The sexual exposure occasioned by COVID-19 pandemic could lead to increase in pregnancyrelated complications due to limited access to family planning commodities. REGINA OTOKPA examines government’s failure and possible ways of changing the narrative
Eight months after the first case of Coronavirus in Nigeria, its crippling and devastative effects on society especially on the reproductive health of women and girls is not reducing.
While the country was forced on a lockdown to keep the virus at bay, women and girls were exposed to emotional bonding and an increased sexual activity as a result of long hours with the opposite sex maintaining or improving warmth, giving health tips or sharing information on the virus in a bid to fight their unseen foe and fears together. With this heightened intimacy during the COVID-19 era came more cases of sexual intercourse without any form of contraceptives.
A preliminary investigation by this correspondent during the COVID-19 lockdown, revealed that condoms, injectable, daily and emergency contraceptive pills were sold out in majority of the pharmacies and patent stores.
Also, there were disruptions in routine healthcare services and clinic appointments especially for ante-natal care, contraceptive counseling or other reproductive health services. This means that majority of women and girls in need of reproductive health services directly or indirectly, were exposed to unplanned pregnancies, risk of contracting sexually transmitted infections (STIs), unsafe abortions and other allied general health concerns
But besides access, a good number of women are still not taking their reproductive health or use of contraceptives seriously due to lack of awareness, fear, confusion, misconceptions, misinformation and failure of the federal government to keep to its commitments to make available the needed resources to ensure availability of family planning commodities.
Many women and girls do not know that besides the traditional methods of contraception which includes periodic abstinence and withdrawal, there are modern contraceptive methods such as female sterilisation, male sterilisation, the pill, the intrauterine device (IUD), injectables, implants, male condoms, female condoms, the diaphragm, foam/jelly and the lactational amenorrhea method.
The FP2020 target indicators shows that Nigeria currently has 13.9 per cent modern contraceptive prevalence rate (MCPR), meaning only one in four married women aged 15-49 has an unmet need for modern contraception. This indicates that about 15.7 million sexually active women may still find it very difficult to avoid pregnancy or sexually transmitted diseases (STDs).
According to Prof. Emmanuel Otolorin, the FP 2020 target has associated commitments in the areas of financing, ensuring availability of services and commodities and building sustainable partnerships. Nigeria, he said released counterpart fund of $2.65 million and $3.313 million for 2017 and 2018 fiscal years respectively, leaving a shortfall of $2.02 million for the two years
Although, contraceptive use before the COVID-19 pandemic increased globally, its use has remained very low in Sub-Saharan Africa including Nigeria.
According to the United Nations (UN) and the World Health Organisation (WHO) in different reports, the world contraceptive prevalence rate (CPR) rose from 54 per cent in 1990 to 57 per cent in 2012 and from 23 per cent to 24 per cent in Africa over the same period.
Furthermore, National surveys in 2012 and 2013 placed the CPR in Nigeria at about 15 per cent which was the same with the 2007 estimate. Recently, the coordinator, Africa Health Budget Network, Dr. Aminu Magashi, raised concerns over the data on the number of women who use family planning commodities as captured in the 2018 Nigeria Demographic Health Survey (NDHS).
The survey which placed current modern contraceptive use by married women at 12 per cent and CPR for any method at 17 per cent, however states that the total fertility rate was 5. 3 children per woman further broken into 4.5 in urban areas and 5.9 in rural areas. According to the Director Programme Operations for Marie Stopes International Organisation Nigeria (MSION), Emmanuel Ajah, some communities in Nigeria have fertility rates as high as 5.9 per cent and six per cent in some states.
The implication is that a lot of women are still having children by chance and not by choice. “We will continue to have high maternal mortality ratio; we will continue to have children we are not able to train which has large implications for our economic and social security because children who are not well spaced, not well planned; their behaviours and what they become in the future is actually what we will not be able to account for.”
The Chair, Association for the Advancement of Family Planning (AAFP), Dr. Ejike Oji, further cautioned that this rapidly increasing and uncontrolled population growth in the country was reason behind the increasing rate of sexual abuse and other gender based violence.
“Remember that every year we add about three million to our population and our resources are not infinite or as much as they used to be few years ago. The most important thing is that we must slow down the growth rate of our population in a way we will be able to take care of the human beings we are bringing into life.”
Unfortunately, the population explosion is also fueling issues of unemployment, poor health indices, economic challenges, insecurity and other vices in the country; there is a high rate of unmet need for family planning among sexually active unmarried women put at 48 per cent, than among women who were currently married representing about 19 per cent. By implication, although a good number of women seek to use modern family planning commodities to reduce pregnancies and births, they cannot access them because they are not readily available.
This is due to the federal government’s failure to keep to its commitment at the Global Family Planning Summit in 2012, to provide 120 million additional women with modern method of contraception by 2020.
In a letter signed by the then Minister of Health, Prof. Isaac Adewole, Nigeria at that Summit, made a commitment to provide $4 million annually from 2017 to 2020, for the procurement of contraceptives for the public sector to boost family planning prevalence to 27 per cent but contrary to its commitment, only $2.8 million; $2million in 2018 and $830,000 in 2019, has been committed to family planning in the country.
“For us to put $830,000 in 2019 instead of the $4 million target is grossly inadequate; this means we have only committed less than 25 per cent of what is actually needed. The budget was cut because in 2018 the government put in more money, $2 million but the fund was cut by 80 per cent in 2019. Up till now we have not seen the approved budget for 2020.”
Sadly, government in the revised 2020 Budget did not show willingness to ensure continued access to quality essential and integrated sexual and reproductive health services, including modern contraceptives, as well as the prevention and treatment of HIV and other STIs.
In December 2019, the initial family planning budget was N1.2 billion at N305 to $1 which amounts to $3.9million, but in the revised budget of June 2020, it was still N1.2 billion but at N360 per $1 now $3.3million. Ordinarily, given the increase in foreign exchange rate, one would have expected to see an increase in the money budgeted for family planning, rather, there is a funding gap of $601,000.
This is not strange, as there have been decreases in the family planning budget yearly. For example, family planning budget in the 2019 appropriation was reduced by 80 per cent compared to that of 2018. It is the lowest since the country started budgeting for family planning to meet the 2020 target.