Maternal/infant mortality: Race to 2020 target looking bleak

• Experts Call For Timely Release Of FP Fund, Youthful Enlightenment
The Federal Government’s target of reducing the high maternal and infant mortality rate by achieving a 27 percent modern contraceptive prevalence rate (mCPR) by 2020 remains a daunting task as the year winds down.

Meanwhile, the country’s maternal mortality remains one of the highest in the world with 576 deaths per 100,000 live births according to Nigeria Demographic Health Survey (NDHS, 2013).

It is known that family planning and precise modern contraceptives has the potential to reduce maternal mortality rate by 30 percent and infant mortality rate by 75 per cent.

Based on this, government in collaboration with key stakeholders have set a target of 27 per cent contraceptives use to reduce prevalence rate and set a standard to be achieved by 2020.

At the moment, The Nigeria Demographic and Household Survey (NDHS) 2013 put Nigeria’s modern Contraceptive Prevalence Rate at 10 per cent and the Unmet Need for Family Planning at 16.1 Percent. A more recent survey-The 2018 Track20, estimates reveal that Nigeria’s modern Contraceptive Prevalence Rate (mCPR) is currently 12percent (for married women) and 14% (for all women) meaning that the mCPR is currently growing at the rate of 0.5percent.

At this rate, experts are worried that the mCPR 2020 may go down the drain just like the previous set targets.

It would be recalled that In 2011, Nigeria had set a target of modern Contraceptive Prevalence (mCPR) of 36percent to be achieved by 2018, which was affirmed as part Nigeria’s FP2020 Commitments during the July 2012 Family Planning (FP2020) Summit in London, United Kingdom.

Deputy Director, Reproductive Division, Federal Ministry of Health, Greg Izuwa, explained during a presentation on family planning at Abuja organised by Drpc/PACFaH@SCALE that as “it became obvious that the mCPR target would not be realised and in recognition of the urgent need to rapidly increase mCPR under a more conducive enabling environment, the former minister of Health as leader of Nigeria’s delegation renewed the country’s FP2020 Commitments at the July 2017 FP2020 Summit in London, United Kingdom.

In order to ensure realistic Renewed Commitments, the mCPR target of 36percent by year 2018 was rebased to 27percent by year 2020.”

He explained that; “the recent renewal and increase in Government Counterpart Funding for the procurement of contraceptive commodities is an opportunity to accelerate the increase in Contraceptive Prevalence Rate (CPR) towards the target of 27percent by year 2020.”

According to NDHS, 2013, the Unmet need for Family Planning was estimated to be 24.2percent, which shows that while more women of reproductive age in Nigeria desire to access family planning, the programme’s capacity to meet their needs is highly inadequate.
“What this means is that there will be more delivery, more health complications for every pregnancy not planned,” Vice President Society of Gynaecologist and Obstetrics of Nigeria (SOGON), Dr. Habib Sadauki, said.

In pursuit of the mCPR 2020 target, the Federal Government has put in place a policy of free family planning information, services and commodities to family planning clients at public health facilities across the country.

Also, select private health facilities are equally being supported with government’s free commodities to enable them provide free family planning services, Izuwa said.

Meanwhile, Civil Society Organisations (CSOs) In Lagos State, and other stakeholders are calling for timely release of family planning funds and enlightenment programmes on contraceptive use, as well as abstinence.

During a recent media dialogue on family planning organised by Pathfinder International in Lagos State, experts called on the state government to ensure the release of the N87, 935,800 that was allocated to family planning services in the state.

Chairman, Public Health Sustainable Advocacy Initiative (PHSAI), Mr. Ayo Adebusoye, said the Lagos State Contraceptive Prevalence Rate (CPR) target of increasing FP uptake from 48 to 74 per cent, by 2018, would have saved an additional 657 mothers and 8,500 children by 2018.

According to him, the major barrier to FP method is the out-of-pocket cost of consumables, especially at the grassroots level.

“Out-of-pocket cost of consumables has deprived many women from taking up FP method, leading to uncontrolled and unplanned population we are witnessing. We are seeing increasing poverty level, increased child and maternal mortality among others.

So, we actually need to reduce the costs of mothers and children dying just because of barriers to FP method, hence, we need policymakers to listen to these cries for the implementation of FP policies, which are already in place.

“There is also the need for increased investment in FP and prompt release of fund, as just one dollar investment in FP can give over 12 times the cost savings through taking care of the child and the mother during delivery and post-delivery care,’’ Adebusoye said.

The state coordinator, Life Planning for Adolescents and Youths (LPAY), Abiodun Ajayi said over the years, Lagos State has taken bold steps to increase young people’s access to youth friendly Sexual Reproductive Health (SRH) services.

“Lagos State appears to have made some progress in its response to adolescent reproductive health with an allocation of N29,840,000 in the 2019 budget, which provides for the establishment of four Youth Friendly Centres at higher institutions across the state, follow up visits to rape victims and physical abuse, maintenance of Hello Lagos Centres, termly mentoring sessions on safe Sex Education to Students in public secondary schools and provision of incentives (e.g. Sanitary pads, game tools, etc.) for student in secondary schools,” he added.

Despite this promising development, Ajayi said Adolescent and Youth SRH response is still largely donor dependent, adding that there is an urgent need to increase discussion around adolescents and youth SRH/FP issues at all levels and then increase funding to sufficiently meet the SRH/FP need of the high risk sexual behaviour of these rapidly growing young population.

Development Communications Network (Devcoms), a non- governmental organisation saidyoung people need quality information to make informed choices.

“Majority of young people in Nigeria are not empowered with quality information to make informed decisions about their reproductive health.  As the country commemorates this year’s World Contraception Day with the theme: It’s your life, it’s your responsibility,” Programme Director of the Network, Akin Jimoh said there is an urgent need to improve awareness of the importance of abstinence, as well as contraception to enable young people make informed choices on their sexual and reproductive health.

According to these stakeholders, Nigeria’s refusal to take action to improve contraceptive use will result in “the country having high rate of unsafe abortion as reported in several studies.  The 2018 Performance Monitoring and Accountability 2020 (PMA2020) Abortion Survey Results states that about 4 to 6percent of women of reproductive age had a likely abortion in the 12 months prior to the study indicating that 1.8 to 2.7 million abortions occur annually in Nigeria. Family planning allows the woman to rest between pregnancies in order to regain her health and strength and enable her to have a healthy child and thereby reducing the incidence of maternal mortality,”Jimoh said.

Bless-me Ajani, the Youth Program Officer, Nigeria Urban Reproductive Initiative (NURHI 2) Lagos, said there are still barriers and challenges young people face in accessing contraception information and services. “As a country, this is a time to prioritize the issues around Adolescent and Youth Sexual and Reproductive Health (AYSRH). These issues, which are discussed year in year out without adequate solutions range from ignorance on the part of the young persons, policy barriers, non-supportive societal environment to judgmental service providers.”

Dr. Adeola Duduyemi, Program Officer Service Delivery NURHI 2, Lagos explains that “Family Planning promotes the health and welfare of the entire family and in turn the whole community and nation; it is also key to unlocking Sustainable Development Goals.”