Family Planning: Lack Of Counselling In Private Hospitals Increase Maternal Deaths

By Chioma Umeha

Lagos – I married early 2008. I have six children now; this one will make the seventh one. I attend antenatal care(ANC) at a private hospital, Holy Trinity Maternity near my house at Okokomaiko, Ojo Local Government Area (LGA) Lagos. They did not tell me anything about family planning in my hospital. I delivered my six children there.

These were the words of Sabina Acho, a 32-year-old mother who have had six children in the space of eight years. , a petty-trader told this reporter that no one had told her of the need to go for family planning, even at ANC.

She had prolonged labour and was induced to deliver in her first four pregnancies. Sabina bled heavily and nearly developed vesico vagina fistula (VVF). So she had the last two babies through ceasarian section (CS) to avoid further complications. Now she is in her seventh pregnancy. Evidently traumatised, Sabina told Independent that she survived delivery of sixth child only by whiskers.

Sabina does not seem to know that family planning can help her. Her words: “I was in labour for three days. I thought the baby will come, even the nurses were surprised. This is because I used to deliver by myself, except that my fifth baby. This my sixth baby also would have died so they did CS for. If I had known, If I was told, If my hospital had taught me about family planning, I won’t be in this situation now.”

The story of Chika Adule, civil servant, aged 24 is not different. She had her first baby through CS at a private hospital, St John Maternity Home, Ikotun, Alimosho Local Government Area (LGA), Lagos state. Her first baby was barely four months and she became pregnant again. Due to fear that the surgery has not fully healed, she considered abortion, though she did not know how to go about it.

Coming from a Christian background, she was scared and did not have the courage to tell her husband.

She decided to have it her own way, but little did she know that it was the beginning of her afflictions.  Armed with counsel from her best friend, she opted for abortion.  Unfortunately, in Nigeria, abortion is yet to be legalised.

Then, she and her friend decided to patronise a quack doctor. The abortion was carried. Three days later, she developed complications, bleeding heavily. Chika’s husband became worried and rushed her to a nearby hospital where it was discovered that she just had an abortion.  So she lost her womb due to the unskilled exercise.

Expressing regrets, she told Independent in an interview: “I did not know about family planning. We were not taught about family planning during antenatals. If I was aware, I would have settled for one of the various methods of family planning, I would not have lost my womb.”

Chika and Sabina represents thousands of women in Lagos who lack access to Family Planning (FP) counselling in private health facilities in the State.

According to experts, FP counselling is a process by which a provider uses appropriate communication skills to provide correct, adequate and unbiased information on available options of family planning to individuals, couples and groups to help them understand and accept family planning.

The information provided will enable the client or couples accept family planning and choose a method.

Precious John is enjoying the benefits of family planning because she had FP counselling.

She has an understanding husband. “I delivered my three babies at the Federal Medical Centre, Ebute Metta, Lagos. Initially, I was very afraid to use family planning listening to what people say about it, but I am happy I did family planning.

Joyfully, she added: “It has helped me space my children and gave me opportunity to avoid pregnancy long enough to get gainful employment and stable family relationships without depending on public assistance.”

Though the Lagos state 2013, National Demographic Health Survey (NDHS) percentage of distribution of users by sources of contraceptive methods showed that almost ¾ of women in the State source their FP methods in the private sector, they lack access to FP counselling.

Commenting on the situation, family planning expert with FistulaCare plus Project, Mrs. Amina Umma Bala, explained that there are a lot of organisations that are supporting public facilities in providing counselling, but do not support private ones.

Bala stressed that FP should not be done without counselling. According to Bala, absence of family planning counselling is a big issue and set back to effective FP services. “Family planning counselling must precede FP service and commodities provision. Nobody has the right to choose for a client. Every client must have a right to FP counseling to make informed choices.”

She said: “FP counselling is key to its acceptance. The information provided during counselling will enable the client accept family planning and voluntarily chooses a method.”

Similarly, experts have also expressed serious concern that only very few women are utilizing the Family Planning services even in public health facilities, despite the efforts of Lagos State government in providing both (FP) counselling and services

According to them, this has given   rise more unwanted pregnancies, unsafe abortion and maternal deaths. From The NDHS 2013 shows that the maternal mortality rate for the state is an alarming 555 per 100,000 women.

Evidence from the 2014/2015 Lagos State Maternal and Newborn Health Service Delivery scorecard also shows that only two per cent of women of reproductive age use contraception in the state. According to the scorecard developed by Lagos State Accountability for Maternal and Newborn Health (LASAM) with support from Mamaye, Lagos state has made insufficient progress in the use of modern family planning methods.

A similar survey carried out in 2014 by the National Population Commission and ICF International on family planning consumption in Lagos State shows that the percentage of married women using contraceptives has decreased from 49.6 to 48.3 per cent.

In view of this, the Nigerian Urban Reproductive Health Initiative (NURHI), has begun training the Ward Health Committees (WHC) Lagos State on sensitization of communities about child spacing and the need to access family planning services at the PHCs.

During the sensitization forum held at Sango PHC Pen Cinema, Agege, recently, the WHC Chairman Iloro PHC, Agege, Elder Emmanuel Adekoya, said there is still low acceptance of modern family planning methods at Agege community. “Many of the people do not yet see the need for modern family planning methods so there is need for more advocacy and teaching. It is also necessary to upgrade the health facilities so that better service will be delivered, which is what NURHI is currently doing and we have tried to support this. Before, the generators and boreholes at the PHC were not working but now we have repaired it,” he said.

Meanwhile, The Lagos Advocacy Working Group (LAWG) has called on Lagos State government to increase family planning budget in the state.

They made the statement on Monday during their review recently, at Alausa Ikeja, Lagos. Speaking at the forum the Programme Officer of the Nigerian Urban Reproductive Health Initiative (NURHI), Adewale Haastrup, called for increase awareness and orientation of the communities on the benefits of family planning uptakes.

They urged donor agencies with specialty on FP counselling and services to expand their reach to private clinics.