Family planning in Kwara: Ministry of Health and its burden
His care to subdue his voice made it sound monotonous. An anxiety was all over his face and was non-pulsed about the mistake. An unwanted pregnancy and another one for that matter. His gray eyes briskly swept over his wife intently gazing at her with a sort of glum disapproval in a fixed stare. The wife stood dejectedly in one of the corners of the sitting room wringing her hands. The man readjusted his position facing this reporter.
He rested his left hand on the end of a long, comfortable, deep, velvet, upholstered seat with a back and arms to steady himself with. A Persian carpet spread out before his feet on a well tiled floor. A breathless stillness reigned in the entire sitting room, interrupted by short, light, regular, repeated sounds of the wall clock, ticking to mark time passing. An intense moment before the man in his ugly gruff tone started hollering endlessly again.
It was exactly two week and a few days after the wife expected her period which she did not see that she broached the topic to her husband. By last week Tuesday when this encounter ensued in their expansive sitting room at Oro Road, off stadium, Ilorin, the pregnancy was already three weeks and a few days ago. This sort of experience above is a recurring decimal among the supposedly middle class families in the urban centre of the Ilorin metropolis. The prevalent rate of unplanned pregnancy which speaks volume of the status of contraceptive uses and family planning in Kwara. This however was despite the heightened saturation of the air in Kwara with increase information about family planning. At least the Nigerian Demographic and Health Survey (2013) indicates high awareness and knowledge of family planning among men and women (100%) (94.7%) respectively in the state.
With this level of awareness, Kwara was able to achieve about 27.2% contraceptive prevalence in 2013 from 15.9% of 2008 through an increased access to family planning. This led to reduction in the percentage of unmet need from 30% to 12.2% while the attentions of politicians and policymakers at state and local government levels were successfully attracted to the family planning programme. Prior to 2010, the family planning programme in Kwara i.e the discussion about it was always in hushed whisper, shrouded in myth and superstition because of the cultural disposition of the state. The emergence of Nigerian Urban Reproductive Health Initiative (NURHI) in 2010 radically altered the entire landscape of family planning. For the stakeholders who were in the known of the scheme of thing, it was a whiff of fresh air.
Imagine this statistics before NURHI came to Kwara in 2010 which was the health indicator or status of the state. Kwara had a high maternal mortality ratio of 980 per 100, 000 live births, high infant mortality ratio of 103 per 1000 live births, and less than 5 mortality ratio of 185 per 1000 live births and neonatal mortality of 53 per 1000. Life expectancy i.e an average life span of an adult in the state was 52 years while the state’s total fertility rate was 5.1 though the wanted fertility rate among the residents of the state was 4.3. This was terribly bad for a state like Kwara with large Yoruba population of about 5.9 literacy rate. Kwara with a population figure of 2,365,353 with an annual growth rate of 3.4% according to 2006 census still underperforms considering other variables that are in its favour such as high literacy rate and access to family planning information on radio and television.
This could have been an impressive outing for the state if compared to other states in the Central North Zone and Northern Region generally under which it falls especially if its record were to compare with national average. This however wasn’t cheering for the state as stated above considering its advantages of high literacy rate and access to information on family planning than other states in the north. What could be responsible for this poor state of family planning in the state before 2010 when NURHI came to the state. First because of the predominance of Muslim population, the religion which favours large family, family planning could not have been favourably disposed to among this population. According to the Kwara State family planning blueprint: Scale up plan issued on March 2015, "most men (in Kwara) were of the strong belief that family planning causes infertility.
"It is anti-Islam and promotes promiscuity and unfaithfulness among women." Another reason for the poor performance of family planning in the state is poor funding by the state and local government. Though the state Ministry of Health has a unit for family planning but as far as those making policy for the health sector were concerned, other health issues often crowded out family planning. This is despite the fact that family planning is a larger developmental project with a multiplier effects on other health issues. For example, apart from the fact that family planning is capable of controlling population that is growing without corresponding economic opportunities, it is also a programme meant to liberate women from culturally imposed limitations in a typically male chauvinistic society. It will also empower women economically by making them available for labour activities after child spacing and birth control.
This is also apart from the fact that by rigorously pursuing family planning through funding, maternal mortality which was 980 per 100,000 live births will be reduced. Ditto for the infant mortality rate which was 103 per every 1000 live births while under 5 mortality i.e those child killer diseases that kill children before their 5years birthday will be reduced because health conditions of mother and child will improve through child spacing and birth control, while money will be available for adequate foods and other necessities for the family. It will also reduce poverty among women just as it will redeem environmental and ecological devastation caused by acute poverty. So family planning is connected to other developmental issues like population, health, environment, economic and good governance, literacy and high standard of living. But why policy makers could not see this bigger picture is difficult to fathom. It is like using a stone to kill two birds or even many birds in development.
The attitude of policy makers is always "after all family planning is a development partners’ project therefore they should finance it" But who are the beneficiaries? The Kwarans. And who will claim the glory if poverty is reduced, maternal and infant mortalities defeated. Of course, the government. The unstated fact more often than not about family planning is that it is capable of achieving virtually all the Millennium Development Goals, especially the MDG 4 and 5. But why government could not just see this bigger picture is difficult to understand. As far as the funding of family planning is concerned in Kwara, it appears it is not a priority health objective as it is often subsumed under other health projects. For example when NURHI successfully drew the government's attention to family planning after 2010, it elicited some commitment from both state and local government in budgetary allocation i.e money was allocated to it in the budget.
State government in 2014 budgeted N2milion for the entire reproductive health services including family planning while Ilorin East, Ilorin West, Ilorin South, Offa and Irepodun the five local governments in the state in which NURHI's family planning projects were to test-run as pilot project budgeted N1.5m, N2m, N500, 000, N1.5m and N500, 00 respectively. When it came to the release of the fund for implementation, while state government achieved 0%, the five local governments' release was between 10%-20%. This inadequate funding largely affected the programme. This was what made NURHI to close down the programme after 2015 therefore pushing it to the government, more or less saying "well they are your people and it is their welfares that are concerned, do as you like with them" while it jetted out of the state to Osun and other states in the South West.
It can be said without fear of contradiction that it was NURHI that has been driving family planning since 2010. And it threatened to withdraw its service if government's attitudes did not change after 2015, the threat it carried out. It even boasted in one of its publications that it was sure that the programme in Kwara will collapse after its exit. Is Kwara going to allow that, considering the importance of the programme as it affects health, economic, population, environment, literacy, good governance e.t.c?
It appears Kwara may not after all allow the programme to collapse as emerging indications show. The state may have turned a new leaf. This was crystal clear in the forward penned by the former Commissioner for Health, Alhaji Abdul Kayode Issa who struggled with pain his heart about the status of the project while penning these forward in the state’s blueprint for family planning. But the snag is commissioner still made it look like it was the Development Partners that should take the bigger role. The reverse should be the case Hon Commissioner. The ministry of Health should convince government to invest in family planning because of its likely impact on other sectors.
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