Why many Nigerians still reject family planning despite economic hardship

Mention family planning to her, and brace yourself for at least a minute spell of enmity with Deborah, her husband says. For many years, Henry has appealed to his wife that the family adopt a contraceptive method to limit the number of children they have.

“My wife does not believe in any form of ‘protection’. I have been trying to make her adopt a method for many years now, but she will always tell me she’s not interested,” Henry told PREMIUM TIMES.

Henry’s insistence on family planning could be linked to the economic reality of the family. He, a National Diploma holder of the Lagos State Polytechnic, popularly known as LASPOTECH, earns N23,000 monthly working as a security guard in Lagos while Deborah earns an irregular amount working as an attendant in a pub at the Mile 2 area of Lagos.

The pressure to get Deborah adopt a family planning method started in 2012 after the couple had their second child.

“After our second child, I told her to make plans to do family planning but she rejected it instantly. I kept pestering her about it but she will tell me that she doesn’t like it. That it is not good. Other times, she will tell me that she won’t enjoy it (sex) well if we do family planning. She doesn’t just want to hear anything about it,” a frustrated Henry said of his wife.

The birth of their third child in 2015 was followed by ‘many rounds of persuasion’ for Deborah to embrace family planning, again, the plea fell on deaf ears. Then came the fourth pregnancy in 2017, one which almost took her life.

Due to early signs of complications, as against what she used to experience, the couple, from second month of conception registered for ante-natal sessions in a private hospital.

Things were moving fine until two days to the Deborah’s expected day of delivery when she collapsed and was rushed to the hospital.

After being stabilised in the private hospital, the doctor informed Henry his wife needed urgent attention which the hospital could not provide as her blood pressure has drastically shot up.

Deborah was referred to the Gbagada General Hospital for further attention. She was diagnosed as having hypertension and when it was time to deliver of the baby, she couldn’t do it on her strength. She had to be cut up to save her and the baby, or at least her life, the doctor informed Henry.

She underwent the surgery two days later and fortunately, she and her baby survived. It’s now a family of five.

Deborah is currently recuperating from the bruises she sustained when she collapsed and from the surgery. She declined to talk to PREMIUM TIMES. Henry however is not fully sure she will agree to family planning after rehabilitation.

“They asked us to come for counselling when she’s fully healed. I have talked to her again and it seems she will do it this time but I’m not fully sure yet,” Henry said.

Like Deborah, many wives in Lagos, the most populated state in Nigeria, reject family planning for several reasons.

In Nigeria, like many parts of Africa, the habitual practice is such that husbands discourage their wives from adopting family planning. But in Lagos, arguably the most populous state in Nigeria, the reverse is becoming the case.

The National Population Commission of Nigeria puts the Lagos population at over 21 million in 2016 with analysts warning of the dangers of overpopulation which the state is currently facing.

To stem rapid increase in population, especially through procreation, family planning methods, through the use of contraceptives, have been proposed as potent means.

These contraception comes in three broad forms: the long-acting reversible contraception, the short-acting reversible contraception and permanent methods.

The long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs) and subdermal contraceptive implants. On the other hand, the short-acting contraceptives (SARC) have to be used in short time intervals such as in case of condoms, and daily intake of pills.

While the SARC are handy and ready to use, some Lagos wives detest the use of LARC methods for certain reasons. For some of wives, the fear of the unknown casts doubts on their disposition towards embracing family planning, especially the LARC methods.

This fear has been fending off Adeyemi Adebisi, a mother of two who ‘will never’ agree to any LARC family planning method.

Her husband, a trader, has been on her neck since the birth of their first child, Fola, in 2011; but she won’t yield even after the birth of her second, Bose, in 2015.

“I have never used it (implant) before. Even if it’s for one day, I don’t want,” the 33-year-old said pulling a face of disgust.

“Most of the people I see around me adopt the implants have defects. Some start with swelling of the belly. You will see that she is not fat but it’s just the belly that is coming out. For others, it will delay their menstruation from flowing well. For some other people, they may have three days flow normally but once they do family planning, it will increase to 10 days.

“The greatest fear is how to get pregnant again. I have a friend, she took an implant which was supposed to work for two months, and it took her up to two years before she got pregnant again.”

Her insistence has resulted in mild and sometimes fierce confrontations between her and her husband. but she is not willing to give up the fight anytime soon.

To partially accede to his wish, Mrs Adebisi uses post-pills, but in situations when it doesn’t work effectively, she has her own way of ‘washing’ (aborting) the pregnancy.

“There is this mixture I use whenever it (pregnancy) comes. There are some things we combine for slimming, we call it combo water. It contains ginger, garlic, turmeric and some other things like that. Once I drink it, it will wash whatever is there away. If I’ve missed my period for some days, it will surely come,” she said.

Like Mrs Adebisi, Precious Michael, 23, will not succumb to her husband’s pressure because of experiences some LARC family planning users have shared with her.

Beyond fertility complications, she is worried about physical deformation some of her friends told her about. The mother of two still wants to be in good shape, hence, her argument for rejection of LARC method.

“I don’t like it, at all. When I was pregnant for my first child, I heard several experiences. If you do it for two years and remove it thereafter, you will have to wait for four years before you will be able to conceive again.

“You will also see some people, they will be fat and their cheeks will become puffy. They will just be shapeless. I don’t want to be like that,” she said.

To avoid her husband’s wrath, which has started coming in form of threats, Precious in June told him she ”would be thinking about it”.

