BY PATIENCE IHEJIRIKA, Abuja, RALIYAT HARUNA, Kano, AISHA ABUBAKAR, Kaduna, UMMA AHMAD, Kano
The campaign for families to adopt family planning methods is facing challenges in Nigeria due to religious beliefs, misconceptions and other factors.
Aisha, 28, strapped her 12-month-old baby, Ahmed, to her back as she leaned against the wall by the entrance of the Primary Healthcare Centre (PHC) in Kafin Sule Community at Misau Local Government Area of Bauchi State.
Kafin Sule is about two hours from Bauchi town with just one PHC serving 30 villages, including Aisha’s village.
Like Aisha, many other women, some with pregnancy, go through the long trek from their villages to access healthcare in Kafin Sule.
Aisha, looking worn-out, later sat down in front of the PHC to breastfeed her son who was crying.
Aisha has eight children, the youngest of whom is Ahmed. She said she had Ahmed’s seven siblings at home, adding that Ahmed was lucky because at the time she was pregnant with him, she learnt that an international organisation was offering women N1, 000 per visit to the hospital for either antenatal care or immunisation for babies, a lot of money for a woman who had never earned her own money as she fully relies on her husband who is a farmer with four wives and 30 children.
The mother of eight, who would have loved to stop having children after her fifth child, said being a woman, she lacks the power to make such a decision.
With tears in her eyes, Aisha said she was told about family planning when she had Ahmed at the facility but she couldn’t even summon the courage to discuss it with her husband because in her village, it is a belief that having a lot of children is a blessing from God.
Also, 26-year-old Zainab, who came to the hospital for antenatal care, was pregnant with her sixth child. Unlike Aisha, Zainab’s husband approved of family planning which Zainab started after her fifth child. However, Zainab started experiencing unusual symptoms and so she had to stop.
Three months after she discontinued, Zainab got pregnant with her sixth child. Now, she is willing to try another method of family planning because she doesn’t want to go through another pregnancy.
Sadly, Aisha is just one of the many women in Nigeria who would love to use contraceptives but cannot due to religious/cultural beliefs while Zainab is among the many women having children by chance because of discontinuation of contraceptives due to side effects, myths and misconception.
Reproductive health experts have identified these factors as major setbacks to the country’s drive to achieve modern contraceptive prevalence targets and control its population growth.
Nigeria’s current population is over 200 million based on Worldometer elaboration of the latest United Nations data. The UN projects that Nigeria’s population will double by the end of 2050.
LEADERSHIP recalls that the federal government had a target in 2012 to increase Modern Contraceptive Prevalence Rate (mCPR) to 36 per cent by 2018.
However, on July 11, 2017 at the Family Planning Summit in London, this target was rebased to 27 per cent by 2020. Two years later, MCPR remained at 12 per cent while traditional contraceptive prevalence was 5 percent, making a total of 17 per cent.
Factors Discouraging Use Of Contraceptives In Nigeria
Though family planning has been identified as key to addressing Nigeria’s looming demographic crisis, many women do not use contraceptives for several reasons, including religious/cultural beliefs, the quest to have more children, fear of side effects, myths and misconception.
According to the research by LEADERSHIP data mining department, 35 per cent of women discontinued use of modern contraceptives due to the desire to get pregnant, 14 per cent due to health concerns and side effects, while 11 per cent was due to infrequent sex or husband being away.
On couple’s perceptions and knowledge, the study revealed that 98 percent of unmarried women in the Northern part of the country were informed of modern contraceptive methods compared to the statistics of married women at 94 percent.
On family planning methods, it was found that the majority of contraceptive users in the country rely on modern methods (10 percent of currently married women), 5 per cent uses traditional methods, 3 per cent uses injectables, and 2 percent uses male condoms or pills as the method of contraception.
The study also showed that fear of side effects is part of the reasons some women discontinue use of contraceptives, with injectables having the highest rate of discontinuation due to side effects at 22.7 percent while male condom had the least at 0.9 percent within 12 months of commencing usage of the method.
