‘Nigeria’s maternal mortality ratio is alarming’
Dr. Duduyemi Adeola is the Programme Officer (Service Delivery) with the Nigerian Urban Reproductive Health Initiative 2 (NURHI 2). In this interview with TOBI AWODIPE, she talks of the country’s alarming Maternal Mortality Ratio, Life Planning (LP) and myths and misconceptions that deter LP in Nigeria.
Can we meet you?
I am Dr. Duduyemi Adeola Olawunmi, the programme officer, service delivery, with the Nigerian Urban Reproductive Health Initiative 2 (NURHI 2), an ongoing five-year family planning project in Lagos state.
You have been stressing life planning as a better alternative to family planning. What is it all about?
There is really no difference between ‘Life planning’ and ‘family planning’ but the word life planning is used just to make people have a better understanding that FP is not all about a person that already has a family. FP is relevant to any individual who is sexually active and also intends to have a family. Planning is done before an actual event and the word LP can be used in place of FP just like the word
‘child spacing’ is used in place of FP in the North because of cultural nuances. FP or life planning is not restricted to the married but also includes unmarried people, single parents, youths and adolescents and this means that you can start planning your life even before marriage. This involves your education, your opinions as an individual and this goes on even when you get married and you plan along with your spouse on the number of children you both want, things you want to do like furthering one’s education, building a career and so on.
Nigeria’s Maternal Mortality Ratio (MMR) has remained alarmingly high for several years now. Why is this still so despite promises and assurances from several governments?
Like I said, according to a 2013 Nigeria Demographic and Health Survey (NDHS) MMR in Nigeria is 576 deaths per 100,000 live births and this figure is just an estimate as not every death is documented. Annually, for every hundred thousand live births, 576 women die. Sadly, this is not even the minimum but an average, because in places like the North for example, we have it as high as over a thousand mortalities per 100, 000 live births. A lot as been going on to reduce the MMR, but we still find out that a large percentage of our women still don’t go to proper hospitals for deliveries. They register late, they go to places where they don’t get proper care, and at the end they die in these places. Some of these deaths are not even recorded. Many times, they go into the hospitals way too late when there are already complications and as a result of this, they die.
The major causes of death in women of child-bearing age that push up the maternal mortality ratio in Nigeria include sepsis, obstetric haemorrhage/bleeding, unsafe abortion, obstructed labour and pre-eclempsia. Over the years, studies have shown that unplanned pregnancies in women of reproductive age (which is where family planning comes in) is also one of the major reasons of high MMR; because a woman that gets pregnant often does not have enough time to recuperate and she’s not yet back to her normal physiological state, hence, there is higher risk of having complications in such pregnancy and that is why family planning is very key in addressing MMR.
You mentioned religion and culture as major barriers to family planning and reducing the MMR. What roles do they play?
Religions and culture play a significant role in the acceptance of FP because we are a product of our cultural and religious beliefs because this is what we are brought up with and they are what we have been made to believe and accept as the norm over the years. Many times, it is very difficult to change some of these beliefs/orientations that we have. Over the years, we have been made to believe that culture and religion are against family planning but we have come to realize that all religions support FP. This can be seen in chapters of the Bible and Quran which relate to FP and also the mechanisms that were put in place by our forefathers to encourage family planning before the advent of the modern methods of FP e.g. women moving to their parents or parents-in-laws’ houses during the first few months of delivery and so on.
But thankfully, people have started to realize that it is really important not only to hold on to your religious and cultural beliefs but also hold on to medical facts that will help you make the right choices as an individual or a couple. As you believe in your God, you also believe that you need to plan your life, because family planning is not just about contraceptive use. It is a way of life and thinking that an individual or a couple takes up voluntarily upon the basis of knowledge and are able to make informed choices.
What are some myths and misconceptions that create a barrier to life planning for women in particular?
A lot of people still believe family planning will cause infertility. They believe that once you get it, you can’t have a child anymore, which is very false. Several people have used family planning and still had their children after discontinuation unless they went for the permanent methods or have other underlying medical problems that may result in infertility. Some also believe it’s a means of reducing Nigeria’s population, while others say it causes cancer. I say it today; there is no research to show that family planning causes cancer. There is no known research to me that shows that family planning causes cancer but however, research has shown that some contraceptive methods can reduce a woman’s chance of getting some cancers. Some people also say the IUD can migrate from your uterus and get to your heart. We hear so many stories, but there is no proof to back up these stories. Another common one is that family planning causes promiscuity. An individual who wants to be promiscuous will be regardless of FP or not. Furthermore, the only method that will protect a person against HIV and STIs is the barrier method. So, even if you use family planning and you don’t stick to a partner, you are at risk of STIs and HIV because family planning doesn’t protect against STIs.
How easy it is for a young woman to get reproductive health advice, support or information now in Lagos?
Family planning services are available in all Primary Health Centers and General Hospitals. In Lagos state, we have six youth and adolescent centers specifically designed to meet the reproductive health needs of the youth without the fear of stigmatization or rejection. This is because a lot of young people may not want to attend the regular FP clinics because they don’t want to be judged or stigmatized. We have educated and are still educating our FP providers in various facilities to ensure they don’t have bias towards providing services. Also, because there are a limited number of such facilities, providers in other facilities that aren’t youth centres have been trained to attend to young people properly so they don’t go seeking help from quacks or end up carrying out unsafe abortions, which can lead to complications or even, death. It’s of note that there are still a lot of challenges but over time, things would get better.
How is funding helping to improve knowledge, awareness and access to these burning issues?
In Lagos state, there are a number of partners, both International partners and local NGOs partnering with the state and working in the youth and adolescents in the area of providing quality reproductive health services and this has been of great help. I can’t say this is enough but I believe the government will do more to ensure that this continues to happen and there is improved access to reproductive health services for youths and adolescents.
When a young woman is sexually assaulted or finds herself pregnant, what can she do?
For sexual assault/rape, the first thing an individual should do is to report in a hospital to be properly cared for and given prophylactic drugs to prevent pregnancy, STIs and HIV. There are also designated phone numbers in Lagos state that individuals can call to report sexual violence. It’s important to seek help immediately and not wait till there is pregnancy or any STIs. It is not a thing anybody is proud of but it is better to seek help immediately to prevent any further complications. The individual may also require counseling and therapy to pull through and this may require the services of an expert.
How will Life Planning help in actualising Nigeria’s 2020 SDG Goals?
All the seventeen SDGs are related to family planning in one way or the other. Number one goal says ‘No poverty’. Family planning is related to this in the sense that if everyone has just the number of children they have planned for and are able to care for, we would gradually put an end to the cycle of poverty. Goal two says ‘No hunger’. Currently, our resources are over stretched as a nation and if everyone resolves to planning their family and everyone has the number of children they can cater for, hunger will become a thing of the past. ‘Good health’ is another SDG Goal related to FP because somebody that is able to access or pay for good health is somebody who has a planned life. This simply means that you have resources planned and you have the number of children you are able to take care of and it also applies to being able to provide quality education, maintain gender equality and so on. When we have a large proportion of dependable population as a result of lack of proper planning, the burden is on the few that are independent, therefore, creating social and economic problems.
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