Nigeria: Changing Attitudes To Contraception
Health workers say an apparent rise in contraceptive use in Nigeria stems largely from a willingness by traditional and religious leaders in some regions to use their influence in promoting reproductive health.
In the predominantly Muslim north, where contraceptive use has historically been far lower than the national average, the support of traditional leaders has helped change attitudes in communities where contraception was long regarded as taboo.
Alhaji Sani Umar, district head of Gagi District, Sokoto State, in northwestern Nigeria, works with the UN Population Fund (UNFPA) to advocate reproductive health in his community.
He said to help overcome cultural and religious concerns about contraception he passes information via traditional and religious leaders, who often hold community meetings. People listen to these leaders, so communicating through them is highly effective, he said.
Umar said he also used culturally relevant performances in villages to promote messages about family planning, reproductive health and safe sex.
Agathe Lawson, UNFPA representative in Nigeria, said that in the north, where she would have expected the most resistance to contraception, she was “having long discussions with religious and traditional leaders” who were working to raise awareness of the need for family planning.
Family planning has also been promoted through radio and TV programmes. But according to Osakue Stevenson Omoera of Nigeria’s Ambrose Ali University, success was limited because the programmes did not address cultural barriers. In a 2010 study in Ebelle community, Edo State, southern Nigeria, Omoera found that 84 percent of people said they had learned about family planning from these programmes, but only 57 percent said they tried the methods themselves. Omoera suggested strong cultural taboos were to blame for this discrepancy.
Condom use more widespread?
While recent figures on contraception are not available, anecdotal evidence suggests a significant rise in its use in the past three years, according to Lawson. UNFPA plans an assessment later this year to quantify the increase.
In 2008 2.7 percent of married women of reproductive age used contraceptives in the northwestern states and 4 percent in the northeast, according to an UNFPA analysis, Demographic and Health Surveys. This compared to a national average of 10 percent, and a 2010 sub-Saharan Africa average of 17 percent.
Lawson said she was surprised at how widely available and acceptable contraception has become in Nigeria over the two years she has been there. In 2008 the government of the southwestern state of Anambra banned condoms and other contraceptives. Lawson said she “has never had any problem [in Anambra]” in her work on family planning.
“In the villages there was a time when there were no condoms,” Umar in Sokoto State said. But now, he said, demand is high and “you see used condoms everywhere.”
“Even in rural areas condoms are being used,” he said. “[People] now know the negative consequences of not using condoms - HIV and pregnancy.”
Umar said he also sees fewer young girls pregnant in rural areas.
Bosede Adeniran, a federal Health Ministry official and UNFPA project director, said more people are using contraceptives now that they are free and “hospitals are requesting twice as much”. Since April the government has provided contraceptives, including condoms, the IUD and the implant Implanon free of charge at hospitals.
Family planning services
Salisu Wada, a nurse at state-run Murtala Mohammed Specialist Hospital, the largest hospital in Kano, said: “In the last decade we have seen a tremendous increase in the number of women accessing our family planning services.”
“Women of [child-bearing age] now seek family planning and child-spacing advice. This is a radical departure from the situation years back when contraception was seen as taboo and women who use contraceptives as sinners.”
She also pointed to the stigma of pregnancy outside of marriage and better awareness of reproductive and sexual health as reasons for the increase.
The Nigerian government in 2011 put US$3 million towards contraceptives as well as towards medicines, vitamins and other supplies for pregnant women. Other funding comes from NGOs and aid organizations.
The Health Ministry’s Adeniran said as well as the government funding for contraception introduced this year, next year’s budget will also include funding to get family planning supplies to remote areas.
“We know the benefits of family planning, [good health care] in early pregnancy and not having too many kids,” Adeniran said. “Family planning also reduces morbidity and other [health] concerns [associated with] early pregnancy.”
Abortion, which is illegal, remains “a very sensitive issue”, the procedure allowed only if the mother is at risk, Adeniran said. She said health workers are now being trained to educate women on how to prevent unwanted pregnancies.
While traditional and religious leaders have become more open to reproductive health and contraception education, the support is not universal.
Tijjani Bala Kalarawi, an Islamic cleric based in the north’s Kano State, said: “For a religious leader to come out and ask his flock to use a condom, for instance, in the name of safe sex is akin to giving them a blank cheque to be promiscuous, which negates our religious duty to ensure people remain morally upright.”
While he is involved in fighting stigmatization of people living with HIV/AIDS, he said under Islam contraception is allowed only for married couples, and then only if it “is mutually agreed by the couple without external influence”.
Umar noted that family planning should not be considered a problem under Islam. “Islam supports everything that gives better health to mothers and babies,” he said.