LAGOSIANS, ZIP UP!

“Leave me alone o, don’t kill me this woman! Are you notconcernedaboutthe threegirlsGod has givenusalready? Are those notchildren?Whatdo you wantto do withmore? Are you goingto sell them? Can’t you feel the harshness oflifein Nigeria today? It isenoughplease.”

Thesewere the angrywords ofJoseph Okagbaro asheandhis wife, Jolaade, engaged in a heatedargument.

“What is enough? It is notenough.   Am I complaining? Tomorrow, your motherwill sayIdid not givebirthto a babyboyand that yourfamilyname willbe lost.   I am notyetdonewithchildbearing,” Jolaade fired back.

Thisscenariois commonplace in many Nigerianhomes. Many families are unable to payfor quality healthcare, provide three square meals, comfortable home and sound education for their children.

It is not unconnected withthe economic challengesthenation is facing. Many parentsareout ofjob while those in businesscannot make endsmeet.

However, just likethesaying, “in every disadvantage there is anadvantage”, it is notallgloom as the situation in Lagos among other states is encouragingmany women ofreproductive age to embrace family planning.

Morecouplesaretrooping to LagosIsland Maternityto accessfamily planning services.

SundayVanguard spoke to someofthese familieswho expressed their newly found love for familyplanningmethods.

It was aroundnoon ona Wednesday that Mrs Yinka Adebayo, 27, and Mrs Modupe Olajide, 32, foundthemselves among several firsttimers at the maternity’s FamilyPlanning Clinic.   Adebayo waswith her two-month-old baby. The twowomen were in conversation about theirhomes. Centralto their discussion wasachieving birth control. They concluded that the falling standard ofliving wasamajor reason to seekfamily planning.

“Financial constraintis thereason Idesire to spacemychildren. My husband was retrenched.Any attempt to get pregnant now will be suicidal. We are strugglingto eat, if I mistakenly getpregnant, wearein trouble”, Adebayosaid.

“I heard about familyplanning througha friendwho she toldme to come here. She toldme that familyplanningwill help me space my childrenespecially now that my husband has nojobto take careofthis one that I have”.

Onher part, Olajide remarked that hers wasalow-income earning family. “I am herefor familyplanning. I want to have anotherchild in three years’ time to enable me takecare ofmy babyandmyself.”

Anotherwoman, Mrs. Musilimot Oluwole, toldSunday Vanguardthat she wasat the clinic to seekfamilyplanningguidance following thebirthofher firstchild.

“My husband is amechanic while Iama pettytrader. Business is not moving well, everybodyknows that doingbusiness in Nigeria is nolonger easy. I am happythat family planning isfree,” she said.

To Mrs BolaAbass,a motherofthree, delay in embracingfamilyplanningwasalready takingtoll onher family. She stated regrettablythat feedingher threekidswas alreadyaproblem. “To haveanother child in this kind ofeconomic situation in the countrywillput usin seriousfinancial burden”, she explained.

According to theWorld HealthOrganisation, WHO, familyplanningallowsindividuals and couplesto anticipate andattaintheir desired number ofchildrenand thespacing andtiming oftheirbirths. This, WHO said, could be achieved through theuse of contraceptive methods.

According to the2013 National Demographic HealthSurvey (NDHS), Nigeria’s Total Fertility Rate (TFR) stoodat 5.5 per cent, which familyplanning experts said would underminethegrowth of the nationif not urgently addressed.

Economic gains

Apartfrom the economic gainsoffamily planning, the methods savelivesandavert unintended pregnancies andtheir complications. Family planningcould prevent at least34per centmaternal deaths if a proactivegovernment would embracescalingup offamilyplanning services asone ofthe maternalsurvival strategies.

According to NDHS 2013, Maternal Mortality Rate inNigeria is at 576/100,000 live births, while lifetimerisk ofmaternal deaths is 1:23 per cent. Meanwhile, Nigeria contributes about 14percent oftheglobal burden of maternal deaths with about 33,000 Nigerian women dying annually from pregnancy-related causes.

Statistics from the 2013 NDHS, revealed that everydayabout 111 womenand girls in Nigeria dieasaresult ofpreventable pregnancy while birth relatedcomplications amount to fivewomen dying every hour. To reverse thealarmingindices, the use, access, and expansion offamilyplanning arethe wayforward.

