The biggest misconception about contraception in Nigeria is that contraceptives encourage promiscuity. The fact is, the education and economic empowerment of women directly correlates to their ability to plan, manage and thrive throughout their experience in the reproductive process.
So today on World Contraception Day 2020, I am leading the Wellbeing Foundation Africa
in joining the WHO Department of Sexual and Reproductive Health and Research (including the United Nations Development Programme, the United Nations Family Planning association, UNICEF, the World Health Organisation and the World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) along with organizations and individuals worldwide in celebrating this important event.
Contraceptive information and services are fundamental to the health and human rights for everyone. Access to safe, quality, affordable contraceptive information and services, together with the provision of fertility care, allows people to decide whether and when to have children, and also the number of children they would like. Ensuring access to preferred contraceptive methods for women and couples is essential to securing their well-being and autonomy, while supporting the health and development of communities.
My decades of work to improve maternal health contributes to the rise of women because in Nigeria, first and foremost there is a critical need for mothers to plan their families, and survive childbirth in order to allow them to thrive. That is the ethos that drives my work as UNFPA Nigeria’s Family Planning Champion, as a co-author of the Lancet Maternal Health Series on stillbirth, as a commitment maker to FP2020 Movement and the International Conference on Population and Development ICPD25, and as a lifelong advocate for women’s rights to contraceptives and family planning.
In November 2016, the 4th Nigeria Family Planning Conference in Abuja hosted the Africa regional launch of The Lancet Maternal Health Series. National and international health leaders joined me and my Wellbeing Foundation Africa for this important gathering, including the Honourable Minister of Health Isaac Folorunso Adewole, Professor Oona Campbell, author of the 2016 Lancet Maternal Health Series and Professor Oying Rimon, The Bill and Melinda Gates Foundation, The Challenge Initiative, the Bloomberg School of Public Health, DFID UK, USAID, Plan International, Evidence For Action, The White Ribbon Alliance and NURHI, the National Council for Women’s societies NCWS, and YWCA, among many national stakeholders.
With insights shaped by co-authoring the previous 2015 Lancet Maternal Health Series: Stillbirths: Economic And Psychosocial Consequences
– and having attended the initial launch of the 2016 Series report at the global stage to coincide with the 71st UN General Assembly in that September, I observed that The Lancet Maternal Health Series covers the epidemiology of maternal health, the current landscape of maternal health care and services in both high- and low-income countries, and laid out future challenges and strategies to improve maternal wellbeing.
Addressing stakeholders alongside fellow panelists Professor Oona Campbell who launched the Series, Professor Adinma, Dr Kole Shettima, Dr Tunde Segun and Dr Allisyn Moran with the discussion entitled: “What is family planning doing for maternal health in Nigeria,” – I welcomed the Nigeria launch of the 2016 series, which provided all stakeholders and policy-makers the evidence with which to guide concrete actions to improve maternal newborn child and adolescent health services.
The launch of the 2016 report coincided with the revised WHO guidelines which recommend that pregnant women in low and middle income regions receive eight antenatal visits, and increased recommendation from the four antenatal visits previously indicated within the WHO’s focused Antenatal Care policy.
It vindicated and validated the Wellbeing Foundation Africa’s MamaCare Antenatal And Postnatal Skills And Drills Curriculum model for midwives and mothers, respectively. It demonstrated that the provision of a midwifery-led continuum of care and counsel, along with universal access to high quality affordable health services through community health insurance, improved training in emergency obstetric and newborn care, underpinned by integrating its robust patient-custody health records with digital facility health records and civil registrations data skill-sets are, together, crucial to improving survival and wellbeing.
As Nigeria’s first civil society community midwives health visitor program, the Wellbeing Foundation Africa’s MamaCare360 Antenatal and Postnatal Education Classes incorporate a postnatal session where breastfeeding techniques are delivered to mothers along with informed family planning advice. We affirm that access to family planning information and contraception is a fundamental human right, empower women to decide when and where to have a child, and how many children they wish to bear according to their circumstances, and recognising those rights, we recommend that mothers space their childbirth by 1000 days
to better sustain the health and socio-economic wellbeing of mother, child and family.
