By Chioma Obinna
When Mrs Juliet Adeniji had her fourth child six years ago she and her husband Kola decided to put a stop to childbearing. But in January last year when she missed her period for the first time in six years, she was shocked. Apparently, not expecting to be pregnant as she was following the natural method taught by their church counsellors, she did not that such a method was not as effective as modern contraceptives.
“It caught me by surprise. I never expected I was going to be pregnant again. All through my four children which I had in eight years I never used any form of form of contraceptives whether long or short term to avoid unplanned pregnancy. I only believed in my calculation to know when I am free or not. My husband has quite understood,” Juliet told Good Health Weekly.
According to Juliet, a private school teacher, her religion vehemently opposes family planning of any kind. Although, some women have used it successfully to monitor their monthly cycle, Juliet and some other unmarried women in Lagos have not been successful.
Kehinde Adenekan is one of them. At 28, she is sexually active, but like hundreds of single women in Lagos, did not bother about family planning.
“I never thought of family planning since I was not married even when some of my friends decide to take up injectables form of contraceptives. I refused because I was not married. Today, I have twins out of wedlock,” she told Good Health Weekly.
Bolanle Olabode is currently faced with such a challenge. A stylist with six children is among fewer women in Lagos opposing family planning due to rumours and myths and misconceptions about the various methods of family planning.
Bolanle, after her third child had agreed to adopt family planning but the story of her neighbour changed her decision.
“My friend, Sola, a mother of four was experiencing heavy menstruation flow every month after she adopted the two years long-acting method. Although nurses said it is part of the side effects but I am still afraid,” she narrated.
Unlike Bolanle and Kehinde, Juliet, Yinka case is different. Although she wanted to adopt family planning after giving birth to six children, she cannot afford to pay the little fee demanded by the healthcare centre for what they described as consumables.
She said: “After five children, I don’t have a choice but to go for a long-term acting method but my inability to afford the consumables affected my chances.”
Yinka, a petty trader was faced with challenges of the upkeep of her children and husband. “The first time I went to the health centre, I thought it was free but I was asked to pay some amount of money which I did not have that day. I was still planning for it when I became pregnant for my sixth child,” she said remorsefully.”
While Kehinde was among the hundreds of women opposing family planning under the guise that they were not married, Juliet, Bolanle and Yinka are among the 20 percent of women in Lagos with unplanned pregnancies due to their inability to use any method of family planning, according to the recently released 5th round of the Performance Monitoring and Accountability 2020 (PMA2020) survey, a family planning indicator survey conducted in Lagos.
Nigeria has one of the highest average fertility rates in Africa, yet the uptake of modern contraceptives is one of the lowest in Sub – Sahara Africa. According to the Co-Chair of Bill and Melinda Gates Foundation, Melinda Gates, the reason family planning is so important is that it particularly empowers women to understand their body and have voluntary access to contraceptive as well as time and space the birth of their children.
It is no longer news that it has been established that for every dollar invested in family planning; there is a $6 return.
Ignorance, myths and misconception, culture, poor funding and delay in the release of funds budgeted for family planning services in the various centres have remained a major factors fuelling the increase in the prevalence of unplanned pregnancies in Nigeria, particularly in Lagos State.
An investigation by Good Health Weekly showed that although there is an increase in awareness and uptake for family planning among women in Lagos, family planning services are not completely free in the state. Many of these women are discouraged by the charges placed on registration, consumables and laboratory and pregnancy tests.
Reviewing the result of the 5th round of Lagos PMA2018 during a meeting organised by Pathfinder International for members of the Media Advocacy Working Group, MAWG, in Lagos, Co-Principal Investigator for PMA 2020, Dr. Funmi Olaolorun attributed the increase in unplanned pregnancy among Lagos women on those not on any family planning method.
Olaolorun who is also Senior Lecturer in the University of Medicine Ibadan said 1 in 5 women in Lagos recorded unintended pregnancy in 2018.
According to Olaolorun, although the state recorded an increase in uptake for all methods of Contraceptive Prevalence Rate (CPR), rising from 35.9 percent in all methods in 2017 to 40.3 percent in 2018, the number of unplanned pregnancies among Lagos women increased from 18.3 percent in 2017 to 20.7 in 2018.
The report showed that 14.5 percent of unplanned pregnancy occurred among women who agreed to delay childbearing while 6.1 percent occurred among women who wanted no more children.
A total demand among all women rose from 56.7 percent in 2017 to 58.0 percent in 2018, and demand for modern method rose from 45.8 percent in 2017 to 49.8 percent for all, with a slight increase for married women from 41.1 percent in 2017 to 44.0 percent in 2018.
Continuing, Olaolorun said to stem the increasing unplanned pregnancies, there is a need for women to embrace Long-Acting and Permanent Methods, LAPMs, of Family Planning, instead of condoms and injectables in the State.
She regretted that LAPMs are not on high demand by women in Lagos as it suffered a slight decrease from 4.2 in 2017 to only 4.0 in 2018. LAPMs are longer acting methods such as intrauterine devices and implants, female and male sterilisation.
Furthermore, the report also showed an increase in uptake of modern methods of CPR from 20.6 percent to 22.7 per cent across all women, while married women uptake improved from 23.3 per cent in 2017 to 25.3 per cent as at 2018.
Scoring Nigeria very low in family planning services, she said with 4 percent increase in CPR of all methods and 3 percent increase in mCPR among married women in Lagos, one of the ways to boost uptake and dispel myths and misconceptions, was to encourage women to seek information about family planning because only 25.5 percent of married women are reported using a modern method in 2018.
“We can do better than that, many of them have unmet need, and the unmet need continues to be very high that means we expect them to be using family planning method but they are not using because they don’t want to have a baby in the next two years but they are not using the method. So just getting people to understand that family planning is safe and family planning is available, obtaining the right information and using the method will reduce the proportion of women who report an unintended pregnancy. So women need information and they should be able to access the services which are readily available in the state.”
Olaolorun said despite the fact that some local governments in the State now allocate some of their funds for consumables, where consumables are available; women are still charged for registration and laboratory investigations.
To further boost the uptake of all methods, she said the government can pay for the poorest women who cannot afford it possibly through a voucher system with a view to improving the health of Nigerian women.
“Government said the commodities are free but many times money is not set aside for the consumables. When women pay for registration, consumables like syringes, investigations such as the pregnancy test. So it is not completely free they are still paying out of pocket.
“Implants do not migrate and the side effects of family planning methods are usually very few and I think it is overhyped that family planning can be negative because in the majority of cases it is beneficial to women, ” she said.