Making children by choice, not by chance

Low use of family planning has long been a seemingly intractable problem. In this report by Sade Oguntola, experts say an integrated family planning programme that focuses on both supply and demand works is central to reversing this trend.

For Mrs Abidemi Adedigba, a mother of three, the decision to have her son immunised at Abidiodan Primary Health Care (PHC), Ayegoro, a nearby health facility, was not too difficult.

“Its environment looks presentable; it is more like a good hospital, for me to have my son complete his immunisation although he was delivered at the University College Hospital (UCH), Ibadan,” Mrs Adedigba, who lives in Zion Estate, Lagelu recounted.

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She was at the PHC’s immunisation clinic run every Thursday. The clinic had recently undergone a 72-hour clinic makeover by CCP’s Nigerian Urban Reproductive Health Initiative (NURHI).

Over the past two years, NURHI has conducted 140 of these clinic makeovers throughout Nigeria’s cities in facilities that offer antenatal and postpartum care and deliver babies.

In Oyo State, Abidiodan Primary Health Care (PHC) is one of the 56 health facilities that had enjoyed such makeover under the NURHI 2 project Oyo state.

“We came up with the 72-Hour Clinic Makeover in a facility to ensure that the status of health facility and utilisation in relation to Family Planning is improved in the 15 local government areas we had worked in as NURHI in Oyo State,” said Mrs Stella Akinso, State Team leader for NURHI in Oyo State.

The 72-Hour Clinic makeover supports the facility and community members to “make-over” the facility, ensuring that the healthcare centre can provide optimal family planning service in a beautiful environment.

It involves the government, service providers and the local communities with every step of the process. Together, they determine what a clinic needs and develop a plan to make the changes. The makeover itself begins on Friday afternoon and ends on Monday with the clinic wearing a whole new look and feel.

Services in each health facility are also linked to strong community-based social mobilisation and complemented by partnerships with religious and traditional leaders as well as teams of youth urban social mobilisers.

A survey carried out in Lagos in 2015 tagged PMA2014/Lagos, for instance, found that over 67 per cent of women in the state do not access family planning services in public and private health facilities due to health-related concerns, issues of acceptability, accessibility and affordability as well as the poor state of the health facility.

Basically, NURHI seeks to bridge the gap between demand and supply of contraceptives. It is to contribute to the reduction of maternal mortality and to make family planning a household affair or a social norm, both at the structural level, community and facility levels.

Amazingly, the turnaround is felt nearly immediately in every community where a makeover takes place.

Mrs Titilayo Wojuade, a senior Community health worker said there was low patronage at the Abidiodan Primary Health Care (PHC) before implementing the project.

“Since July 2017 that Abidiodan Primary Health Care (PHC) enjoyed the 72-hour makeover, on the average we see 20 old and new patients for family planning daily,” Mrs Wojuade declared.

At Lalupon Maternity Centre, Mrs Omotayo Oladimeji, a chief nursing officer, said patronage for family planning services jumped from an average of eight clients a day to 10 clients with a spate of two weeks it undergoes the NURHI’s 72-hour clinic makeover.

Mrs Oladimeji added that NURHI’s no tolerance to out of stock syndrome of contraceptives had also contributed to increasing numbers of clients the clinic now attend to daily.

A client at the Lalupon Maternity Centre, 39-year-old Mrs Adeniyi Taiwo, and a mother of four, who was brought in by her husband on his motorcycle to the health centre said “I am happy to be here. People told me that their reception is good as well as their environment.”

After seeing the results of the renovation to the clinic in his Lalupon community, government leader Onolakpo Olayiwola said he was inspired to take it a step further.

There wasn’t always room at the Lalupon clinic for women and children to wait inside when they arrived for services, something the community really needed.

“In order to appreciate the work done by NURHI, we also built-up a waiting area to accommodate our mothers and children when they come to the clinic,” he said.

Demand for family planning information and services has not always been widespread in Oyo State.  Oyo State has a modern Contraceptive Prevalence Rate (mCPR) of 24 per cent, according to the last NDHS conducted in 2013.

In the past few years, this has changed remarkably as people now talk about family planning, request for information and eventually take up a method.

The efforts put into raising awareness about family planning seems to be paying off, as the 2017 Multi-Indicator Cluster Survey (MICS) shows an increase in the state’s mCPR to 30 per cent.

Oyo State now has the highest modern contraceptive rate in the country, higher than the national average, which is 10.8 per cent, according to the same survey.

Mrs Akinso, however, linked this achievement to different interventions by the body such as its social mobilization which incorporates neighbourhood campaigns using a door-to-door approach had also reduced the myths and misconceptions on family planning.

According to her, the misconceptions that clients had against family planning providers had greatly reduced so people are more willing to refer friends to family planning service providers in their communities and health facilities.

Demand and advocacy are key components of three-prong strategies adopted by NURHI to increase family planning uptake.

“I come on immunisation days to mobilise in the community for family planning. It is important for women of childbearing age to do family planning rather than resort to abortion. Many myths and misconceptions on family planning still exist in the community,” said Mrs Elizabeth Adebayo, a community-based family planning mobilise.

Treasurer, Advocacy Network of Nigeria, Mr Abiodun Akande, linked the increased contraceptive use in the state to increased media involvement and funding for contraceptive consumables by at least 50 per cent by all LGAs in the state.

Advocacy Network of Nigeria is an offshoot of NURHI facilitated to advocate for increased funding and government support to ensure access to family planning supplies and services to the urban poor.

NURHI’s Project Director, Dr Mojisola Odeku, stated that the project had used the ideation theory to tackle the complexities in the Oyo Family Planning landscape to achieve this positive outcome and impart reflected in the 2017 Multi-Indicator Cluster Survey and previously the NDHS 2013.

The approaches, she said, included creating a coordinated campaign to create the demand for those services; targeting health providers as audiences in need of behaviour change; improving supply chain problems and training health providers with the most up-to-date evidence around the value of birth spacing and smaller families.

Executive Secretary of Oyo State Primary Health Care Board, Dr Waheed Abass, who noted that family planning as an intervention can reduce maternal mortality by 30 per cent, assuring that the government will be copying and scaling up the model to transform its other health facilities in the state.