Dr. Farouk Jega is the country director of Pathfinder International. He fielded questions from journalists recently at a media training on family planning. APPOLONIA ADEYEMI reports
Negative attitude of service providers towards adolescents
The issue of provider barriers is not only for adolescent but for all groups. Unfortunately, it has no place for modern contraceptives. The only thing we can do is to raise awareness, continue teaching and building capacity.
We expect the media to write stories about these issues because they are really a hindrance in the uptake of family planning. All of us are clients and, as clients, we have a role to demand good and quality services and not in a judgemental way. It is also not bad for an adolescent to take up family planning. Providers of family planning have no reason to be judgemental. Being judgemental is a breach of service and code of ethics is thwarted in providing services in a very judgemental way.
Service providers have no reason to think that they will make a decision on behalf of the adolescent. You have no reason to think that and I see no reason anybody should do that.
We are too often being judgemental especially in our traditional setting. Unfortunately, it continues and the only way we will deal with it is by training. To this end, Pathfinder ensures that we train our health workers. In our training, we include issues of values to address provider bias. You have to respect the wishes of the client and part of it is for you to provide services without being judgemental.
Place of male involvement in family planning?
Men should be involved in family planning because a woman cannot be pregnant all by herself. It takes a man and a woman to adequately plan for the family and not only their next birth but their resources like education of the children, foods and general upkeep of the family.
A lot of times, men often shy away from these key responsibilities and they go away but, unfortunately, the reproductive biology of the female is much more amenable to interruption and manipulation than the male reproductive biology. A woman at least has one fertile cycle every 28 days and at most every 30 days. It takes an average of 90 days for male spermatozoa from the beginning of the life cycle until they become fully mature and they are able to impregnate a woman. That is three times the number of a female reproductive cycle. And the various hormones that are at play in reproduction are very easy to understand and manipulate whereas the process of spermatogenesis is not easy to manipulate. I say this because almost all the family planning methods are for women. The various hormones that are at play in reproduction are easily manipulated, but the spermatogenesis cycle of the male is much more complex and cannot be manipulated. Almost all the family planning methods are for women and not men because of trials. Scientists have tried very hard but they did not have any break way in developing a male-specific method. Perhaps, if some of these hormones with terrible side effects are directed at men, perhaps we would have seen much male involvement.
It is not right that simply because most of the methods are targeted at women, men will just sit back and not be involved. I think men can play a key role. A typical Nigeria society is always male-dominated. The man always makes all decisions including whether his wife or his woman should have family planning or not, that alone suggests that men should be fully involved. As I know, I play that role very well.
On the contrary, a man can be very useful in terms of making sure that the woman not only takes a useful method but also maintains that method. These methods are not 100 per cent full proof. Almost all of them have one or two issues that are not life-threatening, but are usually self-limiting with time and almost 100 per cent reversible once the woman stops using a method but they can constitute a huge nuisance.
I understand family planning effects very well. The spotting, headache, feeling of blotting, all of these are normal.
People should think of the benefits. I usually encourage my wife to think of the benefits that we are having about spacing or limiting the number of children. The little nuisance women are feeling is a small sacrifice to me. I believe men can play more of these larger roles than the smaller ones I just mentioned. In many parts of the country, men are the total decision makers, they decide everything including family income and contraceptives and I think they should be fully involved in making these critical decisions.
Making youth friendly centres impactful for family planning services
From the little I know, the concept of having adolescent-friendly centres have really not been impactful. Research in retrospect did not meet the expectations of a lot of adolescents. But having the providers themselves to be very well trained, you may call it adolescent-friendly providers; I think it will make a difference. It is not the health facilities or hospitals or family planning centres but for the providers to be adolescent-friendly that makes all the difference. No matter what centres they are working in, if they understand their duties and they understand that it is their duty to provide information and services irrespective of the age of the adolescent that makes the difference. I think what I feel we should do, in any way possible, is to make sure we create the critical mass of those providers that are adolescent-friendly that know exactly what to do; that is the only way out. Pathfinder and other civil society organisations have finite resources from donors, so we can only reach finite numbers of providers and hospitals and other facilities. I agree that government should lead because they have the capacity. If government brings out a circular, every doctor or nurse will comply. Our own is to cajole, plead with them.
Human beings are rational and they want a rational argument and reasons they should do something. Most times these providers have failed to provide service to these young people and they actually feel they are doing the right thing. When they do this, they feel it is a normal thing for adolescent not to have sex. They feel that if adolescents have access to contraceptives, they are encouraging them to have premarital sex. For me, the key thing is that they are just being judgemental. The best thing is not to judge anybody. All of us were once adolescents before we became adults. Our experience is enough for us to make a rational decision on what to do.
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