Joy Anyim
Increasing the prevalence rate of Family Planning (FP) or contraceptive use, has been identified as a potent and cost effective way of reducing maternal and Infant mortalities, as well as control growing population in any country.
In Nigeria, experts say 512 maternal deaths were recorded in every 100,000 births as at 2018, this is as a 2019 report obtained from the website of the World Health Organisation (WHO), states that Nigeria accounts for close to 20percent of the world maternal deaths.
Also, with a population of over 200million, and a population growth rate of 3.18 percent, Nigeria’s population is expected to hit 450million by 2050, a situation which may not be palatable especially when the greater population may be dependent.
It is to avert a crisis considering the obvious challenges in the country, occasioned by scarce resources, that the Federal government took the bold step to make FP free at all public health facilities in the country.
However, despite coming at no cost, and having tremendous benefits toward achieving demographic dividend, reduction in maternal and infant mortalities, the prevalence rate remains low as less than 20percent of sexually active persons use contraceptives of some sort.
This is in contrast to countries like Rwanda, 45percent, and Ethiopia 27.3 percent, according to USAID Demographic and Health Surveys states.
It was to salvage the situation and fashion modalities on how to increase the use of FP, to achieve the needed result in Nigeria, that the Rotary Action Group for Reproductive Maternal and Child Health (RMCH), recently organised a fives days webinar to train journalists, as well as brainstorm on the way forward.
With the theme “ How Family Planning Contributes to Prevention of Unnecessary Deaths of Women, and Babies and Slows Population Growth ”, experts spoke on the benefits of FP as well as examined challenges impeding the prevalence of FP in the country.
Benefits FP holds formaternal and infant health
Experts at the webinar identified that FP holds social, economic, mental and personal benefit for users.
They stated that with an improved prevalence of FP to say 36 percent by the end of 2020 in Nigeria, 22,000 mothers and 101,000 children will be saved from dying.
A professor of Obstetrics and Gynecology at the Bayero University Kano, Nigeria, Hadiza Galadanci, who spoke extensively on the benefits said that FP can help achieve adequate child spacing, which will prevent unwanted pregnancies as well as save lives lost during unsafe abortion.
Galadanci advocated for four to five years child spacing, as mother, child, family and community will benefit from such.
The professor, who is the Director Africa Centre of Excellence for Population Health and Policy, Aminu Kano Teaching Hospital, emphasised that the health benefits of FP are immediate.
She said: “ The effect of non use of child spacing or family planning will include unwanted pregnancy, unsafe abortion, and in my close to 30year of practice, it is even married couple that come requesting for termination of pregnancies. Unfortunately, terminating a pregnancy is illegal. The law forbids it, so they end up going for unsafe abortions.
“ WHO estimates that 17.6million unsafe abortions are carried out in developing countries annually and mortality rate of 55 per 100,000 live births. In some parts unsafe abortion accounts for up to 10-40 percent of maternal deaths. FP will also reduce complications associated with unsafe abortion, reduce mortality and morbidity associated with unsafe abortion. ”
“ The prevalence of FP will also reduce high risk pregnancies, that is pregnancies that occur too early, too frequent, or too late. Improve birth outcome and delivery of healthy babies. Contraceptive use will reduce prematurity, reduce low birth weight babies, reduce pregnancy related morbidity and mortality, reduce school dropout, because for girls who are in say secondary school, when they get pregnant, they dropout of school.
“ Also with the use of contraceptives, there will be reduced menstrual bleeding, we also use contraceptives to treat premenstrual tension. There will be reduced Iron deficiency which is as a result of less bleeding. Some contraceptives also help in treating acne, there will be improved relationships with spouse, children and people around us.
“ Contraceptive reduces anxiety, improves children’s mental heath and behavioural development, reduces the risk of endometrial cancer, reduces Sexual Transmitted Infections(STI), and HIV, that is with the use of condoms, reduces risk of ectopic pregnancy. ”
Galadanci also highlighted the social benefits of FP saying that it will lead to educational attainment, reduced school absence, ability to graduated achieve educational goals and better employment, increased earning power, increased family development, and societal development.
Similarly, the President Society of Gynaecology and Obstetrics of Nigeria (SOGON), Professor Oluwarotimi Akinola sated that FP will increase the financial potential for families, and improve the quality of life for the community, society and the country.
Akinola who spoke on “ Potentials for Contraceptives in Nigeria”, said with an increase in the use of contraceptives, there will be great decrease in maternal mortality and infant mortality in Nigeria.
The SOGON president said the nation with her current population which does not tally with available resources, is already experiencing a crisis, hence the need to manage population growth.
He said: “ Nigeria’s population is about 210million and it is the most populous country in Africa. With a high population growth rate of 3:18percent, by 2050, Nigeria’s population will hit about 450milliom. Sixty-four percent of the population is below the age of 25, while 45peecent is below the age of 15, so the greater population of Nigeria is dependent not productive.
