Family Planning: Will Nigeria Achieve FP2020 Commitment?

In recent times, the advocacy for family planning has become crucial as demand for reproductive, and population reduction, economic, health care grows.

There is no doubt anymore that the benefits of family planning are numerous and if properly executed will go a long way in enabling countries to achieve the Sustainable Development Goals (SDGs).

At the July 11, 2017 Family Planning Summit in London, U.K., the  Federal Government of Nigeria updated its commitment and pledged to achieve a modern contraceptive prevalence rate (mCPR) of 27 per cent among all women by 2020.

The 2017 Family Planning Summit was a forum of network of partners to bring local actions and solutions to scale, particularly for populations that have traditionally been left behind on family planning, such as adolescents and youth, and women and girls in humanitarian situations.

FP2020 is an outcome of the July 2012 London Summit where over 20 countries committed to enable 120 million more women and girls, have access to live saving contraceptives, irrespective of where they are by 2020.

However, at the dawn of 2019, which is barely 12 months to reaching the target FP2020 objectives on contraceptives usage, indicators show that Nigeria currently has a 13. 9 per cent Modern Contraceptive Prevalence Rate (mCPR), for all women.

mCPR refers to a proportion of women, ages 15-49 , who are using, or whose sexual partners are using a modern method of contraception, including hormonal and barrier methods, sterilisation, emergency contraception, Lactational Amenorrhea Method (LAM) and standard days/cycle beads method.

Mr Adebiyi Adesina, is a Senior Economist on the Track20 Project, implemented by Avenir Health, a U.S.-based company and Nigeria Country Lead for the Track20 Project.

The Track 20 Project, implemented by Avenir Health, monitors progress toward achieving the goals of the global FP2020 initiative.

Adesina told the News Agency of Nigeria (NAN) on Dec. 6, 2018 in Abuja that Nigeria is currently at a 13.9 per cent mCPR for all women, which is a national average as situations in each state varies.

“This is for all women of reproductive age which refers to women between the ages of 15 and 49, however, there is a wide variety of context across states as each state has its own realities, so you will of course see that difference.

“What it looks like in the different states vary from as low as two per cent to as high as `20 something’ per cent prevalence rate by state.’’

For a target which initially started in 2012, it is only realistic to evaluate the feasibility of achieving this commitment, pinpoint the challenges, proffer some solutions as well as emphasise the benefits of achieving this target.

Adesina told NAN that two key populations will trigger Nigeria’s growth in FP use.

“They are the youth, women between the ages of 15 and 24, and post-partum women, women who have just delivered, within the first six months of delivery.

“These population is going to be key; but because we are talking about Nigeria nationally, there is going to be differences in states.

“In some states, because they have a large youth population, the youth might be their focus.

“Other places, because they have a large married population and delivering population, then that might be their key demographic to focus for FP services.

“What is important to understand is that in all these programmes, the growth in FP can only be achieved if we identify what the context is and each state has to take the lead in doing that.’’

Adesina said that in terms of programme implementation, data is key and state data is going to be even more crucial in achieving the contraceptive usage and FP2020 targets.

“It is up to the states to make that decision to drive this by also designing programmes, policies on how to improve FP programmes and service delivery.

“These will include commitment to budgeting and financing, improved distribution, increased sensitisation and other interventions,’’ Adesina says.

The Family Planning 2020 in its “FP2020: Catalyzing Collaboration’’, says that modern methods of contraception have prevented over 2 million unintended pregnancies and 735,000 unsafe abortions between July 2017 and July 2018.

Inspite of  this progress, only 13.3 per cent of women aged 15-49 are using modern contraception in Nigeria, and one-in-four married women aged 15-49 have unmet need for modern contraception.

This status quo goes further to raise apprehension on Nigeria’s possibility of meeting its FP2020 commitments.

Dr Olumide Okunola, a Senior Health Specialist in IFC and World Bank, says yes for some states but No for most states; but generally, it is not likely that Nigeria will meet its target for FP by 2020.

He identifies some problems affecting FP uptake in the country.

“One of the problems always associated with the limited coverage of family planning services is socio-cultural.

“However, while it is okay to rebrand and be strategic about these issues, there is need to situate expansion of coverage within economic growth.

“To situate this discussion within the context of human capital development and not focus on family planning and its methods.

“One, the government of Nigeria is a government that spends the least on health in the world for its level of wealth.

“Also, our human capital ranking is poor and there is urgent need to improve on it, in 157 countries, Nigeria is 152 among the countries in that bracket from 140 to 157.’’

Okunola advises that family planning advocacy and activities expand to focus in particular states because family planning advocates and activists have been absent completely in most states.

“To achieve key indicators, NGOs, governments, organisations and individuals should go to states to help them develop work plans to expand NCPR.’’

The obstetrics and gynaecologist turned financial expert also noted that contrary to popular notions, funding is not necessarily a barrier to FP services in Nigeria as presently, there is “at least 172 million dollars to buy services’’.

Okunola also said that one of  the biggest challenges in public Primary Heathcare Centres (PHCs) is not necessarily the commodities but the consumables such as “the menthylated spirit and cotton wool, even in delivering some products as well as lack of prompt operational expenses for PHCs’’.

Going forward, Okunola says: “We won’t reach the goal but we can accelerate; we can do better than what we are doing if we focus on the key enablers and changing the policies when they need to be changed.

