Family Planning: Adolescents Tell Stories Of Stigma Inside Lagos Youth-Friendly Centres

BY CHIOMA UMEHA

Lagos – When women and girls have access to contraception, fewer babies and mothers die. Around the world, millions of women can’t get the contraception they want.

Numerous studies show that the ability to plan pregnancy is directly and unequivocally linked to lower maternal mortality, lower infant and under-five mortality, lower mother-to-child transmission of HIV, and a whole host of improved health indicators.

Here is just one example: when a woman spaces her births by at least three years, her newborn baby is twice as likely to reach its first birthday.

However, negative reports on sexual reproductive health (SRH) outcomes in the country show that there is a need to improve access to family planning information and services for Nigerian adolescents.

The 2014 World Health Organisation’s (WHO) report and 2013 Nigeria by our Reporter Demographic and Health Survey (NDHS) presented the worrisome statistics of Nigerian young women whose lives are cut short due to reproductive health complications.

At 576 maternal deaths per 1,000 live births, the country accounts for 14 per cent of the global burden of maternal mortality.

Statistics put the average age of first sexual experience at roughly 15 years among Nigerian adolescent mothers (NDHS 2003, 2008, 2013).

Similarly, the National adolescent fertility rate in Nigeria is 122 births per 1,000 women aged 15 to 19.

Imagine what life would be like if you were not able to make your own decisions. Take a minute and step into the shoes of a young woman who does not share the same power to make choices about family planning.

To curb maternal deaths, the Lagos State government with support from donor agencies has set up youth-friendly health care centres with care providers to offer an appropriate response to youths’ sexual reproductive health needs.

Barriers to sexual reproductive health services

But, despite the friendly-centres, gaps that limit youths’ access to SRH in the country still persist, including, poor awareness, lack of confidentiality in service delivery among others.

Our Reporter’s investigations show that many Lagos youths who are sexually active remain confronted with several barriers in obtaining necessary information about the different method of contraception, available at the youth-friendly centres.

The barriers include; provider bias, the attitude of the family planning officer, religious sentiments among others.

The issue of improving youths' access to family planning was a major agenda of a three-day capacity building workshop on investigative journalism organised recently, for Media Advocacy Working Group (MAWG) by Pathfinder In family planning International Nigeria, in Lagos.

Youths decry care providers’ attitude

At some of the Lagos-based youth-friendly centres, some adolescents who interacted with our Reporter expressed dismay over the attitude of some family planning providers.

The story of unfriendliness and poor counseling about family planning from counselors was the same from Ikotun to Alimosho, even Agege youth-friendly centres, Mary Ibrahim, aged 25 and a graduate of Economics who spoke to Our Reporter confirmed the situation. She said that the first question from a service provider at the youth-friendly centre was targeted on her age bracket.

Decrying the situation, she said; “Immediately I declared that I have three boyfriends at 25, the body language of the service provider changed. This may not be unconnected with religious sentiments, judging from her countenance. I say this because; I noticed the way she was looking at me.

“So I was neither given an opportunity of seeing a condom nor counseled properly on other options of contraception, so, I left the centre.”

Miss Ibrahim regretted that the reception from family planning providers were not warm as anticipated. “I wondered if it should have been better to have an unplanned pregnancy than to receive such cold and disdainful treatment from family planning units of a Public Healthcare Centre (PHC), despite being sexually active,” she said.

Another female youth, Yomi Martins 22, who admitted being sexually active also, decried the attitude of the health service provider she met at the Hello Lagos Life planning centre. Martins said; “The service provider was obviously furious on noticing that I was a Catholic. I guess that was why she denied me the required attention and information on family planning. She neither showed courtesy of offering me a seat nor made any attempt to make me feel relaxed before grilling me.”

Martins further lamented; “In the course of our tensed-discussion, I learned that both female and male condoms were available at the facility. Rather than giving me the female condom which I had demanded, a male condom was offered to me.”

“I decided to go with the male condom, a roll-of-four,” the visibly distraught Martins told Our Reporter, with an air of dejection.

“As if that was not enough, I became a subject of gossip in the facility. Immediately, I turned my back, I noticed one of the counselors pointing and jeering at me, while the other two wore a sneering outlook.”

For 20-years-old Adeola Esther, who is a filmmaker, she visited a PHC centre near her community, at Agege, Lagos. Following the poor responses to her questions as a teenager seeking family planning services, she had to switch role from making a personal inquiry to doing an errand for her mother. Her words; “When I noticed the facial expressions of the family planning counselors, I pretended that I was on an errand for my mother to make inquiries about family planning.”

Also, she was neither counseled nor shown any option of family planning, but was told that for her to access any available service, she must be ovulating.

Training of family planning providers

Training and retraining for family planning providers reacting, family planning experts, disagree that a woman does not need to be in ovulation to do any method, though some women still ovulate while pregnant.

Commenting, Adekoya Abiola, a retired nurse said that these service providers in these cases were bad examples and opposite of what they should be, especially in the area of counselling these youths by sharing available options of contraception with them and possibly allows these youths make an informed decision.

Mrs. Adekoya insisted that those service providers need to be trained in the right contemporary ways to help the teeming youths who need proper counseling to make the right choices about family planning.

She said youths like Mary Ibrahim, Yomi Martins, Adeola Esther may not possibly return to the centres again eventually even when they may be ready for family planning. She described their case as ‘missed opportunities’ to win for family planning and better equip the youth.

Concerning the need for experienced family planning providers in health care centres, Dr. Farouk Jega, the Country Director, Pathfinder International Nigeria said it would make a lot of difference in the health care sector.

Dr. Jega said well-informed service providers will bring about enormous change towards building trust in the adoption of family planning and increasing uptake in the country.

Also, the Pathfinder boss said that every woman, especially in developing economies like Nigeria deserves a quality family planning information.

This will enable them to make an informed decision, stating that every woman deserves quality information on family planning, he stressed.

Jega said; “Every woman no matter the age has the right to know and access quality family planning information.”

Restrictive norms and stigma 

On her part, Kosi Izundu, Programme Officer, Pathfinder International while presenting a topic on, ‘Youth and Adolescent Access to Family Planning,’ said the major challenges youth face in accessing family planning are structural barriers such as laws and policies requesting parental consent.

She added that socio-cultural barriers such as restrictive norms and stigma around adolescents and youth sexuality and individual barriers such as young people limited or incorrect knowledge of Sexual Reproductive Health (SRH).

Though the government has tried in terms of policies and laws to advance SRH, Izundu said there is the need for government to fully implement those policies.

Speaking on the topic: ‘Youth and Adolescent access to family planning in Lagos State’, Abiodun Ajayi, State Coordinator, Life Planning for Adolescents and Youths (LPAY) said some of the barriers to youth access to family planning services are; lack of access to adequate and accurate life planning information and services, providers’ bias, religious doctrine as well as policies barriers.

To tackle these issues, Abiodun said, government should integrate youth-friendly family planning services in all PHCs to meet their needs.

He said, community, religious and traditional leaders should speak positively about SRH of young people; parents should engage their children on SRH information and advocacy efforts should be made to key players by Civil Society Organisations (CSOs).