87 per cent of women in Nigeria or their partners do not use modern or traditional contraceptives.
Statistics from the 2016/17 Multiple Indicator Cluster Survey (MICS) indicate that only 11 percent of women of ages 15 to 49, currently married or in union, use the method in the country.
The statistics reveals that much needs to be done, especially in the northern part of the country to make Nigerian women embrace modern contraceptives.
Nigeria high in maternal, child deaths
Nigeria also has one of the highest burdens of maternal and child mortality globally.
While there has been 43 per cent drop in the rate of global mortality since 1990, Nigeria has the highest in Sub-Saharan Africa of maternal deaths.
According to World Bank estimates, Nigeria’s Maternal Mortality Rate (MMR) is 821 per 100,000 live births. Bill Gates, the Co-Chair of Bill and Melinda Gates Foundation, on a visit to the country said Nigeria is one of the most dangerous places to give birth, with the fourth worst maternal mortality rate in the world ahead of Sierra Leone, Central African Republic and Chad.
For a more vivid picture, 58,000 of the 303,000 women who died globally due to complications in pregnancy and child births in 2015 were in Nigeria.
The Nigerian Demographic and Health Survey 2013, showed that about 23 per cent of girls between the ages of 15 and 19 years are either pregnant with their first child or are already mothers, while half of the women between 25 and 49 years married between 18 and 20 years.
Researches placed the fertility rate in Nigeria at 5.7 children per woman, while sexual and reproductive behaviour of Nigerians show that majority of men and women practice sex before marriage.
This picture necessitates the advocacy of birth control pills or contraceptive technique to reduce unintended pregnancies, and encourage child birth spacing.
According to medical researches, it is ideal for a woman to wait for at least 18 months after the last birth before another conception.
However, due to lack of effective child spacing mechanism, most women conceive weeks or month after last birth.
Injectable, most preferred contraceptive
Among those who use contraceptives in Nigeria, the most acceptable form is the injectable method, with about four per cent acceptance from women. This is followed by use of pills embraced by two percent and the use of implants which is embraced by one percent.
The three modern methods least accepted are female sterilisation, female condoms, and diaphragm/Foa/m/jelly which had 0.2, 01 and 0.1 percent acceptance respectively.
The use of male condoms is also very low, with one per cent acceptance. However, it cannot be determined if the condoms are used for FP or disease protection.
Another contraceptive method known as male sterilisation had zero acceptance in Nigeria. This picture implies that most men do not concern themselves with family planning programmes, which they have left to the women.
Experts and health workers explain the reasons why it is difficult getting Nigerians to embrace contraceptives.
Martha Zdikko, a community extension worker in charge of a primary health care centre in Dakwa in the Federal Capital Territory, said though there is a gradual acceptance of family planning methods by women in the community, the decision to participate is mainly left to the men.
“We most times want them (women) to come to the facility with their husbands before we put them on any family planning method. This is because in this area, the women cannot solely make that decision. It often leads to problem when they adopt a family planning option without the knowledge of their spouses,” Mrs Zdikko said.
Based on geopolitical zones, women from the North-east and North-west (92 per cent) constituted the highest percentage of those who do not use any form of contraceptives.
The rate of none use of contraceptives among women is also lower in urban areas than in rural areas, with 78.9 to 90 percent respectively.
Survey also showed that most of the women who do not use any form of contraceptives were those within the high fertility age band (15-29).
Among the three major ethnic groups, the Hausa are the least group who uses any form of contraceptive. 92 per cent of sexually active Hausa women were not using any contraceptive followed by Igbo which was 77 per cent and Yoruba 72 per cent respectively. Non usage averages 84 per cent among the other ethnic groups.
The three states in Nigeria with the highest prevalence of non-usage of contraceptive were Jigawa, Ebonyi and Yobe with 98, 97 and 96 per cent respectively.
According to the report, the acceptance of modern contraceptive methods was higher among people with higher and secondary school education.
Misconception about FP detriment to services
Family planning experts blame the low acceptance of contraceptives in Nigeria on misconception and lack of knowledge of the various options available.
Dimosthenis Sakellarids, Country Director DKT, said one of the major challenges many women have is the misconception about FP. He said misinformation prevents them from seeking FP when they need it.
“Many women are scared of hormonal imbalances, but as a general rule, FP does not cause hormonal imbalance. Instead, some form of FP helps to regularise woman’s menstrual period. Though few women complain of irregular periods after using any contraceptive method and this stops almost immediately. There is something for every woman.
“There are non-hormonal methods of contraceptives like the IUD (Intra Uterine Device) commonly known as the ‘coil’ which offers contraception for up to 10 years with minimal or none hormonal side effects.
Mr Sakellarids however lamented that the attitude of health workers has been another challenge. Some healthcare providers are biased and also have limited perception about FP. This bias prevents them from either offering FP services or makes them give wrong information to women seeking the services.
“Health providers are generally biased about providing family planning to women especially if they are unmarried. It should be pointed out that in most cases the bias stems out of religious inclination or cultural beliefs. This limiting perception about FP endangers women’s lives as these drives them to terminate unwanted pregnancies through dangerous unsafe procedures,” he said.
Speaking in similar vein, Lagos State Team Leader of the Nigerian Urban Reproductive Health Initiative (NURHI) II, Edun Omasanjuwa, said government needs to step up advocacy and educating Nigerians on the merit of using FP method.
He said though many NGOs advocate FP, Nigerians are not embracing the use largely due to cultural beliefs, misconception about its effect on their health and physique and based on religious beliefs.
“To ensure a larger acceptance, there is a need for government and CSOs to involve traditional, religious and society influencers in the campaign,” he said.