|Year : 2021 | Volume
| Issue : 2 | Page : 124-130
Regional variation of family planning services in Nigerian health facilities
Johnson A Onoja1, Olaniyi F Sanni2, Chris O Ogedengge3, Sheila I Onoja1, Paul O Abiodun4, Aisha Abubakar5
1 Research Department, African Health Project, Abuja, Nigeria
2 Public Health Department, Triune Biblical University Global Extension, Brooklyn, NY, USA
3 Alpha Research and Development Centre Limited, Abuja, Nigeria
4 Department of National Integrated Specimen Referral Network, AXIOS International, Abuja, Nigeria
5 Department of Microbiology, National Institute for Pharmaceutical Research and Development, Abuja, Nigeria
|Date of Submission||11-Apr-2021|
|Date of Acceptance||24-Apr-2021|
|Date of Web Publication||02-Jun-2021|
Dr. Johnson A Onoja
Chief Executive Officer, African Health Project, Plot 7, Ellicott Street, Kubwa Ext 3, Kubwa, Abuja FCT. Phone: 2348037879939 & 2348056793961.
Source of Support: None, Conflict of Interest: None
Background: Availability and accessibility of family planning (FP) services are the major factors affecting the fertility pattern and population growth rate in low-resource settings. This study aimed at assessing the availability of contraceptive methods in Nigeria health facilities offering FP services. Materials and Methods: This study compared survey data on FP services available from each of the six geopolitical zones in Nigeria. The study was a descriptive analysis of variations in the availability of FP services and contraceptive methods across the regions. Result: Out of the 767 facilities surveyed, 375 (48.9%) were located in rural areas and 392 (51.1%) in urban areas. The Northwest had the highest male condom availability of 96.2%. The emergency contraceptive method was being offered by 35.8% of the total 636 facilities reportedly offering the service. The proportion of the facilities offering the oral contraceptive method was higher in the Northeast (100.0%), Northwest (94.9%), and South-South (92.0%) than other regions (P = 0.002). While only 9.3% of facilities in the Northeast and 10.0% in the North-Central were offering sterilization for males, higher proportions, 17.7% of South-East and 32.7% of South-South facilities were offering it. The level of stockout of at least one FP method on the day of this survey was high across all regions, with the Northeast (60.8%) and North-Central (59.9%) having the highest proportion and the Northwest having the least stockouts (46.1%). Conclusion: This study found inconsistent FP services across all the six regions. Also, the proportion of facilities that had a stockout of at least one contraceptive method is unacceptably high and deserves improvement interventions.
Keywords: Child-spacing, contraception, family planning
|How to cite this article:|
Onoja JA, Sanni OF, Ogedengge CO, Onoja SI, Abiodun PO, Abubakar A. Regional variation of family planning services in Nigerian health facilities. MGM J Med Sci 2021;8:124-30
|How to cite this URL:|
Onoja JA, Sanni OF, Ogedengge CO, Onoja SI, Abiodun PO, Abubakar A. Regional variation of family planning services in Nigerian health facilities. MGM J Med Sci [serial online] 2021 [cited 2021 Sep 20];8:124-30. Available from: http://www.mgmjms.com/text.asp?2021/8/2/124/317446
| Introduction|| |
The availability and accessibility of FP services and the various contraceptive methods are important determinants of universal FP programs. FP could be described as a prepared measure by a couple to reduce or create a gap between the number of children they plan to have through the use of contraceptives. Nigeria’s population was about 150 million, with a yearly population growth rate of 3.2% in 2008. The population rose to about 205,990,223, with a total fertility rate of 5.4 live births per woman in 2020. This indicates a birth rate of six children for a Nigerian woman during her lifetime if she undergoes the current age-specific fertility rates during her reproductive age.
Poor uptake of FP has been recognized as an important factor affecting the fertility rate as well as the population size in Nigeria. A Nigerian demographic and health survey recorded poor uptake of modern contraceptives in the north of the country between 2008 and 2013 due to the fears of modern contraceptive methods and the desire to have large families. In addition to the reduced use of FP, other factors include poverty, wrong perception of FP methods, poor quality of services, nonavailability of essential FP commodities, health-care providers’ indifferent attitudes, high level of female illiteracy, inadequate demand for FP services, and a woman’s strong unmet need for contraceptives and her inability to obtain them.,
According to the United Nations reports, the demand for FP will increase by 40% in 2050 due to a high number of adolescents who will move into their full reproductive ages. It is, therefore, very important that FP is restructured to become a matter of choice and a health and growth need of Nigeria. Several studies have explored the prospect, the use, and the unmet need of FP in Nigeria[5-7], but it is very important to access the health facilities in readiness to actualize the sustainable development goal of universal health coverage. This study aimed at evaluating the regional variation of FP services in Nigerian health facilities.
| Materials and methods|| |
This cross-sectional study used structured questionnaire instruments, including physical inspection and interviews with health-care providers, at the surveyed sites. The study was conducted across all Nigerian states and the Federal Capital territory with the exception of three States (Borno, Adamawa, and Yobe) that were facing security threats. The facility assessment was conducted using a quantitative method. The methodology included visits to the health facilities offering FP services to carry out physical inventory of the modern contraceptive methods in stock.
