Muhammad Kabir Abdullahi is the State Team Leader of the Nigeria Urban Reproductive Health Initiative (NURHI), Kaduna state. He speaks to ADAM ALQALI about the initiative and its work around child-spacing in northern Nigeria
What is the Urban Reproductive Health Initiative (NURHI) about?
The Urban Reproductive Health Initiative is a global program that has been in existence since 2009. In Nigeria, the initiative is in its second phase of implementation, the first phase focused on city-specific interventions in Kaduna, Zaria, Ibadan, Benin, Ilorin and Abuja.
Now, in first two we are covering the entire states of Kaduna, Lagos and Oyo states and we are now expanding into Kano and Kebbi states. Now, the intervention in phase one was focused around advocacy, demand generation and service delivery. It had five objectives; the primary objectives were achieving improved quality of healthcare, strengthened health systems, private public partnerships as well as advocacy and demand generation.
In phase two, the focus is basically around institutionalizing and sustaining the interventions because of the success that were gained in phase one and we are actually focused around three result areas which are service delivery, enabling environment and access to contraceptives.
We also have demand generation and we do have research, monitoring and evaluation component that continuously interrogate the intervention to see whether or not we are sustaining and improving on the successes of the program. These interventions are overall designed to reduce maternal mortality and improve the health of women.
The interventions are changing social norms positively by enhancing access to services which is improving the health of citizens of each of the states covered by the program. Overall, based on our intervention in phase one, we have seen 11.5% increase in contraceptives prevalence rate across the board in all the sites we intervened.
In this phase, the goal is to increase contraceptives prevalence rate by 12.5% in all the states we work as well as to strengthen institutions to be able to replicate our programs by expanding and scaling up the interventions into new locations.
Kaduna state is supposed to act as learning hub for the whole of northern Nigeria because the intervention there results in improvement in Zaria which is an indication that even in conservative environments the interventions can take form and root and therefore lead to increase the rate of access to contraceptives.
I think the key issue is that people need to understand the benefits of birth spacing so they can voluntarily use the services but they also need to be informed and that’s what our demand generation component is seeking to achieve. We are also engaging religious and traditional leaders to be able to expand access to knowledge and clarify to people the permissibility of birth spacing within the religion of Islam.
We have been able to achieve tremendous milestones whereby the religious are very supportive and are providing the necessary community voices to increase awareness by calling people to access the services as well as calling on government to increase funding to allow for more access to the services and reduce cost which can be a major constraint in terms of access to contraceptives.
The issue of child birth spacing is a very tricky issue in a society like Northern Nigeria, what can you says are the major bottlenecks you have faced in the course of implementing this project?
I think the major bottleneck is the people’s levels of knowledge on the issue but then our interventions are designed to increase knowledge, to shift attitude around practices to inspire people to access the services.
Another bottleneck has to do with myths and misconceptions, there are myths arising from the possibilities of side effects and future fertility desires. In terms of misconception it has to do with misconceptions about the permissibility of the use of contraceptives in Islam.
Now, we have engaged Islamic religious leaders who have been able to clarify that healthy timing and spacing of birth is permissible in Islam and they indicated that the practice of Azla (withdrawal) is a clear indication that it is permissible.
So, they unanimously agree on non-permanent or reversible methods but disagree on the permanent methods. Now, our program is very sensitive to the environment; it takes local nuances very serious.
Also, our interventions are geared towards improving understanding and increasing awareness about the services as well as guiding governments to understand that these interventions are required by the communities and will help the government improve the health and wellbeing of members of their people, particularly that of women and children.
This is because birth spacing helps to reduce maternal mortality by 40% and if that is the case, investment in birth spacing services is an investment that can quadruple the prevention of future burden on the health system.
How important is the role of religious leaders in the success of your campaign in northern Nigeria?
Well, what is important is the fact religious leaders are being involved. The Islamic scholars are very critical because they are trusted by members of the community and they also provide guidance on theological issues, specifically what is permissible in Islam and what is not, since religious injunctions in Islam are very clear.
The engagement of Islamic scholars helps to ensure increased awareness about the permissibility of birth spacing in Islam. It is important that religious leaders help clarify to the people the issue so that they can practice birth spacing which will help reduce maternal mortality rate in the region.
What are the social and economic benefits of child spacing to the family and society at large?
There are social and economic benefits of child birth spacing in the sense that a healthy family has a lower out of pocket expenses on health which allows the family to invest their resources in productive ventures like the education of their children or improving the quality of the food they eat. The social benefit is that families will be able to take good care of their children and as a result the children do not become a nuisance in the society.
