By Chioma Obinna
Nigeria may become the third among the 10 most populous countries in the world by 2050, if the projection of the United Nations, UN, report, ‘World Population Prospects: The 2015 Revision’, is anything to go by.
According to the report, currently, the country is the 7th largest in the world. The population is growing rapidly and is projected to surpass that of the United States by 2050.
Unfortunately, with a fertility rate of 5.39, higher than the global fertility average rate of 2.5, if not checked, experts say this may cause a population explosion that would throw the country into extreme poverty.
It is also believed that overpopulation could worsen the already unacceptable health indices of the country, put a strain on basic amenities and escalate outbreaks of diseases.
However, family planning has been identified as one of the major strategies and cures for the rapidly growing population. This may have prompted the Federal government commitment to the FP2020 aimed at achieving a Contraceptive Prevalence of 27 per cent.
Sadly, despite good policies, strategies and set targets on family planning access by the Nigerian government, there have not been any significant outcomes nine years after Nigeria adopted family planning as a tool to slow population growth, reduce infant and women’s death from childbirth. Sunday Vanguard reports:
Precisely in 2012, Nigeria pledged to achieve a target of 36 per cent Contraceptive Prevalence Rate by 2018. After the review of the target in 2017, the Federal Government pledged to achieve a Modern Contraceptive Prevalence Rate, MCPR, of 27 per cent among women aged 15¬–49, regardless of marital status, by 2020.
But Nigeria’s latest National Demographic and Health Survey, NDHS, shows that the CPR is still far below the target, which means that the country failed to meet the global target it promised along with other countries.
Currently, the 2018 NDHS shows that the country’s CPR stands at 17 per cent in married women and 14 per cent among all women.
Although the NDHS report shows a slight increase from 1990, the increase was insignificant compared to the population of women.
As the worlds roll out drums to celebrate another world Contraceptive Day today, experts lament that though Nigeria has the best of policies and strategies to meet the family planning target, the outcomes have been poor due to poor budgeting and non-investment at the sub-national levels – state and local government.
According to a family planning expert, Dr Ejike Orji, even though it is on record that the country budgeted $3m and eventually upgraded to $4 million for family planning commodities and services, there have not been effective releases of the fund.
Orji, who is the Chairman of Association for the Advancement of Family Planning, AAFP, said statistics show that the Nigerian government has continued to lag behind in budgeting for domestic funding to improve family planning services.
Orji identified leadership, governance and service delivery structures as some of the issues hampering family planning progress, maintaining that the major challenges were at the sub-national levels – state and local levels.
He said states are not budgeting enough for family planning while most of the states don’t even have a line item for family planning services in their budget or commodities.
Orji said the situation has led to a lot of stock out, adding that most states do not even put money on-demand generation.
“As we speak, the little that has been done, 20 per cent of the Nigerian women said they want family planning but they are not getting it. So that means that we are not meeting the demands of the women, he lamented.
He said his association (Association for the Advancement of Family Planning 2010-2011) was able to convince the Federal Government to make family planning free in all government hospitals.
Orji disclosed that the country was in the process of reconstituting again for 2030, warning that, this time, the civil society groups and the media should make governors and local government chairmen tell them what they are doing.
In a report by the Guttmacher Institute, of the 45 million Nigerian women of reproductive age (15¬–49), 15.7 million are sexually active and do not want a child for at least two years, saying they may not have access to family planning due to lack of funding.
The institute report notes that, of the estimated 10.3 million pregnancies in Nigeria, 24 per cent were unintended and women with an unmet need for modern contraception accounted for 90 per cent of all unintended pregnancies.
According to the report, if all the unmet needs for modern contraception in Nigeria were satisfied, unintended pregnancies would drop by 77 per cent, from 2.5 million to 555,000 per year.
As a result, the annual number of unplanned births would decrease from 885,000 to 200,000 and the number of abortions would drop from 1.3 million to 287,000 respectively.
The report further explains that meeting the need for modern contraception among women in Nigeria who want to prevent pregnancy will cost $546 million annually, an increase of $478 million over current costs. This additional investment would provide improved quality of care for current users and coverage for new users.
Citing the important roles of contraceptives in controlling population and poverty, it says some years back, China and India took a decision to reduce the fertility rate of the country and, today, their economy improved from what it used to be.
