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.
