By Sola Ogundipe, Chioma Obinna & Gabriel Olawale
“Leave me alone o, don’t kill me this woman! Are you not concerned about the three girls God has given us already? Are those not children? What do you want to do with more? Are you going to sell them? Can’t you feel the harshness of life in Nigeria today? It is enough please.”
These were the angry words of Joseph Okagbaro as he and his wife, Jolaade, engaged in a heated argument.
“What is enough? It is not enough. Am I complaining? Tomorrow, your mother will say I did not give birth to a baby boy and that your family name will be lost. I am not yet done with childbearing,” Jolaade fired back.
This scenario is commonplace in many Nigerian homes. Many families are unable to pay for quality healthcare, provide three square meals, comfortable home and sound education for their children.
It is not unconnected with the economic challenges the nation is facing. Many parents are out of job while those in business cannot make ends meet.
However, just like the saying, “in every disadvantage there is an advantage”, it is not all gloom as the situation in Lagos among other states is encouraging many women of reproductive age to embrace family planning.
More couples are trooping to Lagos Island Maternity to access family planning services.
Sunday Vanguard spoke to some of these families who expressed their newly found love for family planning methods.
It was around noon on a Wednesday that Mrs Yinka Adebayo, 27, and Mrs Modupe Olajide, 32, found themselves among several first timers at the maternity’s Family Planning Clinic. Adebayo was with her two-month-old baby. The two women were in conversation about their homes. Central to their discussion was achieving birth control. They concluded that the falling standard of living was a major reason to seek family planning.
“Financial constraint is the reason I desire to space my children. My husband was retrenched. Any attempt to get pregnant now will be suicidal. We are struggling to eat, if I mistakenly get pregnant, we are in trouble”, Adebayo said.
“I heard about family planning through a friend who she told me to come here. She told me that family planning will help me space my children especially now that my husband has no job to take care of this one that I have”.
On her part, Olajide remarked that hers was a low-income earning family. “I am here for family planning. I want to have another child in three years’ time to enable me take care of my baby and myself.”
Another woman, Mrs. Musilimot Oluwole, told Sunday Vanguard that she was at the clinic to seek family planning guidance following the birth of her first child.
“My husband is a mechanic while I am a petty trader. Business is not moving well, everybody knows that doing business in Nigeria is no longer easy. I am happy that family planning is free,” she said.
To Mrs Bola Abass, a mother of three, delay in embracing family planning was already taking toll on her family. She stated regrettably that feeding her three kids was already a problem. “To have another child in this kind of economic situation in the country will put us in serious financial burden”, she explained.
According to the World Health Organisation, WHO, family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. This, WHO said, could be achieved through the use of contraceptive methods.
According to the 2013 National Demographic Health Survey (NDHS), Nigeria’s Total Fertility Rate (TFR) stood at 5.5 per cent, which family planning experts said would undermine the growth of the nation if not urgently addressed.
Apart from the economic gains of family planning, the methods save lives and avert unintended pregnancies and their complications. Family planning could prevent at least 34 per cent maternal deaths if a proactive government would embrace scaling up of family planning services as one of the maternal survival strategies.
According to NDHS 2013, Maternal Mortality Rate in Nigeria is at 576/100,000 live births, while lifetime risk of maternal deaths is 1:23 per cent. Meanwhile, Nigeria contributes about 14 per cent of the global burden of maternal deaths with about 33,000 Nigerian women dying annually from pregnancy-related causes.
Statistics from the 2013 NDHS, revealed that everyday about 111 women and girls in Nigeria die as a result of preventable pregnancy while birth related complications amount to five women dying every hour. To reverse the alarming indices, the use, access, and expansion of family planning are the way forward.
Thankfully, family planning products are available free of charge in Lagos State. Findings from the Nigeria Family Planning Blueprint 2014-2020 show that Nigeria desires to increase contraceptive prevalence rate from 15 per cent in 2014 to 36 per cent by 2020, while Lagos State is pursuing the agenda of increasing from 48 per cent in 2014 to 74 per cent by 2020. Achieving the Blueprint’s goal would avert 1.6 million unintended pregnancies, and 400,000 infant and 700,000 child deaths in the country.
Statistics from Lagos State government showed that out of 5,460,712 women of reproductive age in the state, an estimated 600,000 women are using a modern method of contraception; hence the state has prevented 143,000 unintended pregnancies, averted 46,000 unsafe abortions and 900 maternal deaths.
Reacting to the development, a reproductive health expert, Dr Mariam Jagun, regretted that funding for family planning was not increasing over the years as most activities are donor-driven.
“Government needs to create budget line and release of funds for family planning at the local government level to cover consumables and other logistics because, approximately, 30 per cent of women in Lagos need a contraceptive but do not have access to it and about 56.0 per cent of youth have intention to use family planning but 33.5 per cent are using”, Jagun said.
“Community involvement and outreaches are crucial to achieving increased family planning uptake. Timely application of Integrated Last Mile distribution of commodities will guarantee the continuous availability of supplies at facilities.
“Strengthen the capacity of health providers both at private and public health facilities in providing longer-term/permanent contraceptive methods as well as logistics management for data management.
“Community health extension workers represent a new potential channel for injectables, but will require training and incentives to scale up delivery. A major shortage of skilled personnel to do insertion for LARCs limits uptake
“We have about 286 health facilities providing family planning services in public sector with minimum of one provider per service delivery point and commodities are readily available and provided free but consumables are not available and procured by clients”.
According to the reproductive health expert, promotion of family planning and ensuring access to preferred contraceptive methods for women and couples is essential to securing the well-being and autonomy of women, while supporting the health and development of communities.
“Mothers and babies will be healthier because risky pregnancies are avoided. Fewer children mean more food for each child. Family planning can also help you and your partner to enjoy sex more because you are not afraid of unwanted pregnancy.
“Contraception can help to avoid unwanted pregnancies and space births; protect against STDs, including HIV/AIDS; and provide other health benefits. It also decreases abortion and advances individuals’ rights to decide their own family size, improves women’s opportunities for education, employment and full growth at the family, community and national levels and also mitigates the impact of population dynamics on natural resources and state stability
“It protects women’s and children’s health by reducing high-risk pregnancies and allowing sufficient time between pregnancies”.
Continuing, she explained that the demographic dividend is the economic growth that arises as a result of changes in population age structure, coupled with investments in education and a policy environment that stimulates economic development.
“Health and demographic impact translates to reduction in maternal deaths by 30 per cent, saves the lives of children under 5 and helps to save $1 on every $6 spent while such savings could be invested in other aspects of health care”, Jagun said.
“It also enables countries to reap dividend based on expanded youth population with good investments in critical sectors of the economy.
“As regards the monetary effect, there is $1.20 per year per capita (averaged across all people in the developing world), with a benefit of $8 per year for every woman who practices modern contraception (averaged across all methods).
“Providing contraception and other reproductive-health services to all who want them would cost $3.6 billion a year, and generate annual benefits of $432 billion or $120 per dollar spent per year.
“Health investments translate to increased desire for smaller families and increased schooling and achievement while educational investment improved human capital and governance reforms lead to increased domestic and foreign investment”.
Myths and misconceptions, fear of contraceptives’ side effects, lack of male involvement, inadequate funding at all levels of government, lack of consumables, religious and socio-cultural restrictions, providers bias and suboptimal counselling of health facilities, limited operating hours, and low proficiency of providers on LARC are among the key barriers to modern family planning uptake in Nigeria.
Perceived risk of becoming pregnant is also low-the stated reason for one–to-two-thirds of women with unmet need.