Thursday, 13 June 2019

Family Planning: Making Childbearing A Sweet Experience, Not A Tragedy

Recently, the news of a husband of a 35-year-old woman, Mrs. Queen Udekwe, based in Benin, Edo
State, who previously had a set of twins absconded after she was delivered of triplets made the rounds in the media.
The report has it that her husband fled immediately he discovered the children through the result of a scan conducted while his wife was still pregnant and vowed not to return home.
Several reactions greeted the development with many Nigerians condemning the action of the escapee husband. Some schools of thought reasoned that the birth of the triplets is a divine blessing and not a curse.
Therefore, they saw it as an act of wickedness and ingratitude to God for the man to abscond from his family. Some others, who reacted differently to the situation, said, it was a sign of high fertility rate in the couple.
Whichever perspective one decides to view, the issue throws up high fertility as one of the main causes of overpopulation problems.
The case of Udekwe’s family is only one sad example of how childbearing which is supposedly a sweet experience turns to a tragedy. There are uglier media reports of consequences unplanned pregnancies, uncontrolled births, and overpopulation.
Some couples have committed suicide simply for this reason. Recently, a man reportedly committed suicide after his wife gave birth to a new baby in Delta State.
According to media reports, the man killed himself by hanging after his wife delivered a baby through caesarean section, and was charged N15, 000.
It was gathered that he didn’t have the money hence he decided to kill himself.
Some women also commit suicide or abortion due to unplanned pregnancies and births, those who survive the abortion, often done by unskilled personal risk giving birth to children with deformities.
Others even abandon their child in odd places like the gutters, even toilets.
These are just a few examples of social problems of high uncontrolled childbirths which ultimately lead to overpopulation in any country.
However, studies have shown that this is preventable through the use of contraception.
Overpopulation is an undesirable condition where numbers of existing human population exceed the carrying capacity of the earth. This is mainly because of high fertility levels.
Currently, one of Africa’s problems is extremely the rapid population growth rate that makes it extremely difficult for governments to supply the needed social and economic programmes to improve quality of life.
For example, the total population in Nigeria was estimated at 191 million people in 2017 and a net increase of about 14, 000 people (21,000 births and 7,000 deaths) daily or about five million annually.
In 1960, Nigeria had 45.1 million people. 
The United Kingdom, on the other hand, had a population of 52.2 million people in 1960 and was estimated at 66.2 million People in 2017, according to the latest census figures.
Although the UK had more people than Nigeria in
1960, Nigeria has about three times more people compared to the UK in 2017.
Between 1969 and 2019, Nigeria’s population grew by 267.4 per cent at 54.7 million people, while it has now increased to 201 million this year.
Nigeria’s population grew at an annual average growth rate of 2.6 percent in the last 10 years.
However, the World Health Organisation (WHO) defines the Total Fertility Rate (TFR) as the average number of children a woman would have if she survives all her childbearing (or reproductive) years.
Women are fertile from the age of 15 to 49.
Nigeria’s average TFR is rated between 5.5 and 5.7 children per woman which is higher than the African average of 4.7 children per woman.
With this figure, Nigeria is a lead contributor to Africa’s position as the region with the highest TFR, while Europe has the lowest TFR of 1.6 children per woman.
Health experts recommend family planning as a tool to check Nigeria’s burgeoning population.
Population growth can be a blessing to a nation if it is at par with economic growth, but Nigeria’s 201 million populations are outpacing economic growth by 0.63 per cent. This was the position of economic analysts.
Declining high fertility is often a blessing as it brings multiple positive consequences for human welfare and society.
After all, nation-building is by the people and for the people.
There is, therefore, the need to balance the reproduction and production capacities of the citizenry through effective policies and programmes with the welfare of the people as the paramount goal.
Healthy people are more productive while unhealthy, malnourished, stunted, poorly skilled people consume more than they produce.