“ Unemployment rate in Nigeria is put at 23percent which makes desperate youths engage in crime or emigrate to developed countries. Social crisis is on the increase in Nigeria. Kidnapping, insurgency, terrorism, armed robbery and general discontent among youth. These are associated with high rate of unemployment and lack of opportunities for youths. ”
FP and demographic dividend
According to the United Nations Population Fund (UNFPA), demographic dividend is the economic growth potential that can result from shifts in a population’s age structure, mainly when the share of the working-age population (15 to 64) is larger than the non-working age share of the population (14 and younger and 65 and older).
Sadly, Nigeria still has the greater number of her population dependent and not within the working-age, hence the urgent need for FP for a shift to achieve demographic dividend.
In an extensive presentation at the Webinar, Oladapo Shittu, a renowned Professor of Obstetric & Gynaecology at the Ahmadu Bello University Teaching Hospital, Kaduna, said that when birth rate decline significantly, the age structure shifts in favour of more working -age adults.
This he said will accelerate economic growth through increased productivity, greater household savings and lower costs for basic social services provided to a young population.
For Africa and indeed Nigeria to harness demographic dividend, Shittu said more needs to be done.
He said: “ There has to be enhanced political and investments for strong family planning programs, education, and general empowerment of women. We also need enhanced investments in public health for greater child survival and healthy workforce, adopt economic policies and reforms that help develop industries of comparative advantage to ensure mass job creation.
“ Enhance savings and investments. Improve governance and accountable use of public resource and invest in people.”
Challenges of FP in Nigeria.
A major highlight of the webinar was the consensus that some factors, which are surmountable, militates against the prevalence of FP in Nigeria.
According to a Professor of Obstetric and Gynecology at the University of Jos University Teaching Hospital, Josiah Mutihir, religion, culture, and myths influence the usage of contraceptives in Nigeria.
Making a presentation titled “ Strategies for Meeting Contraceptive Needs Across Nigeria”, Mutihir stated that covid-19 pandemic has exposed the gross inadequacies of the health infrastructure in Nigeria.
He said although the unmet need for FP around the world is put at 222 million, Nigeria has a high number of unmet need for FP which is placed at 32percent.
He further stated that FP is a human right issue, as intending users has the freedom of choice on methods that suits them.
Mutihir who prides himself as the only gynaecologist that has done 10 vasectomy in the country said : “ There is influence of culture, tradition, religion and fears of side effect. Myths and misconception about FP also affects its prevalence in Nigeria.
“ The number of health care providers especially in rural areas is also grossly inadequate. Government’s policies, budgets, allocation of funds distribution of commodities are still a challenge.”
Similarly, a trained mid-wife, Evelyn Kutelu, said that a major challenge in the country was in the distribution of FP commodities, especially to rural area. She attributed the inadequacies in distribution to poor record keeping at the state, local government and facility levels.
Kutelu revealed that though different methods of commodity distribution has been adopted in the country, none has addressed the recurrent stock-out in stores and health facilities.
She said: “ FP is an integral part of maternal health, but the challenges in commodity distribution in Nigeria has resulted in stock-out in all the states at different point in time. In spite of the continued support from development partners, donor agencies, and other stakeholders in the health sector. Though there has been improvement, much is still needed to be done to bring the situation under control once and for all. ”
Commenting on the myths and misconceptions, which is a major setback to the use of contraceptives, Kutelu said proactive steps needs to be taken to correct the erroneous beliefs.
“ Myths and misconceptions about FP does exist, though not true, yet they have remained a huge setback in uptake and use of birth control in our society. There is urgent need for more advocacy and sharing of correct information about contraceptives through all media.
“ potential users should visit skilled service providers in hospitals for counselling and safe services, various saw methods are available and informed decision can be made when information is sort from the appropriate quarter.”
The USAID fact sheet for 2017 also has it that financing for FP remains a challenge in Nigeria as yearly allocation is still low, hence the delay in achieving the required goal.
The role of government A Director at the Department of Family Health, Federal Ministry of Health (FMOH), Dr. Salma Anas-Kolo, emphasised that the federal government has remained committed to ensuring availability, accessibility and use of contraceptives.
Anas-Kolo said that the federal government had over the years initiated several programmes to promote the use of contraceptives in the country.
She noted that the minsters of health and finance, were ensuring that the nation meets the FP 2020 goal for 120million women and young girls to access FP, regardless of the pandemic.
Also giving an incite into governments effort, a Director of Reproductive Health at the Federal Ministry of Health, Dr. Kayode Afolabi, said that the Task Shifting and Task Sharing (TSTS) Policy was adopted to help in this regard.
