Inclusive family planning and good governance
It is heart-warming to note that Nigerian women are beginning to embrace family planning, a key component of maternal and reproductive health that Sustainable Development Goals (SDG) programme has to be serious about this time. The MDGs programme failed the nation on this score despite a significant funding model the Paris Club debt relief negotiators obtained for the UN development goals including maternal health improvement.
Even before, the United Nations declaration of MDG No 5 – improving maternal health and SDG N03 – good health; reproductive health and rights have been a major concern at some global conferences such as the 1974 World Population Conference at Bucharest, 1994 International Conference on Population and Development (ICPD) held in Cairo, and the 1995 Fourth World Conference on Women (FWCW) in Beijing, and “Beijing+5” in 2000.
The declaration of the MDG heightened the issue of women’s reproductive health with the various ‘Women Deliver Conferences’ starting with the one held in London in 2007, Washington DC, 2010; Kuala Lumpur, 2013 and Copenhagen, 2016. Each brought new ammunition to the case for investing in maternal health.
Despite these attempts, a recent study has shown that annually, an estimated 52,900 Nigerian women die from pregnancy-related complications out of a global total of 529,000 maternal deaths. So, Nigerian maternal death is 10 per cent of the global figure.
Maternal death is in the domain of reproductive health and the components of reproductive health include safe motherhood; adolescent reproductive health; management of sexually transmitted infections including HIV/AIDS; family planning information and services; elimination of harmful traditional practices; prevention and management of the complications of unsafe abortions; prevention and treatment of infertility and sexual dysfunction; and management of reproductive tract. This may account for why the United Nations posits that preventing unintended pregnancies and reducing adolescent childbearing through universal access to sexual and reproductive health care is crucial to the health and well-being of women, children and adolescents.
This came to the fore during the celebration of the 2017 World Contraception Day (WCD), which took place on September 26, as it continued the campaign around a vision where every pregnancy is wanted through enabling women and young people to make informed choices on their sexual and reproductive health.
Interestingly, the statistics presented showed an uptake in Family Planing (FP) among women in Lagos, resulting in a drop in maternal mortality rates. However, the statistics showed that contraceptive prevalence rate (CRP), which is the percentage of women practising or whose sexual partners are practising any form of contraception, has increased in Lagos; women in the lower socio-economic group may be excluded as the richest women were reported to have more access to FP services and commodities and are more open to choices.
Furthermore, according to the United Nations, in 2017, 78 per cent of women of reproductive age (15 to 49 years of age) worldwide who were married or in union had their need for family planning satisfied with modern methods, up from 75 per cent in 2000.
However, UNICEF states that in Nigeria, contraceptive prevalence is 15.10 as of 2013; while the highest value over the past 31 years was 15.30 in 1999.
Notwithstanding, FP service can be more inclusive as the Federal Government is committed to achieving the Family Planning 2020 target of 36 per cent, CRP by year 2018, up from the 2016 figure of 16 per cent, which is an indication that Nigerian government has risen up to the occasion and becoming more responsive to the reproductive rights of Nigerians, especially women.
To complement this gesture, the authorities should ensure that women of child-bearing age (WCBA) have the right to information on reproduction matters. Furthermore, while driving demand for FP services and commodities, the government should also ensure supply to enhance the reproductive rights of women, which is part of gender friendly development and an indication of good governance. This is against the backdrop that good governance is about transparency, responsiveness, consensus oriented policies and programmes, equity and inclusiveness in policy formulation, programmes design and implementation, effectiveness and efficiency in programme execution, accountability and gender equity.
Essentially, good governance impacts on reproductive health and rights. Yes, good governance can improve women’s access to affordable, preventive and curative reproductive health interventions, which can prevent mortality and morbidity. This calls for increased commitment on the part of governments at all levels to ensure basic improvements in reproductive health services, including family planning.
Achieving these requires the provision of enabling conditions such as women empowerment and gender equality and equity; elimination of discrimination against the girl-child; male involvement and participation; improved educational opportunities. More important too is improved access to primary health care (PHC), a model that even the minister of health said has suffered some reverses.
Also, there is the need for improved working relationship between the media and health sector as the media can help raise awareness and educate women and men on the importance of accessing FP. Educating men is critical because arguably, most men (under some guise of cultural influences) undermine the severity of maternal mortality and thus fail to give their wives the necessary support to access Family Planning services. In the main, it is indeed cheering to note that women are beginning to imbibe social intelligence and understanding needed to embrace FP in the country.