Our successes, struggles with family planning – women speak out

Despite its enormous benefits, some women ignorantly shun family planning. Juliet Umeh spoke to a cross section of women who share their experiences some of which are enough to convince the staunchest cynic. 

Contraceptives and devices

Each morning as they dress up to go out with their parents, Mohammed, Oyinda and Mariam Abdullahi (not real names), aged eight, six and two respectively, regret missing school. Mohammed and Oyinda in particular, are more pained by this development since they were withdrawn over two years ago.

The three children do not hide their frustrations as their parents, both fashion designers, get set for their shop. They make it known, loudly and clearly how much they want to emulate their peers who on their way to school, regularly pass in front of the shop located in Okuola area of Egbeda in Alimosho Local Government Area, Lagos.

The Abdullahi children are victims of a situation that is not of their own doing. Their mother, 38-year-old Rukayait Abdullahi, admitted that it was wrong to deny the children their education, but explained to Nigeria Health Online (NHO) that she and her husband have no means of sending them to school at the moment.

Rukayat, who is pregnant with the 4^th child, was almost in tears as she relayed their predicament, even as she promised that she was doing everything possible to ensure they all returned to school as soon as the family’s fortune improves.

“My heart bleeds whenever I see my children lamenting not being in school. I feel very sorry that this is happening, but it is only temporary. If not for this my pregnancy we would not have withdrawn them from the private school. We didn’t plan it but since it has come, we have to manage.

“My husband detests public school and as such, we are waiting for sufficient finance to be able to send them back to private school. We want the best education for our children and my husband and I have agreed that they will go back to their former schools as soon as the new baby arrives and our financial situation improves.”

Rukayat is aware of Family Planning, but does not practice it. Apparently, she requires more enlightenment in view of the 4th pregnancy.

“I have never practiced family planning because I never really knew much about it. I did not think that I needed it,” she remarked.

It was however, a case of “embarrassment” for 31-year-old mother of two, Deborah Williams, an employee of a blue chip company in Lagos when she got pregnant recently. Pregnancy that is usually a thing of joy turned into an object of ridicule for her. Deborah confessed she was so ashamed when she discovered she was pregnant barely two months after giving birth. As a result, she resigned from her job. Narrating her experience, she said the pregnancy earned her scornful names such as “back to back”, “I didn’t want to go for abortion and therefore had to leave my job to face my issues squarely.

“I was breastfeeding, and was still on maternity leave. I could not stand the shame of resuming with another pregnancy less than two months after putting to bed, so I quietly resigned. I did not even regret my decision because my former employers would not tolerate me going on maternity leave again within so a short time. I would certainly have been sacked,” she stated.

Deborah is aware of family planning, but chose to ignore it even though she realized it would have saved her from all the stress.

“I have learned my lesson the hard way,” she lamented.

Her plight is only one many conditions that push women into unsafe abortion in a society where abortion is illegal. But then, had Deborah chosen the option, she just might be one of the unlucky women who passed that route and didn’t live to tell their story.

In Nigeria, abortion is only permitted when the life of the mother is in danger as a result of the pregnancy. Family planning advocates hinge on gap to push for prevention of unplanned pregnancy and appropriate spacing of births.

Experts say most of the needless maternal deaths could have been prevented through family planning, which refers to the use of natural or modern contraceptive methods to delay/space or limit future pregnancies. They argue that if a woman uses a method of family planning, she will not be able to get pregnant again, unless she wants to.

But there are still so many women that continue to battle with a number of myths and misconceptions surrounding family planning. Ignorance, cultural and religious beliefs, poverty are also not helping matters. Ujunwa Bassey, a 33-year-old mother of three, is among the group of women that shun family planning.

“I am not going to do that rubbish,” she remarked barely a week after she put to bed her third son. Her response was a reaction to a friendly advice.

“The president of my fellowship is 50 and she said family planning causes infertility. She told us she did family planning after giving birth to three girls and when she stopped using it, conception was not possible. Now, the last child is 17 years old. She told us that nobody should try that kind of rubbish. She is full of regrets that she brought the trouble herself,” Ujunwa said.

Dr. Oshodi

But those that know better continually dispel these and other myths and misconceptions about family planning. “Family planning does not cause infertility,” said Dr Yusuf Oshodi, an obstetrician/gynaecologist at the Lagos State University Teaching Hospital, (LASUTH).

