With 21 children, Mustafa says, had he learnt about family planning and its benefits earlier, he would have had fewer. His oldest child is 33 years and the youngest is nine.
“I did not plan to have many. It just happened that my wives and I had them. Every year, my wives would each give birth. The knowledge of family planning came late when I had 18 children,” Mustafa says. He has two wives, Mastula and Amina. “By this time, I wanted to stop but I did not know what to do.”
Mustafa’s story is a reflection of current studies and statistics, it mirrors the lives of many families in the poorest communities of Africa. Yet, Nigeria is special as it is already the most populous African nation and on the seventh rank in the world. 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.
“Although Nigeria has the largest economy in Africa, population growth is outpacing the economic growth and increasing the poverty risk for many Nigerians!”, explains Professor Robert Zinser, CEO of the 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”
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. Today, the country has managed to increase the CPR to17 per cent, but there is still much work to be done.
Family planning is the conscious effort of couples using contraceptives to limit or space the number of children they want to have. Using modern contraceptives also helps reduce maternal and infant deaths. According to Nigeria’s Demographic and Health Survey (NDHS) 2018, out of 100,000 woman 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.
Provision of modern contraceptive methods is one of the main components of sustainable development and poverty alleviation. When couples have fewer children, they spend less income on immediate survival needs of food, housing and clothing, leaving some savings for education or investment capital. Education and investment create productivity, make industries grow and raise employment. When people work, the government can tax their incomes and generate capital to invest in important sectors such as education, infrastructure, health and food production. This contributes to long-term productivity and raises the living standards of the people.
So what is stopping Nigeria from achieving its desired family planning goals? And how can the country prevent more and more families from falling into a poverty trap without any chance of escape?
Nigeria’s Demographic and Health Survey states that one of the many ways Nigeria can avert this situation is by increasing the knowledge and use of modern family planning methods among women of reproductive age. It estimates that meeting women’s need for modern contraceptives can prevent about one-third of all maternal deaths.
However, 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 percent 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.
And here is where the problem comes from. Many women who expressed a desire to delay their next pregnancy by at least two years were not using a modern method of contraception because they lack access to contraceptives.
Many hospitals are not able to fulfill the needs for family planning products and services. And even worse: 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 hit with frequent stock-outs of contraceptive commodities and, where they are available, many centres still lack equipment to administer the contraceptives like implants and Intrauterine devices.
The second problem affecting uptake has its roots 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. Yet, going to school long enough allows girls to delay child bearing but 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 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.”
What Nigeria can do
In 2012, the government pledged to provide US$ 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 and demand creating communication campaign was designed by Nigeria’s Federal Ministry of Health focusing on increasing the knowledge and uptake of Modern FP 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. This campaign builds on a model that was 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 over all 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.”