In 2018, on a work assignment to a rural community in Kebbi State, our team interviewed a woman who had given birth to 24 children. Her elderly husband had prevented her from going to a local clinic to get advice about family planning. He did not believe in it and was open to having more children, because, of the 24 children, six had died. While we were visiting the family, her husband spoke for her, and the woman could only nod in agreement. According to the 2018 Nigeria Demographic and Health Survey, demand for family planning is lowest among currently married women in the Northwest, particularly women in Kebbi and Sokoto States, at 15% respectively.
In spite of dedicated advocacy from organisations like Marie Stopes International (MSI), Society for Family Health (SFH), and projects like the Nigerian Urban Reproductive Health Initiative (NURHI), there is no refuting the fact that women are still being denied the right to make decisions about their sexual and reproductive needs. A woman who doesn’t have control over these three things: her healthcare, her contraception needs and whether she wants to engage in any sexual activity, cannot be said to have bodily autonomy. The United Nations Population Fund (UNFPA) report, My Body is My Own found that in Nigeria, 46% of women aged 15-49 years make their own decisions about health care, contraception and sex with their husbands or partners.
Family planning blueprint
Access to contraception is critical to women’s health and social and economic well-being. It allows women to make more informed decisions about their health and bodies, including when and how many children they want to have. Sustainable Development Goals 3 and 5, which speak to health and wellbeing and gender equality and women empowerment respectively, are linked to access to reproductive health commodities and services. It will be impossible to end poverty and hunger, ensure quality education for all and promote sustained economic growth, without ensuring that every woman has access to quality, rights-based family planning services.
Nigeria Health Watch
According to the Nigeria Demographic and Health Survey (NDHS) 2018, Nigeria’s national contraceptive prevalence rate (CPR) and modern contraceptive prevalence rate (mCPR) are 18% and 13% among all women and 17% and 12% among married women, respectively. Although this revealed an average of a 2%-point increase in CPR and mCPR among both married and all women from the NDHS 2013, it fell short of the national goal of increasing CPR to 36% by 2018. The current goal set for the revised National Family Planning Blueprint (2020-2024) is 27% mCPR by 2024 which represents a projected 3% annual growth from the present national mCPR.
Nigeria Health Watch
In collaboration with the private sector and other partners, the Nigerian government has introduced several initiatives to encourage increased uptake. However, the absence of adequate funding for family planning or public awareness campaigns on child spacing in the 2022 budget can limit the chances of achieving the goal set in the revised national family planning blueprint.
Spousal opposition to uptake of family planning services
There are several factors behind the low demand and high unmet need for modern family planning services in the country: myths and misconceptions about modern methods of contraception, low awareness about its benefits among traditional and religious leaders, fear of side effects, family planning provider bias and spousal opposition among women of reproductive age.
Regarding spousal opposition, women point to their male partner’s resistance to family planning as a significant barrier to uptake and maintenance of continuous use of family planning methods, resulting in them making the decision to use contraception secretly or not at all. Therefore, a situation where a woman is denied the right to make decisions about her sexual and reproductive health cannot be overlooked. Programmes that solely engage men in the family planning discourse with the aim of enhancing communication and destigmatising family planning have been piloted and while they have achieved some measure of success, the opposition still exists.
Nigeria Health Watch
In rural India, for example, the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) intervention, a multi-session intervention -presented to males alone but including a session with their wives – was designed in 2015 to improve male engagement in family planning. The CHARM model was successful because it was created exclusively for males and includes gender equality to counteract male reproductive control ideas.
Tackling the opposition
One of the many benefits of family planning is the reduction in unplanned pregnancies and maternal mortality. Programs designed to engage with men should seek to understand men’s attitudes and perceptions towards female contraceptive use. They should be designed to effectively address the factors that are limiting their involvement. An in-depth understanding of the rationale for a partner’s opposition can help in the tailoring of activities to address some of the misconceptions about family planning
Deliberate efforts should be made in schools to educate boys and girls about sexual and reproductive health and rights. This will equip and empower them with the right information to counter arguments, dispel myths and enable them to make better informed decisions.
To strengthen the uptake of family planning services, the government must keep in focus the 2030 Agenda for Sustainable Development, which emphasises that achieving gender equality is a matter of human rights, calls for the adoption and strengthening of sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels.
At over 200 million, Nigeria has the largest population in Africa. The United Nations has projected that the overall population of Nigeria will reach about 401.31 million by the end of the year 2050. However, as noted in the recently published Lancet Nigeria Commission, the population projection is premised on a decline in the current fertility rate from 5.1 to 3.3 by 2050. To address the population growth rate, the government must make a concerted effort to ensure that there is adequate funding for family planning services.
In addition, there is a need to ensure that adolescent girls stay in school. When adolescent girls stay in school, it leads to greater literacy, increased economic productivity and growth from higher wages. It also reduces early marriage, delaying the first birth and so when they do start having families, they are better able to plan how many children they have and when.
In addition, effective programmes need to be put in place to ensure that men are well informed about the value and economic benefits of planning families better. This is in terms of the health and well-being of the children and their wives. Men could be effective changemakers in ensuring that women have access to sexual and reproductive health services and products and are able to have greater autonomy over their bodies.