Meadows1 notes that within the realm of any global culture around the world, the poorest people have been outlined as having more children compared to the rich people. What comes out of her assessment is whether having many children makes people to become poor, or whether being poor makes people to recreate more children? Poverty and population are two issues which are linked and intertwined with each other. As Meadows notes, population growth has been the root cause of the worsening level of poverty. The situation has resulted into intense advocacy on family programs and population education especially among women.
Explaining this scenario, Eastwood and MIcahel2 argues that rapid population growth forms the major undermining factor to economic progress in the poorest countries. This is especially so in the developing countries such as Nigeria. This rapid population growth has deprived Nigerian societies a chance of getting sufficient funds that they can invest. Of greater significance is the way overpopulation has hindered women in Nigeria, especially those in Northern Nigeria, from getting incentives on reproduction health as means of having fewer children.
While one of the main aims of the Millennium Development Goals (MDGs) is to address acute problems arising from extreme poverty, especially those of people living with less than $1 per day by 2015, this has not been achieved effectively. According to Eastwood and Michael2, fertility and poverty are correlated of which indication of their causation can be directed both or contributed by a third factor. They note that the fertility is based on demand side which attribute to the desire by family to have more children, and the supply side which depicts the pattern of unmet need in controlling fertility among women. In so doing, poor families with larger households may enjoy worse educational prospects of which may hinder young women’s acquaintance with birth control measures. Inability to control fertility rate results into bad MDG outcomes.
Based on 2009 MDG report, almost a half of the population in some developing countries such as China and those of Asia had greatly reduced proportion of the population living in extreme poverty by 1990. As reported on BBC News Africa3, Nigeria’s National Bureau of Statistics had 60.9% of its citizens living under absolute poverty by 2010. The same report also provided that the northern part of the country was the worst hit with Sokoto state having the highest poverty rate of 86.4% compared to 59.1% of the southern part. This low reduction in population growth in developing countries especially in Northern Nigeria has been contributed by the inability of women to access contraceptives due to administration, distribution, cultural, religious and affordability issues.
Poverty and overpopulation have resulted into economic declined in the Northern Nigeria hindering the Northern Nigeria women from excising their reproductive health rights.
As defined by World Health Organization4 (WHO), reproductive health refers to the ability of people to have a responsible, satisfying, and safe sex life. The concept endures people with the capability to reproduce and have the freedom to decided if, when, and how often they should have children. According to WHO, the greatest reproductive health right especially that which should be enjoyed by women is the right to information. This entails informing them on how to access effective, safe, affordable, and acceptable family planning methods as well as health care services. In so doing, women can be safe during their pregnancy and childbirth thereby recreating healthy infants. Such children will also continue enjoying healthy living since their mothers are empowered with relevant information needed for their upbringing.
In Northern Nigeria, women’s reproductive rights have not been effectively addressed. According to Egboh5, women in the northern states of Nigeria are less advantaged compared to their southern counterparts as they are characterized by less demand for and access to reproductive health services. While 90% of women have at least primary education in the southern region, only 25% to 30% of women have the same educational level in the northern region. This has affected the ability of northern women to access rightful reproductive health information that can enable them to enjoy their reproductive health rights. Egboh points out that demand for children in northern region is higher compared to that experienced in the southern region. For instance, northern women bear on average seven children as compared to only four children in the southern region (Egboh5). This high fertility rate reflects a lower demand for contraceptive use among women in the northern region as compared to higher 50% demand for family planning methods in the southern region.
Discussing the demand for reproductive health rights among Northern Nigeria women is thus an important topic especially in the field of global reproductive health. This is due to the fact that the failure to address women’s reproductive rights would result into unresolved high childhood mortality evident in the region. As was discussed in class, a larger percentage of sub-Sahara Africans, which in our case is Northern Nigerians, live on less than $1 per day. The situation is worsened by the fact that the maternal and child mortality rate is the highest in such regions. Egboh 5 also concurs with such findings noting that northern Nigeria region has extremely high childhood mortality. He further reports that one in four children dies before their fifth birthday. This contrasts the southern region where almost one to ten children die before attaining their fifth year. Thus the assessing of the demand for contraceptive use among Northern Nigerian women helps in tracking in strategies and programs that are able to address the unmet needs within the population.
Additionally, the demand for reproductive rights through the use of contraceptives among Northern region women cannot be separated from the issue of population and poverty that was discussed in the classroom. This is due to the fact that high fertility rates do not just affect the mother’s health, but her family’s as well thereby increasing the risk of maternal and childhood mortality all of which contribute to poverty. However, the constructs from social cognitive theory and health belief model seem to be very applicable in explaining the factors influencing behavioural outcomes in contraceptive use among the Northern Nigerian women.