“We can do better by accelerating the pace of those policy change and also focusing on implementing what works, what is evidence-based and we have it already,’’ he says.

Dr Oladapo Ladipo, a renowned obstetrician and gynaecologist and the President, Association for Reproductive and Family Health (ARFH), also told NAN that meeting the 27 per cent mCPR by 2020 is unrealistic given the current data that we have.

“However, we need to at least appreciate the effort that has gone into increasing the CPR by at least two per cent point per annum,’’ he says.

On things that can be done to be near the target, Ladipo told NAN that it was important to improve the knowledge aspect about the product themselves.

“There is also need to appreciate that family planning is a rights issue; there are three rationales for family planning.

“There are the health rationale that it is in the interest of mother and child to reduce mortality and morbidity and the secondly, the economic advantage.

“Thirdly is the current posture which is the rights rationale; it is the right of everybody to know, to have information about FP commodities and it is the right of man and woman to have access to FP commodities.

“So, to ensure we achieve the target, there must be availability of commodities, and we want to encourage couples to discuss and take decisions on method they would accept.’’

According to Ladipo, there is need to also ensure a good logistics system that will ensure commodities are available in rural areas because if people now voluntarily want to have a family planning product that is not available, it will discourage them.

“I think the country should not despair; we should not lose the momentum; we should keep doing and look for ways of improving the service we are offering toward achieving that goal.

“We have to look at areas that have the need for that intervention, also, ways for partners and stakeholders to work closely with the government in service delivery, advocacy, data and others.

“There is need to engage the education sector because adolescent girls need to go to school to get enlightened and not be exposed to teenage pregnancy and early marriage,’’ Ladipo told NAN.

The Bill and Melinda Gates Foundation advises that Nigerian government should urgently increases domestic funding for FP.

According to the foundation, this has become necessary as donor funding is dwindling and healthy people still remain the greatest assets of any nation.

Dr Paulin Basinga, the foundation’s Nigeria Country Director, through Ms Diallo, says: “For Nigeria to reach its full potential, it needs to prioritse its greatest assets, its people.

“This is by investing in their health, education and equal opportunity which ensures prosperity that is sustained from generation to generation.’’

The foundation affirms that “Nigeria has the resources and knows how to get this right.

“So, more funding is needed and also data as well as strong and bold leadership to accelerate progress.

“Donor money is shrinking and it is urgent to increase domestic funding for health and more specifically for family planning.’’

The Chairman, Senate Committee on Health, Sen. Olarenwa Tejuosho, calls on the executive to release the additional one million dollars to the three million already committed for FP services.

Tejuosho (APC-Ogun) says it is important for the nation to improve on its FP purposes in order to reach its full potential; also, investment in FP is one of the smartest investments in achieving demographic dividend.

“FP is a major contributor in the progress of Nigeria as it will help to reduce the nation’s populace; if we continue to allow the families grow, it means we are heading to doom.

“The most important thing is the `green dot’ and every woman should be encouraged to walk into any outlet with the green dot to access FP services,” he says.

Beth Schlachter, Executive Director of FP2020 says: “Women represent half the global population, and there can be no healthy population globally or in Nigeria without reproductive health care.

“As we continue to build the framework for Universal Health Coverage (UHC), we must ensure access to full, free, voluntary contraception is included for all women and girls.’’

Also, Dr Ejike Orji, Chairman, Association for the Advancement of Family Planning (AAFP), says Family Planning (FP) is a must for Nigeria to avoid demographic doom.

Indeed, the Minister of State for Health, Dr Osagie Ehanire, acknowledges that FP can serve as a positive force to improve national planning and development, and so, it must be taken as priority.

In conclusion, the situation may not be totally bleak but achieving FP2020 goal will be a critical milestone to ensuring universal access to sexual and reproductive health and rights by 2030, as laid out in Sustainable Development Goals 3 and 5, and is key to unlocking all development priorities.

Consequently, in 2019, there is need to remind and ensure that the Federa; Government stands by the commitment to achieving the goal of a contraceptive prevalence rate of 27 per cent mCPR by 2020 based on the FP Country Implementation Plan (Blue Print 2014).

These commitments include but not limited to ensuring sustainable financing and funding for the National Family Planning Programme and the health sector in general.

The commitment to improve availability of services and commodities; also, taking measures that improve access and create the enabling environment for sexual and reproductive health services across Nigeria.

“To invest in increasing the number of health facilities providing FP services in the 36 states plus FCT from 9,500 as at 2016 to 20,000 by 2020 to reach the target of 13.5 million current users of family planning by 2020.

There is also the need to remind the Federal Government about its commitment  to build partnerships to improve access to family planning for women with lowest socio-economic status irrespective of age, location and religion, as well as train at least 3,700 community health workers (CHWs) to deliver the range of contraceptives.

The government should also focus on education, especially education of girls and the commitment to the use of social marketing to mitigate socio-cultural barriers such as preference for large families, religious restrictions, and women’s lack of decision-making power must be upheld.

All these are necessary because achieving the FP2020 will help to reduce Nigeria’s disturbing maternal mortality, curb the alarming population growth, protect the environment, improve standard of living, offer women more choices, encourage adoption of safer sexual behavior and generally aid development. (NAN)

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