The policy which is the brainchild of the WHO, involves the rational redistribution of tasks among health workforce teams and movements of specific tasks, where appropriate from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more effect use of the available human resources for health.
According Dr. Afolabi, the rationale for the TSTS policy in Nigeria is due to uneven distribution of skilled personnel in the county.
Afolabi who gave a detailed presentation on the TSTS policy, identified other factors why the policy was domesticated in Nigeria, saying it will help increase the access to health care, including FP.
Citing other needs that necessitated TSTS, he said : “ Difficulties ensuring staff retention of higher cadres in certain setting like rural areas, lower salary levels of mid or lower cadres health personnel which reduce the budgetary cost of providing FP services without compromising quality of service and client safety.
“ Availability of more time for the higher cadre health personnel enabling them to better focus on service provision requiring a higher level of technical proficiency, expanding the skills and tasks for providing FP methods to community level as health personnel can significantly improve access to FP information and services.”
He emphasised that task shifting in FP is a strategy for improving access to contraceptive methods thereby contributing to the achievement of health related Sustainable Development Gaols in Nigeria.
Afolabi said TSTS will promote the best use of competency and expertise of well-trained mid-level cadres to meet the Nigerian population health needs.
He noted that states in the country have adopted the policy and it has been yielding results, as significant improvement has been recorded in the access to quality FP services.
Rotray Action Group to the rescue With a success story of assisting the Nigerian government from 1988, in the eradication of polio, the Rotary Action Group launched a project on maternal and child health in 1994 and has since remained consistent.
The Rotary Maternal and Child Health (RMCH) has since 2013, been supporting the Nigerian government with the distribution of Levonorgestrel -Releasing Intrauterine System (LNG-IUS), a safe, effective and acceptable form of contraceptive used by millions of women worldwide.
The past chairman of Rotary Action Group and the national coordinator of RMCH, Professor Emmanuel Lufadejo said the group is also supporting the Maternal and Perinatal Deaths Survellinace and Response (MPDSR) database, a web based platform which is operational nationwide.
MPDSR, is said to be a policy of the Federal government to improve Quality of Care of women of Child bearing age to monitor maternal and infant delivery process to document deaths as a result of child birth and pregnancy complications and to be able to determine the causes of mortalities and to respond by instituting corrective preventive interventions at the facility, community and private levels.
Lufadejo said Rotary has also sponsored à bill for an act to provide for effective surveillance of maternal and perinatal deaths and related matters.
He said the bill had scaled the first reading and awaits the second reading at the National assembly.
He said: “ The emerging evidences from the practical lessons learnt from the operations of the web based electronic platform for data management on MPDSR, across Nigeria since 2015, suggests it has the potential to accelerate rapid reduction in maternal and perinatal death in the country.
“ Rotary initiated a meeting attended by FMOH officials and other stakeholders to propose legislation on MPDSR at the National Assembly on August 23, 2019. The consensus of opinion of stakeholders was that such legislation is timely. The bill was developed and a draft had been sent to the National assembly. ”
Rotary Action group also boasts of the National Obstetric Quality Assurance (NOAQ) Network, which has digitalised the health care system.
Speaking on NOQA, Nicholas Lake, a trained medical statistician, said that the platform covers all levels of health care, gives objective data, and enables intervention. He said the network will embrace MPDSR, amongst others.
Way forward amidst Covid-19 pandemic Covid-19 has dealt a terrible blow on economy of the world and Nigeria has had a share of it. Maternal and child health has also suffered owing to the pandemic.
In a presentation on “ The Impact of Covid-19 on Maternal Health and Family Planning, in Nigeria”, Dr. Anas-Kolo said Covid-19 is an indirect cause of maternal, new born and child morbidity and mortality in Nigeria.
She also stated that the Covid-19 lockdown restriction had affected Reproductive, Matetnal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH+N) implementation and data management.
She said consumption of key commodities which were on upward trajectory between September and December 2019, decreased between January and April 2020.
On the way forward, Dr Anas-Kolo said: “ There is need to put in place mitigations to avoid prolonged interruption to health facility services to prevent very poor health indices especially RMCAH+N action.
Professor Mutihir also called for the active involvement of men, professional bodies, doctors, nurses pharmacists, all healthcare providers, and the media, to increase the usage of contraceptive.
On his path, SOGON president said the government, civil societies, health workers, and journalists must commit to addressing the cause of maternal deaths.
“ Improvement in the status of women through provision of universal basic education, provision of universal health care, promotion of adolescent sexual and reproductive health rights, increase in the national contraceptive prevalence.”
Experts unanimously called on the media to enlighten, educate and furnish the public with information that can help dispel the myths and misconception on FP.
They also called for a collaborative effort on the part of religious leaders, community heads and civil societies to improve the use of FP.
To also reach rural areas, experts said information must be packaged and delivered in a language they understand.