Family Planning To The Rescue

Nigerian Urban Reproductive Health Initiative spearheads family planning in Nigeria to reduce maternal and infant mortality 

When Angela, a middle-level employee in a large government company, was almost due to give birth to her first child just a little over a year after her marriage, the company graciously approved for her the mandatory three-month maternity leave. On her first day at work after the leave, an elderly woman who cleaned her office noticed that she was again pregnant, a fact not even Angela was aware of. And 12 months after the birth of her first son, Angela was delivered of another baby boy. Again, she was given three months leave to care for her child.

Presenting herself in office on resumption from leave after delivery of her second son, the bubbly Angela was stunned when the same elderly cleaner noticed that she came with yet another pregnancy, just three month after giving birth to her second child. Angela had to endure constant jibes from her colleagues for her seeming uncontrolled libido. Some friends even urged her to terminate the pregnancy to save face. But she decided to have the child. This time, however, the pregnancy proved life-threatening to Angela. Her doctors said her uterus and stomach muscles were not yet strong enough to carry the third pregnancy. But thanks to God, she survived it. She had another baby boy, ending up having three children in 24 months.

This unplanned childbearing took a toll on every member of Angela’s family. The first child failed to get the essential nutrients and immunity from the mother’s breast milk because breastfeeding was suspended in the fourth month when the mother became aware that she was again pregnant. The child died. The whole scenario was repeated when she became pregnant with the third child.

This true story happened many years ago in a land where ‘Ognenevwaire’ – God brings (the children) – is a very popular name. The belief was that every pregnancy is pre-determined by God, so there os nothing one can do to prevent it. However, a popular parlance in Yoruba is, ‘Omo be e re, osi be e re’ – abundance of children translates to abundant poverty. This implies that while God may be responsible for the miracle of child bearing, mating couples also have the responsibility to regulate how often the process of mating should result in child-bearing. In another word, responsible child-bearing.

It is pertinent to say that Angela and thousands of other women would have been spared the threat to their lives and the agony of burying their offspring had family planning methods been in common use as they are today. Simply put, family planning is the the use of  a wide variety of birth control methods to determine when to have children and how many. It is often applied by female-male couples to limit the number of children they have, and to control the timing of pregnancy – the art of spacing children. Family planning may involve sterilisation, abortion, and other birth control methods and techniques to achieve this aim. Other techniques commonly used include sexuality education, abstinence, prevention and management of sexually transmitted infections, pre-conception counseling and management, and infertility management. The most available type of birth control is condom.

In Africa, countries with highest fertility rates and lowest rates of contraceptive use have the highest maternal, infant, and child mortality rates. Only about 30 per cent of all African women use birth control although over half of them would have liked to if it was available. The main obstacles to use of birth control are unavailability, poor health care services, spousal disapproval, religious concerns, and misinformation about the effects of birth control. Both public policies and cultural attitudes play a role in birth control prevalence.

Available statistics show that increased use of family planning methods decreases maternal and infant mortality rates, improves quality of life for mothers, and stimulates economic development. At least 53 per cent of African women of reproductive age have an unmet need for modern contraception.

Use of contraceptive among women in sub-Saharan Africa has however risen from about 5 per cent in 1991 to about 30 per cent in 2006. For family planning to be effective, both the male and female are expected to be fully involved in the decision-making and the implementation of whichever method to adopt.

At the forefront of the campaign for family planning in the country is the Nigerian Urban Reproductive Health Initiative, NURHI. Funded by the Bill and Melinda Gates Foundation, NURHI partners the Nigerian Association for Reproductive and Family Health and the Centre for Communication Programmes Nigeria to reduce supply and demand barriers to the use of family planning services in urban Nigeria. The programme is bringing together private and public sector resources to strengthen the delivery of family health services while gradually increasing demand for such services across project sites.

Focused in six urban centers – Abuja FCT, Benin City, Ibadan, Ilorin, Kaduna and Zaria – NURHI is developing workable approaches that will provide rapid scale-up models for other urban areas in Nigeria and the African continent. The Benin office of NURHI has provided training for journalists, family planning service providers from both public and private health institutions, religious leaders, market women and the general public, just as it has also paid advocacy visits to law makers in the state.

According to Mrs. Adetoke Akinbami, manager of the Benin office of NURHI, “Amongst other things, the training programme updated participants’ skills with a view to enable them provide appropriate family planning services to meet clients’ needs as well as providing them with knowledge and information to enable them counsel and discuss adequately on precautions and management of side effects of family planning.”

It engages prominent religious and traditional leaders who in turn have publically endorsed family planning/child spacing, encouraging Nigerian men and women to find a method that will help them care for their desired family size and protect each mother’s health. The ‘Know, Talk, Go’ mass media campaign encourages Nigerians to ‘Know” about family planning, ‘Talk’ to their partner about family planning, and ‘Go’ for services. It also provides family planning commodities free of charge at selected public health facilities, including primary healthcare centres. To make it easy for interested couples to get access to family planning services, designated facilities are clearly marked with the logo of the programme, which carry the words: “Know the facts about family planning; Talk about it, and Go for it.”

It is expected that when couples know about family planning, talk about it and go for it, not only will the health of both mothers and children improve, the society at large will be better off for it.

—Jethro Ibileke