•Even a girl as young as 12 may need family planning – Edun, reproductive health expert By Chioma Obinna The use of contraceptives by adolescents is a sensitive issue in a country like Nigeria with strong religious attachments.
Although government policy is to ensure availability of such service for men and women who are ready and need it, to many, doing the same for teenagers is still a hot topic.
According to the World Health Organisation, WHO, about 50,000 teenage girls die in Nigeria every year as a result of complications from pregnancy.
The weather is very hot on this fateful day, but for this pale looking girl work must go on. With a worn out piece of a Nigerian made fabric, popularly known as ankara, wrapped a little above her breasts, she hurries helplessly on one of the busy streets of the densely populated slums in the Makoko area of Lagos. Her protruding stomach gives her away as pregnant. Intermittently she straightens up to catch some breadth as she walks along and to pull her falling wrapper back into position. At a shack built on top of stagnant water, she puts aside her wrapper and walks into the wooden shack. Few minutes later another teenager calls aloud the name Kehinde! And commands: “Madam wants to see you.” The pale looking and pregnant girl has apparently arrived her place of work for the day. Her work is to help the madam in question to do her laundering after which she is paid a stipend. But, today, Kehinde is not in the best mood for work.
“I am weak and have headache,” she complains in a tiny voice but work she must. Thirty minutes after, Kehinde’s condition gets worse. Reeling in more pains, she abandons work for the day and begins the slow and painful walk back home. This correspondent in the area for an event and watching closely her pains offers to assist her get to home. Makoko is a riverine slum in Lagos. With thick smoke rising into the sky from the fires of fishermen baking fish, breathing is not as easy task here. Heaps of dirt litter everywhere. But that is home for Kehinde, her family and many others. Also common sight is the litany of pregnant teenagers who inhabit the area. A few minutes after arriving home, Kehinde’s mother walks in. “See her condition at 16. She has repeatedly given me sadness. She did not even consider our situation. Since my husband died, I have been the only person shouldering the responsibility of the family as a single mother. Now, she can no longer go to school”, she bellows.
In the next house is Bola, 17. She has just been delivered of a baby girl. Like the old saying, becoming a mother comes with bigger responsibilities. But Bola continues to have difficulty putting her baby to breast without the help of her mother, a challenge that has created more problems for the family. Since Bola put to bed, her mother has abandoned her business to take care of mother and child because she will have to hold the baby to suckle. According to Sunday Vanguard investigation, many young mothers in the area are becoming grandmothers at very young age because Makoko, a predominantly riverine community, has a high rate of teenage pregnancy. While Bola and Kehnde’s mothers are bemoaning their present conditions, the mother of 17-year-old Evelyn is happy that her child is about to sit for her Senior Secondary Certificate Examination, SSCE. Sunday Vanguard learnt that at age 14, Eve, as she is fondly called, was introduced to family planning.
Her mother’s decision to introduce her to family planning was not unconnected with the happenings in the environment and the need to keep her away from unwanted pregnancy. Today, her decision has paid off. While she is getting ready to write her SSCE, her best friend has given birth to two children at age 17.
Introducing Eve to family planning was not an easy decision, the mother admits to Sunday Vanguard. According to her, when she discovered that Eve had become sexually active, she was very uncomfortable and decided she had to do something to prevent her from getting pregnant. “Although I received so much criticism the first time I told some of my friends what I was about doing, I never allowed myself to be discouraged,”she points out. She states that she became an object of discussion when she took her daughter to a nearby health centre requesting for family planning. According to her, she was even castigated. The mother adds: “Even one of the nurses at the centre queried my intention and I left but I refused to be discouraged.
I later took Eve to one of the Lagos State friendly health centres where she was counselled and was finally given Depo-Provera”. Depo-Provera is a contraceptive injection for women that contains the hormone progestin. Three years on, Evelyn has no problem with it and she is safe from unwanted pregnancy and unsafe abortion that claimed about 16 million girls, aged 15 to 19, annually. She was also able to escape from the one million girls, under 15 years, that give birth yearly worldwide, according to the World Health Organisation, WHO. According to health experts, it is no longer news that complications during child-birth and pregnancy are the second biggest causes of death for 15-19 years old girls worldwide.
They also say that, currently, many girls do not know how to avoid being pregnant as sex education is still rare and elitist in Nigeria. Worse still, they say many Nigerian girls are ignorant or ashamed to seek contraception services.