Another factor that has contributed to the low demand for contraceptive use among the women of Northern Nigeria is the inability by the public as well as the private health agencies to successfully apply the health belief models. As pointed out in UNFPA6 website, the Health Belief Model (2) was first established in 1950 to help in understanding why people did or did not use healthcare preventive services as recommended by public health departments. According to UNFPA, HBM theorizes that people’s readiness to take health care preventive actions is based on their beliefs and perception of the benefit of engaging in such actions. These are such beliefs that have made Northern Nigerian women to perceive themselves as susceptible to any risks or threat of complication during pregnancy and after delivery.
For instance, there is a slight difference in knowledge and attitude among Northern Nigerian women towards sexually transmitted infections as compared to their perception of other reproductive health issues. Egboh5 notes that an average of 30% to 50% women in northern states had positive attitude towards the use of condoms as a way of reducing the risk of contracting HIV/AIDS infections. But when the same women were asked if they could have contact with persons known to have HIV/AIDS, only 20% to 35 % agreed so. This shows that their health beliefs have instilled in them a pre-contemplation characteristic which has denied them a chance of recognizing the need of having a clear understanding of their reproductive health.
One of the theories related to what is happening among the Northern Nigerian women is the social cognitive theory (SCT). The theory explains how personal factors, environmental influences, and human behaviours have continually affected Northern Nigerian women from using contraceptives. According to UNFPA6, social cognitive theory points out that people tend to learn either through their experience or through observing the actions which had been taken by others. If properly administered, SCT can construct self-control, reinforcement, and self-efficacy all of which are lacking towards the issue of contraceptive use among women in Northern Nigeria. Instilling self-efficacy of reproductive health services in northern women would make them confident and capable to persist in using birth control methods despite economic, cultural, or religious challenges.
The Existing Strategies Attempting to Address Low Demands on Contraceptive Use among Northern Nigerian Women and their Critiques
One of the existing strategies is funding non-governmental agency programs or projects that empower women to use family planning methods. Under the U.S. Agency for International Development (USAID), the Extended Service Delivery Project (ESD) has been funded to try and promote family planning services’ use among women in Northern part of Nigeria. The project aims at improving the women’s ability to practise healthy timing and spacing pregnancy (HTSP). One of the main strength of this strategy is that it embraces HTSP which has been seen as culturally appropriate way of addressing maternal and child health, and more significantly, family planning.
According to Lane, Hassan & Pryor7, the persistent problem of early and closely spaced pregnancies are among the other factors that have contributed to the poor reproductive health outcomes associated with women and children in Northern Nigeria. This has majorly been attributed to the low rates of contraceptive use among Northern Nigerian women. Studies have shown that 84.7% of young women between 15 to 19 years old have spaced births of less than 36 months apart. This is also the case with 70% of women between 20-29 years old who are also experiencing the same challenge of closely spaced births. Through a sample population, the project was able to identify childbearing among women in Northern Nigeria as based on the assumption that it demonstrates fertility of women to their husbands and entire families especially their mothers-in-law.
This strategy as reported by Lane, Hassan & Pryor7 had yielded positive results among the young women because of the manner in which it was conducted. They note that ESD engaged household visits to young married women, their respective husbands, and mothers-in-law in order to sensitize them on the benefits of using contraceptives in practicing. However, the main weakness of this strategy was its inability to effectively educate young women and their families on the side effects of family planning methods. The issue of side effects are a thorny issue that has continuously affected the use of modern contraceptives among young women. Additionally, the short time duration for which this strategy is administered cannot allow it to effectively overcome the pervasive fears that women have towards family planning side effects.
Another strategy deployed to help enhance contraceptive use among Northern Nigerian women is educating and sensitizing other related groups to incorporate HTSP message within their occupation and activism. This has seen the international organization funding projects that are entitled to partner with respective leaders in disseminating HTSP information. For instance, ESD partnered with Federation of Muslim Women Association of Nigeria (FOMWAN), religious leaders, community health workers, and opinion leaders in ensuring that it reaches out to the community (Lane, Hassan & Pryor7). Additionally, FOMWAN members together with Muslim religious leaders were trained on how to incorporate HTSP information within their activism and sermons to young women. However the problem with this strategy is that it does not give out financial assistance required by these poor women to enable them to afford family planning methods of their choices. Moreover, involving religious leaders in the community outreach program without additional investment of resources cannot offer comprehensive intervention especially in changing community norms regarding the use of contraceptives (Lane, Hassan & Pryor7).
As Roudi-Fahimi8 points out, the Islam religion which makes higher percentage of women in Northern Nigeria tend to address the use of contraceptives within the marriage and family context. He notes that Islam normally identifies the husband and wife as principal in the formation of marriage, a sacred union. Based on Quran writing, “God has made for you mates from yourselves and made for you out of them, children and grandchildren,” the author notes tranquillity as the main purpose of engaging family life through marriage. Therefore, he points out contraceptives as helping Islam families in achieving tranquillity by either having children when they want them or when prepared to have them.
