Editor’s Note: This week the FP2020 Summit took place in London to discuss efforts to reach the Family Planning 2020 goals and ensure that more women and girls around the world are able to plan their families and their futures. In Nigeria several organisations are making a tremendous effort to ensure that family planning becomes integrated into health services and are striving to improve access for women in dire need of these services. In this week’s blog, Dara Ajala of Nigeria Health Watch explores the efforts of Marie Stopes Nigeria in the nation’s food basket, Benue. This is the first blog in a two-part series.
“When women and girls have access to family planning, they are able to complete their education, create or seize better economic opportunities, and fulfill their full potential—in short, entire families, communities and nations benefit.” ~ FP2020 Summit, London
“Nigeria has one of the world’s fastest growing populations. Based on current trends, it will have become the world’s third most populous country by 2050, with around 100 million women of reproductive age.” ~ Marie Stopes Nigeria
Growing up, when I first heard that Benue is known as the food basket of the nation, I half expected to see low-hanging fruit and food trees lining the streets. I thought my first trip to Benue, which was to document Marie Stopes’ family planning interventions in the state, would be a great way to find out if this was remotely possible. Imagine my surprise as we drove into the city, past the well-tended farmlands and orchards, to see that there was literally foodstuff on display everywhere you turned!
This must be an awesome place to live, I think to myself. Surely no one can go hungry. Yes, the people of Benue state, who seem to have an average of five kids per family have been blessed. Despite the immense hardships they face, including limited of access to health facilities and prohibitive costs of supplies, their children are not malnourished, and for this I am grateful, even as we make our way to Anongo Mbajor PHC, our major destination for the day.
But Benue has a unique challenge. There is a dire need for family planning services, but a majority of the people do not know what services are available or how to access them. We visit the health centre in Anongo Mbajor in Vandekiya LGA, and strike up a few conversations with the women who have gathered that day to access family planning services.
They are tired. With women having to juggle gruelling farm work, house chores, strenuous treks over long distances, in addition to taking care of their children, it is understandable that they are tired. With the rising costs of education for children and the frustration of not being able to provide for the needs of their families, many of the men we spoke to were also ready for an alternative.
And this is why they have come to this PHC today. One of the women, who had been at the health centre since 7 am, told me, “I wanted this family planning method (bilateral tubal ligation) to reduce the poor condition we live in. We don’t have enough land to work with, we don’t have enough to feed and clothe the children we have and send them to school.”
Thankfully the Marie Stopes team is here with us. They are helping to alleviate this nation-wide challenge, based on the evidence that multiple pregnancies can become increasingly demanding for a mother, and can put her and her baby’s life at greater risk. So, they work in states like Benue to support women to plan and space their children through access to appropriate contraception, to educate women about safe motherhood, provide prenatal and obstetric care, train skilled birth attendants, manage complications and emergencies as well as care for mothers after birth.
Today the team at the health centre is focused on an irreversible method of family planning; bilateral tubal ligation. I am surprised how many women have come out for the procedure, and am curious to find out exactly why they have chosen this method. The women are frank with me.
“The children I have are enough for me so that I can attend to them and they will be able to attend school. I was told about the tubal ligation and it is preferable for me so that I can have my rest.”
“I want to do this because the children I have are enough for me. I don’t have enough to take care of all of them. I know that if I adopt it I won’t have any more children and that will make me concentrate on the ones I have.”
The doctor in charge of the bilateral tubal ligation outreach is Dr. Kingsley Odogwu. He is a gynecologist and Head of Clinical Services at Marie Stopes Nigeria. He explains why women in Benue are amenable to this irreversible method of family planning. “I found out that women really want to live a quality life,” he said, adding, “No woman wants to die and they don’t want to go through all the stresses that come with having too many children, not being able to take care of them and so on and so forth.”
The organization’s success in rural, hard to reach areas is due in part to foot soldiers’ knowledge of both the terrain and the people. Outreach Team Leader for Benue State, Ms. Ejiroghene Mayuku, tells us that they work with a network of community mobilizers to get the word out about Marie Stopes services.
“We have community agents that we work with, we have a community mobilizer agent from Benue state, so he discusses with the demand creation managers (DECMAs) and they go to the villages to announce and tell them about family planning. They meet with the traditional rulers and help educate them about family planning so that they can pass this information across. They also go to the churches to announce so that at the time of our arrival, they would have given the community the information they need so they’ll have an idea about what we are coming to do. This also gives them ample time to discuss with their partners and decide on what method of family planning they want and how many years they want to space.”
These community mobilizers have been crucial in dispelling a lot of wrong perceptions community members had about family planning and its objectives. A midwife at the PHC, Mrs Kpilah Esther, told us, “In our community, they used to think that family planning was here to reduce their population. They also used to think that family planning will make the women to become naughty to their husbands but we lecture the people and re-educate them from time to time about family planning. And now that they have received family planning services, they are very happy because they see that it has helped them to control the number of children they give birth to because they have realized that too many unplanned children lead would be very difficult to feed, clothe and educate.”
Over the two days that we are in Benue, the surgical team performed 24 surgical procedures at the PHC in Vandeikya LGA. Dr. Odogwu expressed surprise at how many women have accepted bilateral tubal ligation as a family planning method. In a narrative about one patient, he said:
“One client who I counselled during one of the Marie Stopes outreaches, to my greatest surprise, revealed that what she actually wanted was the permanent method of family planning. I further questioned her to make she that she understood that this method was non-reversible. She emphatically said yes, and that she never even knew that such opportunities existed.”
Besides the irreversible family planning methods, Marie Stopes also provides reversible contraceptive methods for women in the communities. Ejiroghene Mayuku said, “There has been uptake of ‘Jadhel’, IUCD, & Implanon; they also accept all these methods. We also do long-acting reversible contraceptive (LARC) besides these. We even have some here now so if any women requests for it, it’ll be available to her.”
Marie Stopes provides its bilateral tubal ligation services free to its clients. Dr. Odogwu pointed out that a single procedure would normally cost a client roughly between N50,000 to N150,000 depending on where it is done.
He commends the effort that Marie Stopes has made in pushing for family planning services in Nigeria. “Marie Stopes Nigeria has delivered the highest number of services in terms of long term and permanent methods of contraception than any other organization in Nigeria,” he said. “We have worked in very rural areas, we work in very hard to reach communities like this one, we also try to reach out to women who ordinarily would not have access to health facilities where there is a skilled healthcare provider to give them long-acting and reversible family planning methods. We have also brought permanent methods of family planning to the hard to reach areas of the communities.”
As the discussion over family planning takes place on the global scale, there is much still to do in Nigeria. Efforts like that of Marie Stopes we hope will be one more step towards a healthier Nigerian population.
Effiom Nyong, the Country Director of Marie Stopes is currently participating in the FP2020 Summit and will share key learnings from Marie Stopes’ intervention in Nigeria.