Emmanuel Ajah, the Director of Programme Operations for Marie Stopes International Organisation Nigeria (MSION) in this interview with CHIOMA UMEHA, speaks on the risks of the high rate of fertility, poor budgets, unmet family needs in Nigeria among other issues. Excerpts:
In 2020 proposed health budget, N32 billion out of the N46 billion allocated to the Health Capital Budget goes to immunisation. How will that further affect the demands or unmet needs for family planning in the country?
We discovered that the budget for family planning in 2019 was dropped. And in the budget for 2020, which is being reviewed, much as there is that for health, we have not seen significant allocation for family planning. It may be interpreted that the government is not paying the needed attention to family planning.
Advocacies are already being led to the National Assembly through stakeholders, especially the associations for Family Planning in Nigeria, to ensure that the needed budget allocation is provided for family planning.
One of the biggest implications we have for that is what is happening currently where people need commodities and they are not able to get them, but we should get to a point where beyond the national, that there are budget provisions in the various states for family planning. Beyond making those budgets available is to make sure that they are actually released at the point when we need them, ensuring that there is the capacity for providers and commodities are readily available for people who desire to have one family planning method or the other to take such.
WhatwouldhappenifNigeriafailstoinvestin family planning?
We will continue to have high maternal mortality ratio. We will continue to have children we are not able to train, which have large implications for our economy and social security because of children who are not well spaced and not well planned, their behaviours and what they become in the future is actually what we will not be able to account for.
If you look at the issues that are happening from Boko Haram to kidnapping, armed banditry, herdsmen attack and all of that, it is telling us that we are having increased crime within the country and we can only curtail that if we have children that are controlled, and we are able to take care of those we have by giving them a good education, good food and ensuring that pregnant and nursing mothers are equally healthy.
What are the risks of the high rate of fertility as seen now in Nigeria?
Our overall fertility rate on an average is still standing at 5.3 per cent, which is very high. The implication is that we are still having multiple pregnancies.
There are communities with fertility rates as high as 5.9 per cent and six per cent in some states. The implication is that a lot of women are still having children by chance and not a choice.
Nigeria has a high maternal mortality rate with recent statistics showing that 451 women die annually out of one hundred thousand live births while three thousand women die every year from unsafe abortion.
The country’s high maternal ratio would be controlled if women do not give birth by chance, but does so by using any contraceptives of their choice.
Demand for contraceptives has increased in the country to 36 per cent, but cultural and religious barriers still inhibits women’s access to modern family planning services, hence the need for more advocacy. Marie Stopes International Nigeria believes that children should be by choice and not by chance.
As a nation, we need to ask ourselves what we should do is to ensure that women who desire to get family planning get it as at when necessary and when they desire that.
If you look at the 2018 National Demographic Health Survey (NDHS), our family planning unmet needs increased from 16 per cent to 19 per cent whereas, our demand for family planning equally increased tremendously. It simply means that we have not gotten to where we should be which is why we just had only two per cent shift from 12 per cent of our modern contraceptive prevalence rate to 16 per cent. We have not moved significantly to where we really want to be.
We always have failed targets, so how can Nigeria do things differently to attain a level where family planning becomes every family’s business top having issues of either safe or unsafe abortions?
We must ensure the different stakeholders play their different roles. It varies from government to government and trusted individuals have their own views about what should be done or not be done.
The government must make comments not just by word of mouth, but by following up with action that requires collective advocacy and follow up from different stakeholders. Those who work as implementing partners and donors must hold the government to account and the media as it were must hold government to account by asking the right questions to know what the government is doing.
The media’s regular presence at budget presentations both at the state and the national level, especially during reviews is necessary so they are able to ask how family planning is being handled in the country, recognising that maternal mortality is a big issue in the country. So, it is a multifaceted issue that requires all of us to put our hands on deck to ensure the government is held accountable regularly.
The media must carry the right messages to persons who do not know. There is a lot of ignorance out there. We expect to see changes in terms of what the media reports to make life more meaningful for women and reduce maternal mortality rates
What are your challenges of attaining the ratio you initially, designed to reach when MSION started operations in Nigeria?
Nigeria as a country is a very complex place with different religious backgrounds, different ethnic backgrounds, which is why the movement you see in some states you do not see them in certain states.
Again, health sits on the concurrent list in Nigeria, not on the executive list. The implication is that even what has been legislated at the national level can be handled differently at the state level. We continue to have different variations from one state to another.
By and large, we still have cultural norms that inhibit a lot of uptakes. We still have prices being issues in certain locations, we still have a lot of people who are completely rejecters who do not want to take up family planning services and we still have a lot of religious leaders who will not support family planning.
Where would you say family planning services are most accepted among the six geopolitical zones in the country?
The Contraceptive Prevalence Rate (CPR) in the country varies; the south obviously is higher but in the north the likes of Jigawa, Borno, are very low but we have increased CPRs in Kano, which has moved up a a little bit, Gombe, Adamawa have equally moved a little bit.