Family Planning: Uganda’s success, lesson for Nigeria

Since the 2012 London Summit on Family Planning, the fortunes of family planning in Nigeria took a turn for the better. The country made a historic commitment at the Summit which galvanised the Federal Ministry of Health, FMOH, to initiate the Nigeria Family Planning Blueprint with the national objective of increasing uptake of Family Planning of a contraceptive prevalence rate, CPR, to 36 per cent by 2018.

Today, however, much is yet to be desired, as far as maternal health is concerned. The Maternal Mortality Ratio remains one of the highest in the world at 576 per 100,000 live births.  On the average, 116 women die every day in Nigeria from complications of pregnancy, labour or childbirth.

Only 15 percent of Nigerian women are utilising any form of family planning, at variance with the 2012 London Summit targets.

In the blueprint on FP, approximately US$600 million is needed to achieve Nigeria’s FP goals.  But the 2016 Family Planning 2020, FP2020, report attributed Nigeria’s poor records to failure of the government to fulfil the pledge it made at the London Summit in 2012.

In sharp contrast, Uganda has adopted a deliberate attempt to introduce innovative programmes to accelerate rate of modern Contraceptive Prevalence Rate, mCPR, and this has not only pushed it up the curve but made it one of the places where most rapid growth occurs.

Uganda has sharpened its reproductive Maternal and Child Health plan that emphasises strengthening district health management and scaling -up community -based health service delivery while building capacity through health skills hubs.  The plan addresses both supply -side constraints and demand side challenges.  Uganda, as a member of the FP2020 Reference Group, recently launched its National Adolescent Health Roadmap.

But one of the innovations currently driving accesses to FP in the rural areas in Uganda is the Sayana Press project.  The initiative, a self injectable FP method, is currently improving access to a safe and effective contraceptive option for women as well as increasing women’s autonomy.

Currently, PATH is conducting research on self-injection of Sayana Press in collaboration with ministries of health in Uganda.  Today, the innovation is being used by many rural Uganda women who had in the past rejected FP due to unconfirmed myths.

Nigeria may take a cue from Uganda, as the method has been adjudged one of the best to tackle misconceptions and myths about FP.  It has restored confidence in FP among women and increased uptake of services. A visit to one of the pilot centres, Kanseera Health Centre 11, in Mubende District, Uganda was an eye opener.  Many of the beneficiaries attested to its effectiveness.

“Sayana Press keeps your secrets because I don’t want to be seen around the hospital”, a woman with Study Number 412 told Good Health Weekly.

According to the mother of two, she has not had any challenge using Sayana press as it does not only save her cost of transportation, keep preying eyes away but saves time.

For another user with six children, it has provided her opportunity to work again.  “I have not been able to use any form of FP because of the distance between my house and the health centre.

“I used to walk not less than 5 miles before getting to the health centre. I had most of my children within a space of less than a year.  At a point it became a challenge.  When I heard about Sayana press I decided to join in the study to save my life and that of my family. Life is better now. With Sayana Press I don’t need to leave my house to take it.  I inject myself at my own convenient.”

Saraha Coutinho, the Sayana Press Continuation Study’s Nurse at the Centre said the Centre has recorded tremendous success as many of the women who come for family planning now prefer Sayana Press injectable for convenience.

Sayana Press is a three-month, progestin-only, all-in-one injectable contraceptive that combines the drug and needle in the Uniject injection system.

Sayana Press is small, light, easy to use, and requires minimal training, making it suitable for community-based distribution and for women to administer themselves through self-injection.

She said the contraceptive has eliminated the challenge of distance in accessing FP in the community.  This is because the women are given the correct dosage to take to their homes and inject themselves at their convinencies.

“When we started there were so many misconceptions ranging from alleged secondary infertility which earlier affected the study. With Sayana press, you teach them how to inject themselves at home.  We have a hand book that is self explanatory.

“All you do is to give them required doses.  It has to some extent boosted family planning access. At least every month about 35 women show up at the clinic. Although, we are still having challenges from their spouses, traditional beliefs and domestic violence amongst other but it has been a success. ”

On her part, the Nurse In-charge of the Centre, Kauma Amina confirmed that the uptake of family planning has increased.

“To motivate more men into allowing their wives to come to the centre, she said they have a policy of attending to women who come with their husbands first before others.”

The Coordinator, Sayana Project in Uganda for PATH, Mrs. Fiona Walugembe said that Uganda under its action plan priorities is committed in innovative financing solutions for commodities.  Walugembe said Uganda is committed under the FP2020 to reduce unmet needs to 10 per cent in 2022 from its current rate of 34.8 percent.

“Uganda is already rolling out youth friendly services in all government health centre and District Hospital. There are plans to increase annual budget allocation for family planning campaign.”

On specifics, Uganda is committed to creating an enabling policy environment for family planning, increasing financial investment into health human resources development and strengthening the delivery of health services.

However, information showed that despite significant global progress which has given more than 30 million additional women and girls access to modern contraction across the 69 FP2020 focus countries, Nigeria is still among the poor performing countries.

Reports have shown that there are more than 300 million women and girls using modern methods of contraceptives, a development that has averted 82 million unintended pregnancies, 25 million unsafe abortions and 124,000 maternal deaths, but better progress could come from Nigeria.

In Africa, according to the FP2020 Report, Eastern and Southern African countries have experienced the fastest growth in the use of modern methods and the steepest decline in unmet need, and for the first time, more than 30 percent of women are using a modern method of contraceptives in the regions.

This progress is in sharp contrast with Nigeria where only 2.7 percent of women of reproductive age are using a modern method of contraceptives whereas Nigeria committed at the London Summit to increase the percentage of women and couples using contraceptives by 2 percent each year to reach 36 percent by 2018.

For failing to meet up with its commitment to FP2020, and in its allocation to healthcare, health watchers are worried that Nigerian women will continue to die from unwanted and complications of pregnancies.

It is also evident that the country will also continue to witness population explosion and this will also impact negatively on its economic development.  Also, poor investment in family planning has made it impossible for Nigeria to be at par with countries like Malawi, Kenya and Zimbabwe who are on the level off of the FP2020 contraceptive acceleration curve.