Rebecca Ejifoma who carried out investigation on the use of family planning by Nigerian couples, reports that the overall acceptance is still below expectations in the country.
Ruth and her children
Nigeria has made progress in improving the use of contraceptives over the past decades. However, there is room for improvement even in the face of longstanding myths and misconceptions concerning their use.
Women of all age groups have adduced different reasons to explaining their non-acceptance of contraceptives. Omonigo Onwuka is one of such. The 33-year-old mother of six has never believed in the use of modern contraceptives or family planning.
Omonigo narrated a scary tale she heard on her first visit to Amuwo-Odofin Primary Healthcare Centre (PHC) recently. “Waiting at the family planning unit, I got talking with a patient about the joy of motherhood among other things including family planning and what she said gave me the fright of my life.
“She narrated how her younger sister, who used the Implant, had a nasty experience that almost resulted in being infertile and even losing her life in the process. She spoke in such a pathetic way that I developed goose bumps. Ever since, I have had fear about contraceptive devices. My husband is not even aware I went there.”
After six successful pregnancies, Omonigo is not on any family planning method because she is yet to decide which of the contraceptives to adopt. “I’m still scared,” she confessed.
Her children have just a year difference in age and could pass for twins and triplets. But this was as a result of her thirst for a male. “I have never gone for family planning before because I wanted to still have more children, two boys at least. But it didn’t happen. Now I have five girls and a boy – the fifth child. So, I’ll just continue with my life that way.”
Sadly, Omonigo is not among the 15 per cent of women in Nigeria using any form of contraceptives for limiting and spacing birth, as reported by World Bank Collection, World Health Organisation and United Nations Population Fund (UNFPA).
But Chinaza Ibeneme, a mother of three is part of the statistics. Chinasa – whose children are aged six, four and two – shares her experience. “I had my first child in 2011. And the age gap between them is two years. Actually, I didn’t use any contraceptive after my first child, a girl. I noticed that my body was different. Whenever I was breastfeeding, I don’t take in,” she explained.
But Chinaza, a Human Resources Practitioner and Masters degree holder, later discovered she was pregnant even while breastfeeding her second child. “I didn’t know I was pregnant until I fell ill. I went to my doctor, who advised a pregnancy test. I was so sure that I could not be pregnant and that I had malaria. So, he advised that I took malaria and pregnancy tests. To my surprise, I was pregnant.”
The lesson from the third pregnancy prepared her for the next one. “I didn’t want to take chances again. I went for family planning but the provider insisted my husband be present. According to the provider, they had encountered problems in the past after giving family planning methods to women without their husbands’ consents.
“I’m currently on the injectable method called Sayana Press as the provider recommended. I take it every three months. The doctor asked me if I still wanted to have another baby. I said yes, but not now.”
Although some people have complained about weight gain as a result of some contraceptives, Chinasa debunked the myth. “It is not true. If you control your cravings, you will be fine. When I started, I observed that I craved to eat more. But I met a friend, who told me I could control it. She had been on it for three years. My weight has been 60 kg in the last three years.”
Today, Chinasa is an advocate for family planning. “I did family planning at the Amuwo Odofin PHC and I don’t regret it. The provider was so nice to us. He enlightened us step by step. I even recommend it to my friends.”
But Ijeoma Okoro, a career woman, believes use of contraceptives is against her maternal lineage. And whoever uses it in her extended family experiences continuous miscarriage.
“Actually, it’s a family thing. My mum had three children then went for family planning just to delay child birth. That was 26 years ago. So, she visited the general hospital in Abuja. I don’t know if they carried out any test on her as done these days. The providers did Inter-Urine Device (IUD) for her. But she still got pregnant. So because our background does not permit abortion, she kept the pregnancy,” she told THISDAY.
She continued that her “mum went for implant after the fourth child. It lasted for three years. That was where the troubles began. Every pregnancy she had afterwards resulted in miscarriage. She got frustrated and ruled out her mind on children.”
According to Ijeoma, who is in her late 20s, when it was time for her to go for family planning after her first child, her mother vehemently declined. “My mother refused when she heard I was about to do it.
Hence, Ijeoma’s first child is just months old and she is heavily pregnant with her second child. “My first child is months old. Because of my medical condition, my gynaecologist advised me to take in every year. I’m not using any form of contraceptives. We just need the space between the children to be a year plus. My husband and I are okay with it.”
Sadly, the UNFPA has said that about 20 million Nigerian women have no access to safe effective family planning services. The organisation says fulfilling the unmet demand for FP in Nigeria will avert 750,000 unintended pregnancies and reduce one-third of the estimated over 40,000 annual maternal mortality.
This is also backed up by the Federal Ministry of Health (FMOH), which disclosed that the current CPR (2013) for family planning is 15 per cent and the modern CPR is 10 per cent; however, relatively little progress has been made over the past five years.
The goal is to increase CPR to 36 per cent by 2018; this target was announced at the London Family Planning Summit (2012). 400,000 infant and 700,000 child deaths will be averted by achieving the CPR goal. 1.6 million unintended pregnancies will be averted by achieving the CPR goal. Approximately US$600 million is needed to achieve Nigeria’s FP goals.
A family planning expert and member of Public Health Sustainable Advocacy Initiative, Mrs. Abiola Olabisi Adekoya, backed this up: “The uptake of family planning in Nigeria is very low. Right now, it is 15 per cent, and we are saying by 2018, we should reach 36 per cent. In Lagos, we are clamouring for 74 per cent. Right now we are at 48 per cent. And 2018 is almost here.”
