A Long, Hard Road to Reversing Stagnation of Family Planning in Nigeria
By David J. Olson
LAGOS, Nigeria — Lydia, a community health worker for DKT Nigeria, steps carefully as she navigates the grimy streets of Makoko, one of the worst slums of Lagos. She is trying to avoid mud or something worse. The sanitation is abysmal. But Lydia is on a mission — to bring contraception to some of the most disadvantaged women in Nigeria.
This day, she calls on Iya Lekan. Although neither Iya, 36 years old, or her husband have regular work or specific sources of income, they have five children to look after.
“I don’t know how many times I have given birth,” she says in Yoruba, the local language here. “I’m tired.”
Iya told Lydia she was ready to start practicing family planning. Lydia presented various options, and Iya chose a three-month injectable called Sayana Press. Lydia immediately gave her the injection in her upper thigh.
Some people think Sayana Press could be a game-changer. It’s a new version of the well-known Depo-Provera injectable contraceptive, but contains 30% less of the active ingredient and can be administered by lesser-skilled health workers. The United Kingdom has already approved it for self-injection.
Last month, I spent an afternoon with Lydia, a member of the DKT Bees, a group of community health workers (CHWs) who focus on family planning in some of the grittiest parts of Lagos. DKT calls their CHWs “bees” because they are like the hard-working insects that go from flower to flower spreading pollen. But instead of pollen, DKT Bees go house to house counseling, educating and dispensing contraceptives.
The road to greater contraceptive use in Nigeria has not been smooth. It’s shocking that the percentage of married women using modern contraception in Nigeria is only 9.8 percent (Nigeria Demographic & Health Survey 2013). That figure is lower than all countries in West Africa except Gambia, Guinea and Mauritania, according to the 2016 World Population Data Sheet, and has has hardly changed in the last ten years. Nigeria has a population of 187 million, making it the seventh largest country on earth. If current trends continue, it will be tied for third, with the United States, in 2050.
Clearly, family planning has stagnated in Nigeria since 1999. The reasons are many but certainly family planning myths and misinformation play a huge role. A DKT outreach worker told me that some of the most common questions she gets from Nigerian women are:
- What are the side effects of each method?
- Does family planning result in infertility?
- Does family planning increase body weight or make me fat?
- What do I do if bleeding occurs?
- Does contraceptive use predispose me to cancer?
The bottom line is that contraceptives are good for the health of women. In fact, Nigerian health experts blame the low uptake of family planning as one of the reasons why Nigeria still reports high maternal mortality.
The good news is that 16.1% of married women in Nigeria who are not using family planning want to start using it. The figure is even higher among sexually active unmarried women: 21.8 percent of them want to use contraception.
World Contraception Day on Sept. 26 provides a good opportunity to reflect on the current situation and what we can do to improve it in places like Makoko, so that every Nigerian woman who wants contraception can access it.
Decades of research have shown that modest investments in family planning can save lives and improve maternal and child health. And consider that family planning has been proven to be one of the most cost-effective health interventions. In short, family planning improves the economic well-being of families, communities and nations.
DKT Bees are one of the programs of DKT Nigeria, an affiliate of DKT International. DKT came to Nigeria in 2013 to help change the family planning paradigm. Using social marketing, it launched Kiss and Fiesta condoms, Postpill emergency contraception, Levofem oral contraceptive, Sayana Press injectable, Implanon NXT and Jadelle implants, Lydia intrauterine devices (IUDs) and Miso-Fem (Misoprostol). After only three years, it contributed 14% of Nigeria’s contraceptive prevalence rate in 2015.
Dimos Sakellaridis, the country director of DKT Nigeria, says he wants to make affordable contraceptives as easily available in Nigeria as Coca-Cola.
“Like women’s beauty products or hairstyles, modern family planning should be consumer-oriented and easy to understand, access and use,” he says. “When a woman wants to feel beautiful, she walks to a nearby store and buys a beauty product or service. Family planning should be obtained for the same consumer benefits — to enable women to feel beautiful by allowing them to manage their fertility and life.”
DKT Nigeria launched a new family planning communications campaign that coincides with World Contraception Day on Sept. 26. The target audience of its campaign is young women ages 18-34 (primary) and young men ages 20-34 (secondary) in the lower middle and working classes of southwest Nigeria. A new website, Honey and Banana, will serve as the central hub of the campaign and will be the destination for other traffic sources, such as Facebook, Twitter and Instagram.
The theme of the campaign is “Be Sharp.” The phrase is common slang that resonates with the target audiences. It means be smart, not dull. It means making the right decisions, especially concerning birth control and contraception, to avoid unwanted surprises.
Almost one in five people living in sub-Saharan Africa is a Nigerian. If enough girls and women are motivated to adopt contraception, the government will meet its goal of reaching 36% contraceptive prevalence rate by 2018, and their health will improve. It all comes down to community health workers like Lydia and the DKT Bees, going from house to house, taking one step at a time, to meet the needs of disadvantaged Nigerian girls and women.