A major barrier to accessing family planning commodities in the country is the out-of-pocket cost of consumables, especially at the local government supported Primary Healthcare Centres (PHCs). But increasing budget lines for family planning as well their timely release would make needed services more accessible. APPOLONIA ADEYEMI reports
Living in Nigeria with a growing population estimated at 198 million by the National Population Commission (NpopC), it is common to hear about advocacy groups promoting the use of family planning to curb the exponential population.
Such advocacies are usually hinged on curbing population growth, which experts said was growing beyond available resources; it was also geared to highlight numerous health benefits that are associated with adopting and using family planning.
The World Health Organisation (WHO) defines family planning as something that “allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods.”
For instance, pregnancies that are too early, too close, too late or too many carry extra hazards not only for the health of the woman but also for the child and based on these benefits and more, advocates of family planning raise the current level of awareness in this regard, while speaking positively for the adoption and use of family planning.
The highlighted points above are some of the issues discussed at the World Contraceptive Day 2019 Media Dialogue on Family Planning in Lagos State, which was organised by Pathfinder International Nigeria.
The World Contraception Day is a worldwide campaign observed annually on September 26, with the aim to improve awareness of contraception and to enable young people to make informed choices on their sexual and reproductive health (SRH).
The media forum sought amongst other issues, to unpack the significance of contraception, drive conversation with key cross-sectoral stakeholders in the Adolesecent and Youth Sexual Reproductive Health (AYSRH) space with a view to securing more efficient funding for AYSRH in Lagos State.
Among family experts at the media dialogue were Senior Reproductive Health Officer at the Ministry of Health in Lagos State, Mrs Idowu Okanlawon; Rasheedat Umar, Youth Development Officer at the Ministry of Youth and Social Development in Lagos State; the Assistant Reproductive Health Programme Officer at the Primary Health Care Board in Lagos State, Dr. Abimbola Folami; Chairman of Public Health Sustainable Initiative Advocacy (PHSAI), Abiodun Ajayi, who is the Lagos State Coordinator, Life Planning Adolescent Youths (LPAY), among others. The programme similarly had in attendance other key members of Public Health Sustainable Advocacy Initiative (PHSAI) and members of the Media Advocacy Working Group (MAWG) in Lagos State.
Part of the big issue raised on that day was that if used effectively, family planning can save lives.
For instance, with a maternal mortality ratio at 546 deaths per 100,000 live births (amounting to 40,000 pregnancy-related deaths annually), Nigeria accounts for 14 per cent of the global burden of maternal deaths, 95 per cent of which are caused by seven preventable conditions, including unsafe abortion.
Each year, it is estimated that between 610,000 and 1.2 million abortions are procured by women aged 15 to 44 years. Experts say that if all females who need family planning had access to the commodities, 44 per cent of all maternal deaths in Nigeria could be averted.
However, what plays out in the country is that about 85 per cent of women and 95 per cent of men report that they know contraceptive method, but just 15 per cent were using it.
The unmet need of women willing to stop or delay births but not using contraception is 18 per cent, according to the 2018 National Demographic Health Survey (NDHS).
According to the Chairman of PHSAI, Ayo Adebusoye, going by the Lagos State Contraceptive Prevalence Rate (CPR) target to increase its family planning uptake from 48 to 74 per cent by 2018, the target of which has now been revised after the 2017 London Summit to target 2020., the increase in CPR alone would have saved an additional 657 mothers and 8,500 children lives by 2018. In addition, Lagos State would have saved an additional N3.5 billion (approximately $10 million) in direct healthcare expenses by 2018.
However, Adebusoye said these achievable targets will not be possible without eliminating current barriers to family planning methods, choice and use, adding that a major barrier to accessing family planning commodities is the out-of-pocket cost of consumables, especially at the local government supported primary healthcare centres (PHCs).
While family planning commodities including injectables, implants, intra uterine devices (IUD), condoms, among others, are provided free by the Federal Government with support from the United Nations Population Fund (UNFPA), the shortage and sometimes the non-availability of consumables like cotton wool, gloves, syringes, spirit, plaster, gels, creams, among others, used to administer the commodities on clients, could limit access to family planning uptake.
Demand from most clients of low-income families, as little as N500 for a consumable with which family planning commodity would be administered on the client, usually ended in ‘no-deal’ for most poor clients.
These category of women don’t have money for consumables, no matter how little. When they depart a family planning clinic with the promise to return on a future date because of lack of money for consumables, often they do not go back there.
According to a family planning expert, Dr. Salami Habeeb, when next they are seen at the health facility, they are already pregnant. Habeeb is a consultant obstetrics and gynaecologist and consultant with the Pathfinder International Nigeria.
Poor budgeting and sometimes, delay or lack of budget release have been largely blamed for shortage of consumables. For instance, available records show that the family planning budget at the Lagos State Ministry of Health in 2018 was N103 million. Also, the budget for family planning consumables at State Primary Health Care (PHC) Board in 2018 was N50 million, but none of the above budgets were released that year.
To prevent delays in release of budgeted funds as well as ensure the provision of improved family planning budget, Adebusoye said PHSAI members have engaged sole administrators of the local government council areas in Lagos, heads of local council development authorities, medical officers of health, and chairmen of community development committees.
Based on findings that many local government council area chairmen lack the understanding of family planning, Okanlawon said more frequent advocacy visits to them should take place to educate them on the importance of providing funds for family planning consumables.
“If we really want to achieve our objective of getting increased funding for consumables, we should pay more courtesy visits and conduct more awareness campaign to the chairmen,” he said.
On her part, Umar explained that the Ministry of Youth and Social Development in Lagos State where she is a desk officer, has a budget line for HIV/AIDS, but the UNFPA funds most of the ministry’s activities around sexual and reproductive health (SRH).
She said: “For my ministry, we have a budget line for HIV/AIDS, but sometimes, we try to inject sexual and reproductive health rights (SRHR) into it. Hence, we are still trying to find a way of merging it. “UNFPA is supporting us by giving us condoms,” she said, adding, “We don’t go beyond giving condoms because we are youth officers.”
Asked what was done when young persons need more than condoms, Umar said they were usually referred to health facilities.
On unfriendly officers, she said: “We are improving on that while ensuring that most officials on that beat are young persons who the youth clients could trust so as to achieve a youth-friendly atmosphere.”
Based on the high risk sexual behaviour among young people, which is responsible for the increased teenage pregnancy, out of school girls, baby dumping, post abortion complication and death in Lagos State, the Chairman of LPAY under the auspices of PHSAI, Abiodun Ajayi called for increased discussion around adolescents and youth SRH/family planning.
In addition, he called for sustained increase in the budgetary allocation for Adolescent Youth and Sexual Reproductive Health (AYSRH) in the 2020 Budget in Lagos. If the highlighted recommendations could be carried out effectively in Lagos and other states, family planning experts and other stakeholders agreed that these could increase uptake of family planning in the country.
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