Adekoya, however, decried that consumables was the challenge in Nigeria. “Although government is trying, it needs to put more effort. Even development partners are trying. But if the development partner comes and goes, what do we do?”
She further described one of the biggest reasons for non-adoption of family planning as lack of knowledge about the various available options combined with misconceptions about the use of contraceptives.
Although Nigeria Family Planning Blueprint of October 2014 compiled by the Federal Ministry of Health (FMOH) shows that to date out of the 36 states, only Lagos has officially disbursed budget monies directly for family planning services.
Accordingly, the State Team Leader for Nigerian Urban Reproductive Health Initiative (NURHI), Dr. Edun Omasanjuwa, said in the last couple of years, there hasn’t been an increase in the health budget. “And there hasn’t been an increase in the family planning reproductive health component of the budget. So, one thing that will really fast track the increase to access of FP services would be to increase at least the minimum of RH FP component of the health budget for Lagos State.”
In line with this, State Team Leader Kaduna, Nigerian Urban and Reproductive Health Initiative,” Mr. Kabir Abdulahi, blamed myths and misconceptions as responsible for the poor statistics.
Findings from PHCs– Amuwo, Isolo and Igando– in Lagos State, showed that FP units do not operate under the same standard and do not break protocols. A visit to the Amuwo PHC on 41 Road Festac Town on a Friday was instructive. The family planning provider was not too helpful. “Come back next Thursday by 8.00a.m. or 9.00a.m,”she said.
THISDAY went undercover on a Friday as a nursing mother to Isolo PHC. Inside the dilapidated building, a woman dressed in pale brown instructed that the client should return on Tuesday or Wednesday for the services. Her excuse was that the family planning provider was on leave. “He will resume on Tuesday. So, come by 12.00p.m., we will tell you everything you need to know.”
Efforts to obtain more information proved abortive. As it was only on Thursdays (at Amuwo) or Tuesdays and Wednesdays (at Isolo) that family planning care and services could be obtained.
THISDAY, also, visited Igando PHC on Akesan Street on a Monday. She disguised as a new bride in the vicinity, and met with three staff including two women at the family planning department.
They chorused: “The provider is not on seat. Come back tomorrow by 12p.m.’’ One of the women said: “This must be your first time. When you come tomorrow, we will know if you are on or not before we do anything for you.”
The bottom line is that at the PHCs, there are delays at the point of service. They also do not operate long enough.
The current Contraceptive Prevalence Rate (CPR) for Nigeria is 16 per cent while next year target is 36 per cent in line with the global movement on FP 2020. This aims to enable 120 million women and girls have informed choice and access to family planning information and various modern contraceptive methods.
The Maternal and Child Mortality Reduction Programme in Lagos, according to Head Nurse and FP provider, Okokomaiko PHC, Mrs. Mifirinso Kent recognises the role family planning plays in improving the health of women and children throughout the state as paramount.
She told THISDAY during a visit: “We have administered over 15 injectables among other contraceptives since we were given this place. We have donors providing the commodities. We ensure they get contraceptives whenever they come for antenatal or immunisation.”
Kent asked for more consumables. “Some of the women appreciate us with N100 at most. We got N900 in total and bought some bowls and disinfectants. We hope the contraceptives will always be available.”
According to the National Demographic and Health Surveys (NDHS) 2013, only 9.8 per cent of married women use modern contraception. This figure has remained static in the last five years.
The NDHS listed some reasons women eschew contraception as: concerns about health risks or side effects, opposition to use, either by the woman or her partner, for personal or religious reasons; perception that they would not get pregnant because they had sex infrequently, had postpartum amenorrhea, or were breastfeeding; lack of knowledge about methods of contraception or where they could get them and inability to obtain or afford contraceptives.
Ruth Chijioke, a 33-year- old mother of three boys told THISDAY that more awareness is needed if Lagos intends to reach the 2018 target of 74 per cent. “I had mixed feelings about using any of the methods. But I’m not done with childbearing. I love to have one more children.”
Ruth had her first child at age 25. Her children are aged eight, seven and three. “I have used contraceptives before for spacing. I used pills first then retired for condoms. The reason I stopped pills was that I was no longer comfortable with it. Most times, I unintentionally skipped my dose.”
Ruth holds firmly to faith that the next child would be a girl. “Another boy? Hopefully not!” She exclaimed. “With the help of doctors’ chart and prayers, as my God has told me to ask and it shall be unto my request, I don’t believe it will be otherwise. By three months, the ultrasound will show it. And by choice, I can do DNC.”
But experts say the misconceptions about family planning are borne out of ignorance about its benefits. Kabir said: “People don’t even understand that the health of the woman is very critical for the survival of the family and also their viability. It affects the family as well as the society.”
According to the expert, family planning methods allow the woman’s body to rest from last birth thus promoting good health, allows her to plan and utilise her time productively. It removes the fear of unintended pregnancy; promotes mother’s nutritional status and reduces maternal ill health and death. “It can save over 1.2 million women of reproductive age annually especially with our high maternal mortality rate – 576 deaths per 100,000 live births.”
But Omasanjuwa said: “That is why we need more awareness from the government to the people. They need to know the many benefits of family planning.”
He listed: For the father, it eliminates the fear of unwanted pregnancy and promotes his social well-being. It allows him to plan for the future of the children; spend more time on the advantages of family planning to mother, father, child, family, community and country.
For the child, family planning reduces infant illness and death; promotes bonding with family; enjoys opportunity for better life, and for the family as a whole, enhances nutrition, promotes economic growth and children’s education.