The medic is worried that a lot of misconceptions are still trailing family planning even from the perspective of religious beliefs. He notes that family planning on its own will help in preventing maternal death by 40 percent also saying  family planning  helps to reduce maternal mortality, pre-term birth, and low birth weight among children because underweight is actually the cause of 60 – 80 percent of neonatal deaths.

“Family planning is termed ‘life saving’ and should be recommended for women immediately after giving birth. Family planning just means that you plan the time you want to get pregnant, the number of children you want to have then the interval between one child and the other so as to have optimal health for every member of the family.”

“It is only sensible to have the pregnancy you need. In fact, there is an acronym, make love not babies. The fact that you have to make love does not mean that it has to result in pregnancy. In fact, some people are taking abortion as a form of family planning.”

Describing every pregnancy as a “journey into the valley of death”, he said it was illogical and baffling that somebody could be pregnant in 2013, 2014, 2015, and 2016 and still have another pregnancy in 2017. “What else does she want?” Oshodi lamented.

There are various methods ranging from long term, short term and permanent methods. Some of the methods include pills, injectables, condoms, implants, IUD, tubal ligation, vasectomy and lactational amenorrhea.

According to United Nations Population Fund (UNFPA), Nigeria contributes about 40 percent to global burden of maternal deaths. “The reality is that every day in Nigeria 110 women die due to preventable pregnancies-related complications,” says Diene Keita, UNFPA Country Representative, in one of the events organized by the Federal Ministry of Health to ask for more investment on family planning.

She also noted that Nigeria had made significant progress towards improving the health status of its women and children. She said this had led to the reduction in maternal and child mortality and morbidity in the last five decades. According to her, about one-third of preventable maternal deaths can be avoided delaying motherhood among young girls and by use of family planning commodities.

“UNFPA is committed to helping the world including Nigeria to deliver a future where every pregnancy is wanted, every birth is safe and every young person’s potential is fulfilled,” the UNFPA she stated.

It’s no longer news that a woman’s lifetime risk of dying from pregnancy or pregnancy-related complication in Nigeria is 1 in 3 which also brings the Maternal Mortality Ratio (MMR) to 576 per 100, 000 live births according to (NDHS 2013). In Lagos State, the MMR is 555 per 100, 000 live births (NDHS 2013).

Studies show that the percentage of women currently using, or whose sexual partner is currently using at least one method of contraception also known as the National Contraceptive Prevalence Rate, CPR, regardless of the method, is just 15.1 percent with target of 36 percent by 2018.

In Nigeria, about 39.2% of women are between the reproductive ages of 15-49 and only 30% of them use any method of contraceptive, 20% use modern contraceptive methods, while 10% use traditional methods (NDHS 2013).

Dr Sadiat Okaga, State Reproductive Health Coordinator, Lagos State Ministry of Health, says there are 4,730,000 women of reproductive age in Lagos. According to her, the Lagos State CPR is 48 per cent with target of 74 percent by 2018, even as there is an unmet need of 11.8 percent for married women and 8.1 percent for all women. In Nigeria, the unmet need for modern contraception according to NDHS 2013 report has remained 16 percent.

The World Health Organization (WHO) estimates that some 214 million women have an unmet need for modern contraception and this need is greatest among the most vulnerable and where the risks of maternal mortality are correspondingly highest.

Spirited efforts have been on to stem the tide of the unmet need for family planning in Nigeria. Organizations like the Nigerian Urban Reproductive Health Initiative (NURHI) have been at the forefront of family planning promotion, nevertheless, reports from the UNFPA show that no fewer than 20 million women in Nigeria have no access to safe and effective Family Planning services.

A family planning provider with Ibafon Primary Health Centre, Cecilia Oluborode, has had numerous experiences about women who believe that family planning causes infertility.

“We always assure them that it’s not so, I often use myself as an example and also explain that it does not cause miscarriage. Some women have penchant of not allowing their husbands to have sexual relations with them, and as a result there’s always conflict in the home but with family planning, there would be peace.

According to Oluborode, family planning is not just about child-spacing, but something that reduces conflict in the home. “My husband is proud of me because I am ready for him, anywhere, any time, so it has been good for me.”