This article was adapted from the Media Advocacy Working Group Family Being Column in Leadership Newspaper

Why Family Planning Is Now A Must For Nigerian Couples

It is not news that family planning protects the health of women and children as well as reduces ugly risky overpopulation burdens by helping a family to plan and responsibly fulfill its parental roles.
The media is replete with many reports which X- rays the roles of family planning in population control, more so in view of the newest Nigeria’s population figures.
Nigeria’s population has risen to 201 million in 2019, according to the latest State of World
Population Report released recently by United
Nations Population Fund (UNFPA).
Nigeria is considered the populous country in Africa, yet it is only the fourth largest African nation in arable land area.
Nigeria’s annual growth rate of 2.8 % means the population is growing by nearly three million people every year.
Nigeria is considered the populous country in Africa, yet it is only the fourth largest African nation in arable land area.
Nigeria’s annual growth rate of 2.8  percent means the population is growing by nearly three million people every year.
To put this in perspective, in 1911, the population was 16 million. It grew to 114 million by the year 2000 and to an estimated 174 million in 2014.
Based on the 2014 trend, it was estimated that the population would nearly double in 20 years.
According to the new UNFPA report, Nigeria’s population grew at an annual average growth rate of
2.6 per cent in the last 10 years.
Between 1969 and 2019, Nigeria’s population grew by 267.4 percent. In 1969, Nigeria’s population was estimated at 54.7 million people, while it has now increased to 201million in 2019.
Today, the reality is staring at everyone. Keen analysts say without urgent intervention through effective and strategic implementation of family planning models, the country, already on recession threshold, is bound to spiral more downwards into further socio-economic decline.
The rapid growth of the Nigerian population has widespread implications for its present and future citizens.
On Nigerian campuses, students stand by windows to listen to lectures and a typical room where only two students lodged in the 1970s now house up to 10 students.
Major cities like Lagos, Ibadan, Abuja, Port
Harcourt, Kano, and Kaduna are already experiencing an explosion in population; housing is overstretched, and a growing number of Nigerians are homeless.
The rate of population growth is outpacing huge attempts to increase employment opportunities in Nigeria, leading to considerable waste of the talents of young people.
Food imports will need to increase dramatically as use of land for building continues to compete with the use of land for farming.
Due to the use of land for building, by 1996, land used for agriculture had reduced to only 266,407 sq. km, or 29 per cent of available land for agriculture.
As available land for agriculture decreases, it becomes more difficult to feed the growing population.
People in large families are more likely to suffer from poor nutrition, stunting, and malnutrition, especially among children with broad dangerous implications.
Although there is no single answer to the population explosion challenges facing the nation, it is clear that the population needs to be balanced with the amount of land available to feed and house Nigerian citizenry.
By reducing the birth rate and slowing population growth, family planning would improve the health of Nigerians, especially children and mothers, in addition to providing significant socio-economic benefits.
Beyond obvious societal benefits, healthy timing and the spacing of pregnancies through family planning has incredible health benefits for mothers and children.
Approximately 814 women die in Nigeria due to complications related to pregnancy according to 2015 World Bank indicators. Women are more likely to die when pregnancies are spaced close together or the mother is very young or beyond the age that is healthy for childbirth.
Children are also more likely to die when they have siblings very close in age.
According to a USAID-supported Demographic and
Health Survey report, if all women waited three years to conceive after the birth of a child, 25 per cent of all deaths of children under five could be avoided.
Saving the lives of mothers and children is now a public health emergency. That is why family planning should become the greatest priority of every Nigerian couple today.
This article was adapted from the Media Advocacy Working Group Family Being Column in Leadership Newspaper

This article was published in the Media Advocacy working group family being column in Leadership Newspaper

