CHIOMA UMEHA
Nigeria’s population is currently estimated at 190
million. Experts claim that if nothing
is done about the unusual population explosion in the country, by 2050 it could
hit above 400 million.
Yet, Nigeria is special as
it is already the most populous African nation and on the seventh rank in the
world. If its population of 200 million people continues to grow at the current
rate of 3.2 per cent each year, the country will have the third largest
population worldwide with 411 million people by 2050.
“Although Nigeria has the
largest economy in Africa, population growth is outpacing the economic growth
and increasing the poverty risk for many Nigerians!”, explains Professor Robert
Zinser, CEO of the Rotarian Action Group for Population and Development (RFPD).
“More than half of the population already lives below the poverty line, while
women and children continue to die from preventable causes.”
In 2012, the government pledged
to increase the contraceptive prevalence rate (CPR) from 15 to 36 per cent by
2020 by buying contraceptives and providing them to women who need them. Today,
the country has managed to increase the CPR to17 per cent, but there is still
much work to be done.
Family planning is the
conscious effort of couples using contraceptives to limit or space the number
of children they want to have. Using modern contraceptives also helps reduce
maternal and infant deaths. According to Nigeria’s Demographic and Health
Survey (NDHS) 2018, out of 100,000 woman giving birth 576 die, and out of 1000
children being born 67 do not survive. In international comparison these
Maternal Mortality (MMR) and Infant Mortality Ratios are very high.
Provision of modern
contraceptive methods is one of the main components of sustainable development
and poverty alleviation. When couples have fewer children, they spend less
income on immediate survival needs of food, housing and clothing, leaving some
savings for education or investment capital. Education and investment create
productivity, make industries grow and raise employment. When people work, the
government can tax their incomes and generate capital to invest in important
sectors such as education, infrastructure, and health and food production. This
contributes to long-term productivity and raises the living standards of the
people.
So what is stopping
Nigeria from achieving its desired family planning goals? And how can the
country prevent more and more families from falling into a poverty trap without
any chance of escape?
Nigeria’s Demographic and
Health Survey states that one of the many ways Nigeria can avert this situation
is by increasing the knowledge and use of modern family planning methods among
women of reproductive age. It estimates that meeting women's need for modern
contraceptives can prevent about one-third of all maternal deaths.
However, out of the 45
million women of child bearing age in Nigeria, only 7.6 million are using a
modern family planning method. According to Nigeria’s National Family Planning
Communication Campaign, the country wants to generate an additional 7.3 million
new users of modern Family Planning methods in Nigeria.
The country has increased
awareness of family planning to 85 per cent for women and 95 percent for men.
Yet, Nigeria still grapples with the sad reality of little in-depth knowledge,
low demand and uptake of family planning products and services.
And here lies the root of
the problem.
Many women who expressed a
desire to delay their next pregnancy by at least two years were not using a
modern method of contraception because they lack access to contraceptives.
Many hospitals are not
able to fulfill the needs for family planning products and services. And even
worse: Primary Health Centres, which are the health institutions closest to the
people, are often desperately lacking in trained staff for family planning
services. Health centres are also hit with frequent stock-outs of contraceptive
commodities and, where they are available, many centres still lack equipment to
administer the contraceptives like implants and Intrauterine devices.
The second problem
affecting uptake has its roots in myths and misconceptions of contraceptives,
fear of side effects as well as widespread opposition to the use of
contraceptives by women due to socio-cultural, religion and spousal objections.
Another, very important
reason is a lack of education: About 47 per cent of women in Nigeria don’t have
any form of education. Yet, going to school long enough allows girls to delay
child bearing but also empowers them to make decisions about their bodies and
future lives. Their low status leaves women at the mercy of their husbands to
make their healthcare decisions.
"Changing this
situation takes more than provision of family planning services. It requires
helping people understand the personal benefits in health, wealth, and family
harmony of limiting and spacing births,” says William Ryerson in his paper
Unmet Need - Lack of Access or Lack of Cultural and Informational Support. “It
also involves role modelling family planning use and overcoming fear that
contraceptives are dangerous or that planning one’s family is unacceptable. It
requires getting husbands and wives to talk to each other about use of family
planning – a key step in the process to begin using contraceptives.”
What Nigeria can do
In 2012, the government
pledged to provide US$ 8,3 million annually for the procurement of reproductive
health commodities, which includes contraceptives. They also agreed to enlist
the support of development partners like UNFPA, WHO, The Gates Foundation, and
Rotary International to provide contraceptives, including oral pills, implants,
injectables, IUDs and male condoms.
A robust national
multimedia Family Planning and demand creating communication campaign was
designed by Nigeria’s Federal Ministry of Health focusing on increasing the
knowledge and uptake of Modern FP methods.
Using targeted media, the
campaign will help to dispel myths and misconceptions about family planning
that are stopping women from starting or continuously and consistently using
contraceptives. With financial support from the Rotarian Action Group for
Population and Development (RFPD), the US-based NGO “Population Media Center”
will use targeted serialised dramas to dispel cultural barriers as well as
myths and misconceptions. This will be complemented by community dialogues with
support from traditional and religious leaders as well as engage men to support
their partners in making decisions on desired family size.
The country is working
towards increasing and improving its service delivery points from 31 to 89 per
cent to take contraceptives closer to women who need them and make them
available at any time and every day. This will further be supported with
improved transport of contraceptives from national government stores to the
state stores and further down to the nearest health centres in villages.
The Nigerian government’s
efforts are supported by RFPD’s ongoing nationwide family planning campaign.
This campaign builds on a model that was piloted in two northern states of
Kaduna and Kano that saw a 60 per cent reduction in maternal deaths and 15 per
cent reduction in infant deaths in participating hospitals.
A digital tool developed
by RFPD for improving maternal and child health will now include family
planning in 4000 health centres over all 36 Nigerian states and the federal
capital. The tool is used to closely monitor the quality of hospital facilities
and structures and the quality of care provided by the medical personal.
Participating hospitals
can draw lessons from this analysis to improve the quality of care to mothers
and babies. "Further training and education of medical staff and
administrative officers will help to improve the quality of care provided”,
explains Dolapo Lufadeju, RFPD’s National Coordinator in Nigeria. “This
increased competency on the side of health staff will allow the established
system to be fully run and be administered by local partners when the project
ends.”
