By Chijioke Kaduru
Access to Family Planning and Reproductive Health information and services is widely acknowledged as the bedrock of gender equality. Access to Family Planning and Reproductive Health information and services is an essential right for our women and girls, and it empowers them, gives them greater influence over their lives and futures, and enables them reach their full potentials.
Family Planning is arguably the single, most cost-effective and impactful intervention, in Health and Development, with the potential to save lives, improve health, empower women and girls, and strengthen communities and whole nations. Yet, the United Nations Population Fund (UNFPA) estimates that approximately 225 million of the World’s women require and yet lack access to family planning information and services (United Nations Population Fund 2014). This gap is even more concerning for Countries like Nigeria, where only about 10% of women have access to and are using a modern method of Family Planning (National Population Commission (Nigeria) 2013).
UNFPA estimates that meeting the unmet need for Family Planning around the world can prevent as many as 24 million abortions, 70,000 maternal deaths and 500,000 infant deaths (United Nations Population Fund 2014). Nigeria estimates that increasing its percentage of women using a Family Planning method to 36% can reduce 30% of Maternal Mortality, and prevent 700,000 Child deaths and 400,000 infant deaths (Federal Government of Nigeria 2014).
Whilst the experts recognize the huge benefits of Family Planning in shaping health and development, questions remain among the wider public about how exactly Family Planning brings benefits. A look at Maternal Mortality in Nigeria can help showcase some of these benefits of Family Planning.
Nigeria has a maternal mortality ratio of 576 deaths per 100,000 live births (National Population Commission (Nigeria) 2013). This translates to 111 maternal deaths every day in Nigeria. An overwhelming majority of these maternal deaths are preventable. These women die either because they become pregnant too early in life, too frequently, or too many times. Family Planning can allow a woman to delay her pregnancy, to space her pregnancies or to limit pregnancies, and empowering a woman with these choices, drastically reduces the likelihood that she will die from a pregnancy related complication.
This is a major benefit of Family Planning, along with similar benefits to infant and child survival, benefits to State educational systems, benefits to the economic well being of families and the economic growth and development of States.
Having recognized the key role of Family Planning in saving the lives of our women, and in empowering women and girls to take control of their futures, a key consideration must revolve around some key policy thrusts, which can advance Family Planning in Nigeria.
Nigeria has a relatively enabling environment for Family Planning, having a costed strategy for scaling up family planning (called a Costed Implementation Plan), having a policy to enable task shifting and task sharing among health workers, having a Governance reform framework for Primary Health Care and political will to drive revitalization of Primary Health Care, as well as supportive thrusts like advocacy working groups, technical working groups and guidelines for condom programming and reproductive health services.
Notwithstanding the progress recorded so far in expanding and extending the use of Family Planning services especially to hard-to-reach areas, many women continue to have an unmet need. To meet this need and expand access, States need Costed Implementation Plans (CIPs) to help determine requirements for human, financial, and technical resources, as well as for commodities and equipment. A CIP is essentially a “multi-year actionable roadmap designed to help governments achieve their family planning goals” (Population Action International 2016; Jurczynska 2017; FP2020 2016). Nigeria has a CIP covering a scale up plan till 2018, with a goal to increase the number of women using contraceptives to 36%, but many States do not.
Nigeria faces significant Human Resource for Health challenges (Global Health Workforce Alliance 2014), which impacts significantly on the delivery of Family Planning services to women who need them. Towards combating this challenge, Nigeria developed a task shifting and sharing policy (Federal Ministry of Health 2014), which essentially provides a framework for redistribution of tasks among health workers, to maximally utilize the competence of every available health worker, towards meeting the needs for Family Planning services. This redistribution of tasks has seen trained community health workers (CHWs) and community health extension workers (CHEWs) help to manage and deliver family planning services. It has also seen efforts to integrate patented private medicine vendors, all in a bid to improve access to FP services especially in hard-to-reach areas.
The World Health Organization defines Primary Health Care (PHC) as “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination” (World Health Organization 2007). Primary Health Care in essence delivers needed care to people close to where they live and work, in a manner that is affordable and accessible. Functional primary health care systems therefore are a rock on which Family Planning services can be delivered to Nigerian women (World Health Organization 2011).
Despite these relatively enabling policy frameworks, significant challenges remain in the Funding of Family Planning at the National level. Nigeria committed in 2017, to spend $4 million annually on Family Planning commodities towards enhancing service delivery. Nigeria has also made countless other commitments at a National level, to invest financially to strengthen the policy environment and to improve service delivery. Yet the key challenge here lies with cash backing these commitments.
An even greater challenge to surmount in driving Family Planning access in Nigeria, is at the Sub-National level, with the majority of States in Nigeria lacking an enabling policy environment, failing to provide funding support, failing to provide services and ultimately suffering detrimental outcomes to the health and wellbeing of women and children.
Having considered the benefits of Family Planning, the required policy inputs and the required funding inputs, Nigerians have a civic responsibility to examine the contexts at National and Sub-National levels, and to demand accountability from its leaders on Family Planning. It is the only way we can reap the benefits of Family Planning and stop our women and children from dying.
For more information, please check out www.fp.techfaa.org from 1st December 2017.
Dr. Kaduru is a Public Health Physician working to advance Reproductive, Maternal, Newborn and Child Health in Nigeria.