…As Providers lament poor male involvement in contraception
By Chioma Obinna
Mrs Sakinat Azeez will not forget in a hurry her experience with her husband the first time she tried to initiate a discussion about family planning. Sakinat said the encounter was discouraging and scary. She narrated her encounter with Good Health Weekly at one of the Primary Health Centres in Ijora.
Cross-section of women at Ijora Health Centre in Lagos recently
“My story is not a pleasant one. I felt like the ground would open and swallow me. My decision to take up family planning was just to put an end to my misery, “she recounted.
Sakinat admitted she was not ready to have more children, hence her quest to prevent unintended pregnancy made her raise the issue with her husband. But she was severely grilled and accused being promiscuous.
“He reminded me of our religion, I was neither given opportunity to say something or even explain why we need family planning. I was almost beaten so I left the bedroom in annoyance,” she added.
Daramola Adeoye, 37, had a similar story but was smarter and vowed to obtain a family planning method despite all odds. The mother of four with no meaningful livelihood, said she desired family planning after a devastating miscarriage. But her husband was opposed to the idea.
In desperation, Daramola decided to visit the Primary Health Centre in her area in Lagos, where she was counselled and given a contraceptive of her choice for a five-year period.
As the years rolled by, her husband became weary that she was not getting pregnant and began to ask questions. “I opened up and told him I have adopted family planning. He became angry and demanded I must remove it.”
However, despite all the pleas by the family planning providers at the health centre, Daramola’s husband insisted they must removed it. She was forced to remove it.
Her case is common among women in Lagos today.
Bola is in her second marriage with four children, with three from her first marriage She spoke to Good Health weekly at the Ojora Primary Health Centre, Apapa, said she was there to take up family planning without her husband’s consent.
Although educated, he is opposed to family planning. “I came here voluntarily to do it. I did not tell my husband because he would not agree. I prefer the one of five years. Then when it expires I can bear two more children,” she narrated.
Unlike Bola, Sakinat, and Daramola, Mrs Josephine Adedeji’s case is different. Her husband understands the importance of family planning. He is aware.
“I have been on family planning even before I had my baby and I am planning to take another one today.” Josephine said noting that she and her husband adopted family planning to keep the marriage.
“I want to be happy in my home to avoid problems. I have three children. When I noticed my husband does not sleep around, I decided to do family planning so that there’ll be no problems about sex in the house.
“Now, we are happy together. He is in support and I am comfortable with the two months injection contraceptive I have been using. I want to have another child in three years.”
She, however, expressed fear over long-acting method of family planning, adding that “due to the fear of the unknown she had decided to use short-acting method.
The experiences of these women with their husbands reflect the plight of millions of Nigerian women of childbearing age who are denied their reproductive health rights due to religious and cultural issues.
According to experts, family planning is a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. Population analysts have said that an effective family planning programme would not only check population explosion but will help reduce maternal mortality.
However, the general attitude of married men to family planning may have contributed to the increase in unmet need for contraception by women of child bearing age from 16 percent in 2013 to 19 percent in 2018, according to the, 2018 National Demographic Health Survey, NDHS 2018.
The survey also showed that despite the campaign for family planning, only 17 percent of currently married women use at least one method of family planning, with 12 percent using a modern method and 5 percent using a traditional method.
The NDHS 2018 shows that use of contraception is highest among currently married women in the South West with 35 percent and lowest among those in the North West with 7 percent.
The survey shows that almost 50 per cent of the currently married women in Lagos use a method of contraception, as compared with only 2 per cent of currently married women in Sokoto and Yobe.
Attesting to the poor male involvement in family planning in Lagos during a field report of the Media Advocacy Working Group, MAWG, supported by Pathfinder International, Family Planning Manager at the Ijora Primary Health Care, PHC, Lagos, Mrs. Patience Ihejirika said cases of men not allowing their wives to take up family planning abound in the PHCs.
“Some of the challenges we have has to do with men and consumables. Many of the women want to use family planning but their husbands will not agree. There are instances where a woman will come today to get a contraceptive, tomorrow she is back at the centre demanding to remove it because her husband is complaining. Many of them are forced to remove the contraceptive,” she explained.
“Sometimes they claim their husbands are expecting more children, and when they are not forthcoming, they will begin to ask questions. Some do it without the consent of their husbands.
“We always tell them to take consent to avoid this situation but they will tell you they did and some will tell you that their husbands will not allow them. It is a common problem here.
“At least, 3 out of 20 women in this centre will come back to say remove it because of their husbands. Sometimes, we invite the husbands but some will still insist that they must remove it.”
Further, Ihejirika said lack of consumables is hindering smooth running of family planning services in the PHCs in Apapa.
She said only N10, 000 is released to each PHCs that attends to between 40 and 100 women in a month for family planning by the Local Government.
“In a month, we buy all sorts of things like gloves, bleach, and detergents among others. Family planning is free and this N10, 000 is not regular every month but we try to avoid telling our clients to pay for these consumables.”
She said upward review of the money to N50, 000 monthly per PHC monthly would go a long way to end challenges of consumables, especially, during the Maternal and Child Health Week.
Speaking on some of the services being offered at the centre, she said: “We have injectables like depo, sayana press, the oral contraceptives, the pills, microgynon, excrutien for nursing mothers, the implants and the IUCDs. We also have condoms for both male and females.
Ihejirika also noted that bleeding is one of the most common complaints the women have about contraceptives. She said this development sometimes discourages many women to change to other methods or to stop using any method.
Corroborating her views, representative of the Medical Officer of Health, Apapa, Dr Kehinde Ososanaya, Dr Folashade Iyanda, who declared there has been a steady rise in the number of women accessing family planning said lack of funding for consumables remains a challenge.
According to her, there should be a statutory allocation for consumables for better service delivery. She explained that family planning was an effective tool in child spacing.
“Family planning brings a happy home. With family planning, a woman will have a relaxed mind and space her children and have the number of children she wants. It lessens the financial burden. The husband will be happy and entire family will be happy. It helps women to enjoy sex because they have confidence and peaceful minds and the husband will be happy with them.”
However, the 2018 National Demographic Health Survey, NDHS shows that use of contraceptives is highest among married women in the South West zone of the country, health watchers say to maintain the lead , there is urgent need to create programmes that would promote men’s involvement in family planning in Lagos.