Thoughts on world contraception day

As we mark the World Contraception Day this week, it would be appropriate to see where Nigeria stands with its family planning and population growth. Nigeria is projected to have population of 429 million in 32 years’ time. And this is a spectacular increase from its current 190 million population. This means that Nigeria will more than double in size by 2050. Recent reports have also indicated that Nigeria has become the new ‘poverty capital of the world’ with 87 million people currently living in extreme poverty. It is obvious that this number is expected to grow and surpass 150 million by 2050.

As Goalkeepers report (Bill & Melinda Gates Foundation) states; “by 2050, more than 40 percent of the extremely poor people in the world will live in just two countries: Democratic Republic of Congo and Nigeria.” Rapid population growth and extreme poverty are closely related and inevitably, both are growing hand in hand.

A noticeable example of a country that has succeeded with its family planning programs is Ethiopia. Ethiopia’s Contraceptive Prevalence Rate (CPR) grew from 4.8% in 1990 to 44% in 2017. In order to achieve this, the Ethiopian government placed family planning at the top of its agenda, formulated developmental policies, paid increasing attention to demographic factors and recognized ‘unconstrained’ population growth as one of the major challenges to poverty reduction.

Since the mid-1990s, the Ethiopian government has upgraded its policy environment and executed friendly policies that improved family planning programs implementation, supply chain and overall contraceptive accessibility and availability. The government waived import taxes on contraceptives and liberalized the regulatory laws on emergency contraceptives and oral contraceptives pills. Contraceptive methods such as emergency contraceptives and oral contraceptive pills became over-the-counter (OTC).

This helped increase inflow and availability of contraceptives in the country and accessibility to products such as emergency contraceptives and daily oral contraceptive pills to women of all socio-economic groups including those living in rural and hard to reach areas. OTC switches allow more consumers to access established medicines.

This had a significant effect on the improvement of Ethiopian women’s access to contraceptives in a very tangible way. From the same Goalskeepers report “Ethiopia once the global poster child for famine is projected to eliminate extreme poverty by 2050.”Thailand is another good example. Thailand was a very poor country 40 years ago with many of her citizens living in poverty. Thailand’s total fertility rate at that time stood at seven children per family! The Thailand government recognized that their very high rate of population growth was an obstacle to the economic and social development of the country. Thailand prioritized the availability of condoms and pills as a means of increasing the popularity of contraception and liberalized its regulatory laws.

Oral contraceptives pills and emergency contraceptives pills were made available to customers/women over-the-counter (OTC). Increased pills and condoms availability helped to change the citizen’s attitudes and behaviors towards unprotected intercourse and unwanted pregnancies. Contraceptive information flow and engagement with the women was greatly improved. Legal restrictions in Thailand on advertising contraception were relaxed. Public awareness of contraceptive options became a top government priority in keeping with its overall population plan including the efforts to curb the spread of HIV/AIDS.

The private sector played the most significant role in ensuring that condoms and pills were distributed throughout the country. Stores selling provisions in villages within the country had condoms and pills. Needless to talk about pharmacies and drugstores as the supply went beyond them. Pills and condoms were readily available and accessible to all women and men respectively without bottlenecks.

What was the result of Thailand’s efforts? Their TFR (total fertility rate) reduced from 7 children to 1.5 children within a generation, population growth rate went down from 3.3 to 0.5%. We are all conversant with Thailand’s current economic development, increased standard of living and improved life expectancy. Thailand has made remarkable progress in social and economic development, moving from a low-income country to an upper-income country in less than a generation. Thailand was able to tackle the poverty issue by addressing its rapid population growth assertively and decisively.

In Nigeria, the family planning environment is different. Contraceptives importation faces huge obstacles and bottlenecks at ports. Although import duty is zero for contraceptive importation there are other taxes such as VAT, ETL and CIS import taxes, which cumulatively increase the cost of the commodities.

Recently, the Central Bank of Nigeria (CBN) included rubber products on the list of items not valid for foreign exchange in the Nigerian Foreign Exchange markets. Condoms unfortunately fall within the rubber products class. Condoms currently contribute about 19.2% among married contraceptive users and 49.7% among unmarried contraceptive users of the already inadequate CPR (contraceptive prevalence rate) in Nigeria.

It is necessary for policies like this to consider health-related items when they (policies) are being formulated. This makes the cost of goods higher thus affecting smooth and continuous supply at affordable prices. Furthermore, the regulatory status makes it impossible to have direct-to-consumer engagement and education, thus enabling the low levels of family planning methods awareness and knowledge. Myths and misconceptions still exist, and this further inhibits uptake of family planning.

Many countries in Africa (and in the world) have researched the prescription and OTC (over-the-counter) risk/benefit profile of oral contraceptives and found that it is acceptable for women to have access to them without prescription. It means that instead of a woman going to her doctor for a prescription, she can head into a pharmacy or drugstore and get her contraceptive pill over the counter. Today, women look for ways to take charge of their own health, and make decisions about their healthcare. Assisting women in this way by shortening their journey to family planning will help increase uptake and meet the Federal Government’s CPR (Contraceptive Prevalence Rate) target of 27% by 2020.

Family planning helps to save lives and increases standards of living, reduces maternal mortality and improves overall child and mother health. We have seen examples in Africa, in Asia and around the world of countries coming out of extreme poverty by becoming more decisively active on family planning implementation. For Nigeria to become a better place for its citizens to live in, it is necessary to take giant strides similar to the ones that Ethiopia and Thailand countries have taken. We already have lemons let’s make lemonade.
Dimos Sakellaridis is the Country Director for DKT Nigeria