Family planning, if well harnessed, can reduce maternal mortality by 40 per cent. Yet, more than 60 per cent of women of reproductive age in Nigeria, still have challenges taking up a method, due to high user fees and out-of-pocket payments for medical consumables, BENGBENRO has learned.
In Nigeria, most women of reproductive age do not habitually seek or demand for modern contraceptive methods such as hormonal pills, Intrauterine Contraceptive Device (IUCD) or injectables, rather, they are more comfortable utilizing the withdrawal or rhythm methods among other traditional birth control methods.
Findings by BENGBENRO revealed that the level of acceptance and uptake of family planning services in Nigeria deserves urgent attention if the country hopes to attain the global Family Planning 2020 target of ensuring that additional 120 million women in Nigeria and 68 other developing countries, have access to modern contraceptives of their choice.
According to a groundbreaking international report with the title, “FP2020: Catalyzing Collaboration” by Family Planning 2020, modern methods of contraception have prevented over 2 million unintended pregnancies and 735,000 unsafe abortions between July 2017 and July 2018.
Despite this progress, only 13.3 per cent of women aged 15-49 are using modern contraception in Nigeria, and one-in-four married women aged 15-49 have unmet need for modern contraception.
Some of the women who spoke with BENGBENRO said they had difficulty going to the hospital regularly to collect condoms or pills or asking for the long acting and reversible contraceptives. However, they particularly complained about the high cost of testing for pregnancy and paying for medical consumables like gloves, surgical blades, cotton wool etc.
When Mrs Chinyere Kanayo gave birth to her baby in Ogudu Primary Health Centre, she was educated on the need to take up a family planning method. But she got discouraged when she was ready to take up a method about four months after delivery, because of incessant demand to pay for so many items.
Mrs Kanayo said, “I actually wanted to do the Long Acting Method because of the objection by my husband. He was not really in support, so my plan was to take up one of the modern contraceptives. I planned it one day when I took my son to the PHC for his immunization and was told to go for pregnancy test at a laboratory which will cost me N1500 and then pay an additional N500 for consumables required for the surgery.
“The money is not really too much when compared to the benefits, but I am not working. My husband provides everything for us. How can I tell him I need money for family planning that he is not in support of? That was the only challenge I had.”
When asked how she copes with prevention of pregnancy since her baby is just a year old, she said, “My husband and I have been utilizing the withdrawal method.”
Abike Ahmed who resides in Irede community, in Lagos state said her challenges in accessing family planning services are numerous. “To start with, there is no PHC in the community. “The only way I can access health services is to cross the river that separates Irede, Ikaare and Iyagbe communities from people living in the nearest community that has a functioning PHC.
“I have four children that I am taking care on my own because my husband does not care about us. Though, I have heard about family planning because some government people do come to our community once in a while to educate us on the need to delay pregnancy with family planning, but then, the facility that offers such services is a bit far from my community.
“There was a time I had to look for money for transport to Ojo PHC. On getting there, the nurse said I had to do pregnancy test before she would give me a method. I was frustrated because I don’t have such money. I had to go home that day without taking a method. Then I got pregnant again.
Abike has other problems to contend with. “It is difficult to feed my children, so I cannot use that money for transport fare, because I would have to cross the river to the PHC, and then look for more money for pregnancy test and for other consumables.”
Chinyere and Abike are among millions of women who want to use a contraceptive method of their choice but are unable to. High user fees to family planning services is one major barrier. According to the 2016/17 Multiple Indicators Cluster Survey (MICS), the unmet need for contraceptives is generally high and increasing across the states.
For instance, in Edo state, the unmet need for contraceptive as at 2007 was 22.6 per cent. In 2011, it increased to 29.6 per cent and further increased to 39 per cent.
In Ogun state, the unmet need for contraceptive as at 2007 was 19.3 per cent. In 2011, it increased to 20.7 per cent and 29.6 per cent in 2016/2017.
In Lagos state, the unmet need for contraceptive as at 2007 was 8.1 per cent. In 2011, it increased to 20.2 per cent and further increased to 29.6 per cent in 2016/2017. The survey further revealed that in 2007, women age 15-49 years living in Lagos, currently married or in union and using a contraceptive method stood at 40.6 percent. It dropped to 28.5 per cent in 2011 and 22.6 per cent in 2016/2017.
Despite the reduction in the uptake of contraception, findings revealed that the funds allocated to family planning services in Nigeria is very low compared to other African countries.
According to the FP2020 report, in 2016, the Nigerian government domestic spending on family planning was $8.5 million, compared to $19 million in Kenya.
This funding gap has further affected the uptake of modern contraception in Nigeria as investigation has shown that one of the barriers to access of modern contraceptives for women in Nigeria is high user fees.
The implication of this, according to critical observers in the health industry is that the family planning indices in the country may be further depleted in 2018 because the funds are meant for the procurement of family planning consumables, sensitization of the people and awareness creation on the need to take up a method, training of staff, among others.