Precious was still thinking about it on the day this reporter interviewed her. Favour Adebayo, a student of Kwara State University will get married by December; but she already envisages her life with her partner. Even though, her partner wanted her to adopt an LARC method, Favour has been able to convince him to seek other methods of preventing pregnancy.

She says: “Though, people have been saying it. I and my spouse have been having several discussions on how to space our children but what have been hearing about it, I don’t like it.

“I just have to convince him. I don’t like a situation where I will be menstruating for a week, two weeks, one month and the ‘thing’ will be rushing or a situation where I will be adding weight.

“Some people will say they do it, they miss their periods for like six months. Some will menstruate for long, some will be like, they opened tap. Some people will do it and become big.

“Those things piss me off. I don’t like doing it. I don’t even have interest. I don’t think I can ever do it because of all this I’m hearing and seeing it.”

She will continue to use condom or find alternative means, she says with finality. Adekunle Sodiq, a welder, who resides in the Ketu axis of Lagos is one of those husbands that had challenges in talking their wives into adopting LARC method of family planning. He, however, got her into it in a most ridiculous manner.

After the birth of their second child in 2011, Mr Sodiq said he instructed his wife to visit a family planning provider to know which method would work best for her. She didn’t. Her disobedience resulted in a pregnancy which the two never prepared for in 2013.

“I was the one that introduced it to her. After our third child, I told her to go for family planning. She told me she doesn’t want it.

“Then I threatened her that I will continue to do it (have sex with her) and she’ll continue to bear children. And she will take responsibility for the children. That was how she embraced it. She took the one of five years.”

Mr Sodiq said he has quit childbearing and would make his wife continue to use the implant until she reaches menopause.

Family planning providers say the women’s negative mind-set could be attributed to poor access to information.

A retired nurse and family planning consultant, Adekoya Abiola. shared her experience on how she talks such wives into taking up family planning.

“It’s through counselling. I counsel them, I look for people who can share positive experiences with them so as to convince them. And from there, some of them will say ‘yes’ and take an implant.

“To prevent maternal mortality rate, FP (family planning) is the way. It has to be reduced. FP will prevent unwanted and unplanned pregnancy. By that, it won’t put the life of the mother in danger. So, I think that is the way.”

Data from the 2013 Nigeria Demographic and Health Survey (NDHS) puts maternal mortality rate in Lagos at 555 per 100,000 live births with a contraceptive prevalence rate of 48.3 per cent.

This is milder in contrast to a national figure of 576 per 100,000 live births and 15.1 per cent.

The Lagos State Team Lead of the Nigerian Urban Reproductive Health Initiative (NURHI) II, Edun Omasanjuwa, said the excuses given by the women are ”mere misconceptions borne out of misinformation or lack of information”.

He, however, noted that effects such as weight gain, delayed menstruation and delayed conceptions are all part of the undesirable effects of using family planning.

“For hormonal contraceptives, it’s part of the undesirable effects. The person’s water retention will be higher. Once your body retains water, chances are that you’ll begin to add weight. That’s why we usually ask women who are hypertensive not to use hormonal methods because it would further increase the blood pressure. We also advise women who are above 75kg not to use hormonal method because, chances are that first, you will add more weight and secondly, it will not last up to five years.

“For example, because of the undesirable effects, you see some women go from size eight to size 10. But by the time you see a size eight go to like 14 in space of two years, it is no longer the drug. It is as a result of other factors.”

Mr Edun added that delayed menstruation should not be seen as abnormal.

“Because the hormonal methods work on your hormones, some people, for the period they are on hormonal contraceptives, might not see their periods. If they are taking it for three months, six months or even a year, they may not see their periods. Absence of menstrual period is not a disease. The fear in some people is that when they don’t menstruate, the menstruation is accumulating in their body which is false. What they should understand is that menstruation is as a result of the body trying to prepare for pregnancy.

“When you are not on hormonal method, the body, every month prepares to carry a child. By the end of that month, if that child does not come, all the preparation the body has done is nothing. There is no ovulation, there is nothing to prepare, so at the end of the month, there is nothing to churn out. That’s why some people don’t see their menstruation.”

For delay in conception, the family planning expert said it is normal if it doesn’t go beyond six months.

“Depending on the method, your fertility can return almost immediately or in some cases up to three, six months. But if it goes beyond six months and gets to one year, the reason is beyond the method

“We have found out that most of the time, there is usually a secondary reason for which most of these women don’t pay attention to.”

For Babafunke Fagbemi, a family planning expert and Executive Director, Centre for Communication and Social Impact (CCSI), family planning should be listed as a basic and fundamental human right of Nigerians in the constitution.

This move, she opined, will bridge the gap of availability of the full range of safe and effective family planning methods that are fundamental to saving the lives of women and adolescents ”as well as a key factor in the realisation of the Sustainable Development Goals by 2030”.

“The theme of this year’s World Population Day is speaking to the many myths and misconceptions about modern family planning methods, it is a direct attack on norms and cultures that seek to criminalise or ridicule those who have chosen to plan their family. The government and our lawmakers must rise up and play a key role in ensuring the well-being of Nigerian women and ensuring their human right to family planning is one way to go,” Mrs Fagbemi said.

“We need to let people know that modern family planning method is safe and people can actually return to their fertility once they are ready.”

Perhaps, if this message is relayed to Lagos women, their conceptions about family planning will change.

Editor’s Note: Names of respondents except the experts changed (on request) to protect their identities.

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