It was 1:05 p.m. on a hot Sunday in Benisheik, a small community in the Kaga Local Government Area of Borno State. As a wind swept across the dusty road that divides the town, two women stood in conversation under a tree. “I will not go back to any hospital again,” said one of them, Yagana Isma’il*, 25, her anger unmistakable as she spoke.
Benisheik is a community steeped in tradition, and Mrs Isma’il’s story reflects a common theme in the community. A mother of five children within seven years, she described her silent battles with reproductive health.
|
|
After her fifth child, Mrs Isma’il and her husband decided to seek family planning. But four visits to the local facility ended in disappointment: the methods she needed were unavailable.
|
|
|
|---|
“I went to the facility four times after giving birth to my fifth daughter, but I couldn’t get the family planning method,” she said.
Ibrahim Babagana, 29, also shared his experience. “My wife wanted pills after our second child. She went four or five times, and each time they said it was not available. I am not happy about that. We want all methods to be accessible.”
Global Problem, Local Struggle
The struggles of women in Kaga reflect a much larger crisis. A 2022 report by the UN Population Fund (UNFPA) estimates that nearly 121 million pregnancies worldwide each year are unintended.
The UNFPA Executive Director, Natalia Kanem, said the staggering number of unintended pregnancies represents a global failure to uphold women and girls’ basic human rights.
Nigeria mirrors this reality. According to the 2018 Nigeria Demographic and Health Survey 2018, only about 17 per cent of married women in the country use any family planning method.
The survey also puts the unmet need for family planning among married women at 19 per cent.
In states like Borno, where insecurity and poverty prevail and access to family planning is severely limited, the figures are more alarming. In 2023, the Borno State Commissioner for Health, Baba Gana, said only 6.7 per cent of married women in the state were using modern contraceptive methods.
Also, the Deputy Director of the State Primary Health Care Development Agency, Mala Abdulwahab, said only 269 out of the 436 health facilities in the state offer family planning services.
Despite existing policies such as the Nigerian National Health Act 2014, which affirms the right to healthcare services, including reproductive health, and shows commitment to issues around sexual and reproductive health rights, women still suffer from a lack of access, especially in rural communities.
National budget cuts deepen the crisis
But just as demand for family planning grows, support for it is shrinking. In the 2025 budget, the Nigerian government slashed allocations for family planning by 97 per cent from the N2.2 billion allocated in 2024 to N66.39 million.
The budget cut comes as the United States Agency for International Development (USAID) froze funding support for key health initiatives in developing countries, including family planning programmes in Nigeria.
For a country with one of the highest maternal death rates in the world, with many of the deaths preventable with timely access to contraception and quality care, experts say this drop in funding could reverse the progress made over the years.
The United Nations recently warned that global reductions in health aid could reverse decades of progress in tackling maternal mortality.
Data from the WHO estimates Nigeria’s maternal mortality ratio (MMR) at 1,047 deaths per 100,000 live births, making it the country with the third-highest maternal mortality rate globally.
The turn to herbs and the risks
Out of desperation, many women in Kaga now resort to traditional herbs for family planning and even abortion.
Mrs Isma’il recounted using some herbs that failed her. “I bought Gurun tazara (a herb wrapped in animal skin) from a herbalist for ₦2,500. A lot of women used to tie it on their waist for child distancing, but unfortunately, it didn’t work for me; I got pregnant 38 days after giving birth.”
After confirming her pregnancy at the hospital, she went back to the herbalist, who offered a bitter herb for aborting the pregnancy.
Mrs Isma’il consulted her husband, and he agreed. “We paid him ₦4,000 for that abortion,” she recalled.
The bitter herb worked, but Mrs Isma’il bled for two days until her husband took her to the Benisheik PHC, where she was eventually referred to a general hospital.
“I stayed at General Hospital Damaturu for 13 days; I nearly died,” she said.
For Aisha Modu, 27, visits to her local clinic often ended in frustration. “They kept telling me to come back when the medicines were available,” she said.
A mother of six who had already gone through two unintended abortions, Mrs Modu was desperate to avoid another pregnancy. Short of options, she too turned to gurun tazara.
“I bought it for ₦1,500. When I tied it around my waist, I started bleeding nonstop. My period usually lasts five days, but this one went on for 14,” she recalled. The heavy bleeding continued for two months, until a neighbour, who had suffered a similar experience, advised her to seek medical help at the hospital.
Months later, still determined to prevent pregnancy, Mrs Modu tried another herb sold by a local vendor. “The seller told me that if I drank it three times, I would not conceive again for three years. But that was a lie. I got pregnant six months after taking it,” she lamented.
In Kaga LGA, Mrs Isma’il and Mrs Modu are among the many women who don’t have access to essential family planning commodities.
“A friend in Maiduguri introduced me to a medicine that looked like beans. Each one was ₦1,000. I bought two, but they didn’t work. In the end, I had to buy pills from a medicine store for ₦1,700,” she said.
Lack of access to quality information
A report by the WHO reveals that a lack of access to comprehensive, good-quality information about sexual health increases the vulnerability of women toward diseases and other consequences, such as cancer, infertility, unsafe abortion, and maternal and infant mortality.
Abdullahi Usman, a senior registrar and obstetrician at the University of Maiduguri Teaching Hospital, explained that the use of traditional herbs for abortion and contraception is a long-standing practice in rural communities.
