Country Profile: Nigeria

Newborn and maternal health in Nigeria. Photo: Gates FoundatPopulation and Family Planning in Nigeria

Nigeria’s population—at over 170 million—is the largest in Africa, and the sixth largest in the world. It has increased by about 275% from an estimated 45 million in 1960 when the country gained independence from the United Kingdom. This staggering rate of growth has had hugely detrimental effects on overall living standards and economic development efforts in the country, where 70% of people live below the poverty line. And this trend is not expected to end any time soon; the national fertility rate is estimated at 5.5 children per woman, and experts project that the Nigerian population will be 440 million by the year 2050, even if the fertility rate starts declining now and reaches 3.5 by then. This massive growth is happening in a country whose landmass is only one-tenth the size of the United States.

The single largest contributor to the rate of growth in Nigeria is the very high birth rate—three times higher than the birth rate in the U.S. Despite decades of family planning programming by both the government and non-governmental organizations, the prevalence of modern contraceptive use is only 9%. As a result, the rates of unintended pregnancy and maternal mortality remain high; a woman in Nigeria has a 1-in-29 lifetime risk of maternal death. Up to 40% of these deaths are the direct outcome of attempted abortions, which are illegal in Nigeria except to save a woman’s life, leading many women to seek unsafe abortions from unqualified practitioners. Survey data indicate that 1 in 7 women of reproductive age have attempted an abortion, suggesting that 760,000 induced abortions occur every year (the latest data on this is from 1998, so this figure is likely quite conservative because of the population growth that has occurred since then). The danger to mothers in these circumstances is exacerbated by the low average age at which women begin bearing children—29% of girls in Nigeria have already had at least one child by the time they are 18 years old.

Obstacles and Misconceptions

While women appear to be well informed about the existence of family planning—the majority of female students aged 15-24 are able to name at least one method—the primary source of information on family planning is friends and siblings, with very few respondents obtaining information from health workers. And although the Nigerian government has sponsored a national program providing free contraception for the past 10 years, most users continue to purchase contraceptives from private vendors. This means that cost may quickly become an obstacle, and that women may not be getting complete information about proper usage and avoidance of side effects.

In addition to practical obstacles, there are also strong social and cultural forces discouraging the use of contraception. An affinity for large family size (average ideal family size is 6.7 children, and 18% of women with six or more children would like to have another), a preference for male children, and the relative powerlessness of women in Nigerian culture have all been identified as factors that impede family planning programs. For adolescents, who make up a huge proportion of the Nigerian population (43% of Nigerians are under 15 years of age), these cultural factors are an even greater barrier.

Nigerian tradition strongly discourages the discussion of sex and sexuality with unmarried youth, despite the fact that a large percentage of this group is sexually active—with studies indicating that the average Nigerian begins having sex between 12 and 16. The taboo makes it very difficult for community health workers to effectively engage with adolescents. As a result, misinformation and myths about contraception are amplified, and few teenagers risk purchasing contraception or visiting free clinics in case they are seen by an older family member or neighbor.

Recent events have further exacerbated obstacles to contraceptive use. Violence carried out in the north of the country by the Islamic insurgency group Boko Haram has forced hundreds of thousands of people to flee their homes, and a new report indicates that Nigeria now has the largest internally displaced population in Africa, and the third largest in the world. This mass migration has led to widespread instability and there is evidence of large-scale human rights abuse, particularly towards women in the form of rape, sexual violence, and forced marriage, placing them at even greater risk of unintended pregnancy.

Conclusion

Experts project that an increase in contraceptive prevalence by as little as 2% per year would dramatically reduce maternal and child mortality, while improving educational attainment and standards of living for millions of Nigerians. Education is correlated in both directions when it comes to contraceptive use: Only 1.7% of women with no education use modern contraception, whereas 22.4% with more than secondary education do. And with so many girls giving birth in their teen years, it’s no wonder that only half of women and girls over age 15 can read and write.

Donor agencies have begun making strides in changing cultural attitudes and misconceptions regarding family planning, and slowly increasing the prevalence of contraceptive use in the country. Projects that have seen the most success are those that include a high degree of community involvement; providing local leaders, particularly religious leaders, with training ensures project sustainability. In addition, projects that seek to address other health concerns, besides reproductive health, gain a greater level of community trust. Furthermore, use of mass-media such as radio and television programming to spread awareness has been shown to be highly effective in changing perceptions of contraception, particularly among men.

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