Family planning

Nigeria: Putting Family Planning First – Lessons from Zimbabwe for Lagos State

Like many countries in sub-Saharan Africa, Nigeria continues to face challenges in meeting the health needs of its population, particularly in sexual and reproductive health. Despite cuts in funding from international development partners for family planning (FP) services and the revision of Nigeria’s Family Planning Master Plan (Scaling-up Plan): 2014-2018 to the Family Planning Nigeria 2020-2024 currently revised, incorporating issues that have emerged since the development of the original master plan, there is no budget line for FP services and commodities in Nigeria’s 2022 budget. Considering that Nigeria is set to become the third most populous country in the world by 2050, with an estimated population of over 400 million due to its annual growth rate of 2.6%, this calls into question the country’s continued commitment to closing the huge gaps in FP access across the country.

Increasing funding and demand for FP services and products is essential because without it, FP services and products will not be demanded and made accessible. Recognizing the consequences of poor access to FP services, Nigeria Health Watch recently convened a Policy Dialogue to intensify conversations on different ways Nigeria can improve its domestic resource mobilization for FP services. #FundFPNaija dialogue speakers presented a business case for increasing private sector participation in funding FP services, highlighting potential benefits such as reduced taxes for participating organizations, reduced maternal mortality, increased revenue generation and health financing through earmarked taxes and effective resource management. The Nigeria Family Planning Blueprint 2020-2024 already highlighted that 80% of modern contraceptives are provided by the private sector.

Family planning in a new Lagos

Each year, September 8 is celebrated as World Contraception Day (WDD), to recognize the rights of couples and individuals to decide freely and responsibly the number and spacing of their children. In its pursuit of excellence in women’s health and empowerment, the Lagos State Ministry of Health and the Lagos State Government supported by the Post Pregnancy Family Planning Project, the The National Institute Alumni Association (AANI)[email protected] project (PAS) Project and other civil society organizations commemorated WCD 2021 with a policy dialogue on “Family Planning in a new Lagos: a catalytic pillar for women’s empowerment and socio-economic development”. During the policy dialogue, the First Lady of Lagos State, Her Excellency Dr. Ibijoke Sanwo-Olu said that despite the benefits of FP, it is disheartening to know that for many women, the right to decide when or if having children is hampered by the lack of access to safe and modern methods of contraception, as “many women in Lagos who wish to delay or avoid pregnancy are currently not using any form of modern contraception and our aim is to reach these women,” she added.

The business of women’s health

The return on investment of spending to increase access to contraception yields incredible benefits, both in terms of well-being, socio-economic impact and development for the state, which is why over the Last 18 months, the Lagos State Government has commissioned four modern daycare centers for optimal service delivery.

Professor Adesegun Fatusi, in his presentation, noted that contraceptive prevalence has gradually increased in Lagos, but unevenly across different groups. With an annual mCPR of 1.38% for the period 2014-2020, male condoms and implants remain the most regularly used modern contraception. Fatusi pointed out that the use of traditional contraceptives is higher than that of modern contraceptives, as about 68% of users seek contraception from local vendors. “People are using FP, but they’re not using the most effective method,” he said. According to Professor Fatusi, the private sector, particularly through community pharmacies (CPs) and patented and proprietary medicine vendors (PPMVs), are key access points to modern contraceptives for more than 65% of users in Lagos.

This is an important entry point that the government can target for financial incentives to also improve the provision of and access to FP services. The IntegratE project, a 4-year project funded by MSD for Mothers and implemented by a consortium led by the Society for Family Health (SFH) with the Federal Department of Health, piloted a 3-tier accreditation system, led by the Pharmacy Council of Nigeria (PCN) to pilot a task shifting model in Lagos and Kaduna. The objective was to enable increased access to FP products and services, particularly in rural areas where the informal private sector was already an important source of FP services.

The Zimbabwean example

As the African continent continues to grapple with family planning issues, there is an economic benefit if developing countries maintain their investments in FP services, which could result in a substantial decrease in unintended pregnancies. desired. For every dollar invested in contraceptive services, there is a savings of $3 in the cost of maternal, newborn and abortion care.

Zimbabwe, Botswana and Kenya were the first countries in sub-Saharan Africa to experience a fertility transition from 6.7 to 4.0 births per woman between 1984 and 2015. Over the past two decades, the rate of Modern contraceptive prevalence (mCPR) for Zimbabwe was estimated at 67% for all methods among married women and currently stands out as one of the highest in sub-Saharan Africa. The Zimbabwean model of FP is an outstanding African success story that should be adopted by other countries.

Although Lagos State is not a country, it is similar in size to Zimbabwe and can adopt many of the structures found in its FP model. As the state prepares to achieve a comprehensive development agenda through access to FP, it can integrate the following three approaches from the Zimbabwean model.

The Zimbabwean government has ensured the availability of FP services through a wide range of delivery points. The government has maintained and strengthened its programs for delivering FP services from the tertiary hospital to community platforms in the public and private sectors. Mobile clinics, field health workers, health centers, private doctors, private hospitals/clinics have been deployed in an effort to reduce access to FP service delivery. They have shown that correct and ethical use of modern contraception has major social and life implications.

Zimbabwe’s ability to achieve an above-average mCPR for sub-Saharan Africa indicates the government’s willingness to create an enabling environment that has helped FP programs thrive. Showing political will, the government of Zimbabwe has become a signatory to several international and regional conventions, including the International Conference on Population and Development and the Abuja Declaration, to which Nigeria is also a signatory. In addition, the government has also revised the marriage law and in 2016 a law was passed raising the legal age of marriage from 16 to 18 for both boys and girls.

Finally, to help the government and partners better understand the country’s FP budgetary needs over a period, the government of Zimbabwe has defined financial resource requirements. Thus, FP funding gaps were identified, allowing the government and donor partners to strengthen their commitments through more targeted resource mobilization for FP program needs over a 5-year period.

Final Thoughts

While the long-term goal of the World Contraception Day Policy Dialogue was to promote gender equality and empower women through the provision of unfettered access to FP, we must not losing sight of the complexity of FP and ensuring that women’s voices are heard and that women and girls are able to choose and negotiate their sexual and reproductive health needs.

For Zimbabwe, successful FP also meant improved health services contributing to a drop in the infant mortality rate from 960 deaths per 100,000 live births in 2010 to 614 deaths per 100,000 live births in 2014. In Nigeria , the under-five mortality rate is 132 per 1000 live births, meaning that about one in ten Nigerian children never reach the age of 5. It is crucial that health services be strengthened to improve the health of women and children.

Family planning should become an urgent national priority, and governments at all levels should invest their money in ensuring that FP programs and services are well funded in the 2022 budget and beyond. Efforts should be made to ensure full implementation of Nigeria’s FP Master Plan in health facilities by ensuring that there are properly trained service providers and adequate equipment and infrastructure to support service delivery . In addition, the Ministry of Health should lead the implementation of the National Family Planning Communication Plan (PNCPF) to increase demand for family planning. The unmet need for contraceptives among young unmarried users needs to be addressed, and counseling services need to provide care without judgement.