Experts have expressed deep concerns that COVID-19 response is impacting negatively on the availability of essential health services, especially those that have direct bearing on pregnant women and new babies. They spoke at a webinar training by Rotary Action Group for Reproductive, Maternal and Child Health (RMCH) in partnership with the Society of Gynaecology and Obstetrics of Nigeria (SOGON) and the Federal Ministry of Health,
Some hospitals are converting maternity wards to make space for COVID-19 patients, limiting birth companions in the delivery room, and offering induced labour to get women in and out of the hospital as quickly as possible.
Neonatal intensive care units are preparing for staff shortages as an increasing number of health workers are being exposed, while midwifery services are overwhelmed by calls from concerned mothers now exploring home birth options.
Director, Department of Family Health, Federal Ministry of Health, Dr Salma Anas-Kolo, during the training asserted that ensuring access for people to their preferred contraceptive methods advances several human rights. These included right to life and liberty, freedom of opinion and expression and the right to work and education, as well as bringing significant health and other benefits:
“COVID-19 is an indirect cause of maternal, new born and child morbidity and mortality in Nigeria. COVID-19 total samples tested across the 36 states and FCT confirmed active cases and deaths have been on the rise. The general impact of COVID-19 pandemic in Nigeria is unknown due to its present coverage of data collection, collation, analysis, use and reporting.
“Poor data reporting rate and low patronage of public health facilities at this period has a negative impact as well as the movement restriction and lockdown measure, which has affected Rotary Maternal Child Adolescent Health and Nutrition (RMNCAH+N) implementations and data management.
“Although, there are other socio-economic challenges facing us as a country that needs attention, however, non-prioritisation of family planning and issues concerning population growth by government and its agencies had triggered more maternal and child mortalities nationwide.”
Decline in family planning
Anas-Kolo disclosed that at the start of 2020, the country recorded a 1.4 per cent and 1.3 per cent increase in proportion of reporting facilities which provided family planning and long-acting reversible contraception (LARC) services respectively when compared to the end of 2019:
“Between January and April 2020 however, the proportion of facilities providing family planning dropped by seven per cent while those providing LARC dropped by twice 14 per cent. The decreasing 2020 numbers could be attributed to several factors including; patients’ reluctance to visit health facilities during the COVID-19 pandemic or the challenges with full commodity supply experienced across multiple states also owing to the pandemic delaying commodity replenishment at the state stores.
“Similarly, consumption of key commodities which were on an upward trajectory between September and December 2019 decreased between January and April 2020. Of the five commodities presented, injectables recorded the highest percentage decline at 29 per cent, closely followed by oral pills at 24 per cent and implants at 20 per cent.”
While recommending health facility workers to return to work with personal protective equipment, she added that attitudes of health workers to patients in public health facilities should be improved and RMNCAH+N activities implemented without restriction by providing mitigations.
Benefits, importance of family
Director, Africa Centre of Excellence for Population Health and Policy, Aminu Kano Teaching Hospital/Bayero University Kano, Prof Hadiza Galadanci, said the use of contraception prevents pregnancy-related health risks for women, especially for adolescent girls:
“When births are separated by less than two years, the infant mortality rate tends to be higher than it is when births are two to three years. Therefore, birth spacing methods to at least two years would have significantly saved about 94,000 infant lives and more in subsequent years.
“Implementing family planning and integrating RMNCAH also help to reduce maternal new born deaths in Nigeria by 30 per cent as well as reduce risks for diseases such as endometrial cancer, ovarian tumours in women by 40 per cent, cancer and sexually transmitted infection like HIV as well as reduce risk of ectopic pregnancy.
“And again, increasing public sector investments in family planning will enable Nigeria to meet her family planning 36 per cent contraceptive prevalence rate (CPR) by 2020, thereby saving an additional 22,000 mothers and 101,000 children from dying.
“The effect of family planning on maternal health would ensure the reduction in pregnancy-related and infant morbidity and mortality; improve birth outcome, reduce premature and low birth weight babies as well as better healthy babies.
“Family planning offers a range of potential health benefits that encompass expanded education opportunities and empowerment for women, and sustainable population growth and economic development for countries.”
Need for family planning awareness
The World Health Organisation (WHO), said among the 1.9 billion women of reproductive age group (15-49 years) worldwide in 2019, 1.1 billion have a need for family planning. Out of these, 842 million are using contraceptive methods, and 270 million have an unmet need for contraception:
“The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 37.1, was 75.7 per cent globally in 2019, yet less than half of the need for family planning was met in Middle and Western Africa. Only one contraceptive method, condoms, can prevent both a pregnancy and the transmission of sexually transmitted infections, including HIV.
“Modern contraceptive prevalence among married women of reproductive age (MWRA) increased worldwide between 2000 and 2019 by 2.1 percentage points from 55.0 per cent (95 per cent UI 53.7 per cent–56.3 per cent) to 57.1 per cent (95 per cent UI 54.6 per cent–59.5 per cent). “Reasons for this slow increase include: limited choice of methods; limited access to services, particularly among young, poorer and unmarried people; fear or experience of side-effects; cultural or religious opposition; poor quality of available services; users’ and providers’ bias against some methods; and gender-based barriers to accessing services.”
Meanwhile, the United Nations Population Fund (UNFPA), revealed that in developing regions, “an estimated 232 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities. This threatens their ability to build a better future for themselves, their families and their communities.