The Chairman, Senate Committee on Health, Senator Olarenwaju Tejuosho, has called on the federal government to release additional one million dollars meant for family planning services in the country.
Tejuosho said access to family planning services would help reduce maternal mortality rates in the society.
He said, “The most important thing is the “green dot’’ and every woman should be encouraged to walk into any outlet with the green dot to access family planning services.”
Tejuosho also said that it was important for the nation to improve on their family planning purposes in order to reach its full potential, adding that investment in family planning was one of the smartest investments in achieving demographic dividend.
He therefore admonished the government, private sector and stakeholders to improve on the accessibility of family planning products.
In the views of the Co-chair, Lagos State Accountability Mechanism (LASAM), Barrister Ayo Adebusoye, N92, 676 billion, representing 8.86 per cent of the total Lagos State government budget was allocated to health.
Giving a rundown of the 2018 Lagos state budget, Adebusoye remarked: that: “This puts the state government allocation for health as proportionally higher than the national health allocation of 3.9 per cent, (without the newly passed 1 per cent consolidated revenue fund).
“Though, family planning commodities are funded at the national level but the state is responsible for service provision funding. Of all 36 states, Lagos state was one of the first states to officially disburse budget monies directly for family planning services.
Further he stated: “The only challenge is that actual release of funds is yet to be tracked. We recently found out that a considerable amount, out of the N103 million allocated for family planning services in 2018 was released.
“The state government only released the funds, in December 2018, when nothing can be done. My fear is that the poor family planning indices may remain the same, if not worsened.
“However, I am calling on the government to release the funds allocated to family planning services in 2019 to facilitate activities that would help boost uptake,” he added.
Health Finance and Advocacy Advisor for MamaYe,/Evidence4Action, Esther Agbon, explained that the recent maternal health scorecards conducted by LASAM revealed that uptake of family planning methods in Lagos state is still very low due to high user fees.
“As at the fourth quarter of 2018, Lagos state government did not release funds for the procurement of medical consumables. The funds are meant to procure the consumables in all the health facilities and to eliminate high cost of user fees. It is also meant to create awareness on the need for Lagosians to embrace family planning, that is, to sensitize the people on the need to take up a method.
“The implication of not releasing in a timely manner, the funds allocated to family planning, is that the Contraceptive Prevalence Rate (CPR) would remain the same and the FP2020 goal may not be achieved. By not releasing the funds, nothing changes, the attitude of the people towards family planning would remain the same and that can worsen the achievements made so far.”
As 2018 draws to a close, Agbon however pleaded with the State government to release in a timely manner, the 2019 budget for family planning at all levels and add a separate budget line to the routine monitoring checklist for regular tracking of facilities that have family planning information materials.
She said research has shown that family planning contributes to reducing maternal maternal indirectly by ensuring a woman’s body has sufficient time to recover before another pregnancy.
“The fertility rate of women living in Nigeria is between 6 to 7 per cent and frequent pregnancies can lead to maternal death. Family planning is one sure way to control how frequent a woman gets pregnant.
“It is common knowledge that couples who fail to plan their family often run into the problem of having unwanted pregnancies. When that happens, they may resort to having the babies aborted. Worse still is where such abortion is carried out by quacks under unhygienic conditions. Such abortion may even complicate matters resulting in ailments such as abdominal pain, abnormal vaginal bleeding, vaginal infection or infertility.
“Other health issues such as high blood pressure, anaemia, uterine and placenta problems may arise from unsafe abortion. Regrettably, abortion may lead to death. This is apart from the fact that abortion is illegal in Nigeria,” she added.
The state team leader, the Nigerian Urban Reproductive Health Initiative (NURHI), Dr. Omasanjuwa Edun, said the United Nations Children’s Fund (UNICEF) recent statistics indicates that every single day, Nigeria loses about 2,300 under-five-year olds and 145 women of childbearing age, making the country the second largest contributor to the under-five and maternal mortality rate in the world.
Edun said the maternal mortality rate in Lagos state is almost that of the national. “Incidentally, this high mortality rate of mother and child can be reduced through family planning such as abstinence, natural planning, use of contraceptives, hormonal birth control, etc,” he added.
He recommends at least two years in between two births to reduce maternal and infant deaths. He said, “There is a correlation between children’s and mothers’ health and the intervals between births. The mortality rate among children born at intervals of less than one year, is twice higher than among children born at intervals of two years or more.”
“As for the women, birth spacing has other advantages. For instance, it enables the body of the mother to have enough time to replace lost nutrients after birth before another pregnancy. Thus, she would have more energy and ample opportunity to bond with her child. Moreover, parents would have more time and less financial stress in caring for the family.”
The team leader however called on government to start putting structures in place to ensure that high quality family planning services are available in all public health facilities at no cost and should be available in private clinics, at an affordable price.
“Government should also intensify efforts in creating more awareness and embark on massive sensitization on the need for women of reproductive age to embrace family planning. Part of the awareness messages should be the economic impart family planning would have on the economy of Lagos state and Nigeria at large, if well harnessed,” he added.