Dr. Farouk Jega is Senior Country Director of Pathfinder in Nigeria, where he oversees technical and administrative aspects of a multi-million dollar portfolio of projects in maternal health, family planning, HIV and AIDS, and advocacy. In this interview with CHIOMA UMEHA, he speaks on family planning and sundry issues. Experts:
Nigeria has one of the highest fertility rates in the world, 235 million in 2013, what is the significance of this prediction in the face of the contending family planning services issues in the country?
The significance is in many different ways, but we need to make a clarification. First, the absolute population number is not a bad thing if it goes at pace with the level of development but unfortunately, Nigeria’s population growth has not really been in pace with our level of human development.
So, we have this huge population and very bad infrastructure in terms of educational and healthcare facilities, even employment and that is why it is a problem. About a quarter of our population is full of young people and they are the most productive segment of any population group. They lack opportunities to reach their full potential and because of that, they are a waste rather than an asset to the country.
I think quite honestly that some of the contemporary issues in the country can quite directly be attributed to the huge population that we have. If you have a huge population and do not care for their social and economic development, then there is definitely going to be a problem.
What is the place of family planning in helping to address this huge population?
This is very clear. I will even speak from the right perspective of family planning. Many studies have shown that if people have the ability to space and plan out their families it is a win-win situation for everybody – the family, individuals, communities and government.
Spacing families or delaying the next pregnancy gives women especially time for them to recover physically and also psychologically so that they can even be employed to contribute to the family income whereas, if they are having children every year they would hardly ever have time to even think of any other thing. But if they use family planning and they are able to space their children that can help the mother to work and contribute meaningfully to the family.
Of course, the children also would be well fed with breast milk which would make them have full benefit of achieving good mental, physical and cognitive development of the child.
Are you saying that family planning would help the country to achieve economic development?
Family planning is key to the concept of having a developed country. For instance, with the population that we have, if we invest in education, this will help the youths to learn skills that would provide them good jobs and economic power. Thus they will obtain adequate health care that would make them achieve their full potential.
If they have family planning also, this would help people of child bearing age to avoid a vicious cycle of childbirth, then they are definitely going to grow the economy because they are going to be employed and would contribute to the improvement of the economy, not just for themselves and families but also for the country.
There is a huge issue of meeting contraceptive needs of women and ensuring that they have the right to choose the kind of family planning they want. What do you think can be done to achieve this in the country?
I think there are several things to look at, one of them is MET NEED. What exactly is MET NEED? Met need is the ability of a woman to have the family planning of her choice. There can be several reasons a woman would not have the method of her choice. The key one here in Nigeria is the lack of availability of commodity or lack of availability of skills by a provider to provide that particular method.
For the commodity, the government of Nigeria has a policy that was done several years ago whereby the Federal Government provides family planning facilities and makes them free of charge for women in the health facility. If the commodity is available at the health facility level and the providers are trained to counsel and provide that service, I think a lot of MET NEED would be addressed.
There is an unmet need that is probably related to ignorance on both women and men that need family planning. I think it is the responsibility of the government to make sure that the commodities are available not just in the store, but at the health facility level where health care is provided. It is also government’s responsibility to make sure that health workers are trained in giving out information and services.
Do you see this country achieving a universal access to family planning?
I think we can achieve that if we work seriously to implement the policy that we have already. We already have a policy on universal health coverage. We already have a budget packing to implement that policy under the basic health care provision fund and universal healthcare policy.” It provides assurance that every Nigerian irrespective of any factor should have access to a basic package of healthcare which also includes family planning.
What are the major challenges in family planning and how can we overcome them from your experience?
There are several issues that family planning is face in Nigeria and I think the first and most critical one is actually the terminology, ‘family planning.’ It is a very controversial term to say family planning. There are similar terms that are more acceptable like ‘child spacing.’ Many Nigerians irrespective of cultural and religious beliefs would agree that there is a need to space births to achieve both health and wellbeing of women.
Our religious values are not on the same page with some of the contemporary beliefs that reducing the number of children can increase prosperity; they are alien to some of our belief systems.
For instance, some religious people will tell you that God that created you has already decided your sustenance for the whole of your life and that children are blessings from God and that God gives you sustenance to take care of them. I think it is one of the big issues because that definitely affected the acceptance of family planning, especially because of what we call it and what we say about family planning.
That means that all the knowledge, attitude and behavioural change around the uptake of modern family planning has to be factored in. However, we all know that we have a severe resource shortage for commodities, consumables, capacity building of healthcare workers, even for logistics, that is a big issue.
Then, there are policy issues as well; a policy that, for instance, prevents certain things, it prevents health workers to be able to render certain services.
It must also be said that the task sharing policy has largely addressed some of those barriers because now the healthcare providers are able to provide a wider range of family planning services to people that need them.
The other issue which I have already talked about is resistance. That is, the cultural and religious perspective about family planning and I said that resistance stems from what we call it and I feel to a large extent that we should be able to reduce all that tension.
Instead of family planning, what do you think is the appropriate term to use?
As I said, most of the religious leaders accept ‘birth spacing’ as a good thing, they believe it is a good thing, but when you say family planning, they believe that you have a superior plan to God’s plan and that is where the problem arises.