By Chibuzo Ihegboro
As Africa’s most populous country, Nigeria is currently the seventh rank in world population. 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.
While Nigeria has the largest economy in Africa, its population growth “is outpacing the economic growth and increasing the poverty risk for many Nigerians”, warned Professor Robert Zinser, CEO, 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.”
According to Nigeria’s Demographic and Health Survey (NDHS) 2018, out of 100,000 women 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.
These dire indicators underscore the need to control population. The obvious solution is the embrace of family planning which is the conscious effort of couples using contraceptives to limit or space the number of children they want to have. Provision of modern contraceptive methods is one of the main components of sustainable development and poverty alleviation. With fewer children, families spend less income on immediate survival needs of food, housing and clothing and will have savings for education or investment capital.
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. While the country has managed to increase the CPR to 17 per cent, there is still, however, much work to be done.
For instance, 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 per cent 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.
Many hospitals are not able to fulfil the needs for family planning products and services. 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 frequently out of stock with contraceptive commodities. Where they are available, many centres still lack the equipment to administer the contraceptives like implants and Intrauterine devices.
The second problem is rooted 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. Going to school long enough allows girls to delay childbearing and 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 the 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.”
In 2012, the Nigerian government pledged to provide $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 with demand-creating communication campaign was designed by Nigeria’s Federal Ministry of Health focusing on increasing the knowledge and uptake of modern family planning 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 by improving the 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. The campaign builds on a model 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 across the 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.”