By IJEOMA UKAZU
In Nigeria, young people are faced with challenges accessing family planning services, some say, lack of confidentiality, out-of-pocket expenses to commodities hinder uptake of contraception, to address these barriers, stakeholders said efforts of government and partners are needed to curb unwanted pregnancies.
According to the United Nations, adolescents include persons aged 10 to 19 years and youth as those between 15 to 24 years for statistical purposes while in Wikipedia, youth in Nigeria includes citizens of the federal republic of Nigeria aged 18 to 30 years.
Data from Demographic and Health Surveys, DHS, said since 2005 for 53 countries, including 31 in Africa with Nigeria inclusive, indicate that the share of women beginning sexual activity before marriage is large. Thus, the percentage of women aged 20-24 at the time of interview who reported having begun sexual activity before age 20 is generally higher than the percentage who married before age 20 with the exception of a few countries in Asia.
Because contraceptive use is low among adolescent women, early initiation of sexual activity, whether after marriage or before, is associated with higher levels of adolescent fertility.
According to the National Demographic Health Survey NDHS, 2018, data on sexual and reproductive health, SRH, outcomes in Nigeria highlight the importance of focusing on adolescents.
The data states that “At 512 maternal deaths per 100,000 live births, Nigeria accounts for roughly 14 percent of the global burden of maternal mortality. Global evidence shows that young girls bear a higher burden of maternal mortality and morbidity.”
The Demographic Health Survey, 2003, 2008, and 2013, shows that the average age at sexual debut is roughly 15 years among adolescent mothers in Nigeria.
The NDHS 2018 further states that the percentage of women aged 15-19 years who have a live birth is 14.4 percent, those pregnant with a first child is 4.3 percent, and those who have begun childbearing is 18.7percent.
The survey further posits that the percentage of women 15-19 years who are not using any method of family planning is 96.8 percent and those with an unmet need for Family planning are put at 12.2 percent and those 20-24 years are 16.1 percent.
With support from partners and donor agencies, the government of Nigeria has put in place youth-friendly health care centers and trained health care providers to provide youth-friendly services, but despite these efforts uptake to family planning services remain low.
To address these wide range of barriers hindering access to high-quality sexual and reproductive health, SRH, services, stakeholders at a three-day workshop for health editors and On-Air Personalities, OAPs, in Abuja agreed that more efforts are needed to scale-up uptake.
Speaking during his presentation, the Communication Officer, Pathfinder International, Bayo Ewuola highlights some of the barriers to include; Structural barriers which have to do with laws and policies requiring parental or partner consent, distance from facilities, costs of services and/or transportation, long wait times for services, inconvenient hours, lack of necessary commodities at health facilities, and lack of privacy and confidentiality.
Another barrier according to Ewuola is, “Sociocultural barriers: such as restrictive norms and stigma around adolescent and youth sexuality; inequitable or harmful gender norms; and discrimination and judgment of adolescents by communities, families, partners, and providers.
“Individual barriers: such as young people’s limited or incorrect knowledge of SRH especially family planning, including myths and misconceptions around contraception; limited self-efficacy and individual agency; limited ability to navigate internalized social and gender norms; and limited information about what SRH services are available and where to seek services.”
To address these barriers, the Communication Officer, Pathfinder International said, government, partners, and all stakeholders should ensure that, there is budget allocation specifically for adolescents and youths SRH services, there should be an updated policy on the sexual reproductive health rights of young people, there should be full implementation of these policies and laws.
He said, “Stakeholders should work together and address the lack of confidentiality of service providers, cut down on the high out-of-pocket expenditure for services, provide more SRH centers for easy access to young people and as well make available disaggregated data on adolescents and young people to aid planning, program implementation, and interventions amongst others.
Contributing, the Country Director Nigeria, Pathfinder International, Dr. Amina Aminu Dorayi said, “A woman in her reproductive age is either wanting pregnancy or stopping pregnancy. It is part of our lives as women or an adolescent girl in her reproductive age.
“For us at Pathfinder, is not just about stopping or having children, it is about our individual reproductive health goals. If you decide to have three children, we advocate that they are well spaced, so they can be healthy and for the mother to achieve her individual goal in life.”
Dorayi said the onus to control birth lies in the hands of the woman as most family planning methods usually use the physiological processes of ovulation and menstrual cycle, though research is ongoing to develop more family planning methods for men in order for them to have more options other than condoms and vasectomy.
Recently, during the launch of Nigeria’s Family Planning 2030, FP2030, Commitment and Dissemination of Other Reproductive Health Policy Documents in Abuja, the Minister of Health, Dr. Osagie Ehanire disclosed that an estimated 100 women still die every day in the process of giving life and about 50 percent of adolescent girls in Nigeria are already mothers by the time they celebrate their 20th birthday.
He said, recognized that the modest improvement made is slow with huge gaps of unmet need for contraceptive however, while the above present a gloomy picture, the government is aggressively stepping up action and efforts, particularly at the subnational levels to traject the trend in the right direction and bridge the gaps.
Ehanire said Nigeria’s rapid population growth rate can be attributed mainly to the high Total Fertility Rate, TFR, of 5.3 and low modern Contraceptive Prevalence Rate, mCPR, of 12 percent.
He adds that Ehanire further disclosed that Nigeria has the highest mortality ratios for women and children in Africa and 2nd highest in the world but significant progress is being made in improving the health status of women and children over the last 20 years.
Ehanire further revealed that the President of the Federal Republic of Nigeria, Muhammadu Buhari has launched the revised National Policy on Population Management for Sustainable Development.
According to him, “The President emphasized the importance of fertility control for improvement of the health of women and children, but also as viable intervention for sustainable growth and socio-economic development of the country.”
The Minister of Health further adds, “Efforts are ongoing to leverage additional domestic resources and harness the potentials existing within our large but youthful population through concerted and coordinated efforts of multi-sectoral players in the areas of health, women affairs, education and gainful employment, including Humanitarian crisis as the insecurity has impacted negatively on the health education of girls and adolescents.”