By Doris Obinna
In the face of the ravaging COVID-19 pandemic, experts believe there is the urgent need for birth control. This is because a large proportion of the population growth is occurring in the least developed parts of the world, particularly in Sub-Saharan Africa.
To address the population growth and the strain that it places on societal resources, experts said there is an increased focus on strategies to reduce fertility rates, which has been incorporated in the Millennium Development Goals (MDGs) to improve maternal and child health.
They asserted at a webinar training, that the rates of maternal mortality are among the highest in the world in Sub-Saharan Africa, sometimes as high as one maternal death per 100 births.
Studies have shown that women identify their fear of partner’s reaction or disclosure as a barrier to contraceptive uptake and use. Nigeria in particular remains a focus for increasing contraceptive use, as it is one of the most populous countries in Sub-Saharan Africa.
Chief Midwife, Rotary Maternal Child and Health (RMCH), Evelyn Kutelu, defined contraceptives as devices or products used to prevent pregnancy intentionally, also known as child spacing, birth control or family planning. Examples include implants, oral pills, intrauterine devices, condoms and injectable:
“Contraceptive logistics, which also include, inadequate family planning (FP) commodity distribution system in Nigeria among other causes can also be attributed to poor record keeping at the state, local government and facility levels.
“There have been different methods of commodity distribution adopted in the country, which has been inconsistent and neither has it addressed the recurrent stock-out in stores and health facilities. Some state has no data of FP commodity been received and consumed in their facility because they operate last mile distribution (LMD) system.
“Haven under studied the inconsistence trend of commodity distribution, and in a bid to proffer a lasting and sustainable solution, the RMCH introduced an electronic platform for data reporting in real time directly from health facilities.
“This will enable the concerned persons to have first hand information about commodity availability status, and imminent stock-out so that priority can be given to the most needy, and plans made for procurement with logistics timing in mind. That is why RMCH’s National Obstetric Quality Assurance (NOQA) has included FP on its platform, since FP is an integral part of maternal health.”
Kutelu disclosed that the challenges in commodities distribution in Nigeria have resulted in stock out in all the states at different point in time, in spite of the continued support from development partners, donor agencies and other stakeholders in the health sector: “Though there has been improvement much is still needed to be done to bring the situation under control once and for all.
“So, it’s good to know that since 2013 RMCH has been supporting the government of Nigeria with levonorgestrel-releasing intrauterine system (LNG-IUS) supply and distribution to the states for ease of transportation.
“For all other types of contraceptives, RMCH’s National Family Planning Campaign (NFPC) project is ready to work with the government in establishing a standard contraceptive distribution plan from the National warehouse to the state, local government and health facility level. This is in a bid to halt the set back in the contraceptive gains brought about by chronic FP commodity stock out at all levels.”
Rate of contraceptive use in Nigeria
The most recent Demographic and Health Survey (DHS), said Nigeria has a high total fertility rate (TFR), estimated to be between 5.5 and 5.7 for women of reproductive age (15–49). Low rates of contraceptive use are also pervasive in Nigeria:
“Approximately 15 per cent of married women report using contraceptives and 16 per cent report an unmet need for family planning services. The majority of contraceptive users in Nigeria rely on modern methods (10 per cent of currently married women), five per cent use traditional methods, three per cent use injectable, and two per cent use male condoms or pills as a method of contraception.
“Rates of contraception in Nigeria have stagnated, remaining approximately nine per cent between 2008 and 2013. Though the contraceptive trend has not reversed, it is still concerning that contraceptive uptake is not increasing as it has been in other countries of Sub-Saharan Africa.”
Methods of contraception
Kutelu said there are three methods, traditional, natural and modern: “These methods are further classified into various categories and types; traditional methods, which include the arm band, waist band, herbs/concoction an incisions. Natural methods include abstinence, withdrawal method, lactational amenorrhea method (LAM), calendar method, billings method and fertility-awareness method.
“Modern methods, which are further classified as the barrier methods; (e.g. condoms, diaphragm) and hormonal methods; e.g. vaginal ring, pills, injectables, implants (Jadelle, Implanon), LNG-IUS, intrauterine device (copper – IUD), emergency contraception and sterilisation method (vasectomy and bilateral tubal ligation).
“It is worthy to note that the male and female condoms are only contraceptives that offer protection against sexually transmitted infections, HIV and pregnancy. All others contraceptives only offer protection against pregnancy.
“The sterilisation also known as vasectomy and bilateral tubal ligation has been debunked by technology as a permanent method but because the harvesting of sperm and ovaries with support of a surrogate mother, fertilization can still go on.”
Benefits of contraceptives
She said pregnancy and childbirth carry risks of morbidity and mortality. Although the contraceptives that couples use to avoid pregnancy have their own health risks, they also have substantial non-contraceptive health benefits:
“To the woman/mother, healthy motherhood, women financial potential grows as they’re able to pursue their education or career and prevents morbidity and mortality related to pregnancy and abortion complications.
“To the man/father, manageable family to cater for; enjoys healthy wife and children and increased chance of investment for better living. To the children: reduced mortality, healthy and well children, good education, more care and attention from parents.
“While to the government and society, improved socio-economic growth, manageable population, and improved quality of life of the population as well as improvement in life expectancy of the citizen.”
Preventing HIV, others among women, girls
According to the recent Evidence for Contraceptive Options and HIV Outcomes Study (ECHO), by World Health Organisation (WHO):
“Urgent action is required to invest in and expand HIV prevention, sexually transmitted infections (STI) services and contraceptive choices in the broader context of providing sexual and reproductive health (SRH) services that uphold the rights of adolescent girls and women.”
The study said with the physical distancing as a result of the COVID-19 pandemic reducing contact with health services, it would be essential that interactions with health-care providers be optimised through integrating services. “Prevention of HIV and sexually transmitted infections should be the standard of care for contraception information and services provided to women at a high risk of acquiring HIV,” said James Kiarie, Unit Lead, Contraception and Fertility Care, Department of Sexual and Reproductive Health, WHO.
“Contraceptive use help prevent unplanned pregnancy, thereby reducing pregnancy related risks and complications including death. Myths and misconception about family planning does exist, though not true yet they have remained a huge set back in uptake and use of birth control in our society. There’s urgent need for more advocacy to stakeholders, and sharing of correct information about contraceptives through all media.
“Potential users should visit skilled service providers in hospitals for counselling and safe services. Various safe methods are available, and informed decision can be made when information is sought from the appropriate quota. We all have a role to play in addressing uncontrolled population growth, poor maternal and child health and poor socio-economic growth by supporting contraceptive use by all eligible women and girls.
“Therefore, there are different methods of contraceptives available to choose from. Trained healthcare providers are skilled to provide safe services for potential users, while the use of birth control among women and girls will further improve tremendously when right pieces of information are shared against rumours.
“Real time data reporting will improve its quality and help to address commodity stock-out menace. Individual, family, community and the government will benefit from increase in uptake of modern contraceptives.”w