Recently, the world gathered in Brussels, Belgium, for the 18th General Meeting on Reproductive Health Supplies Coalition, RHSC. Good Health Weekly was there and spoke to Dr. Salisu Ishiaku, Director for Reproductive Health, Population Council Office, Nigeria on issues bordering on the country’s high fertility rate and family planning. He spoke to CHIOMA OBINNA on a wide range of issues including the fact that Nigeria is yet to have an established family planning programme. Excerpts:
How will you rate Family planning programme in Nigeria?
What is currently happening in Nigeria today is not really Family planning. Like the Federal Government and NGOs are distributing condoms and contraceptives, that is not it. It is sad, but the truth is that we never had family planning programme in Nigeria.
Family planning programme is a deliberate programme established by the government of the country to achieve a purpose around population control over a period of time. What we have now is people talking about family planning, encouraging women to seek family planning to improve their health, their children and family income but this is not family planning.
Family planning programme is a programme owned by government and it is all over the country. Right now, what we see in Nigeria like a particular NGO, for example, Population Council for instance is into family planning in Nassarawa and Ibadan. NURHI is in Kaduna, Ebonyi and Cross River states. FP programme should involve everybody in the country and every woman must have access to the FP programme and of high quality standard.
According to the last DHS, our unmet needs has increased to 16 percent. Unmet needs for spacing is 12 percent, for limiting 4 percent.
Are there talks with government about setting up FP programme?
Last year, there was collaboration between local partners and international partners to really encourage the government of Nigeria to start a FP programme. The meeting took place in Aso Rock and the Vice President Prof. Yemi Osibanjo who supposed to be there at the last minute could not make it but he sent three ministers. This issue was discussed and committee established and the government actually promised to do something about it to ensure that Nigeria has a family planning programme. After the formation of the committee I don’t really know where they are now. But the meeting was to set things in motion. But I don’t think government has done anything.
But for the first time in Nigeria, the government is approving two million dollars to buy family planning commodities. As of last month, the money has been approved but I don’t know if it has been released. The government promised for the first time to provide $4 million dollars every year in the next five years but for this current budget they have approved $2 million. A sign of something different has happened from the past.
How do we ensure that this money approved is released?
For the first time, they are saying that it has been approved in the budget and now it has been approved for release that means a higher step from the promise. The point now is that when it is released how are we sure the ministry will not divert it for a different purpose or misappropriate the money? That is a challenge.
Implication of high fertility rate?
Globally, when it comes to fertility, there is a recommended replacement fertility rate for any population to remain balanced and be economically viable. And with this replacement rate, the population must be kept healthy while others with higher fertility rate should be supported to achieve the replacement rate.
Also, those that have fertility below that global rate are also an issue because they are not going to support the system. And that replacement fertility rate is slightly above 2 (2.1) children per woman. And that is the target any country that wants to be viable and healthy should actually aspire to achieve.
Unfortunately, Nigeria has more than that. We have above 5 per a woman. But when you talk about rapid population growth and the need to review it that is why the current discussion even in Nigeria and globally is about the demographic dividends. Simply put, Demographic dividend, is the kind of benefit the country is likely going to achieve when youth population of the country is actually educated, make healthy and also given employment.
In Nigeria, the population age group of 15 to 24 is probably about 40 percent of the country. And they are the future of the country.
If you want to really achieve the four demographic dividends, that category of people, must be highly educated and kept healthy. For instance, they are youth and prone to sexually transmitted infections including HIV/AIDS.
There must be a programme targeted at those youth. No matter how you see it, it is a lot of investment. You want to educate people, let say Nigeria about 160 million people, it is a lot of money. For you to be able to make sure that the investment is beneficial and successful, you have to make sure that more and more of the children are not being produced.
You have to control the volume because as you are taken care of this problem you don’t need more problems to be added to the already existing one. To check this, you need a family planning programme for the youths and the adults.
Currently, our healthcare arrangement is that every Local government headquarter have a general hospital and that general hospital is affiliated to four primary healthcare Centres. It is created in such a way that every village is located 5 kilometres to a PHC. The reason is that most women cannot even walk more than that.
At least once a month, they can walk 5 kilometres and come back. If we make sure that those PHCs are equipped with skillful Family Planning care providers who are skillful in providing FP services and the contraceptives are available that will be the first significant milestone we can do. Even if nothing happens, at least just one.
Checking rapid population/increase access to FP
When we look at everything within the demographic dividend, there is need to prevent pregnancy among young people.
But fortunately, they are more in number. So the only thing is to prevent pregnancy so that they won’t go and have unsafe abortion and die. Keep them healthy by providing both female and male condoms.
Ten years ago, I worked in youth friendly centres. This is an important centre because young people are having sex whether we like it or not. There was a survey in Kano that showed that up to 30 percent of secondary school girls who are not married below the age of 14 have already have sex. That is just a state.
Certainly, it is very important that there should be more centres that would be friendly to young people where they can go to access any services and there won’t be any provider bias. Where the providers will not be judgmental which is a major factor that puts young people off. In such centres, providers must be skilled and trained about issues of family planning. It is very essential.
What do we need to do? It is simple. There are three preventive steps in preventing maternal mortality. In the first place, maternal mortality is the number of women that die during pregnancy or delivery up to 42 days after delivery as a result of complications.
For maternal mortality to happen there must be pregnancy. The first step is to reduce the number of pregnancy. The second step is to reduce the number of pregnancy that ends with complications that is where we have ANC. The last step now is to reduce the number of complications that result in deaths.
To resolve the first step, we should make sure that more women are taking family planning and ensure that all pregnancies are planned.
Family Planning and World Bank estimates of 821 per 100,000 live births
First, let me explain that the World Bank does not do the real counting but their figures are based on estimation. What they do is that since we don’t have data in Africa and many women are dying in the villages and nobody is reporting, and no data to check and see truly how many women die per delivery, they look at the history of a country that has data. For instance Belgium, what is the amount of the investment Belgium put in place to achieve the reduction of a particular number of maternal mortality.
And because this is scientific, as you are investing, you are seeing reduction. So the World Bank and other international agencies, then at the data in Belgium, what is the amount of reduction when Belgium was at this level of investment in maternal health and maternal mortality, when they increased to a particular level, what was the reduction? When they look at it, they will now come back to Africa where we don’t have data and look at what is our level of investment today. Compare it with when Belgium was at that level of development or the mortality.
Then, they will extrapolate from Belgium’s experience because of they have data. In most cases it is correct because the methodology is scientific and it has been validated over and over again. But that is not the actual counting. But it is important we take the figure very seriously.
What do we need to do to bring the number down? It is simple. There are three preventive steps in preventing maternal mortality. In the first place, maternal mortality is the number of women that die as a result of complications during pregnancy or delivery within 42 days after delivery. For maternal mortality to happen there must be pregnancy.
The first step is to reduce the number of pregnancy. The second step is to reduce the number of pregnancy that ends with complications that is where we have Ante natal care and the last step now is to reduce the number of complications that result in deaths. To resolve the first step, we should make sure that more women are taking family planning and ensure that all pregnancies are planned.