By Sola Ogundipe

SOME months ago, a 13-year-old girl turned up at the Family Planning Clinic in one of the Mother & Child Centres, MCCs, in Lagos. Family planning providers were shocked to discover, on examination, that the unnamed girl had a contraceptive device—the Intra-Uterine Contraceptive Device, IUCD (a.k.a The Coil) inserted as a fertility control method.

The Matron at the Clinic, who later related the story, recalled that the girl in question, who was then a student at an educational institution in Ogun State, was accompanied by her father. Following the unexpected discovery, the girl was queried how she came about having such a sophisticated family planning device inserted at such a young age, particularly when she was most likely unmarried. Initially, the girl was not forthcoming with any reasonable response.

More dismayed than they could imagine, the health care providers couldn’t stop wondering why a 13-year-old would be wearing a contraceptive device. Apart from indicating sexual activity, it was ill-advised and illegal. Probed further to disclose who introduced family planning to her, the girl would not yield and no amount of threat or plea would make her talk.

Attempts by the father to manipulate the girl’s responses quickly became obvious. Although he declined to talk, the man appeared uncomfortable, nervous and restless. Suspicious health providers asked him to step out while the girl was further questioned. On closer examination, the girl opened up and admitted to undergoing a previous pregnancy termination through Dilatation & Curettage (D&C) with the approval of the father.

As if that was not bad enough, the girl confirmed it was her father who took her for the procedure and even paid for it. Further, she claimed that afterward her father took her to “a place” where she was asked to lie down, and the IUCD (Copper-T) was put inside her. Even as the health workers’ amazement slowly turned into fury, the girl became agitated and began to plead that they shouldn’t let her father know she had let the cat out of the bag.

Don’t tell my father, she pleaded. He would stop paying my school fees if you challenge him. He has many daughters, but I am the only girl he is sending to school. She fears that he would stop sponsoring her education if he was indicted. Unexpectedly, she burst into tears. The Matron was in a dilemma.

If she challenged the father, the girl risked losing her source of education; and if she said nothing, the girl risked pregnancy and another D&C, or contracting a sexually transmitted infection, or even worse. After weighing the options, the Matron checked the coil, ensuring it was well positioned and that she felt comfortable wearing it. Then she sent the girl to the family planning counselors.

The Matron did not confront or cross-examine the father. She said she chose not to for obvious reasons. Although duty-bound to hand over the girl to the social welfare unit, the Matron claimed she declined to do that because of the girl’s appeal. This case in question, though unusual is not uncommon. Scores of instances like this readily occur.

Essentially, the Lagos state government’s policy for family planning covers persons aged 18 and above. At 13, the girl is a minor and legally unqualified for any family planning method. But the converse happens. Several young and underage girls do request and obtain contraceptives. Although the legal age for consent to sexual activity is 18, surveys suggest that at least one in three teenagers have had sexual intercourse before this time.

Teenage pregnancy rates in Nigeria are currently on the rise. But the use of contraception is still low, according to studies. Successful reduction in teenage pregnancy is achieved where an open, tolerant, pragmatic attitude to sexuality is adopted with effective programmes of sex education and confidential contraceptive advice.

Teenage pregnancy is a serious social problem. Having children at a young age often damages a young woman’s mental and physical health, limit her education and career prospects, and increase risk of living in poverty and social isolation. Pregnancy termination carries its own medical and emotional adverse effects, whilst continuing pregnancy carries a higher risk of maternal and foetal disadvantage.

Worse still, women pregnant in their teens are more likely to suffer complications and their babies at even more risk. Generally, before providing contraceptive advice or treatment to a competent young person aged less than 18 years, a health professional needs to be satisfied that: The young person could understand the advice and have sufficient maturity to understand what was involved in terms of the moral, social and emotional implications.

A young person’s best interests required the health professional to give contraceptive advice or treatment or both without parental consent. It may help to provide information of all methods of contraception, their benefits and risks to allow informed choice. Age alone should not limit contraceptive choices, including intrauterine methods. But many methods are not recommended for women below 18 years of age because safety and efficacy have only been established for women aged 18 to 40 years.