Victor Ohenhen, an Obstetrician and Gynaecologist at Central Hospital, Benin is also the Edo State Chairman of Medical and Dental Consultants Association of Nigeria (MDCAN). In this interview with CHURCHILL OKORO, he speaks on the role of family planning to national development and what can be done to increase contraceptive uptake in Nigeria.
With Nigeria’s population growing at more than three per cent annually and projected to double in the next three decades, what can the relevant authorities do to slow the growth of population in the country?
Population overgrowth can bring about harmful consequences hence all relevant stakeholders should enact and implement policies to ensure only sustainable population growth. The following are some of the steps that can be put into consideration; firstly, the relevant authorities should engage in massive campaigns to sensitise the public on family planning and its benefits. Secondly, there should be overhauling of primary health care sector with emphasis on reproductive health. Others are strong political will on the part of local and foreign actors to provide resources for capacity building and training of reproductive health care providers. Ensuring adequate access to contraception as an important means to achieve family planning. Decriminalization of abortion and ensuring access to safe abortion and post abortion care. Lastly, encouragement of rural to urban migration as rural dwellers are more likely to give birth to many children.
What is family planning/contraception, the methods and its benefits?
Family planning is a process that allows people to attain their desired number of children and determine the spaces of pregnancy. This is achieved through the use of contraceptives and treatment of infertility. Contraception on the other hand include all measures which could be temporary/permanent, designed to prevent pregnancy due to coital act. The methods of contraception include: hormonal method for example Combined Oral Contraceptive Pills (COCP), Progesterone Only Pills (POP), Injectable progesterone, Progesterone implants; Intrauterine devices such as copper releasing Intrauterine Contraceptive Device (IUCD), progesterone IUCD; Barrier method such as male condoms, female condoms, cervical cap and diaphragm; non-medical methods for example rhythm methods, cervical mucus testing, coitus interruptus, ovulation testing, lactation; emergency/post-coital method such as the use of postinor-2 in the first 72hours after unprotected sex; sterilisation for example tubal ligation for women, vasectomy for men. In addition to preventing unwanted and high risk pregnancies which often lead to death of mothers and babies, contraception also has benefits which include: reduction of women’s dependency by allowing them more opportunities to work; it can lower population growth, and boost economic development. Also, barrier methods like condoms help prevent transmission of Sexually Transmitted Diseases (STD) and HIV/AIDS.
Despite public campaigns to increase modern contraceptive use in Nigeria, it is still strange to majority of women of reproductive age and this has resulted to high maternal mortality from unintended pregnancies and illegal abortions. What are the factors contributing to low contraceptive use?
In Nigeria, this is not unconnected to myths, misconceptions and beliefs that people who use contraceptives end up with health problems or permanent infertility, contraceptives reduce sexual urge, and also increase promiscuity among women.
Others are low access to health care facilities, lack of knowledge about the various available options as most methods known by Nigerians are those that carry high risk of pregnancy such as pills which has a failure rate of 9 per cent and condoms which has a failure rate of 18 per cent.
The patriarchal nature of societies where husbands make the final decision and in some cases they may not accept any of the family planning methods and the wives would have no choice than to comply. The desire for more male child among married women has also influenced contraceptive uses. This has made most women to get pregnant up to 6 to 7 times all in a bid to have a male child.
There have been significant global improvement in the use of contraceptives but little or no progress has been made in the last decade in Nigeria. What can be done to increase the use of contraceptive among women/men?
There should be concerted efforts by relevant authorities to educate the public on family planning and its benefits. Efforts should be made to develop new approaches to family planning, including male contraceptives. New ways should be explored to pool the procurement of supplies across regions and countries, with donors providing guaranteed incentives to manufacturers to invest and produce at low cost.
Mobile phones have the potential to transform family planning and it is still an underexploited frontier in the quest to increase contraception uptake. They can help monitor contraceptive supplies and improve distribution. Their wide availability, portability and privacy also mean that they can provide advice targeting remote communities, and frequently excluded groups.
Some communities within leading faiths notably within Christianity and Islam are perceived to be resistant to family planning such as Catholic objections to abortion. It is imperative to work with religious and community leaders to educate and enlighten their followers that sexual and reproductive health for women is essential for community welfare.
Encouraging spacing of children should also be advocated. There should be integration of contraceptive provision into other networks and services, allowing them to reach a larger group. Young mothers, for instance, may prove reluctant to visit a family planning office because of social pressures or simply inconvenience and cost.
However, they are motivated to bring in their infants to clinics for vaccinations and more willing to seek contraception at that time. There should be incentivization of the whole process which may consist of cash reward or other incentives. There is mounting evidence that this has led to more contraception uptake in many countries.
One of the proposed 2030 Sustainable Development Goals (SDG) targets is universal access to sexual and reproductive healthcare services including family planning. If properly practiced, do you think it can address myriad of problems hindering development in the country?
Of course if family planning is properly practiced, it will go a long way in addressing some of the problems hindering development in Nigeria. First of all, women who practice family planning and child spacing have enough time to work, thereby contributing to the economic development of the country. Maternal/child mortality is a major problem in Nigeria. Family planning is one of the most cost-effective ways to prevent maternal, infant, and child mortality. It can reduce maternal mortality by reducing the number of unintended pregnancies, the number of abortions, and the proportion of births at high risk.
Boko haram and other terrorist groups in Nigeria have in the last few years had a negative impact on Nigeria’s economy, directly and indirectly. These groups mostly recruit members from street children who are most times result of non-practice of family planning. If family planning is properly practiced, there would be a reduction in the number of street children, leading to reduced number of children for recruit into these terrorist groups.
