Haleema Yousef lives in an uncompleted building in Kubwa, a suburb of Abuja. She shares the single room with her husband and five children.
The shack also serves as a shop where she does henna designs for her customers and prepares the ‘moi-moi’ (a local delicacy) her children help her sell. Haleema does odd jobs such as house cleaning, hair weaving, among others to make a living.
While tending to her youngest son, Malik, who kept wailing for attention as she applied henna on the customer. The customer jokes that Malik would soon be having a young sibling.
Haleema replied she is not against the idea. When prodded, she said she does not use any modern Family Planning (FP) method.
According to her, although she has the knowledge of FP, she uses the local traditional methods for child spacing.
“My husband must not hear that I want to use family planning. He will be very angry and there is no how I will use it without him knowing. I don’t want trouble for myself,” she said.
Hasana’s story is slightly different as she has knowledge of family planning and has secretly adopted it without the knowledge of her husband.
At 19, she already has two children. According to her, she wants to have four or five children. She has also taken a bold decision about her reproductive health. She confided in the reporter that she has adopted an FP method without the knowledge or consent of her husband.
She said she was in JS2 in Borno before she got married and moved to Abuja due to the insurgency. She said she got to know about family planning from some of her friends who are also married and using the method, also without the consent of their spouses.
“I cannot tell my husband. He will not agree. He can beat me. It is if he knows, there will be (a) problem. I use injection, so he does not know or see me with drugs or touch my arm and ask what is there,” she said.
Family Planning is the practice of controlling the number of children one has and the intervals between their births. The adoption of modern contraceptives as a way to ensure family planning remains one of the most controversial health issues in Nigeria.
Several factors such as religion and cultural traditions have been used as excuses by many Nigerians who reject family planning. Gender inequalities based on social norms have also been identified as a bane of family planning in the country.
The norms have restricted women’s access to services and stripped them of the powers to access modern contraceptives and making healthy decisions regarding their reproductive health.
For Alisa Umar and her co-wife, Amina Umar, their husband is aware they use family planning although they started more recently.
Alisa, a middle-aged woman, has put to bed 11 times. Seven died before their fifth birthday.
Alisa fled the insurgency in her home in Borno State and now lives at the unofficial Internal Displaced Peoples (IDP) camp at Damangaza on the outskirts of the Federal Capital Territory (FCT).
Alisa said she never heard of modern contraceptives until she followed her co-wife to the hospital in Abuja when the latter had hard labour which led to a stillbirth.
The incident with Amina was after Alisa’s tenth child. Alisa has since been using a modern form of family planning.
She said that helped her space her tenth and eleventh child. She, however, said she is done with childbearing and would not mind having a permanent family planning.
Her narrative in Hausa was translated by her husband, Muhammed.
Before her adoption of modern contraceptives, Alisa and her co-wife have been using the traditional herbs and “relying on nature to plan their pregnancies.”
Most at times, she said, this fails.
“I cannot tell my husband I do not want to have sex, it is unacceptable for a woman to turn down her husband anytime he requests.
“I no wan born reach like that plenty, not ok. But husband comes, go, belle will come, it is “Allah”. Nothing to do,” Alisa giggled, in pidgin.
Alisa said fate had a role to play in the number of children she has because she and her husband never discussed how many children they intended having.
“We have local herbs we used if we don’t want to get pregnant, but sometimes it’s not effective,” she said.
She described the type of family planning method she now uses.
“They put something in my private part but blood was too much so I went back to complain and they put something in the arm (implant) for six months and it is ok.
“I removed it when I wanted to have my last child and I took in almost immediately. After my son, I have been collecting injection and it is free,” she said.
Her co-wife, Amina Umar, had nine children; eight are alive. She got to know about family planning when she lost her last child during delivery.
According to her, a traditional birth attendant and Alisa were the ones who were helping her take deliveries until it became difficult and “she was losing a lot of blood.”.
Amina was rushed to the Gwarinpa General Hospital where she lost the baby. She said it was while she was at the hospital, the doctor introduced family planning to her.
Amina said she first used the intrauterine device like her co-wife but they had to go and remove it when they were having a heavy flow, itching and feeling pains.
She said she could not use the arm implant like her co-wife because the doctor told her she has a blood shortage. She said she opted for injections and has been going for it every three months.
Benefits of Family Planning
FP can prevent closely spaced and ill-timed pregnancies and birth which contributes to some of the world’s highest maternal and infant mortality rates. Nigeria is one of the countries with the highest maternal and child mortality rates globally.
