By Ijeoma Ukazu
Urban-based youths are at a vantage position, considering a large number of family planning and sexual reproductive health, SRH, service outlets available to them.
Apart from primary health care, PHC, facilities manned by nurses and midwives in urban centres, and family planning clinics are also available in metropolitan city centres. Most youth-friendly centres targeting young persons, teenagers and adolescents, and persons between ages 10 and 19, are similarly mostly urban-based.
As young persons access services in these centres, it has become certain that those in rural far-to-reach areas often miss out on the benefits of family planning and SRH services because of the uneven distribution of facilities across the country.
The activities of young persons show that they need family planning services, wherever they are based whether urban or rural area. According to the Demographic Health Survey, DHS 2018, 19 per cent of women aged 15 to 19 in the country had begun childbearing.
Also, early initiation of sexual intercourse, sometimes at the age of 10, abounds. A typical example that readily comes to mind is an incident that happened two years ago of a 10-year-old Masenengen Targba, who was raped at an internally displaced person, IDP, camp in Benue State. She gave birth to a baby girl via caesarean section in August.
Different opinions trailed that her case was an isolated one, the NDHs estimate that about 50 per cent of girls in the country are already married by age 20. They are usually married young and without their consent. Besides, most sexually active adolescents do not practice contraception with the resultant effect of high levels of unintended pregnancy and unsafe abortion.
According to data from Guttmacher Institute, there is wide regional variation in the timing of marriage among Nigerian women. More than nine in 10 women aged 20–24 in the North East and North West had married by age 20, compared with half to three-fourths of women in the three southern regions.
It adds that six in 10 married women aged 15–49 want to space or limit childbearing, and 14 per cent of all births are either mistimed or unwanted. Thirty-two per cent of married women and 54 per cent of sexually active need family planning.
The Institute further said that many women either have never heard of any contraceptive method or do not know where to obtain contraceptives. Additionally, four in 10 married women and nearly five in 10 married men do not approve of contraceptive use. • Having or performing an abortion is illegal in Nigeria except to save a woman’s life. Yet the estimated abortion rate in 1996 was 25 abortions per 1,000 women aged 15–44, translating to about 610,000 abortions performed in that year.
Efforts to reduce unwanted pregnancy and unsafe abortion in Nigeria require the adequate provision of family planning services, as well as public education to dispel rumours and misperceptions about the health consequences and effectiveness of modern methods.
In Lagos State, while only 38.4 per cent of women aged 20 to 24 who are in marriage or union are currently using a contraceptive method, 12.3 per cent of those women have an unmet need for family planning. Women with unmet needs are those who want to stop or delay childbearing but are not using any method of contraception.
The Lagos State Coordinator of Life Planning for Adolescents and Youths, LPAY, Abiodun Ajayi recently blamed high-risk sexual behaviour among young people to be responsible for the increasing teenage pregnancy, out-of-school girls, baby dumping, post-abortion complications and death in Lagos.
Ajayi said, going by the above estimates of unsafe abortions, there is overwhelming evidence that young ones in the country need family planning services just like adults. Such services cover the provision of free birth control methods, devices, and supplies including birth control pills, condoms, the patch, Nuvaring, intra-uterine devices, IUDs, and Nexplanon. Other services are preconception counselling, preventive screening, and family planning options before pregnancy, among others.
While the listed services are widely available in facilities located in urban areas, he adds that the same number of services may not be cited in rural grassroots areas, thereby limiting the family planning benefits that may be accessible and available to persons on the outskirts of towns.
According to him, “On the contrary, all young persons irrespective of where they reside, should have access to needed family planning services, be they counselling, the ABC of sex, the provision of family planning commodities amongst others.
“The ABC strategy is a sex education policy based on a combination of ‘risk avoidance’ and harm reduction, which modifies the approach of abstinence-only sex education by including education about the value of partner reduction safe-sex and birth control methods.
“Given the limitation of available advocacy and services in rural areas, experts have called for increased family planning advocacy and service provision in rural areas to expand access to benefits of the family planning initiative, to young citizens in grassroots areas and hard-to-reach areas.”