Further affecting high fertility rates in the country are misconceptions and negative perceptions about family planning use, such as beliefs that contraceptives are dangerous to a woman’s health, that they can harm a woman’s womb, inhibit subsequent fertility or that they can cause cancer.
LEADERSHIP’s data reveals that 46 per cent of women believe that contraception makes unmarried people “loose”, 33 percent believe that it causes infertility, 15.2 per cent believe that it causes cancer and other diseases while 39.3 per cent believe that it encourages female promiscuity, according to the data.
On availability of family planning products, the data show that approximately 15 percent of married women report using contraceptives and 16 per cent report an unmet need for family planning services.
In Northwestern Nigerian, high parity norms drive fertility with 61.6 percent of women with six or more children wanting more children and 89.1 per cent of men in that category.
This is predominant in the northern part of the country, where the majority of the population are Muslims because many women believe that high fertility honours Allah.
Specifically, one way “to serve God with fertility is to give birth to several children who will worship Him and secure the future of Islam,” they say.
Similarly, the cultural belief is that God places children in the womb and “until they are given birth to, you do not stop.” It is also believed that, to some extent, it is considered haram (unlawful) to have family planning due to the fear of sustenance and capability of taking care of the children.
However, there are other groups of people that still believe that having a modern family planning is lawful in Islam. The positive impact of Islam towards the use of contraception cannot be ruled out, as reasons behind the justification of the use of contraceptives include preserving the quality of the family, health, economics, and even helping the woman preserve her good looks.
The deputy chairman, Ward Development Committee (WDC), in Kafin Sule community, Baidu Liman, said all his wives were accessing family planning services.
He said, “Many people have now understood the importance of family planning. Before now, if you talk about family planning, people will just think that you don’t want them to give birth, but with explanations, men and women now understand that family planning is just to space their children and not stop them from giving birth.”
Sharing his personal experience, he said, “Before I got to know about family planning, I had two children within two years, but since I got this enlightenment, my children now have six years’ gap. Our religion allows family planning, it is only those people who do not know the religion that misinterpret it. We are still preaching and telling them what family planning is all about during marriages and during Islamic gatherings.”
Also, the ‘Facility in Charge’ Amina Abdulahi said, “We write down the days that we give them health talks. Some of them begin to access family planning immediately after birth. About 60 per cent of them access family planning but the remaining 40 per cent said their husbands will not allow them to.
“We also advise them to breastfeed optimally as it serves as a form of family planning.”
She, however, said that for some reasons, some of the women do not want to admit in public that they are accessing family planning.
“Some of them don’t like to come to the facility but they confide in me; they even change their names and addresses when they come for family planning,” she said.
This is an indication that religious and cultural factors have the potential to influence the acceptance and use of contraception by couples from different religious backgrounds in very distinct ways.
Within religions, different sects may interpret religious teachings on this subject in varying ways, and individual women and their partners may choose to ignore religious teachings and follow their personal interests.
Aside from culture and religion, the desire for large families also drives fertility in the northwest region of the country. According to the Nigeria Demographic and Health Survey (NDHS) 2018, 61.6 percent of women with six or more children in this region wanted more children. Among men with six or more children, that percentage was even higher; 89.1 per cent desired more.
LEADERSHIP’s study revealed that social norms driving high fertility in the northwest are tied in part to perceptions of its social advantages, such as signaling greater wealth and status, ensuring the survival of family names, and broadening social networks and influence. Large family size is believed to both represent and engender wealth, influence, respect, and fame.
Furthermore, large families are perceived to have economic benefits, such as serving as social insurance for parents as they age and contributing household labour or income from market-based employment.
However, the perception that men are more against family planning (FP) in northern Nigeria is gradually changing, as a man in Gombe explained how he was able to persuade his wife to embrace child-spacing.
A secondary school teacher and father of eight in the state, Usman Ibrahim, said he tried all means available to convince his wife to go for family planning, including seeking her parents’ help. “Yet, she refused and accused me of planning to marry a second wife.”
He continued to persuade her and promised to send her to school, but she refused until he threatened to take a second wife if she continued to give birth to children every year, before she agreed.