Preventing Imminent Population Explosion, Disaster

It has become glaring to all stakeholders in every sector of the Nigerian economy that the Nigerian huge population, which supposed to serve as strength to the nation, has the tendency to sabotage government policies on economic growth and development.
According to the 2018 National Demographic and Health Survey (NDHS) report, if fertility were to remain constant at current levels, a woman in
Nigeria would bear an average of 5.3 children in her lifetime.
While fertility is low among adolescents (107 births per 1,000 women), the report revealed that it peaks at 256 births per 1,000 among women aged from 25
to 59 years and fertility is higher among rural women than among urban women. On average, rural women will give birth to about 1.4 children more than urban women during their reproductive years (5.9 And 4.5, respectively).
Meanwhile, family planning which refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods like female sterilisation, male
sterilisation, the intrauterine contraceptive device
(IUD), implants, injectables, the pill, condoms, and the lactational amenorrhoea method (LAM), has not been fully utilised by couples.
According to the NDHS report, only 17 per cent of currently married women use a method of family planning, with 12 per cent using a modern method and five per cent using a traditional method.
Among currently married women, the most popular methods are implants, injectables, and withdrawal
(Each used by 3 per cent), followed by male condoms (used by 2 per cent).
The contraceptive prevalence rate (CPR) among married women vary with age, rising from 3 per cent among women age 15 to 19 to a peak of 23 per cent among women age 35 to 39 before declining to
13 per cent among women age 45-49.
The implication of this, according to stakeholders is that tough times await Nigerians due to an impending population explosion.
Governor of Central Bank of Nigeria, Godwin
Emefiele said Nigeria’s population would hit 425 million in 2050, the third largest in the world, unless urgent steps were taken to control it.
Emefiele, who painted a gloomy picture of Nigeria in comparison with other countries said the impending population explosion of Nigeria and attendant economic implications would create tough times for Nigerians.
He said with the rapid population on a yearly basis and a penchant for sabotaging government policies on economic growth and development, there would be a serious crisis if serious actions were not taken to control population growth.
The National Population Commission (NPC), Mr.
Eze Duruiheoma had said that Nigeria remains the
most populous in Africa, the seventh globally.
According to him, the recent World Population Prospects predicts that by 2050, Nigeria will become the third most populated country in the world.
Yet, the explosion in Nigeria’s population has not been commensurate with resources available in the country, hence, the need for Nigerians to embrace family planning says Duruiheoma.
The minister of Health, Prof Isaac Adewole, said universal access to family planning is a human right and a key factor in reducing poverty and attaining the Sustainable Development Goals.
Adewole said with the current Nigerian population of over 190 million people, efforts have to be made to create awareness of moderate family size nationwide, especially in rural areas.
He, however, called on all stakeholders to create more awareness of the need for Nigerians to embrace family planning.
A family planning facilitator, Mrs. Abiola Adekoya,
said family planning, when adopted by Nigerians, would reduce maternal mortality, help in preventing unwanted pregnancies and as well, help in curbing Nigeria’s population explosion.
Adekoya, who has administered family planning on lots of women, especially in her community at
Agboyi Ketu said family planning has been impactful to a lot of women in her community.
“If everybody adopts it; if there is male involvement, sensitisation programmes in churches, mosques, markets, our policy makers, it will go a long way in averting the huge population.
“The issue of abortion is reducing because people are aware of it; adolescents who cannot keep themselves are often advised to go for family planning instead of abortions.
“Parents should be able to counsel their children, they should be able to tell them the reasons why they should face their studies and keep themselves.
But the adolescent that cannot do it, it is better we counsel them on family planning only if they tell their parents”, she said.

This article was adapted from the Media Advocacy Working Group Family Being Column in Leadership Newspaper

Family Planning Critical In Tackling Abortion Rates Among Adolescents

When Udeme Akpa got admitted into secondary school, the joy of the parents knew no bounds.  For them, it was like a prayer answered.
As the first daughter of a family of eight, there were so many expectations including lifting the family from what could be described as ‘age-long poverty.’
Udeme, 18, was living up to expectation until the unexpected occurred.  Her woes began one evening when a man in her neighborhood gave her a ride to school.
Little did she know that the few minutes ride would later become a stumbling block to her life’s dream. 
A few months later, the same man identified as Mr. Udoh invited Udeme to his house, but she turned him down.  After much persuasion, Udeme accepted to visit him.
Sadly, innocent Udeme never knew she was playing with fire until he visited Udoh.  On that fateful
Friday, Udeme decided to visit him.
Sadly, she was raped by the same man whom she thought showed her kindness. Subsequently, she had unprotected sex with Udoh.
Unfortunately, Udeme concealed the incident from her parents. Although Udeme was sexually active, she was not on any type of family planning. A few months later, Udeme discovered she was pregnant.
“I was confused and my friend took me to a chemist and because we didn’t have money to pay, the owner of the shop demanded that he sleeps with me before he will give me drugs. I had no choice than to do it,”
She narrated.
In the process of trying to abort the pregnancy, Udeme had complications that ruptured her womb.
She was hospitalised for weeks.
That incident ended Udeme’s dream to finish college.
Udeme is one out of thousands of adolescents in Nigeria that have either lost their lives or maimed for life due to lack of access to family planning.
The case of Udeme is also among the 214 million women of reproductive age in developing countries who want to avoid pregnancy, but are not using a modern contraceptive method, according to the World Health Organisation (WHO) report.
Sadly, unsafe abortion remains a reality in Nigeria, despite the fact that it is regarded as a taboo and illegal by law.
Stories of young Nigerians who die while undergoing abortion abounds but, the act still goes on in smaller rooms and performed by traditional healers which make it more dangerous and deadly.
Unintended pregnancy has become the bane in society. It is so rampant in society today.
Critical observers believed that pregnant teenagers in Nigeria are victims of the tragedy of all kinds.
Many of these girls have died as a result of unsuccessful abortions, while others like Udeme have also dropped out of schools.
Statistics available put the number of out-of-school children in Nigeria at 10. 5 million, while the United
Nations Children’s Fund, (UNICEF) says about 60 per cent of the figure are girls. Further findings also showed that unplanned pregnancies of teenagers make up the number.
However, for possible solutions, apart from sexual education, experts say encouraging teenagers to adopt family planning reduces the need for abortion, especially unsafe abortion like in the case of Udeme.
Family planning reduces adolescent pregnancies.
WHO report also shows that pregnant adolescents are more likely to have preterm or low birth-weight babies. Babies born to adolescents have higher rates of neonatal mortality.
Many adolescent girls who become pregnant have to leave school. This has long-term implications for them as individuals, their families, and communities.
It is also believed that when teenagers are protected from abortion and unintended pregnancy they do not drop out of school but stay in school.
Also, family planning methods, such as condoms, help prevent the transmission of HIV and other sexually transmitted diseases among adolescents.
It has also been established that by reducing rates of unintended pregnancies, family planning also reduces the need for unsafe abortion.
There is a need to promote and make available for contraceptives for adolescent Nigerians in order to reduce their frustration accessioned by an unplanned pregnancy.
According to WHO, family planning is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, national and regional development efforts.