Data sources, collection, and analysis
Data were collected from health facilities offering FP services across the country. Trained data collectors visited the health facilities to elicit information from the health professionals directly involved in FP services. Data related to the type of contraceptives offered and their availability were obtained. An examination of data from the facilities was carried out to arrive at conclusions. The data collected were screened for errors and inputted to SPSS version 25 for statistical analysis. The statistical analysis performed included descriptive statistics, and the results of the analysis are presented in tables and figures. The Chi-square statistics was conducted to establish the significant association between variables, setting the significance level as P < 0.05.
The study respondents were allowed to sign an informed consent form. They were fully provided with all relevant information about the survey and the expected use of the outcome of the interviews. They were also assured of the confidentiality of the information collected from them and were made to understand that they could decline from answering the questions if they were uncomfortable with them. Ethical approval letter with approval number NHREC/10/11/2018–30/12/2018 was obtained from the Health Research Ethical Committee (HREC) before the study was conducted.
| Results|| |
This study assessed 767 facilities offering FP services, comprising 375 (48.9%) and 392 (51.1%) facilities in both rural and urban areas, respectively.
[Figure 1] shows the availability of FP methods when inventories were taken, based on facility levels. Between 83% and 95% of all tertiary institutions surveyed condoms (male and female), injectables, IUDs, implants, and sterilization for females that were in stock at the time that the inventory was taken. Less than 70% of all primary health facilities had any of the FP methods in stock, except the injectables that were available in 83.8% of the primary facilities. Sterilization for males and emergency contraceptives were generally not in stock in most of the facilities surveyed.
[Table 1] shows the availability of male and female condoms as well as emergency contraceptives in facilities reportedly offering the services. All the facilities offering FP services were expected to offer both male and female condoms; however, 84.2% were actually offering male condoms, whereas 57.8% were offering female condoms. The Northeast had the highest proportion of facilities (97.5%) that offer male condoms, the Northwest recorded the highest male condom availability of 96.2%, and the North-Central had a minimum proportion in both (83.4% and 81.7%). Among the 767 facilities reportedly offering female condoms to FP clients across all the geopolitical regions, only 443 (57.8%) were actually offering the service, of which 85.6% had female condoms in stock when the inventories were taken. Higher proportions of health facilities in the south actually offered female condoms than the north (P < 001), but the availability of the contraceptive method was not statistically different across the zones (P = 0.111).
|Table 1: Availability of condoms and emergency contraceptives in facilities offering FP in each region|
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The emergency contraceptive method was actually being offered by 228 (35.8%) of the total 636 reportedly offering this method. This method was being offered by 60.3% from the Northeast, 55.3% from the Northwest and less than 30% of health facilities from other regions were actually offering the method (P < 0.001). Seventy-five percent of the facilities that offered emergency contraceptives had them in stock during this survey. This was highest in the Northwest (90.7%) and minimum in the Southeast (63/.4%) (P < 0.001).
As shown in [Table 2], 90.7% of all the facilities reportedly offering oral contraceptives were actually offering the method, of which 89.5% had the contraceptive in stock when the inventory was taken. The proportion of the facilities that actually offered the oral contraceptive method was higher in the Northeast (100.0%), Northwest (94.9%), and South-South (92.0%) than other regions (P = 0.002); however, no significant difference was observed in the availability of oral contraceptives across the six regions (P = 0.055).
|Table 2: Availability of oral contraceptives, injectables, and IUDs in facilities offering FP in each region|
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Of the 767 facilities reportedly offering injectables for FP clients, 714 (90.1%) were actually offering this method and 87.4% of them had it in stock at the time of this survey. The least (87.9%%) proportion of the facilities that actually offered injectables was found in the North-Central whereas others were higher than 90%. Also, North-Central had the least availability (89.9%) of injectables in stock as compared with other regions.
Of the 568 facilities reportedly offering IUDs, 449 (79.0%) were actually offering this method, of which 418 (93.1%) had it in stock. The proportion of the facilities that actually offered IUDs was 89.9% in the Southwest, 70.3% in North-Central, and 69.1% in Northwest; however, other regions had less than 60% that was actually offering the method. There was a high availability of IUDs across all facilities that offered the method.
