Nigeria’s efforts to control its population is threatened by the negative attitude many women still have towards family planning, BUKOLA ADEBAYO writes
As if a big blow had hit her, Bolanle Ogunsakin was devastated when she found out that she was pregnant six months after she had another baby boy.
Instead of rejoicing when the nurse broke the ‘good news’ to her, Ogunsakin began wailing such that she had to be taken to the doctor on duty at the Oshodi-Isolo General Hospital, Lagos.
After much probing from the physician, Bola opened up on her dilemma. Her husband had just lost his job as a teacher in a primary school and her three kids were sent home from school because they had not yet gathered enough funds to pay their fees.
The mother of four, who narrated her ordeal to our correspondent while (Ogunsakin) on admission at the Obstetrics and Gynaecology unit at the Lagos University Teaching Hospital , Idi-Araba, for post-abortion complications, said she asked the doctor for what many would consider unthinkable.
‘I told him I wanted to abort the pregnancy. There was no way I was going to tell my husband that I was pregnant again, being the only one that remained employed.”
When the doctor refused to grant this request, Ogunsakin, who earns a living from washing clothes for residents in her neighbourhood, confided in her neighbour who took her to a ‘tested and trusted’ herbal doctor in Ikorodu, Lagos.
The native doctor gave her a herbal potion that would abort the pregnancy before the end of the week.
According to her, the concoction worked as she began bleeding profusely on the third day, which led to her being admitted for three weeks for acute anaemia.
To avoid recurrence, Ogunsakin’s physician advised her to try one of the family planning methods that were available at the hospital. In spite of her predicament, she refused to be placed on any contraceptive.
According to her, she had been told by a traditional birth attendant who delivered her last baby that such methods could lead to cancer or make her bleed to death.
Ogunsakin is not the only woman who has reservations about various family planning methods.
Our correspondent, who was accompanied by officials from the Federal Ministry of Health in February, who had gone to distribute birth control pills and other contraceptives to market women at the popular Tipper Garage in Ketu, Lagos, got the same cold response from the women in the locality.
In spite of the fact that the contraceptives were going to be given freely, a majority of them refused to take them.
One of them, Mrs. Shekina Aderoju, explained to the health officials that a fellow trader who took the birth control had not been able to conceive even after she stopped taking the pill.
She said, “That was how they gave my friend some tablets two years after her first child. Do you know that she has not conceived till now? Her husband just got married to another woman.
“I have just three kids and I don’t want my in-laws to start saying I am barren when they want more children. It is not by force, if am pregnant I am pregnant.”
Between myths and spreading ill health
Further investigations by our correspondent, who spoke to some mothers in Lagos, revealed that more than 70 per cent of Nigerian women do not accept any birth control measures due to misconceptions about the safety not the efficacy of contraceptives.
Another petty trader, Mrs. Omolara Odunfarin, said after much pressure from her husband, she tried one of the family planning methods at a primary health centre in Oshodi-Isolo, Lagos but discontinued such due to excessive bleeding some days after.
She said, “After my third child, my husband insisted that I should do family planning. I was given one of the ‘injectables’ but I had to stop it when I kept seeing blood for three days. I confided in my sister, who told me to stop because she had a similar experience. I did not bleed again when I stopped using it.”
On her part, Chinyere Ekeocha stopped the progesterone vaginal ring, a popular and free family planning method in Nigeria, because it halted her menstruation.
The mother of four said she was scared that the vaginal ring had disrupted some natural processes in her body, which could lead to ill health.
Female condoms
Ekeocha said, “It was the nurses that said I should take it after giving birth to my third child but I when I did not see my menses for four months , I was afraid. I was growing fat, even my husband who initially supported me said I should remove the ring because it could be that it had shifted or turned to cancer.
“Three weeks after I removed it, I saw my menstrual flow began to reduce. All the blood that was not coming out was making me fat and storing in my body to cause cancer. My doctor fixed it for me at the clinic but when I did not use it again, I started my menses again. I won’t advise any woman to use it.”