Mr Usman said cultural beliefs often drive such practices, though limited access to healthcare facilities and available services also contribute.
He warned that the side effects of these herbs are severe. “Some commonly reported complications include gastrointestinal disturbances, liver and kidney damage, and neurological issues.
“In cases of abortion, it often results in incomplete abortion, where parts of the fetal tissue or placenta remain in the uterus, leading to persistent bleeding,” he explained.
He added that because these methods lack standardised dosages and quality control, women face heightened risks of health complications while remaining vulnerable to unintended pregnancies.
Healthcare providers lament situation
A Community Health Extension Worker (CHEW) who has served in the Benisheik Primary Health Centre’s maternity unit for over 25 years described her frustrations.
The health worker, who declined to be named, said women are discouraged when they cannot access the specific family planning services they prefer—especially short-acting methods.
“As a trusted health worker, it is embarrassing when I go around the community giving health talks, only for women to finally agree to try family planning and then discover we don’t have the commodities. It damages our credibility,” she explained.
She also highlighted the absence of essential medicines for post-abortion care at the facility until an intervention by the IPAS Nigeria Health Foundation in December 2024.
“Drugs such as misoprostol, which is critical for managing incomplete abortions and postpartum bleeding, and ulipristal, an emergency contraceptive used in rape cases, were never available here throughout my career until IPAS supplied them.
“Unfortunately, the stock has already run out,” she lamented in an interview in June.
At the Ngamdu Primary Health Centre, Facility Manager Yagana Babagana, who has worked there in various roles since 2001, described the crisis as worsening since early 2025.
Mrs Babagana said there are never enough commodities, and demand is increasing daily as people become more informed.
According to her, most women resist referrals to bigger hospitals: “Whenever we refer them, they refuse to go, some because they cannot afford the cost, others because they fear people will find out they are using family planning.”
These gaps contradict international and national commitments. Section 3 of the Beijing Declaration and Platform for Action (1995) emphasises women’s right to sexual and reproductive health, including the freedom to make informed decisions without coercion, discrimination, or violence.
Similarly, Nigeria’s National Policy on Sexual and Reproductive Health (2018) defines comprehensive care as ensuring access to information, services, and treatment—with a strong focus on women and girls.
Persisting negative perceptions
In Kaga, the barriers to family planning go beyond the shortage of essential services. Deeply ingrained cultural beliefs and misinformation continue to discourage women from seeking reproductive healthcare.
Marka Mohammed, 32, a mother of eight, admitted she wants to try family planning but is held back by fear.
“I want to try the family planning methods, but I am afraid, especially of the implant and injectables, because I have heard that they may even go missing in one’s body, and I am scared not to have a child again,” she said.
“The idea of using any method is something I will not even consider. This thing can stop a woman from having a child completely. My wife will never try it,” he said.
More money for health
For years, Borno State’s budgets have reflected a commitment to strengthening access to essential healthcare through primary health centres (PHCs).
In December 2023, Governor Babagana Zulum presented a ₦340 billion budget for 2024. The health sector received the single largest allocation of ₦52 billion, followed by education and works. The budget was passed by the state legislature, and the governor signed it into law in January 2024. The 2024 allocation was more than double the N20 billion health allocation for 2023.
Yet, despite these allocations, challenges persist regarding essential drugs and family planning commodities. A PREMIUM TIMES investigation in 2024 noted visible infrastructural upgrades across PHCs in Borno, but revealed that poor staffing and drug shortages were hampering service delivery, particularly in rural communities.
READ ALSO: Expert calls for African health sovereignty as global aid declines
Efforts made in Borno
Mohammed Dauda, the chair of the SRH Working Group at the Borno State Ministry of Health and Coordinator of Emergency Medical and Ambulatory Services, said that the state adopted a revised Sexual and Reproductive Health (SRH) policy in early 2025, developed with the ministry and UNFPA.
According to him, Borno currently has family planning and SRH commodities in stock, overseen by two regulatory bodies: Borno State Contributory
Healthcare Management Agency (BOSCHMA) and State Primary Healthcare Development Board (SPHCDB).
“These agencies are responsible for managing and distributing drugs at primary facilities, while BOSCHMA is partially involved with secondary facilities. Commodities are supplied based on requests from facilities,” he said.
Mr Dauda admitted, however, that access gaps remain. “There is sometimes a lack of accountability at the facility level, not always, but occasionally, commodities are diverted or sold.
“Another challenge is poor management; some facilities fail to request new supplies before stocks are exhausted,” he explained.
He recommended stronger accountability frameworks and continuous training for facility managers to close these gaps.
On her part, Jalo Ahmed, the state’s Adolescent, Sexual and Reproductive Health Focal Person and Coordinator of the Community Health Influencers Promoters and Services (CHIPS) programme, reiterated the government’s commitment.
“If there is anything like women not having access to family planning services, then maybe it is a matter of awareness. These commodities are free, but many people don’t know; others still hold negative beliefs about them.
However, despite evidence to the contrary, Ms Ahmed said the availability of family planning drugs is not a problem in Borno State.
“As far as availability is concerned, we have all the drugs,” she said.
+++Names with asterisks are changed to protect sources.
This reporting was completed with the support of the Centre for Journalism Innovation and Development (CJID)