Amina, however, said she might not be going for her next shot because she intends getting pregnant again.
Speaking with PREMIUM TIMES, Amina and Alisa’s husband, Muhammed Umar, who lost a leg to gunshot wounds while running away from the Boko Haram attackers, said he is more comfortable with the fact that his wives are using FP.
He said that has reduced the incidence of getting unwanted pregnancies.
Being the head of the IDP settlement, he said he has also taken it upon himself to advice men to allow their wives to use family planning.
He said most men are, however, yet to embrace the idea based on religious and cultural reasons.
The World Health Organisation in its 2017 fact sheet on the use of contraceptives said there has been an increased usage in many parts of the world, especially in Asia and Latin America. But usage continues to be low in Sub-Saharan Africa.
In Nigeria, the use is still despite the government’s effort to provide family planning services.
According to the 2016/17 Multiple Indicator Cluster Survey (MICS) Report on FP in Nigeria, only 13 per cent of women aged 15 to 49, currently married or in a union, use any family planning method.
The statistics reveal that much still needs to be done, especially in the northern part of the country to make Nigerian women embrace modern contraceptives.
Mohammed Ndalima, a health worker and family planning provider in Dobi Primary Health Care Centre, Gwagwalada, said he will rate adoption of FP services in the community as fair.
Mr Ndalima said there is still a lot of work to do in order to get the people to adopt FP.
“The chief head needs to convince them to go for FP. Most of the women have more than five children and she is taking care of them all by herself. They also need the consent of their husbands to do FP. If they do the FP without the consent of the husband, it’s a problem for them at home,” he said.
Mr Ndalima said the PHC provides free family planning method for the women once every month.
He said the lack of consent from spouses is a major constraining factor affecting the success of the family planning campaign in the community.
He said even if the women accept FP, “the husbands are the main issues.”
“When they come for FP, I either tell them to come with their husbands or give me his number to call him. I call the husband and try to convince him to see the benefit of FP.”
He, however, said, “The new principle on FP is that if a woman wants to do it without anyone’s knowledge, they come over and we do it for them.”
Despite the ‘new principle’, however, the official said he and his colleagues still demand the consent of husbands.
“The FP NGO insists we do it without the husbands’ approval and if there is any trouble, they will stand for us. But because of community issues, we still involve the husbands most of the times,” he said.
Mr Ndalima said the most preferred FP plan is the implant. He said few women accept the injectibles.
“The NGOs that supply us prefer the IUD because it does not have, any hormonal issues. When they use it, the women come back within a week to remove it because their husbands are complaining that it affects their sexual pleasure. Another issue with IUD is that the user needs to be very clean otherwise infection will set in. When infection sets in, it’s an issue because she will be having much bleeding and pains,” he said.
Also at Kubwa General Hospital, the family planning officer who asked not to be named, said more women are embracing FP even without the consent of their spouses.
She said most women who want to space their children prefer the injectables and implant. She said it is less stressful and for those who did not take consent from their spouses, it is more discrete.
She said they have stopped asking women to bring their husbands for consent.
“If a woman walks in for FP, we counsel her on the best method based on her childbearing history, blood pressure, and health status. We chose a suitable method either long term plan or short term for her.
“We do not ask them for their husband’s consent any longer because they have a choice to choose what they want to do. Most of the men will say no, but the health and economic burden of the family is mostly on the women. In most cases the women are the ones who feed the house so they should be able to give birth to the number of children she knows she can cater for,” she said.
Family Planning For Population Control
Apart from health experts, many Nigerian lawmakers have also called on the government to actively encourage family planning to check the country’s burgeoning population.
Nigeria’s population is currently estimated at over 200 million with the country expected to overtake the U.S. population by 2050.
One of the lawmakers who has strongly advocated for family planning is Lanre Tejuoso.
“If we continue to allow the families to grow, it means we are heading to doom,” Mr Tejuoso said at a family planning conference in December.
“The most important thing is the “green dot’’ and every woman should be encouraged to walk into any outlet with the green dot to access FP services,” he said.
Another senator, Ben Murray-Bruce, asked the government to make family planning a policy to control the country’s population.
“What’s our population control policy? Does anybody care how many children we have? Does anybody care how many we ought to have?”
Mr Burray-Bruce linked the lack of population control policy to the high rate of poverty in the country.
“Muslims and Christians will criticise me for my position but unless the government have a population control policy; one, we cannot solve the problem,” he said.