(Lagos, July 10, 2012) Universal access to reproductive health and services has been identified as an important factor in the reduction of maternal deaths among women of reproductive age. The rationale behind this year’s theme of the world population day 2012 – Universal Access to Reproductive Health Services – is further deepened by the need to achieve the millennium development goal (MDG) 5 by the year 2015.
According to the Nigeria Urban Reproductive Health Initiative (NURHI), Nigerian women have on average nearly six children over the course of their lifetime and the national population already the largest in Africa is expected to double within 25 years. Low access to and utilization of modern family planning methods has invariably factored into high fertility maternal, and child mortality rates in the country.
“Nearly 800 women die every day in the process of giving life and about 1.8 billion young people are entering their reproductive years, often without the knowledge, skills and services they need to protect themselves” – UNFPA 2012
Indeed women continue to die because they lack access to contraceptives. Each pregnancy increases a woman’s chance of dying from complications of pregnancy or childbirth. Maternal deaths are particularly high for young and poor women, those who have least access to contraceptive services.
According to a recent report by Population Council, more than 200 million women in the developing world, who want to avoid pregnancies, are not using a modern method of contraception. They face many obstacles, including lack of access to information and health care services, opposition from their husbands and communities, misperceptions about side effects, and cost.
These challenges are formidable but needed to be addressed if any progress is to be made. The President, Federal Republic of Nigeria, Dr. Goodluck Jonathan recently said, ‘the issue of population regulation is very sensitive, but government cannot fold its arms until the country’s population becomes uncontrollable’.
In a statement by the United Nations Secretary-General, Ban Ki-Moon said, “On this World Population Day, I call for urgent, concerted action by Member States to bridge the gap between demand and supply for reproductive health care. We must mainstream reproductive health and rights into all development and poverty reduction plans. Investing in universal access to reproductive health is a crucial investment in healthy societies and a more sustainable future.”
There is no doubt about the need for strong political commitment in order to achieve rapid gains in contraceptive prevalence. Therefore, substantial investments in promoting voluntary family planning programs and increasing access for all women should be a top priority for government.
Reproductive health is a human right and increasing the demands for family planning would avert 54 million unintended pregnancies, more than 79,000 maternal deaths, and more than a million infant deaths each year (Population Council, 2012).
The 2012 World Population Day seeks to address the following reproductive issues which can however become major story and program ideas for the media:
- What reproductive health problems/challenges affect women of reproductive age (15 – 49 years) in Nigeria: There exists persistent unmet need for family planning among women of reproductive age group in Nigeria. This can undermine the achievement of the Millennium Development Goals and compromise global efforts towards human development. In Nigeria, the level of unmet need for family planning exceeds the level of contraceptive use. Family planning as a health programme is very beneficial and very important to reduce the currently high maternal and perinatal morbidity and mortality. Apart from these, there are several non-contraceptive benefits of family planning which include menstrual cycle regulation, decreased menstrual flow, decreased dysmenorrhea, decreased peri-menopausal symptoms, decreased acne, decreased hirsutism, decreased risk of endometrial cancer and decreased risk of ovarian cancer. The potential of contraceptive practice in preventing unsafe and unnecessary abortions, maternal and neonatal deaths, or the transmission of HIV to newborns warrants more stakeholders’ commitment especially that of Nigerians.
- Women are not having access to maternal health services, including family planning. Why? The fertility level in Nigeria is quite high (total fertility rate; TFR is 5.7) which implies that an average Nigerian woman will bear approximately six children in her lifetime (NDHS 2008). The 2006 census (142 million) gave an annual population growth rate figure of 3.2 percent. At this growth rate it would take only 22 years for the population of Nigeria to double. More than two-fifths of the population is currently under the age of 15 years.
Low level of family planning utilization is a major factor in the fertility pattern and population growth rate in Nigeria. According to the NDHS, the contraceptive prevalence rate for Nigeria was 14.62 percent for any method and 9.7 percent for modern methods in 2008. This scenario is largely due to a culture that is highly supportive of large family size, misconceptions about family planning methods, and male child preference. Other major factors include inadequate access to family planning services, poor quality of services and inadequate demand creation efforts.