Oluborode reveals that more women prefer injectables and implants and that there has been more patronage this year more than in the past years.

But with its numerous benefits, why is there so much ignorance or no acceptance with family planning in the state? Dr Ajoke Ashiru, a family planning specialist seems to have answer to this. She told NHO that ignorance remains a huge setback that needs to be tackled to make family planning better accepted.

“So many women are not empowered enough and that is why we are talking of empowerment for women. Can you imagine a woman coming for antenatal for the first time and the doctor or nurse asks when was her last menstrual period and she says let my pick my phone and call my husband. It is that bad, so there is need for us to sensitize and empower these women to let them know their rights and equal opportunity.”

But despite the backlash from certain quarters, there are women who enjoy partaking in family planning. One of such women is 28-year-old Amina Mohammed who has adopted family planning as a means of helping herself and the family. Amina who had given birth to two children before adopting family planning said adopting family planning gave her opportunity to face her business thereby assisting her husband to cater for the family.

Mrs Shade Adesida

As for 35-year-old Shade Adesida, a trader and mother of four, she got to know about family planning through an advert by NURHI. She said she went for the injectable contraceptive and has since been having adequate time for her business and family. Shade has been on the contraceptive method for the past 11 months and challenges other women to visit the nearest health facilities where they can be properly guided about appropriate family planning options.

As for Chika Ohaeri, a 36-year-old mother of five, she is thankful that she discovered family planning. Chika admitted that she probably would have had nine children but for family planning. Married in 2002, and immediately began procreating, Chika said she and her spouse soon got worried about the rate their family was multiplying.

“We were relieved soon after a friend of my husband introduced family planning to us. I adopted the 5-year implant method in March 2014. Perhaps if not for this family planning initiative, I would have probably have had up to nine children by now. Even with it, I am stronger, healthier and my stature is okay,” Chika observed.

Mrs Bioku

Sharing her own experience, a family planning provider, Mrs. Grace Bioku, expressed passion for the job because she loves to see women healthy. As a result she does not mind spending a long time convincing women to embrace it.

“The turnout at the facility has improved. During counseling, we educate them about how family planning allows women to rest between pregnancies in order to regain their health and strength thereby reducing the risk of complications before, during or after pregnancy.

“It also makes fathers able to provide for the family, financially, morally and emotionally, and have quality time for his wife thereby prompting closer relationship. It also gives room for good health and quality education opportunities for the children among others.” Bioku sees women aged 20 – 30 as her major clients. They often opt for injectables and implants.

What is Lagos State government commitment to FP2020, the recommendation by the global health organization? “To increase the CPR to 74% by 2018, increase the current annual budget commitment; trains frontline health workers to deliver a range of contraceptive and action to improve equity and access to family planning for the poorest and partner with the private sector, civil society traditional and religious institutions and development partners,” Dr Okaga itemized.  She admitted there’s need for increased funding for family planning especially for consumables at LGA levels and human and material resources in the state.

Other accelerated interventions include implementation of activities for long-acting reversible contraceptive (LARC) methods; large-scale training to ensure implementation of task shifting with appropriate supervision of the community health extension workers (CHEWs); the family planning costed implementation plan as the state strategy to address existing gaps and line budget item of N22, 270, 000 and N22, 2 40, 000 for family planning (FP/RH) for years 2016 &2017 respectively.

However, it’s still not yet uhuru for the state as identified by Dr. Okaga. Lack of data from the private sector except a few working with partners; non availability of consumables in the Primary Healthcare Centers to provide optimal service thus leading to missed opportunities; staff attrition; late data rendition from some secondary Health facilities; user fees introduced for family services at SDPs (procurement of consumables); a very wide gap between knowledge and use of family planning and sub-optimal demand creation for family services in the state.

Meanwhile, Nigeria seems to be making progress in the provision of access to family in the country as budget for family planning has increased from a zero to U$ 4 million in 2017. It was initially zero as at September according to report from Community Health and Research Initiative (CHR) Africa Health Budget Network, supported by other non-governmental organizations.

The Chairman, Association for Advancement of Family Planning (AAFP) Dr. Ejike Oji, had told NHO Bureau Chief in an interview during the just-concluded FP 2020 Reference Group meeting in Abuja.