Only 54.2% of the 415 facilities reportedly offering sterilization for females were actually offering it, with the least in the Northeast (39.5%) and the highest in the Northwest (67.6%). The majority of these facilities had the method in stock at the time of the survey. For male sterilization, only 16.4% of all the 415 facilities reportedly offering the service were actually offering it, with 94.1% availability. While only 9.3% of facilities in the Northeast and 10.0% in the North-Central were offering sterilization for males, higher proportions, 17.7% of South-East and 32.7% of South-South facilities were offering it. However, more than 70% of the facilities across all regions offering the method had it in stock during this survey.
Less than 50% (44.1%) of South-South health facilities reportedly offering implants were actually offering the services, whereas 87 (71.7%) of Northwest health facilities were offering the FP method [Table 3].
|Table 3: Availability of male and female sterilization and implants in facilities offering FP in each region|
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The level of stockout of at least one FP method within three months and the day of this survey was high across all regions, with Northeast and North-Central having the highest proportion and Northwest having the least [Figure 2].
|Figure 2: Level of stockout of one or more FP methods in three months and during the survey|
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| Discussion|| |
This survey gives insight into the availability of FP services in the six geopolitical zones of Nigeria. Although the results showed overall high levels of FP methods available on the day of the survey, it was discovered that some FP methods were not available in the facilities reportedly offering them. The findings of this survey are similar to the findings of a study of 10 African countries that found high availability of at least one FP method and that also reported disparity between the reported and actual FP methods. The findings of this study also agree with the high availability of FP services reported for both public and private health facilities in Malawi, but they are in contrast to the low availability reported in Haiti and the Demographic Republic of the Congo. Most facilities in this study provide male condoms (84.2%), oral contraceptives (90.7%), injectables (90.1%), and IUDs (79.0%) to FP clients.
The study revealed that the overall proportions of facilities actually providing female condoms, emergency contraceptives, sterilization for males and females, and implants were less than 60%, with emergency contraceptives (35.8%) and sterilization for males (16.4%) being the least offered FP methods. The differences between the reported and actual proportion of health facilities offering various FP methods showed that each region had a disparity in their FP method supplies. A similar disparity has been documented in some other parts of Africa., This may be as a result of lack of trained FP personnel, weak logistics management systems, and lack of proper training of staff on inventory procurement and documentation. Previous studies have proven that availability of skilled personnel affects the process of FP service delivery and the service quality.,[13-16] Also, the gap between demand availability of the FP methods might be responsible for many health facilities not offering them, as reported in some previous studies., The limited contraceptive options in these regions could limit the usage of FP if appropriate methods are not being offered by facilities close to the people in these regions.
The levels of availability of FP methods, especially sterilizations, implants, and emergency contraceptives, were very low in primary health facilities as compared with secondary and tertiary health facilities. A similar finding has been reported in rural India. The fact that most methods are being offered by tertiary and secondary health institutions as compared with primary institution reveals the potential gaps where tertiary and secondary facilities do not exist. To improve FP uptake in rural communities, it is necessary to equip and empower the primary health facilities since they are closest to the people at the grassroots level. This will also contribute to the reduction of maternal and child mortality rates at the grassroots level.
Though this study discovered the high availability of FP methods across all the regions, yet stockouts was a common problem. The level of stockout of at least one FP method is generally unacceptable, as this could limit the level of FP uptake in Nigeria. The high stockout levels in the Northeast and North-Central may be due to poor logistics management and the supply chain system because of the high level of insurgency in these regions. It may as well be a result of poor budget allocation or transport-related challenges, as previously identified. This kind of challenges has been documented in many countries in Africa., Other factors that might have influenced the stock levels of these FP methods include demand and intention for stocking the FP. For example, some facilities only store condoms or clients only demand them for the prevention of sexually transmitted diseases rather than for FP purposes. Besides, the low demand for condoms, due to the belief of some people that women have less control or the efficacy of them as compared with other FP methods, may be the reason for their low stock level.
| Conclusion|| |
This study found inconsistent FP services across all the six regions, as FP methods were not available in some facilities reportedly offering them. Also, the proportion of facilities that had a stockout of at least one contraceptive method was unacceptably high. The availability of most contraceptive methods was generally low in primary health facilities but high in secondary and tertiary health facilities. There is a need to upgrade primary facilities to enable them to provide services to the people at the grassroots level rather than focusing on secondary and tertiary institutions alone. Also, there is a need for further studies to identify the factors responsible for the unavailability of both the FP methods in many health institutions.
The security situation in the Northeast geopolitical region of the country made it difficult for the researchers to visit Adamawa and Borno states, thus data at the state level could not be collected in the states.
Financial support and sponsorship
Conflict of interest
None to declare.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]