For instance, in Nigeria, risks of medical complications are greater for girls under 15, because an undeveloped pelvis can lead to difficulties in child birth and this can also lead to obstructed labour. Where medical services are not available, it can lead to obstetric fistula. Family planning is safe for all Lagos State Team Leader, the Nigerian Urban Reproductive Health Initiative, NURHI, Dr. Omasanjuwa Edun, says contrary to the general belief that Family Planning, FP, is meant for only married people to space their children, it is for every sexually active person not ready to bear children at a particular point in time. To Edun, education of the girl-child on the implication of sexual intercourse as well as introduction of FP to her even when she is yet to be sexually active would help reduce teenage pregnancy.
“FP has no adverse effects on teenagers and there is no health hazard in having teenagers as early as 13 years using contraceptives. More children from the age of 12 or even below engage in sexual intercourse contrary to what we used to know in time past. So we have to start educating them in good time to have the knowledge of family planning so that when they find themselves in such situations, they will be able to prevent unwanted pregnancies.
There is no medical research that proves any effects caused by contraceptives among teenagers, rather they are safer.” He opines that teenagers are more harmed without contraceptives because in the advent of unwanted pregnancy, their education is truncated and their future is put on hold.
“So in order to secure their future as teenagers or adolescents, they need to know the implications of the things they do and how to be on guard to prevent the unwanted circumstances that follow”, the NURHT Team Leader emphasises. According to him, there are specific family planning methods for individuals regardless of their age. “Part of the services provided during family planning is proper counselling and history checking. In that situation where a teenager goes for family planning services, he/she is properly counselled on the method most suitable for him/her.
For example the use of male/ female condom is most suitable for teenagers who might be scared of the side effects of contraceptives. “To the best of my knowledge there has not been any hormonal contraceptive contraindicated in teenagers, rather, like every other side effects, there may be alterations in the menstruation cycle and as seen in adults too. So there is isn’t any complication likened to age but, at same time, you have to use the stated guidelines to know the method most appropriate based on individuals and their history.
” Barriers to contraceptive use Edun believes most girls are restricted from using contraceptive only for socio-cultural reasons despite the fact that they have been proven to be safe for everybody irrespective of age. “One of the major barriers is the fear of side effects. The rumour around FP is usually centred on our cultural belief, our religion, our society; those are some of the things that hinder women from accessing family planning.
Our culture is very significant when it comes to health issues.” He further identifies the fear of side effects as another serious barrier that prevents women from accessing family planning, adding that: “Side effects such as bleeding, especially, when they are blown out of proportion. “It is expected that a woman may or may not bleed.
Our bodies are different and we react differently to the drugs. One person’s reaction might not be the other person’s reaction. But when people tend to blow these things out of proportion, it creates unnecessary fear in the minds of those who are willing to use them,” he stresses.
Dismissing the fear about side effects, Edun says even drugs as simple as paracetamol can have side effects. FP usage in Nigeria Edun disclose that there has been an increase in the Contraceptive Prevalent Rate, CPR, in the country. In Lagos State, according to him, CPR has increased by about 3.5 percent and nationally by about 5 to 6 percent. He is optimistic that by 2018, when the National Demographic Health Survey, NDHS, is done, it would provide a broader idea on what it is right now.
“The last time NDHS was done was in 2013 because , our CPR on modern method is about 10 percent while other methods is about 16 percent. For Lagos, all methods was about 48 percent. So hopefully by next year, when the NDHS is conducted, we would definitely see a more representative on our CPR”.
Also speaking to Sunday Vanguard, the Head of Cross River Sub Office and Programme Coordinator of the United Nations Population Fund, UNFPA, Mr. Kenneth Ehouzou, explains that no fewer than 34.5 million married women are using FP in Nigeria. According to him, the country has an FP blueprint aimed at achieving 36 percent contraceptive rates by 2018.
Why family planning is necessary According to an infographic report by Women Deliver, with a total of 225 million women in developing countries having unmet needs for family planning, investing to meet the needs for modern contraceptive services would reduce unintended pregnancies, reduce unsafe abortions, decrease maternal deaths and reduce newborn deaths.
Investing in FP, the report says, will reduce unwanted pregnancy by 70 percent, unsafe abortions by 74 percent and decrease maternal deaths by 25 percent.
Barriers to accessing FP in Nigeria Lack of awareness especially among rural populace Lack of education, the less educated are less likely to use FP Poverty, uneven distribution of H/F that makes access difficult Religious believes and misconceptions about FP. Societal values where giving birth to more children has value.
Gender inequalities, in some places women cannot access FP without prior permission of their husbands and misconceptions on the effect of FP as well as availability of the commodities where they are needed.
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