- Benefits of family planning as a key maternal health strategy: Voluntary family planning programs are highly cost-effective and have demonstrable poverty-reducing effects. They also help women achieve their human rights to health, autonomy, personal decision making about family size and lead to increase in household earning. Family planning is one of the most successful development interventions of the past 50 years. It is unique in its range of potential benefits, encompassing economic development, maternal and child health, educational advances, and women’s empowerment. Research shows that with high-quality voluntary family planning programs, governments are able to reduce fertility and produce large scale improvements in health, wealth, human rights, and education (Population Council, 2012).
But in countries where contraceptive use is still uncommon and met with hostility and ambivalence, strong political commitment will be crucial to achieve rapid gains in contraceptive prevalence. Substantial investments in promoting voluntary family planning programs and increasing access for all women should be a top priority.
- The RH/FP needs of the young persons, especially girls A survey conducted among women between the ages of 20 to 24 years in northern Nigeria indicated that 45 percent of them were married by age 15 and 73 percent were married at the age of 18 years unlike in the southwest where there is delay in marriage (median age in marriage among 25 to 29 years olds was 20.5) and first childbirth after age 20. This often results in maternal mortality. Nigeria’s maternal mortality ratio of 704/100,000 is one of the highest in the world. For each maternal death that occurs, 15 to 20 other women suffer either short-or long-term maternal morbidities (i.e. fistula). It is estimated that over 600,000 Nigerian women seek abortion each year. A study indicated that one third of women obtaining abortion were adolescents and that up to 80 percent of Nigerian patients with abortion related complications were adolescents. 3.6 million People are estimated to be living with HIV/AIDS in Nigeria by the end of 2005 and an estimated 60 percent of all new HIV infections occur in youth ages 15 to 25 years. Approximately 1,600,000 women between the ages of 15 and 49 years were living with HIV/AIDS by the end of 2005 (NDHS, 2008).
- Girl child education and retention in school; what benefits exists for the girl child and the family: Education is central to poverty reduction and Nation building in Nigeria. However, educational opportunities for young people are unequally distributed particularly for girls. Girls are discriminated against in school enrolment for socio and economic reasons. Young people aged 15-19 have literacy rates of 79 percent for boys and 61 percent for girls compared with older adults aged 45-49 with literacy rates at 60 percent for men and 22 percent for women (UNFPA). Rural women are even more disadvantaged than their urban counterparts. Some socio-cultural groups favour more boys over girls in elementary and secondary school enrolment especially in the north while economic hardship in the south propels girls to go into trading to assist themselves and their families instead of going to school.
Meeting the unmet needs for family planning and maternal and child health needs
More than in other regions of the world, fertility and unmet need for contraception remain much higher in sub-Saharan Africa. Consequently, the prevalence of maternal deaths is increasingly concentrated in this region. Provision of family planning methods to women who wish to avoid pregnancy should thus be a top priority. The use of condoms for pregnancy prevention among sexually active unmarried women has increased markedly and is now the most prevalent method in this segment of the population in both sub-Saharan Africa and Latin America (Population Council).
The interval between a birth and the next conception greatly influences the health and survival of the mother and proven effect on the health and survival of children. The health care that a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her child. Many early childhood deaths can be prevented by immunizing children against preventable diseases and by ensuring that children receive prompt and appropriate treatment when they become ill (NDHS, 2008)..
Eliminating the child marriage; reduces the risks of maternal and newborn deaths: Early marriage for girls, which is often justified as a cultural norm is a major setback for young girls in Nigeria. Among families where this is practiced, their actions are justified on fear that their daughters might conceive out of wedlock and bring shame to the family and thus go about searching for husbands for them, which is often against the wish of the girl. Additionally, they forfeit their schooling and become pregnant once they are married. The consequences of this action can be dire for the girls.
For further information for interview and other materials please contact:
Development Communications Network:
Abiodun Owo (firstname.lastname@example.org, 08023305142)
At the state and FCT level :
Kaduna: State Team Leader, NURHI – Dr. Kabir Mohammed Abdullahi
Kwara: State Team Leader, NURHI – Mr Aliyu Abubakar Sodiq
Abuja (FCT): Team Leader, NURHI – Mrs Olubusola Salako
Oyo State: Team Leader, NURHI – Mrs Stella Akinso