This article was adapted from the Media Advocacy Working Group Family Being Column in Leadership Newspaper

Study Confirms This Popular Birth Control Does Not Increase Your HIV Risk

The world has spent nearly a quarter of a century wondering whether Africa’s most widely used birth control method could make women more likely to contract HIV.
Now, new research, conducted in four countries, including South Africa, has solved the riddle.
The three-month shot Depo-Provera does not increase a woman's risk of HIV infection; prove the results of the Evidence for Contraceptive Options and HIV Outcomes (Echo) study.
The findings were released at the South African Aids Conference in Durban Thursday and published in The Lancet.
For decades, it was like there was a spectre among the data - something researchers thought they saw but couldn't entirely be sure.
From South Africa to Tanzania, studies kept picking up what seemed like an association between the widely used three-month birth control shot marketed as Depo-Provera and HIV infection.
A 2016 review of nearly three dozen studies published in the journal Aids suggested Depo-Provera users could be 20% to 60% more likely to contract the virus compared to women who didn't rely on this hormone-based contraceptive method.
The problem was, none of this research proved it. Why?
Because it was never designed to do that, Scientists couldn’t tell if what they thought they saw in the numbers was right - whether it was the shot or if they were picking up on something else that was putting women at risk such as the lower rates of condom use that a 2005 study by the Guttmacher Institute detected among some DEPO users.
The findings of the Echo study are the product of a three-year study conducted among about 7 800 women in eSwatini, South Africa, Kenya and Zambia.
As part of this, women wanting birth control agreed to be randomly assigned one of three contraceptive methods  a three-monthly shot of Depo-Provera, a copper implant inserted into the uterus; or a small, hormone-based upper arm implant known as Jadelle.
Although women were allowed to change the type of contraception they were assigned to if they wished, most didn't.
And because scientists believed it was unethical to withhold contraception from women who wanted it, everyone got one of the three choices.
Randomisation like this helps ensure that any factors, such as age, that could affect the study's results are spread equally among all groups, making these kinds of "gold standard" studies the best at determining cause and effect relationships.
The Echo found no substantial difference in the rates of HIV infection among the three groups.
So what should South African women know?
"From what we can see there is no increased risk from any of those three methods in terms of increasing your chances of contracting HIV", says executive director of the Wits Reproductive Health Institute Helen Rees. Rees is also a member of the five-person committee that led the study.
"However, none of these methods will protect you against HIV… and you still need to protect yourself from HIV infection", she explains. "But if you want to protect yourself against unplanned pregnancy, these methods are a real option for you."
Its simple messages like this that will now need to filter down to women and communities in languages and ways they can understand.
But their voices will also have to be represented in the high-level discussions that will follow Thursday's results.
Historically, the world has done neither well, and there may be a price to pay for that.
In October 2011, The Lancet published a study that suggested a possible link between Depo-Provera and HIV risk.
It prompted a high-level World Health Organisation (WHO) committee to see if it should issue warnings to doctors and women about the contraception that forms the backbone of birth control programmes in much of the Global South.
But with the kind of conclusive evidence Rees' trial provided this week, the WHO was left without much to say and not a very clear way of saying it: It advised women using Depo-Provera to also use condoms.
Activists were not impressed.
In reality, most women who opt for long-acting contraception like Depo-Provera do so because they are often unable to negotiate condom use, co-director of the international organisation Aids-Free World Paula Donovan pointed out at the time.
Lillian Mworeko is the East Africa regional coordinator of the International Community of Women Living with HIV/Aids.
At the time, Mworeko was one of the few women with HIV who was invited to the high-level WHO consultations on Depo-Provera and HIV.
At one point, the Ugandan activist and others were made to sign a confidentiality agreement that would have prevented them from reporting back to their networks back home, Donovan argued.
Mworeko called the WHO out for issuing a lack of clear guidance at the time: "Women at high risk of or living with HIV still have a right to informed consent, which includes the right to information that affects their health."
