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Can Nigeria Achieve 27% Modern Contraceptive Prevalence Rate?

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In July, 2017, the federal government, in collaboration with its partners and stakeholders in the private sector pledged to achieve a Modern Contraceptive Prevalence Rate (mCPR) of 27 per cent among all women by 2020, in line with the over all drive of achieving family planning goal.

Indeed, achieving the Family Planning goal (FP2020 Goal) is a critical milestone to ensuring universal access to sexual reproductive health services and rights by 2030, as laid out by the Sustainable Development Goals 3 and 5.

However, there are concerns that plausible as the target is, Nigeria may not achieve. As a matter of fact, experts assert that it is becoming clearer by the day that Nigeria may not achieve the 27 per cent mCPR by 2020 and the reason, they noted, is not far-fetched.

At the London Summit in 2012, of which the country has 15 per cent CPR, Nigerian government pledged to achieve 36 per cent CPR by 2018 and an annual CPR growth rate of 2 per cent. However, in 2017, the government also pledged to achieve a mCPR of 27 per cent among all women by 2020.

In a bid to achieve the set FP2020 goals, state governments also gave themselves targets. For instance, Bauchi State which has a current CPR of 2.1 per cent is expected to grow by 23.54 per cent by 2020.

Currently, statistics obtained from the Multiple Indicator Cluster Survey, MICS, 2016/2017 revealed that Kaduna state has 26 per cent CPR. The report also indicates that for the State to reach its goal, it is expected to achieve CPR annual growth of 10.2 per cent. Sadly, the report indicates that the current trend of its growth remains low with a total of 2.3 per cent annually.

In Lagos state, the state government plans to achieve 74 per cent CPR by 2020. According to the Performance Monitoring and Accountability 2020 (PMA2020) report, in 2015, the state CPR was 34.6 per cent.

In 2016, the Lagos state CPR declined to 32.5 per cent and rose 35.9 per cent in 2017. In 2018, it rose again to 40.3 per cent, representing 4 per cent increase of CPR for all methods.

With barely 12 months to reaching the target FP2020 objectives and 27 per cent of contraceptives usage, investigation has shown that Nigeria currently has a 13. 9 per cent mCPR for all women.

While some states have made progress in achieving their CPR targets, stakeholders have decried the slow pace, considering the time left to achieve the 27 per cent mCPR.

The permanent secretary, Bauchi State ministry of health, Dr Aliyu Sa’idu Gital said Bauchi state has the highest fertility rate of 8.1 per cent which is higher than the national average as well as a low take of mCPR of 2.3 per cent.

Gital said the state deemed it necessary to galvanise efforts in developing robust family planning/child spacing strategies that will contribute to improving maternal and child health in the state and in Nigeria at large.

To achieve the Costed Implementation Plan, the permanent secretary however called for supports from donors and the private sector to join efforts with the state government in achieving its targeted CPR.

Senior lecturer, college of medicine, University of Ibadan, Funmilola Ola-Olorun, while scoring Nigeria on their performance toward achieving FP2020 goals, said in general, the country has a pass mark, but a very low pass.

She said though the nation is making progress towards achieving FP2020 goal, the progress is very slow and based on “what we have seen so far, It would be impossible for Nigeria to achieve all the indicators by 2020.

“However, the important thing is that progress is in the right direction and the indicators that we expect to improve such as the mCPR is improving, but just about one per cent per year. But in the real sense, you don’t expect more than a 2 percentage point increase in a year because it takes a while for people to change their behavior,” she added.

To change the narrative, Ola-Olorun said government should start to release funds at the right time, adding that though government allocate funds for reproductive health commodities in the health budget, many times, it takes a very long time for them to release the funds. According, government must go beyond making budgetary provisions to releasing the funds on time, and then increasing the funds allocated to reproductive health and family planning, noting that such would go a long well.

“The fund is just not sufficient and it is delayed before it is released. I think we have made some progress, but the progress is definitely not enough. Many times the allocated funds for family planning services are delayed in being released, sometimes not the entire money budgeted are being released and even what was allocated is not sufficient in the first place as it is generally for commodities, hardly ever for consumables and so we need much more commitments from government. We need a government that is dedicated not just to reproductive health but to the holistic health of Nigerians.

“Ensuring that funds are available and then release at the right time would go a long way. But beyond that, I think government should also ensure that they allocate funds for consumables because most of the funds are used for commodities and then women who visit health centres for delivery are to pay for consumables.

“Some local government chairmen in Lagos state now have started allocating some of their funds for consumables. So allocating more funds for commodities, more funds for consumables and developing some form of voucher system so as to be able to ensure that even the poorest women can have access to family planning services, are very crucial if we must make some meaningful progress,” she added.

Speaking on the voucher system, Ola-Olorun said “Even when commodities and consumables are available, women are still asked to pay for registration, laboratory testing including pregnancy test, consumables like syringe, cotton wool and so on. If the government can pay for that, for the poorest women who cannot afford it, possibly through a voucher system, I think they would have definitely done something positive to improve the health of Nigerian women.
However, some experts are of the view that Nigeria’s ambition of attaining the 27 per cent mCPR is plausible and attainable provided government and other stakeholders including philantropists, will pool resources together.

One sure way of ensuring this, they hinted, include making provision for free services to indigent women.
Binta Larai is a seasoned nurse with over twenty years working experience. She said: “I think that rather than making family planning services free for all women, there should be some form of scale whereby you identify those who truly cannot pay for them and it should be completely free for those women. For those who can pay, they should be asked to pay a token by having it subsidized but to have if free for everyone, is not a sustainable approach.”

She also advised the government to adopt massive sensitization on the need to embrace family planning adding that “the myths and misconceptions raised by most Nigerians, which have deprived women from taking up a method are not true, they are myths, so I think that apart from health workers, we need more people who are family planning advocates, who are regular Nigerians and not necessarily in the health sector, learning what is right and what is true and sharing that with people in their communities.

“I think we need more people who will be willing to advocate for family planning among families and among friends. As a matter of fact, beyond health workers, we need people who are trusted and respected in their communities to be family planning advocates.

She insisted that such was necessary because many people are getting information from the wrong sources.
“For instance, some people claimed that implants migrates. Implant do not migrate and the side effects of family planning methods are usually few. I think it is over- hyped that family planning methods are negative whereas, majority of cases, it is beneficial for women” she said adding: “We need to encourage women to seek information about family planning because only 25.5 percent among married women are reporting use of a modern method, we can do much more better because many of them have an unmet need.

“Unmet needs continue to be very high recently. We expect these women to be using a method, but they are not. We need to get people to understand that family planning methods are safe and available.

“Obtaining the right information and using a method would reduce the proportion of women who report unintended pregnancy. So women need information and they should be able to access the services which are readily available in Lagos state.”

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