By Auwal Ahmad
A renowned Nigerian obstetrician and gynecologist, Prof. Emmanuel Otolorin has said that several issues and occurrences in Nigeria underline the importance of family planning.
Prof. Otolorin during a Media Round-table on Family Planning and Maternal Health organized by MamaYe-Evidence for Action in Abuja in October 2016, that the most important, however, is that as many as 18,000 of the 40,000 women who die of pregnancy-related causes each year can be saved with the availability of family planning, says.
He said due to a complex mix of cultural, religious, economic and social factors, maternal and child deaths were common occurrences in Nigeria.
Also, experts say however that access to family planning (FP) can reduce the risk of death from pregnancy, and indirectly contribute to averting many child and infant deaths and ailments.
Speaking to our Correspondent in Gombe, Community Mobilization and Mark Officer with Marie-Stopes International Organisation Nigeria (MSION), Gombe State, Mr. Ibrahim Yusuf, said that increased access to Family Planning services could prevent about 1.6 million unintended pregnancies in Nigeria every year.
Mr. Yusuf said Family Planning could help save the lives of women and children by reducing unplanned pregnancies and promoting healthy child spacing.
“Evidence has shown that the high death rate is mostly due to unintended high risk pregnancies due to low use of Family Planning services. Increased uptake of Family Planning can avert up to 44 per cent of maternal deaths and 23 per cent of child deaths”, he said. He added that Family Planning is an essential component of reproductive health and key to safe motherhood. Its potential to contribute to maternal and newborn mortality and morbidity reduction is therefore enormous.
Mr. Yusuf explained that the Family Planning uptake in Gombe was hindered by a myriad of factors, ranging from lack of education, poverty and religious barriers, as well as poor access to services and commodities, traditional beliefs favouring high fertility, misconceptions, worries about side effects, lack of male involvement and poor coordination of health programmes, among others.
According to the 2013 edition of the National Demographic and Health Survey (NDHS), the current contraceptive prevalence rate (CPR) of Nigeria, i.e. the proportion of women using Family Planning, both traditional and modern methods, is 15 per cent, out of which modern CPR is 10 percent.
During the London Family Planning Summit in 2012, Nigeria announced a plan to increase its CPR to 36 percent by 2018. Once achieved, the authorities said 400,000 infants and 700,000 child deaths would be averted in the country by then.
Gombe State, in north-eastern region of Nigeria has a projected population of 3,022,590, and maternal mortality ratio that is one of the highest among the states of the federation. The NDHS 2013 survey pegs the maternal deaths in the North East at 1,549 per 100,000 live births. This means that for every 100,000 live deliveries, an estimated 1,549 women lose their lives. The ratio in Gombe State is 800 per 100,000 live births.
The current CPR of Gombe State is 3.8 percent, according to NDHS 2013, while unmet need for Family Planning, i.e. the proportion of women who want to use Family Planning services but do not have access, is 19.4 per cent. According to the 2014 National Family Planning Blueprint, which set targets for states to attain by 2018, 7.5 percent CPR is being targeted.
With a total of 615 health facilities comprising 592 primary health care centres, 22 secondary health facilities, and one tertiary health facility, Gombe State would seem to have the structure to deploy to achieve its CPR target. However, only 349 of the health facilities provide Family Planning services. There are also other factors that militate against the achievement of the Family Planning goal: The number of health care workers in the public sector is just 4,081. Majority of the 1,209 are community health extension workers (CHEWS), who are not qualified to administer the most effective and most demanded Family Planning methods, the so-called LARCs—long-acting reversible contraceptives. Doctors number 163; nurses/midwives 1,150; community health officers 114; and junior community health workers 605; Environmental Health Officer, Environmental Health Technical, Environmental Health Assistance 560 and village health workers over 1,000.
Also, only 150 health workers are trained to provide Family Planning services. In spite of that fact, contraceptive commodities are available through the federal government supply chain as the Government of Nigeria introduced free commodity policy in 2011. Curiously, the free commodities have not translated into better access, as only about 4 per cent of women of reproductive age in the state access Family Planning services. One major reason is that at the average Family Planning clinic, there are charges for consumables like hand gloves, syringe and needle, detergent needed to administer the services on the women.
To make Family Planning service really free, consumables should ordinarily be provided by the state government.
The arrangement is that the Federal Government will provide Family Planning commodities like condoms, pills, IUDs, and injectables, while the state government should provide consumables. But a number of states, Gombe inclusive, have failed to provide those consumables. Analysts say the state government needs to create a budget line, like other states are beginning to do, to provide the effective implementation of Family Planning, an effective and proven way of reducing maternal deaths.
To address its challenges, the Gombe State Ministry of Health developed a policy called the Gombe State Framework for the Implementation of Expanded Access to Family Planning Services – 2013 – 2018, which provides the state with a road map, even though it needs review for current approach.
The Framework has an estimated cost of 1.019 billion Naira over a 6-year implementation period, with four goals, objectives, targets and activities. The goal is to improve access to and uptake of Family Planning methods in Gombe State such that the contraceptive prevalence rate (CPR) increases to 7.5 percent by 2018.
A cardinal objective of the policy is to build the capacity of all CHEWs, doctors, nurses and midwives working in reproductive health (RH) and Family Planning to provide cadre-appropriate Family Planning services in the state by 2018. It will also expand the availability of Family Planning commodities offered by cadre-appropriate providers in the wards, primary health centres, as well as secondary and tertiary facilities. Increased use of Family Planning methods among men, women and young persons of reproductive age in Gombe State by 2018 is the ultimate goal.
Investigations revealed that out of the four objectives only the first was attempted. Forty-eight nurse-midwives and community health officers have been trained by United Nations Population Fund (UNFPA) and Association for Reproductive and Family Health (ARFH) to serve as master trainers.
Marie Stopes has trained 120 nurses and midwives while UNFPA and ARFH have trained another set of 172 community environmental health workers in Gombe, Yamaltu/Deba, and Shongom local government areas of the state. The state government is supposed to train the remaining health workers, but there is no indication that anything has been done in that regard.
Speaking to our correspondent, Ms. Rabi Umar, a stakeholder in the health sector, confirmed that the uptake of Family Planning is low in the state because of a combination of factors, particularly lack of a budget line for Family Planning; insufficiency of trained Family Planning personnel; shortage of consumables; non-involvement of men in the support for Family Planning programme activities; and lack of data tools.
Ms. Usman said the way forward is the creation of an Family Planning budget line, prompt release of the money budgeted, procurement of consumables by the state government, sensitisation of all men groups and training of nurses and midwives in each of the local government areas. She also spoke of the need for communication activities through radio and television programmes to dispel rumours and correct misconceptions related to Family Planning