By 2017, the WHO had changed its tune, telling women that for most, Depo-Provera works well enough, but for some, it may be risky.
It would be another four years before Rees could fundraise the US$50-million (R746-million) needed to finance Echo, the world's first study that investigated whether Depo-Provera fueled HIV infections.
In total, Rees and her fellow researchers spent 15 years planning - and finding money - for the Echo study.
"Was it easy to raise money for this trial?" she asks. "The answer is no, it wasn't, and we have to ask why that is.”
Rees told Bhekisisa in November 2018: “‘if there was a product that men were using that had a question like this hanging over it. We would have had an answer by now."
We have the science, what now?
By 2017, the WHO had begun to tell women that Depo-Provera could make them more likely to contract HIV in hopes that it would allow those already at high risk for HIV - including many women in South Africa - make an informed decision about their choice.
In practice, however, few women in the Global South would have been given panoply of other options.
The WHO is preparing to issue updated guidance on Depo-Provera by late August, WHO spokesperson Tarik Jašarević told Bhekisisa.
As part of this, a 28-person expert panel, including clinical experts and outreach workers from countries such as South Africa and Zimbabwe will review the evidence.
Their nominations were put forth for public comment in May as part of the body's move towards greater transparency.
But only one of the participants is a woman openly living with the virus, according to biographies posted online.
The final composition of this committee is still being finalised.
Meanwhile, years without clear evidence and waffling about what to say to women about contraception and HIV risk, and how to say it, may have taken its toll.
Echo's findings come amid ongoing contraception stock outs that have run into their second year: "At the moment with stock outs, I could be given Depro-Provera one month if it's available and the next time I come to the clinic I might only be able to get [birth control pills].
People are being switched between methods without even being consulted on the side effects", activist Nomfundo Eland says.
Weeks ahead of this week's release of the Echo results, The Lancet accidentally released the Echo research online briefly.
Both the journal's media relations manager Emily Head and Rees confirmed to Bhekisisa that the early release was an administrative error.
Rees explains: "It was absolutely nothing more sinister than that."
But longtime HIV activist Nomfundo Eland argues it's raised suspicions among women who may already be sceptical of the findings despite the study's rigorous methods.
"We are going to have a hectic time [getting] women to believe it, especially women and activists who have been following the Echo agenda because the results were leaked", she says.
"We are asking ourselves questions - who leaked it? For what purposes? What information got out, and who has it?"
Eland warns activists also remain concerned that the early release led some study sites to rush feedback of results to participants, leaving them confused.
 Rees, however, says that although the release did push some time frames forward, each of the 12 sites had already developed its own plan to let women know what the study found at the same time results were made public.
In some cases, sites let women know of the findings before this week.
But Rees admits some scepticism is perhaps to be expected.
"We hope that this study for most people will be massively reassuring.
 This was the gold standard in terms of studies, and it was a study that was very well executed", she explains.
"But this is an issue that has been discussed backwards and forwards for years because no one was able to do a definitive study until now. That's left ambiguity, and when you have ambiguity, people build up a view."
Rees concludes: "There were certainly many people of the view, looking at the data that existed [before]... that there was a trend towards increased risk." Rees continues.
That some people won't believe the results even three years of research may be unavoidable.
It's probably inevitable because of the strength of view that has been built up over the years."
Echo solved one riddle, but it left many more.
About one in 20 women contracted HIV during over the course of the study’s three years - not because of their birth control, but because they face the same social and economic issues that lead 1300 young women in South Africa to contract the virus every week, show the country's latest household survey.
We need better and more contraception choices for women, Rees and Eland warn.
And more ways to reach women with the tools they need to prevent HIV.
"If women go for family planning, they get family planning", Rees explains. "If they go into HIV services, they get HIV services.
"We're not integrating our services… these are women who are presenting themselves and who are sexually active they need both. Together."

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