Proposed Policy Intervention Recommendation
Here a policy intervention will be developed to depict a reflexion of knowledge, access, and affordability of family planning methods to best address the issue of low contraceptive use among Northern Nigerian women. From the onset, I will focus on ensuring that the women in this region have access to correct knowledge towards the use of family planning. This would enable them to understand how these methods work, what their side effects are, and more importantly how to address misinformation attributed to modern contraceptive use. This will be possible through provision of grants and technical assistance to the relevant Nongovernmental organizations (NGOs) on the ground as a means of empowering them to offer quality reproductive health (RH) and Family planning (FP) services to their respective communities. This approach is appropriate for this target group since it makes it easier for these poor women to access affordable family planning services which are hard to get for a large number of women.
This strategy has been successfully used by Pathfinder organization in Northern Nigeria where it has assisted each of its NGOs with the right skills required to provide the clinical needs and services which can help improve the women’s reproductive health knowledge and practices. According to Egboh5, Pathfinder has been able to service through its networks over 130 clinics. It has also trained community-based distributors which includes male motivators, peer health educators, traditional birth attendants, and patient medicine vendors on the skills required in developing plans on how to improve health care quality. Besides such workable strategies, I will ensure that the policies targeting the empowerment of such NGOs do not just gives them skills to train and sensitize community and religious leaders of Northern Nigeria on RH and FP issues, but also put emphasis on the need of practicing family planning methods to help them in supporting their relationship.
Through educating imams, Egboh5 notes that they have become facilitators of implementation of reproductive health sensitization project. According to him, this has been the strength of the organization as it has been able to leverage great funds in achieving broader RH and other social support needed by Northern Nigeria women. In fact, Pathfinder in collaboration with religious leaders has been able to create behavioural change through the use of communication materials such as notebooks, t-shirts, and FP cue cards among others. These materials were developed with the association of all stakeholders in ensuring that they are culturally and religiously accepted by target audience, especially by women.
In ensuring that the provided grants and technical assistants are properly utilized, I will seek to involve all NGOs in sensitizing their operations through health rallies and home visits. In addition, I will ensure that they are engaged in interactive public health campaign in schools, mosques, churches, and workplaces. This will help to further strengthen the dissemination of reproductive health messages to women population. Moreover, supporting vocational training programs through mass media such as radio, phone-in programs as well as TV shows would enable these targeted women in outlying problems they commonly face thereby sharing the same with health institution in addressing these problems.
However, the weakness of providing grants and technical assistance to NGOs is based on the viability of ineffective utilization of funds due to administration issues posed by the country’s political context. Just like the male dominance in political arena, most of the northern states of Nigeria depict a husband, father or male head of the family as having the absolute decision making-powers regarding families issues including RH (Egboh5). Equally, the country’s political context may affect the manner in which FP methods are used among the targeted women. For instance, in northern states, having many children is seen not only as an enhancement to social status, but political advantage as well. Egboh notes that there is a competition among families and communities in constituting larger voting bloc through having their wives producing many children. In such a case, this strategy would not effectively help in changing this cultural norm which has been the major reason for the inability of northern women to embrace the use of modern contraceptives.
However, the anticipated outcomes of sensitizing women through technical and educational assistance have vast beneficial effects. First, reinforcing RH messages through social marketing campaign would create awareness among the target groups enabling them to address any associated misconception on modern contraceptive use. I will also seek for the formulation of policies which support the provision of family planning services closer to targeted women to help the already existing organization in planning and implementing policies that would increase the women’s accessibility to modern contraceptives. This will help in addressing social cognitive and health belief model theories which denotes self-efficacy and confidence as instilled in people provided they are actively involved in a given process.
Additionally, I would also seek for more support for the community-based clinics. This would enable Northern Nigeria women to acquire adequate knowledge and decision making process which would help them in making choices regarding how to control their fertility. I will also seek for the enhancement of self-efficacy results into improved behaviours, motivation, thinking, and emotional well-being. This would promote social cognitive learning thereby enabling women to understand that they are responsible for making decisions about their child bearing and therefore should not be influenced by any social norms.
In conclusion, sensitizing women and community on family planning methods can help in reducing fertility rate in Northern Nigeria. This would help in curbing rapid population growth and poverty in the region. However, there is a need to address the issue of the inability of women to effectively use modern contraceptives which has been a result of the lack of financial support to afford and access FP methods. Moreover, the is a need for all the stakeholders including the Government and Nongovernmental agencies to understand that family planning through modern contraceptive use is an essential public health intervention that can help in addressing overpopulation and poverty issues. Therefore, developing countries such as Nigeria should ensure that family planning methods are envisaged in order to reduce maternal and childhood mortality as well as reduce poverty rate.