Thankfully, familyplanningproducts are available freeofchargeinLagosState. Findings fromtheNigeria Family Planning Blueprint 2014-2020 showthat Nigeria desiresto increasecontraceptive prevalence ratefrom 15percent in 2014 to 36percentby2020, while LagosState is pursuingtheagendaofincreasing from48 percentin 2014to 74percent by2020. Achieving theBlueprint’s goal would avert 1.6 million unintended pregnancies,and 400,000 infantand 700,000 child deathsin thecountry.

Statistics from Lagos Stategovernment showedthat out of5,460,712 womenof reproductive ageinthestate, an estimated 600,000 women are using amodern method ofcontraception;hence the state has prevented143,000 unintended pregnancies, averted 46,000 unsafe abortions and 900 maternal deaths.

Reactingto the development, a reproductive health expert, Dr Mariam Jagun, regretted that funding for family planningwasnot increasing overtheyears as most activities are donor-driven.

“Government needs to createbudgetline andreleaseoffunds for familyplanningat thelocalgovernmentlevel to cover consumables and other logisticsbecause, approximately, 30percent ofwomen in Lagosneeda contraceptive but do not haveaccessto itandabout 56.0 per centof youth have intention to use familyplanning but 33.5 percent areusing”, Jagun said.

“Community involvement and outreaches arecrucial to achievingincreasedfamily planninguptake.Timely applicationof IntegratedLast Miledistribution of commodities will guarantee thecontinuous availability ofsupplies at facilities.

“Strengthen the capacity ofhealth providers both at privateand public health facilities in providing longer-term/ permanent contraceptive methods as well as logisticsmanagementfor data management.

“Community health extension workers representanew potential channel for injectables, butwillrequiretrainingand incentives to scaleup delivery. A major shortageofskilledpersonnel to do insertionfor LARCs limitsuptake

“We have about286health facilities providingfamilyplanningservices inpublic sectorwith minimumof oneprovider per servicedelivery pointandcommoditiesare readily availableandprovidedfreebut consumables are notavailableand procured byclients”.

According to thereproductive health expert, promotion offamilyplanningand ensuring access to preferredcontraceptive methods for womenand couplesis essential to securing the well-being and autonomy ofwomen, while supporting the healthand development ofcommunities.

“Mothers and babies will be healthier because risky pregnanciesare avoided. Fewer childrenmean more food for each child.Family planningcanalsohelp you and yourpartner to enjoysex more because you are notafraid of unwanted pregnancy.

“Contraception can help to avoidunwanted pregnanciesand space births;protect againstSTDs,includingHIV/AIDS; and provide other health benefits. It also decreasesabortionand advances individuals’ rights to decidetheir own family size, improves women’s opportunities for education, employment andfullgrowthat thefamily, community andnational levelsand alsomitigates the impact ofpopulationdynamics onnatural resourcesandstatestability

“It protects women’s and children’s health byreducinghigh-risk pregnancies and allowing sufficient time between pregnancies”.

Demographic dividend

Continuing, she explained that the demographicdividendis theeconomic growththat arisesas a result ofchanges in populationage structure, coupledwith investments in education and apolicy environmentthat stimulates economic development.

“Health and demographic impact translates to reductionin maternaldeathsby30per cent, saves the livesofchildrenunder5and helpsto save$1 on every $6spentwhile such savings could be invested in other aspects ofhealth care”, Jagunsaid.

“It alsoenablescountries to reap dividend basedonexpanded youth populationwith good investmentsin critical sectorsofthe economy.

“As regards the monetary effect, there is $1.20 peryearpercapita(averaged across allpeople inthedevelopingworld), with a benefit of $8per yearfor every woman who practicesmoderncontraception (averaged across allmethods).

“Providing contraceptionand other reproductive-health services to allwho want them would cost $3.6 billion a year, andgenerate annualbenefitsof$432 billion or $120 per dollar spentperyear.

“Health investments translate to increased desire for smallerfamilies andincreased schoolingand achievementwhile educational investmentimproved human capital and governancereforms lead to increaseddomesticandforeign investment”.

Key barriers

Mythsand misconceptions, fear of contraceptives’ side effects, lackofmale involvement, inadequate funding at all levels ofgovernment,lackofconsumables, religiousand socio-cultural restrictions, providers bias andsuboptimalcounselling of health facilities, limited operating hours, andlowproficiency ofprovidersonLARC areamong the key barriers to modern family planning uptakein Nigeria.

Perceived risk ofbecoming pregnant isalso low-the stated reason for one–to-two-thirds of womenwith unmet need.