By Chioma Obinna
One major aim of Family Planning 2020 partners is to end the unmet needs for family planning, by 2030, however, the COVID-19 pandemic has stalled progress towards the achievement of the global goal.
The reasons may not be unconnected with gaps in the country’s health system including the fact that family planning is not considered an essential health service. In Nigeria, the gaps worsened with the COVID pandemic. Women seeking family planning services faced obstacles.
Findings show that the lockdown occasioned by the COVID-19 pandemic reduced access to contraceptives and a significant proportion of women experienced an unmet need for family planning during the period. Experts say these women would have had smooth access if governments had strategised by prioritising family planning as an essential health service.
The experiences of Mrs Bunmi Adeleke, Afisat Usman, and Josephine Effiong confirm are just examples. For the trio, access to family planning services during the lockdown and in the heat of the 2nd and 3rd waves will not be forgotten in a hurry.
Bunmi, a stylist, who accesses the family planning services at the Mascara Primary Health Centre, PHC, Agboyi-Ketu, Lagos, defaulted because the centre was shut down due to a case of COVID infection.
“I tried accessing services at a nearby hospital but the charges were above my earnings. I could not afford it,” Bunmi, a mother of four, said with regret.
Ordinarily, contraceptives are given free of charge at the PHCs. Sometimes we part with N200 although not by compulsion. I have been on contraceptive pills in the last three years but the COVID-19 restrictions caused me an unplanned abortion. Although we agreed not to have more children I could not refuse my husband sex.”
According to Bunmi, she managed to get to the PHC in the morning when she was told to go back home as the PHC was shut due to a case of COVID.
“This gap eventually led to an unplanned pregnancy. I wept, but I decided to do something about it,” Bunmi said.Like Bunmi, 43 years old Afisat, is also on contraceptive pills. According to her, going to Apena PHC became a problem during the lockdown. Even when the restriction was removed, the fear of COVID-19 scared her away from the centre.”I was enjoying sex under the guise that we were using the natural method – withdrawal method,” she explained.
Little did she know the method was not 100 per cent safe. “My husband tried but we never know that there could be errors. I am at the PHC today to immunise the baby, which is the result of not having access to contraceptives.
“I did not have complications but it is seriously affecting our income. I have four children already that are in school. I am bound to bring another housemaid to take care of her because of my job. It has not been easy.”
On her part, Mrs Josephine Effiong said her challenge was not financing, distance or the availability of providers, rather the method she was using was not available at the Apapa PHC. She was on three months injectables.
“If it is not a case of consumables, it will be a case of no contraceptives or the person that should attend to us was not available. One particular day, we were told that the provider was drafted to the COVID-19 response team.”After visiting the PHC three consecutive times without success, Josephine was discouraged and decided to seek help elsewhere. A journalist, Josephine, was able to access and pay for the family planning services in a pharmacy, but millions of other Nigerian women are unable to, and this means a lot to the country’s target of increasing the contraceptive prevalence rate, CPR by 203
Impact of COVID-19
Apart from the challenges faced by some women determined to access family planning services, many centres after the lockdown suffered loss of clients. Those on pills were unable to go for renewal because of fear of infection.
Like Bunmi, Afisat and Josephine, 12 million women may have been unable to access family planning services as a result of the COVID-19 pandemic, with disruption of supplies and services lasting an average of 3.6 months, according to the analysis conducted for 115 low-and middle-income countries in January 2021 by UNFPA and Avenir Health. The report claimed that the number could be as high as 23 million or as low as 4 million at the lower end of projections.
As a result of these disruptions, as many as 1.4 million unintended pregnancies may have occurred before women were able to resume the use of family planning services.Also, data from the National Family Planning Dashboard as of June 2020, between January and April 2020, the proportion of facilities providing family planning in Nigeria dropped by 7 per cent.
The report showed that the decrease in the numbers was partially due to factors such as patients’ reluctance to visit health facilities during the COVID-19 pandemic, out of stock of some commodities and delay in commodity replenishment at the state stores.Bunmi, Afisat and Josephine believe that prioritising access to contraceptives during the pandemic would not only allow women and men to correctly plan childbirth, it will also reduce maternal risks, poverty and undesirable fertility rates.
In the views of a family planning expert, Mrs Abiola Adekoya the COVID-19 pandemic despite the Progress Nigeria has made in the curve of unmet needs, reduced the percentage of women voluntarily coming for family planning services.
Adekoya said one major factor during the heat of the pandemic and lockdown was the fact that some providers were affected by COVID which led to the shutting of some Primary Health Centres. “As a result access to family planning services became difficult for women and girls and this caused a lot of problems for poor women in our area who cannot afford to go to private hospitals or pharmacies. Many of the women taking pills could not continue while some resorted to patronising quacks. Some were even going to auxiliary nurses and community pharmacists. Some of the women who were not lucky came down with a lot of complications.
Adekoya also told Vanguard that the period also provided an opportunity for some sort of sharp practice. There was also the issue of stock-out of commodities in the PHCs because governments and officials were concentrating more on COVID. There was out of pocket payment for family planning.
“Some of the providers were collecting money because there was no monitoring at the different levels of services. So there was racketeering of commodities and a lot of things happened. She said the pandemic also brought about a drop-in client flow and a shortage of providers in the few centres operational then.Again, we found out that, there was no release of budget for family planning because the government concentrated on COVID.”
Adekoya said to overcome barriers to family planning access; governments need to strategise and prioritise family planning as an essential health service to reduce hardships women and girls face during this pandemic.
“Governments at all levels need to prepare for unforeseen circumstances as it happened during the heat of the pandemic. She maintained that government must see maternity and reproductive health as essential health services at all times. Adekoya further lamented the acute shortage of providers at family planning centres.
“Some of our nurses who are family planning providers are travelling abroad for greener pastures. The government needs to employ more nurses. Government should also ensure that all commodities and consumables are made available for easy access.”Another challenge that needs to be addressed is the issue of training. Many of the new providers have limited skills, unfortunately, the older nurses who are more knowledgeable are retiring without replacement,” she stated.
Continuing, the expert-recommended expansion of family planning access and availability through pharmacies due to their convenient locations and flexible working hours.
According to her family planning information, counselling and methods including oral contraceptives, condoms, and injectable contraceptives will be more accessible during the pandemic through the pharmacies. She said funding remain key to successful services as well as improving Family planning access and scaling up of existing health interventions among others. Findings have shown that like other countries, Nigeria diverted essential health services funds to the coronavirus response.
Recent data from the WHO revealed that 70 per cent of upper-middle- and high-income countries allocated additional funding towards the maintenance of essential health services during COVID-19, whereas only roughly 42 per cent of low- and lower-middle-income countries had done so.
Adekoya recommended that along with prioritising family planning as an essential health service, increasing the allocation and efficient use of Domestic Public Funding, DPF, for family planning at national and subnational levels would support the continued availability and accessibility of family planning services during the COVID-19 response.
Access to voluntary family planning information and the ability to choose from a wide range of contraceptive methods protects reproductive, maternal, and child health by promoting healthy timing and spacing of pregnancies, advances the ability of women, young people, and couples to achieve their fertility intentions, and promotes healthier families and communities through secondary economic, social, and environmental impacts.