“Our fertility rate is 5.3. In 1994, today the world has an average of 2.5 per woman”, the report says.
“We should, first of all, reduce the fertility rate. Secondly, it is important for people to have an accessible, qualitative and relevant healthcare system.
“There is a need to invest massively in education.
“Fourth thing is to build an environment that is the ease of doing business then those young people will build their businesses and it will improve the economy and that will be income per capital that environment will encourage direct employment”
Orji, elaborating on the need for family planning, said there was a need to build the intangible wealth of a nation as when there is an atmosphere of freedom, equity, fairness and rule of law, justice, and stability, Nigeria will become a country everyone will like to live in.
On how the COVID-19 pandemic has affected family planning services, he said the advent has affected the international initiatives that would have helped Nigeria to meet the target.
“Initially, we set 36 per cent CPR which was signed during the London Summit in 2012, we said we will attain 36 per cent by 2020, it became obvious to us that our trajectory wasn’t going to meet that target so we reduced it to 27 per cent”, the AAFP Chairman said.
“And then when it was getting near to 2020 we moved it again to 2024.
“So when the last NDHS came out, our family planning rate added only two per cent from 2012.”
According to him, the pandemic worsened and disrupted services both in terms of commodity deliveries in the country and the service delivery side and women couldn’t go to get services.
Orji went on, “Not only that family planning services were disrupted, we also saw what we call ‘shadow pandemic’ globally.
“Some couples that have managed to be living with each other because of the lockdown, such couples now have to stay with each other by force.
“And then, some men, who ordinarily were dealing with sex with their wives, and were not giving so much trouble because they had to go outside, but now they were all locked in and, if they demanded and their wives were not giving, they took it by force.
“Even beyond that was a lot of sexual violence, out of marriage, those are what we dub as shadow pandemic. This is the problem we have in our hands”.
He said the World Contraception Day was established in 2007 to bring attention to family planning, saying it preaches access to comprehensive contraceptives so that every woman having sex doesn’t have to get pregnant.
Non release of funds create huge gap – Pathfinder boss
Also speaking with Sunday Vanguard, Senior Program Advisor Reproductive Health, Pathfinder International, Dr Sakina Amin Bello, who said Nigeria was not absolutely on track to achieving family target, said non-release of funds created a huge gap in meeting the target.
“Why family planning services were added as essential services in some states, funds to procure commodities were not released.”
She said investment in family planning is both impactful and cost-effective”, Bello said.
“We should intensify effort to call for increased funding for family planning by government at all levels.”
She stressed the need for more investment, enabling policies and demand for accountability.
On how COVID-19 has affected access to family planning in Nigeria, Bello said: “COVID-19 came unexpectedly and slowed down sexual and reproductive health services including family planning”.
The expert said measures put in place to circumvent the impact produced little results, adding that the fear of COVID-19 among health care providers and clients increased and led to a reduction in client visits to health facilities.
She added that family planning funds were diverted to COVID-19.
“For instance, states that added family planning in their budget lines did not release the fund because they had to respond to the pandemic”, Bello stated.
Speaking on the link between family planning and population as well as the economy, she explained that high fertility can impose costly burdens on any developing nation.
“It may hamper opportunities for economic development, increase health risks for children and women, and wear down the quality of life by reducing access to education, nutrition, and employment”, the expert said.
Family planning use in Nigeria
According to the NDHS, the use of family planning has increased from 6 per cent in 1990 to 17 per cent in 2018.
The report also shows that during the same period, modern method use increased from 4 per cent in 1990 to 10 per cent in 2008 and 2013 and then slightly increased to 12 per cent in 2018.
It also shows that 17 per cent of married women aged 15-49 use any method of family planning—12 per cent use a modern method and 5 per cent use a traditional method. The most popular methods are implants (3 per cent), injectables (3 per cent) and withdrawal (3 per cent). Among sexually active, unmarried women aged 15-49, 28 per cent use a modern method and 9 per cent use a traditional method.
Also, the use of modern methods of family planning among married women varies by residence, wealth and state. Modern method use is higher among urban women (18 per cent) than rural women (8 per cent).
Also, modern method use ranges from a low of 2 per cent in both Sokoto and Yobe states to a high of 29 per cent in Lagos.
According to the World Health Organisation, WHO, 100,000 maternal deaths could be prevented each year, if women who did not want children adopt contraception.