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Why Family Planning Approval Remains Low

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In this report, ODIRI UCHENUNU-IBEH examines the challenges of ensuring effective family planning in Lagos state.

With a population of over 180 million people in the midst of scarce resource, there are increasing calls for Nigeria to consider family planning so as to effectively control the number of birth.
Of course there are series of awareness campaigns by government and health related non-governmental organisation aimed at taking the message of effective family planning (FP) across homes in towns and villages.
But in spite of series of awareness programmes on family planning in the country, the uptake remains very low.
As a means of ensuring effective population control, the global community has set a target that by 2020; more women and girls around the globe would be able to plan their families and their future with the help of Family Planning programmes.
Obviously acting in sync with this global commitment, Nigeria also set a target that by that 2020, its Contraceptive Prevalence Rate (CPR) would increase from 15 per cent to 27 per cent.

The CPR which is ‘the percentage of women of reproductive age who are currently using, or whose sexual partner is currently using, at least one contraceptive method, regardless of the method used’, is often reported for women aged 15 to 49 who are married or in a union.
Indeed, to achieve the 27 per cent target, state governments also gave themselves target and Lagos state made a commitment to increasing its CPR to 74 per cent by 2020.
But with 2020 around the corner, recent reports obtained by LEADERSHIP have shown that the state CPR is drastically reducing despite concerted efforts by the government.
The National Bureau of Statistics (NBS) revealed that in 2007, women age 15 to 49 years who are currently married or in union and are using a contraceptive methods was 40.6 per cent, but that has reduced to 28.5 per cent and 22.6 per cent in 2011/2017 respectively.
Survey conducted by the Performance Monitoring and Accountability (PMA2020), also identified that CPR in the state has drastically reduced in recent time.

Stakeholders who spoke with LEADERSHIP have pointed out the fact that the issue surrounding the low FP uptake in Lagos state has nothing to do with the commodities.
According to them, the commodities are safe and free in the public health facilities and the government is so interested in it because the provision of free FP services to the entire women and men of child bearing ages in the state is a paramount agenda of the state government.
As an evidence of the pro-activeness of the government, Lagos state is one of the very first states in the federation to create a separate budget line for FP, having recognized the essential role this service plays in the reduction of maternal and child mortality and morbidity rates.
But why is the acceptance still low?
Stakeholders however identified cultural barriers, myths, misconceptions, providers bias, unavailability of sufficient consumables to effectively carry out procedures and lack of support for FP services by men as key stumbling blocks to FP uptake in the state.
The commissioner for health, Lagos state, Dr. Jide Idris, at Isolo local government town hall meeting, said a lot of factors which mitigate against the effective uptake of FP services by women of reproductive age that are living in Lagos state have been recognized from different survey conducted on FP such as PMA2020.

The commissioner who was represented by the coordinator, reproductive health, Lagos state ministry of health, Dr. Saidat Okaga, said all these revealed that cultural barriers, myths, misconceptions, providers bias, unavailability of sufficient consumables to effectively carry out procedures are key stumbling blocks to FP uptake in the state.
“A major problem is also the lack of support for FP services by men. Male involvement is strongly needed to ensure we keep our women healthy. I therefore enjoin all our men to encourage their wives and partners to go for FP as the advantage is not only to the women, but also for the entire family and even the society at large,” he added.
Idris said it is of utmost importance that all the chairman of the different local government areas and Local Council Development Areas (LCDAS) meet the government efforts half way by collaborating with the state ministry of health in the provision of FP consumables for all the PHCs under their LGAs and LCDAS.

These consumables, according to the commissioner are necessary to enable the commodities to be used and must therefore be available free of charge just as the commodities are equally being provided free by the government.
He said it is only by this way that the state can make FP services attractive to the teeming population and it will also go a long way in encouraging women to patronize the health facility thereby increasing FP uptake.
“Our community leaders are majorly recognized as being key in the provision of the right information to our community people on FP services in order to remove barriers and misconceptions to usage.
“I implore you all to become advocates and champions of FP and therefore help in driving the uptake of FP services and usage as all the efforts will in no small way help in contributing to a drastic reduction of maternal and child mortality in our community,” he added.
The chairman of Isolo LCDA, Shameudeen Olaleye said he has discovered that the attitude of nurses towards patients has discouraged a lot of my people from receiving healthcare at PHC, adding that these nurses insult patients and make them feel worthless.
Olaleye however vowed to correct that as he would be holding series of meetings with the nurses with a view to pleading with them to change their attitudes toward his people.

The senior program advisor, Palladium Technical Support Unit, Dr. Moriam Jagun said, “When we talk about FP in the sate, the awareness is quiet high, the funds are available and the commodities are free, all we need to do is to translate the awareness to usage.”
“What we are trying to do nationally, is to add additional seven million women by 2020 for FP method. Initially, the National goal was to have CPR of 36 per cent, but that has been reduced to 27 per cent by 2020 and Lagos state has to contribute to that by increasing its CPR to 74 per cent.
“The state is making progress, it may not be where it ought to be, because the unmet need of family planning is still quiet high, but with concerted efforts, it will get there.”
Speaking on the benefits of FP, Jagun said, “For every one dollar spent on FP, government is saving six dollars. Also, FP is the cheapest means of birth control because abortion is very expensive. It is expensive in terms of the cost and the consequences afterward. FP is free, the commodities are free and when you think about the amount of money you are saving and the benefits of FP, it outweighs abortion.
“Abortion is not cheap. People pay more to secure an abortion and because it is illegal, a lot of people patronize quacks, it can lead to bleeding and complications and the person may lose her life at the end”.



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