Reproductive health has received a lot of attention of late – and none too soon, I would say – with Bill and Melinda Gates Foundation significantly increasing funding for reproductive health, and UNFPA’s launch of the FamilyPlanning2020 project. Globally, there is an estimated 120 million women with unmet family planning needs – those who want and need access to contraceptives services but are not getting it. More on the home front, the recent National Demographic and Health Survey (DHS), 2013 putting at 16%, and is understandably higher in rural areas than urban. However, we are well aware that popular global trends do not necessarily have a trickledown effect in the day to day lives of many. Nigeria presently does not have a robust research base, and mostly have to rely on nation-wide surveys like the five yearly DHS or UNICEF’s Multiple Indicator Cluster Survey (MICS). In this way, we do not really get to see what goes on, state-level wise, and even less for hard-to-reach populations like nomadic groups or the homeless. Therefore, anecdotal accounts can be quite enlightening, such as the education I received on Twitter a while ago.
I had been part of a Twitter conversation that was not at all geared by any advocacy organization, which was the very interesting part. The focus had been specifically about access to service by young unmarried Nigeria female. A surprisingly common experience a number of handlers shared was not the cost of female condoms – which retail at almost three times the cost of regular condoms. It was not even the cloak of shame surrounding the actual job of buying condoms, which has contributory effect on the incidence of HIV which remains unacceptably high in young people aged 15 to 19. The problem these women had was of being barred from buying contraceptive pills from pharmacies because they are unmarried. Culture has in the past been given as one of the barriers to contraceptive use, in that young women are reluctant to ‘advertise’ that they are sexually active despite the high prevalence of sexually transmitted infections (STIs) like gonorrhea and syphilis, teen pregnancy is high (and also recurrent) and unintended teen abortions are not uncommon. So, this was quite a new one. To deter people who are actually aware of their reproductive health needs, and are willing to meet its financial obligation seems rather counterproductive.
A quick look at the 2001 National Policy on Reproductive Health (see here) shows that particularly the sections 18.104.22.168 and 22.214.171.124, shows a recognition of the need to “protect reproductive rights through the creation of an enabling legal environment by, the amendment and repeal of all laws contradicting reproductive rights principles and the enactment of appropriate legislation” and “protect the rights of all people to make and act on decisions about their own reproductive health free from coercion or violence, and based on full information within the framework of acceptable ethical standards. This policy was produced in 2001, fourteen years ago – such protection does not yet exist. Female genital mutilation is still practised in Nigeria, albeit only about 5% but is still very much unacceptable. The practice of a pharmacy and patent medicine vendors to deny a Nigerian resident from making a lawful purchase is an example of the attitude that hinder reproductive health in young people.
Of course, there is still enormous need to be met when it comes to reproductive health – from the raising awareness about sexual and reproductive health and rights, adequately addressing complex-specific issues in this area, to the very limited infrastructural provisions. But, the re-education of health professionals need not take a back seat. There were actually a good number of handles during the aforementioned Twitter conversation claiming to be medical professionals who defended the rightness of their colleagues’ refusal to sell pills to a nulligravida – with accompanying links to what they considered to be evidence that contraceptive pills causes cancer. One would assume that the conversation should have naturally led to questioning why not sought proper family planning service, with medical examination and corresponding counselling, and not the usual “should you be having sex at all?” The fact is that young people are having sex, and they should be protected.
There is much need for an updated National Strategic Framework on the Health & Development of Adolescents & Young People, (the last one was for 2007-2011), as with a revised national policy on SRH. In the meantime, its strategy to develop action plan among media organizations for young people’s reproductive health programming and experience sharing – hopefully, one that is comprehensive – remains useful and one that we at CHELD advocates.
Public Health Specialist
- Nigeria National Demographic and Health Survey 2013
- Nwankwo, Benjamin O., and E. A. Nwake. “Risky sexual behaviours among adolescents in Owerri Municipal: predictors of unmet family health needs.”African journal of reproductive health 13.1 (2009).
- Okereke, Chukwunenye I. “Unmet reproductive health needs and health-seeking behaviour of adolescents in Owerri, Nigeria.” African journal of reproductive health 14.1 (2010).
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