In 2016, Nigeria had cause to celebrate the then-recorded 40% improved survival rates delivered over four years through Nigeria’s Midwives Service Scheme, despite government challenges in sustaining state and local government traction on these gains – which are sorely threatened today. That’s because Nigeria has once again, in 2020, overtaken India
as the worlds capital of multi-dimensional poverty, malnutrition, and under-5 mortality.
Prior to the interrupted access to routine family planning services caused by the coronavirus pandemic, most low- and middle-income countries were on course to experience substantial economic growth, which will increase their fiscal space for health investments in maternal and newborn health. However, with the expected surge in ‘lockdown pregnancies’ we must ready ourselves to harmonise and standardise the wide variations within quality of care, between two broad scenarios which reflect the landscape of poor maternal health care – the absence of timely access to care (defined as ‘too little, too late’) and over-medicalisation of normal antenatal, intrapartum, and postnatal care (defined as ‘too much, too soon’) – and the submerged social determinant factors of economic distress, and co-related domestic and gender-based violence.
Yet we know the steps to take to recapture early successes:
- The National Task-shifting Policy: When community health workers were allowed to administer injectable contraceptives, the uptake of family planning in hard-to-reach areas went up dramatically. That success was irrefutably demonstrated in Nigeria.
- It will be hugely beneficial to improve clarity on Nigeria’s currently confusing ‘dual-qualification nurse-midwife’ overlap, to provide clear distinctions between the midwifery qualification, and the general nursing qualification, applying the learning from the WHO Midwives Voices Midwives Realities Report, which documents the voices and realities of 2,470 midwifery personnel in 93 countries and describes, from their perspective, the barriers they experience to providing quality, respectful care for women, newborns and their families.
I urge our Federal Government and policy makers to consider:
- Integrating the International Confederation of Midwives’ Midwifery Services Framework into Nigeria’s public health policy as the best practice model to strengthen midwifery services to deliver the full complement of maternal and newborn care, including family planning.
- To honor their FP2020 commitments to improving family planning funding and services
- To partner with donors and other non-governmental organizations to increase financing for family planning at all levels
- To strengthen primary health care facilities to provide family planning counseling and services for increased access and improved coverage
- To partner with non- governmental agencies and development partners to build the capacities of healthcare providers across all cadres to encourage task shifting/sharing to overcome human resource constraints
- To strengthen country’s forecasting capacities and supply of family planning capacities
- To adopt innovative approaches such as community-based family planning services, involvement of men, traditional and religious leaders as family planning champions to break religious-cultural barriers
- To continuously create awareness on family planning for women and families to make informed decisions on birth spacing.
- To scale up deployment of patient custody health records and facility and health-worker driven digital records databases to provide real-time transparent and accountable community audit mechanisms in measuring public health services delivery
Poverty, inequality, and geographical barriers all clearly play out in maternal health where both our challenges and opportunities abound.
We should, therefore, guarantee that every woman, everywhere has access to quality care. An essential part of advancing maternal health in Nigeria is accelerating, reinforcing and replenishing the progress of family planning education and services to all women, thus preventing unwanted pregnancy. It is true that women, families and communities need births to grow, yet it is unethical and simply unacceptable to encourage women to give birth in places with low facility capability, with unskilled providers, or where the content of care is not evidence-based. This failing should be remedied as a matter of priority.
To achieve the 2030 SDG global target of a maternal mortality ratio of less than 70 per 100,000 live births, we must prioritise quality maternal health services that respond to local needs; promote equity through universal coverage of quality maternal health services; improve the health workforce and facility capability; guarantee sustainable financing for maternal and perinatal health; and generate better evidence, advocacy, and accountability for progress.
The Wellbeing Foundation Africa’s Mamacare+Nutrition program which sub-implements the Nutrition International and UNFPA NLift Strategy though the Wellbeing Foundation Africa MamaCare Community Midwifery Program, improves maternal education, family planning and nutrition through iron and folic acid supplementation, supported by Global Affairs Canada, currently reaching 11,000 women at 60 Health Facilities and their surrounding households and Ward Development Committees in the Federal Capital Territory, Abuja.