Jumoke Adekogba is the reproductive health and family planning advisor with Engender Health, fistula care plus project. In this interview with AJUMA EDWINA OGIRI, she talks on family planning in Nigeria and why some methods fail.
Modern family planning methods
When we talk about modern family planning methods, we have oral pills, which are hormonal. We also have injectables which can be taken every three months, or noristerat, which can be taken every two months.
There are also implants, which is usually inserted into the arms of the client. There are two types of implants, jadalle; which lasts for five years, and implanon; which last for three years. There is also IUD (intrauterine device), which passes through the vagina into the uterus of the client. It can last up to 10 years and is a non-hormonal method.
There is also a permanent method which is surgical; tubal ligation for women and vasectomy for men.
In addition, we also have natural methods and these are calendar, lactational amenorrhoea and condoms; both male and female.
Benefits and side effects of family planning
We always tell our clients the side effects of all the family planning methods, especially when you talk about the hormonals.
Hormonals like the oral pills, injectables and implants. Sometimes it tempers with the regulation of the menstrual flow; irregular flow.
With time it will regularise itself, but if there is any abnormal or unbearable situation, the client has the right to call the provider and report. If it is getting much, she can go back to the facility and necessary action will be taken.
For the IUD, because it’s non-hormonal some clients may bleed more than normal when they first take it, but within a short period of three to six months, the menstrual cycle will regulate itself.
Family planning ensures healthy timing and spacing of pregnancy. It improves the health of the mother and the child, reduces the chance that new-borns, infants and children will die under five years of age.
It gives couples time to prepare for the next pregnancy and reduces the chance of problems during the next pregnancy. Furthermore, it allows mothers to breastfeed for two full years and have healthy and productive children.
Managing side effects
The best tips that we normally give them is counselling. We counsel them on all the methods and let them know the side effect of each method, because there’s nothing that doesn’t have side effect. Even if you take anti-malarial drug, you may feel nauseated, which is the side effect.
So, we normally tell them the side effects, so that when they feel or have it they will remember we told them in the facility. As a skilled healthcare provider, it is the right of the woman to have adequate information about all the methods and the side effects before she makes a choice of her own.
Achieving family planning by 2030
The challenges we have in family planning in Nigeria is that it is a donor driven project. Since 1998, the United Nations Population Fund (UNFPA) have been giving free commodities, so we need to think about sustainability.
If all NGOs fold their arms without assisting in terms of providing free commodities, I don’t know what will happen, because in the facilities there are no consumables for the providers to use in giving the necessary services.
So, because of this we have been able to do a lot of advocacy to the state and local government, so that they will be able to make a budget line for family planning to make it a sustainable project in Nigeria.
Making family planning decision
When you talk about family planning, it could be as an individual or a couple. But, we normally advice our clients to seek the consent of their husbands, to avoid crisis in their family.
Some men come with their wives to the clinic for family planning services, while some women that come to the clinic do so with the consent of their husbands.
Family planning and population explosion
When we talk about our growth in Nigeria; that is the rate at which we are growing, we need to look at it. Let’s take a look at a woman with eight children for instance, and each of the children gives birth to eight children each, there will be 64 grandchildren in the second generation.
Then the third generation will be 64 multiplied by another eight; that is 512, making it the third generation, and it goes on and on.
Before you know it, we will have population explosion.
We also think that a woman should be able to rest between one pregnancy and labour before another one, so that she will be able to regain all the energy she used to carry the pregnancy to labour, before she has another child.
It also gives women time to take care of their children and husbands. A woman that is having pregnancy every year will not be able to economically support the family.
Why some family planning fail
We usually say that nothing is 100 per cent, but there are some cases that a woman, for example in the case of IUD copper, we normally encourage them that if you know your husband is the type that do fingering during sexual intercourse, the thing can be easily removed or dislodged, and such a woman can become pregnant.
Then in terms of tablets; contraceptives, that a woman is supposed to be taking every day, and she forgets and omits like one or two days, she can become pregnant.
Also, a woman that is taking injectables every three months, and forgets to take when the three months elapses, can become pregnant as long as she is having unprotected sexual intercourse.
So, the failure most of the times depends on the user. There are no instances where a user will follow her family planning methods judiciously and still get pregnant, even if there are, it’s very rare.