A new survey conducted in 20 local government areas in Lagos in 2014 revealed that 57 per cent of women who need these essential services, which are widely available in health care facilities, shy away from it due to the fear of cancer, infertility and other health-related challenges.
Different methods for different women
According to the Co-Principal Investigator of the PMA2020 family planning survey sponsored by the Bill and Melinda Gates Foundation, Dr. Funmilola Olaolorun, only 19.5 per cent of the female population in Lagos use one form of modern contraception or the other.
Olaolorun stated, “We found out that 25.6 per cent had fears and unfounded perceptions about the side effect such as cancer and bleeding. About 6.5 per cent stopped because it interfered with natural processes in their bodies, that is, they stopped menstruating while another 5.1 per cent felt they would become infertile.
“Those who took family planning implants feared that the implants had migrated and entered their stomach and turned into cancers.”
Olaolorun , however, erased these women’s fears. According to her, no research or evidence has shown that any modern birth control method causes cancer, infertility or other serious medical complications.
She stated, “There is no single method that works for every woman. It is not a one-size-fits-all. It is the doctor that will determine which method best suits you but we know that no scientific evidence has showed that modern contraceptives lead to cancer.
“Some of the methods however have their side effects but they are not life-threatening. For instance, we would not want to give a woman who has not given birth an intrauterine device popularly known as coil because it can cause infection in her vagina which can lead to pelvic inflammation. Yet, this is also very rare.
“If a woman is using ‘injectables’, she may not see her menses for years till she stops but it does not mean that the blood that is not coming out is stored somewhere in the stomach. Yet, for a woman who has reached menopause and does not see her menses again, it does not mean that she would have cancer.”
Family planning and maternal mortality rates
In Nigeria, birth control is widely stigmatised and misunderstood by women who need it the most.
According to the United Nations Population Funds, globally Nigeria has one of the lowest contraceptive prevalence rates after India.
The global body also stated that countries with the lowest contraceptive prevalence rate often record the highest maternal and infant mortality rates as women in such countries are more likely to die of child birth complications as a result of unwanted pregnancies and unsafe abortions.
Corroborating this view, consultant gynaecologist and former country director of Ipas, a sexual reproductive health organisation, Dr. Ejike Oji, stated that the low contraceptive prevalence rate in Nigeria ( 11 per cent) is the major reason why the country has the highest maternal mortality rate in the world.
Oji said it was high time government at all levels recognised that family planning was the magic bullet that could decrease the number of women dying from child birth complications and unsafe abortions, which are often the outcomes of an unwanted pregnancy.
He noted that studies had shown that regions with low contraceptive prevalence usually recorded the highest maternal rate in the world.
IUD
“Unwanted pregnancies, unsafe abortions and maternal deaths are like sisters. More than 90 per cent of women who have more children than they can cater for will seek an abortion when they get pregnant again.
‘Statistics also show that about 33 per cent of all maternal deaths that occur in Nigeria have been linked to women who sought unsafe abortions because of an unwanted pregnancy.
“Every pregnancy can be prevented or planned for if more women who should be using this family planning methods use them.”
Apart from reducing maternal deaths, Olaolorun posited, improved uptake and awareness on family planning can also reduce the infant mortality rate in the country.
According to the scientist, mothers who adopt modern family planning, which she said are 99 per cent-efficient in preventing conception, are better positioned to do exclusive breastfeeding.
“The breast milk is the best immunity that you can give your child to survive his/her first five years. A child that is breastfed exclusively is less likely to have problems of diarrhoeal diseases that kill over 90,000 Nigerian children.
“There would be less likelihood of upper and lower respiratory tract infections, pneumonia and other infections that can lead to a baby’s untimely death.
“The mother also stands to benefit as recent evidence have shown that mothers who breastfeed have at least 50 per cent protection against cancer of the breast.
“Breastfeeding helps the bond between the mother and a child such that the child is less likely to end up with behavioural problems.
But if you don’t take family planning to space your children, you won’t be able to breastfeed any of them for the six to one year period that you should – because once you are pregnant, you can’t breastfeed again.”
