Health

September 27, 2022

How family planning impacts Nigerian women, economy

Family Planning

By Chioma Obinna

The just-released 2021 Multiple Indicator Cluster Survey, MICS, states that access to and use of effective means to prevent pregnancy, helps enable women and their partners to exercise their rights to decide freely and responsibly the number, and spacing of their children.

The new MICS, jointly released by the United Nations Children’s Fund, UNICEF and the Federal Ministry of Health and other partners, also enables their access to information, education and means to do so. 

This assertion in no small measure has helped many Nigerian women to achieve their potential in life despite the high rate of the country’s fertility.  The new MICS revealed that adolescents in Nigeria have a total birth rate of 75 births per 1,000 women and 25 times higher for women with no education.

Mrs Benedicta Eke will forever be grateful to her friend, Bola Adebayo. For her, what Bola did for her cannot be quantified in any way. After six live births and two stillbirths, her experience trying to avoid pregnancy is indelible. The experience was scary.  She spoke with Good Health Weekly at one of the Primary Health Centres in the Ilasamaja Area of Lagos.

According to her, the decision to embrace  family planning ended her misery and lifted her family out of poverty. 

“I have had six live births and two miscarriages. After the last miscarriage, things became so bad for my family.  My husband lost his job. Though I am a graduate, I have never worked anywhere. Feeding became a problem. Despite this hardship, my husband continues to demand sex.”

Benedicta solely depends on her husband for everything.  She never earned a kobo after marriage. All she did was to get pregnant. Like every other person, she became tired of the situation.   

“I kept complaining but my complaints fell on deaf ears.  I became pregnant again for the 9th time.  I had no choice but to opt for an abortion.”

 Sadly, the abortion resulted in so many complications.  “I almost lost my life until my friend Bola advised me to adopt family planning,” she said in tears.

Today, Benedicta is a proud family planning advocate.   “I have a job now, I am happy and my husband is also happy with me and peace has returned to our home,” elated Benedicta said.  Today, Benedicta who has never earned money before now receives over N100,000 as take home pay  every month. She no longer run to her husband for everything or buy things on credit. 

Ebunola Olawale, 35, had a similar story but was smarter.  After her 3rd child, she  adopted a family planning mothod.  The full-time housewife  and mother of three needed family planning after a devastating miscarriage. But her husband was not ready for it.

In a desperate move, Ebunola decided to visit a Primary Health Centre in her community where she was counselled and given a contraceptive of her choice.

Today, she is employed in a reputable organisation as a communication director.

“My husband who was initially opposed is even happier than me because I now contribute to the training of our three children in school,” Ebunola said.

Like the married women, Nigerian adolescents also face challenges having access to contraception.  Like Benedicta, Ebunola now works in an oil company where her monthly pay covers her family’s expenses. 

Grace, an undergraduate of the Lagos State University, LASU, will forever be grateful for the bold decision she made to use family planning. Although, according to the 19-year-old, the journey to success was not easy.

Her experience at one of the family planning service centres during her first attempt to use modern contraceptives remains unforgettable.

“My encounter with one of the family planning providers was humiliating.  I was almost discouraged.” she told Good Health Weekly.

Grace has sought for a solution to end a nightmare of an abortion she recently had. “I did not want a repeat since I know I will make such mistake again.  There is no point pretending.”

Her genuine quest to prevent untended pregnancy brought her and her friend to the Youth-Friendly Centre where married and unmarried women are counselled and afterwards given the family planning methods of their choice.

Sadly, the provider they met was not friendly.  According to Grace, “we were brought to our knees. We were delayed for hours and questioned like criminals.  My friend decided to leave the centre, but did not and insisted I must have it.

“We were asked if we were Christian and why are we adopting family planning at a young age. Religion, how many boyfriends she had and why she was adopting family planning at a young age. But I insisted I must have it.  Today, I am a proud user of modern contraceptives.  I do not need to worry about unwanted pregnancy or an abortion.  I am healthy and concentrating on my books.”

Grace is part of the 44 per cent of women aged 15-24 that have been exposed to sex, according to the 2021 MICS.  Situations like that of Benedicta, Ebunola and Grace, abound today in Nigeria but the good news is that family planning services are impacting positively on women and curbing population issues.

A Professor/Consultant Obstetrician and Gynaecologist, College of Medicine, University College Hospital, UCH, Ibadan, Prof. Christopher Aimakhu, noted that families that use family planning usually have stronger and healthier children, while  young people that embrace family planning have the likelihood of remaining in school longer than those who do not. 

Aimakhu in a lecture entitled: “Analysis of Family Planning Budget in Nigeria”, at a Rotary Online Training of Journalists explained that family planning is an important tool in the prevention of child and infant deaths, unintended pregnancies, risky births, unsafe abortions, and maternal mortality deaths.

 Noting that Nigeria has a population of about 201,000,000 with a modern Contraceptive Prevalence Rate (mCPR) of 12 per cent and a fertility rate of 5.3, he expressed worry that by 2050 Nigeria’s estimated  population  would be 543 million if not checked.

He said if all 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.

”If a full provision of modern contraception were combined with adequate care for all pregnant women and their newborns, maternal deaths would drop by 68 per cent from 61,000 to 19,000 per year) and newborn deaths would drop by 85 per cent from 255,000 to 38,000 per year.

 In the views of a Consultant Obstetrician/Gynaecologist, Dr Olagunju Ayodele, access to contraception will help Nigeria to curb population explosion, reduce its high fertility rate and ultimately balance the country’s demography.

Ayodele who spoke in an interview with Good Health Weekly explained that access to family planning means the human resource will become optimal while material resources and human resources will be balanced. 

Noting that too many children means much load and burden on the working population, Ayodele who is also the Chef Executive Officer, Purple IVY Medical Consultants Hospital, Ibadan, said the situation will worsen poverty in the environment, especially in a country with one of the highest fertility rate in Africa.

“Imagine our fertility rate as high as 5.6 per woman, meaning that an average Nigerian woman is likely to deliver about 5 to 6 children, which is very high compared to countries like Sweden where their fertility rate is 1.

Ayodele said unchecked fertility rate will lead to population explosion, escalation of crimes, increased poverty, and conditions will get worse while Nigeria will not be able to manage its natural resources that will become too little for the population.

“It will also mean that the little educational packages we have will not be able to take the population, job challenges will increase because more people will not have jobs and more will be searching for jobs if we don’t have access to contraception.”

He said it was also necessary to pay special attention to the contraception needs of adolescents that will grow into becoming the country’s reproductive population.

“It is important for the country to improve adolescents’ contraceptive package so that challenges of abortion will go down.  As we speak now, in Sub-Saharan Africa, the top five killers of women is haemorrhage meaning any condition that results in excessive bleeding.

Number two are hypertensive disorders like eclampsia, and the third is unsafe abortion which means that effective contraception will reduce it, and in addition, reduce morbidities from the procedure.

He stressed the need for Nigeria to remove the human interface between contraception and adolescents for effective family planning services.

“The services here in Nigeria are so complicated such that when you go to a facility to buy condoms it is usually kept close to the cashier and they will give them grudgingly with an attitude showing that why are they having sex?   These attitudes discourage people from accessing contraception.

“Contraception will benefit the country because it will reduce maternal mortality if done effectively.  It will give the country better outcomes because in future the adolescents will be the ones that will now grow into the reproductive population of the country.  If  a lot of them come down with sexual dysfunction it will affect the economy of the country.    They will be spending money on treating their sexual dysfunction, dropping from work and will not contribute optimally to the services of the country,” he stated.