It will reduce poverty – Experts
Oji said apart from reducing infant and maternal deaths, increased uptake of family planning methods among Nigerian women could significantly reduce the poverty rate in the country as more women would be able to contribute their economic quota to the development of the country.
He said, “The regions in Nigeria that have the lowest contraceptive rate such as the North East and the West have the highest poverty indicators in the country. In fact, there is almost a direct correlation between poverty, high fertility rate, low contraception and low standard of living.
“It will be difficult for a woman who is having children every one and a half years to maintain a job or become a tangible employer of labour. It will be more difficult for her to improve her standard of living and it will be much more difficult for her to establish a viable business.
“Poverty continues to thrive in Nigeria because the women who form about 50 per cent of the population are not able to deliver their full potential because of the many challenges they face – which include unwanted pregnancies.”
Olaolorun pointed out that women who use modern family planning methods were not likely to have more children than they can cater for, which would help them build a tangible family life.
She said, “There will be fewer street children and homeless ones. The regions with the lowest family planning rate in the world often has the highest population of street children. A child that is not well catered for is not likely to get a good education
“Family planning helps couples to plan their finances around the number of children they can afford to educate.”
To encourage more women to embrace family planning, Consultant Gynaecologist and Obstetrician, Lagos University Teaching Hospital, Idi-Araba, Dr. Ayodeji Oluwole, noted that there was a need to correct the perception that the modern methods were not available for all.
According to him, many women in rural areas would rather use local and traditional contraceptives such as traditional rings and concoctions which pose a greater danger to their health even when the modern methods are readily available and are given free of charge in primary health centres in the country.
He stated, “Many women are ignorant about these methods. We also need to talk to mothers, especially those living in the rural areas, who are not benefitting from these methods and who will only listen and do what their friends tell them without consulting the right people.
“Women are dying daily from unsafe abortions they engage in when they have unwanted and unplanned pregnancies.”
Oluwole listed birth control measures that are available in Nigeria to include the use of condoms and the pills.
“We have the hormonal methods, which are oral pills, to be taken once every day. It is 99 per cent efficient. We have the ‘injectables’, which are divided into three parts, and there is a dose for every two or three months depending on the woman. But women who are over-weight are not supposed to use the hormonal methods,” he said.
According to him, there are implants that are inserted underneath the skin, examples of which are the implanon or jadelle.
“They last for about two to five years, depending on the type one chooses. There is the tubal ligation. It is like a tube and is usually prepared for those who do not want babies again. This is done during the Caesarian section or laproscopy. It is a permanent contraceptive.”
It is against our tradition- Faith-based institutions
While stakeholders continue to call on the Federal Government to enlighten more women on the benefits inherent in using modern family planning methods, some religious organisations are against the practice.
In fact, women who fellowship in these institutions are often chastised by their religious leaders for daring to interfere with the natural process of conception – as ordained from ‘above’.
Ada Obinna , a devout catholic, said it would be a sin for her to use any of the birth control methods to space her children.
The 26-year- old- mother of three, who sells food condiments in Ketu market, Lagos, told our correspondent that instead of using birth control pills or other devices, she uses the calendar method popularly known as the Natural Family Planning method.
She said, “It is not even allowed in the Catholic Church for a woman or man to use contraceptives. I usually calculate my period to ensure that I have sex only when I am safe. Even my husband and I have agreed and it is working for us.”
Obinna is not exaggerating. In some faith-based organisations, artificial contraception is regarded as a sin.
For instance, the Catholic Church condemns the use of contraceptives such as tubal ligations, vasectomies and pills.
Indeed, Pope Paul VI, in his landmark encyclical letter tagged Humanae Vitae (Latin, “Human Life”), re-emphasised the church’s constant teaching that it is always intrinsically wrong to use contraception to prevent new human beings from coming into existence.
The letter, which is still an integral part of the church’s doctrine, states, “Contraception is any action which, either in anticipation of the conjugal act (sexual intercourse), or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible.
“This includes sterilisation, condoms and other barrier methods, spermicides, coitus interruptus (withdrawal method), and all other such methods.”
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