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MDGs: Hurdles On The Path Of Reproductive Health

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JUST when other countries are counting their gains of Millennium Development Goals (MDGs) in maternal and child-health, that of Nigeria is getting even worse due to Federal Government’s indifference to the programme.

Barely 400 days to the end of the MDGs’ 15-year action plan, serious threats lie in the way of the little gains nation recorded in reducing maternal and child deaths.

Indeed, practitioners in the field are already having sleepless nights, meeting behind the scene, talking in hush tones, quivering at possibilities, shaking in disbelief and resigning to silent prayers for divine intervention. And unless it happens, the entire country will be in dire straits.

Fillers show that major international donor agencies are threatening to scale down support for reproductive health in 2015. The agencies have in the last 14 years, not only driven the maternal and reproductive health intervention in the country, they have more or less funded it as foreign aid to a poor nation.

The beneficiary of foreign generosity, the Federal Government, has had difficulties accepting responsibility for reproductive health or contributing counterpart funds into the intervention. When FG was convinced in 2011, it pledged the sum of $3 million into the programme. Two years after, the sum was jacked up to $11million, but the FG has not kept any of the promises till date.

Apparently tired of running a reproductive health initiative on credit, amidst deep-seated rumblings from tax-payers at home, international donor agencies are planning to unbind in 2015.

It would be recalled that the United Nations in 2000 inaugurated the MDGs to reduce poverty, diseases and deaths in member countries. Nigeria, a UN member country, has one of the worst maternal and child mortality rates in the world, therefore, the MDGs 4, 5 and 6 apply.

A 10-year evidence-based study around the world shows that to attain MDGs 4-6, that is, reduce maternal-related deaths and promote family health, family planning/child spacing avails the single most cost effective and high-impact strategy to adopt.

Besides the mothers living in good health, families can also have the number of children they want and can cater for, through adequate spacing in between a delivery and the next pregnancy (especially among the adolescents that are responsible for 42 per cent of all pregnancies in the country), using long lasting reversible contraceptives.

International partners like the United States Agency for International Development (USAID), United Nations Population Fund (UNFPA), Bill and Melinda Gates, and so on, are committed heavily to providing contraceptives and create demands by addressing socio-cultural barriers especially in the north. In the last five years, Contraceptive Prevalence Rate (CPR) has only increased to 15.1 per cent. Countries like Ghana, Brazil and Iran have 19, 70 and 77 per cent CPR. Current use of modern contraceptives ranges between 0.5 per cent in Kano, 0.7 in Sokoto to 26 in Lagos and 32 per cent in Osun State.

Contributions by the donor agencies have seen improvements. In the National Demographic Health Survey 2013, unmet needs for family planning commodities have dropped from 22 per cent in 1990 to 16 per cent. Maternal mortality rate has on the average gone down from 585/100,000 to 576/100, 000. Very minute drop, stakeholders said, though could be significantly improved if Nigeria increases CPR to 36 per cent by 2018 (that is, 4.2 per cent increase yearly).

Federal Government’s unkept promises

The immediate and long run demographic dividends were too huge for any government to ignore. The Federal Government, in 2011, pledged a budget line of $3m (N480m) to the course every year.

Two years later, the FG took a bold step to declare free contraceptive commodity policy, with improved funding worth $11m (N1.8b) yearly. The Guardian gathered that less than one-third of the $3m had been released for 2013. No dime has been released for 2014.

The Federal Government’s apparent indifference for women’s health was evident at the three-day Nigeria Family Planning Conference, concluded at the weekend in Abuja. According to the organizers, the government dropped no penny in support of the strategic biennial meeting. After much wait in vain for the supervising minister for health, Dr. Khaliru Alhassan, billed to declare the conference open, the conference went on to launch three documents on family planning action plans: Nigerian Family Planning Blueprint (Scale-up Plan); National Long Acting Reversible Contraceptives (LARC) strategy and Global Programme to enhance Reproductive Health Commodity Security (GPRHCS) Survey Report 2013. The minister never showed up while the conference lasted.

In like manner, Minister of Finance and Coordinating Minister of the Economy, Dr. Ngozi Okonjo-Iweala was to give the keynote address. She did not show up too, neither did she convey any message to that effect.

e “The key question we keep asking her is why is it difficult for her to release this money? The whole fund is with her and we know the blame game between the ministries of health and that of finance on this matter. Yet, it was the president of Nigeria who signed to giving this $11m to reproductive health every year. So, why is it so difficult to release? As we are getting money to do our 100th year centenary among others, are we saying an effort to reduce maternal deaths by 30 per cent and child deaths by 25 per cent is a big problem for us in Nigeria?” a participant at the conference asked in frustration.

While the government stayed aloof, Nigeria’s international donor partners warned that the beggarly approach to reproductive health intervention is not sustainable. Mission Director USAID Nigeria, Mr. Michael Harvey, in his goodwill message at the conference, pledged to abide with Nigeria, but stressed that mere verbal commitment by the Federal and State governments are no longer sufficient.

He said Nigeria, being the largest USAID donor country, must go beyond mere budgeting to “having it actually appropriated to better the lives of women and children.”

The consequences are already here

UNFPA, which procures drugs and family planning commodities, has been supplying commodities from the pool of contributions from other countries. Their supply chain to Nigeria is already at risk under the current donor fatigue.

Stakeholders attested that one of the issues that accounted for the current 16 per cent unmet contraceptive needs and continuous reliance on ineffective traditional methods of contraceptives is under-the-table charges for family planning commodities at health facilities, despite FG’s policy on free contraceptives.

Caregivers revealed that though the commodities were supplied freely, but they didn’t come with consumables (which the FG’s unreleased funds ought to have procured) and have to be bought before contraceptives were administered. Several women have turned back because they have no fees to pay.

Fillers are that, while some of the stored commodities are already nearing expiration date, the current stock is less than 50 per cent of the demands that are still being created nationwide.

Project Director of Nigerian Urban Reproductive Health Initiative (NURHI), a project sponsored by Bill and Melinda Gates, Dr. Mojisola Odeku said: “The commodities we have are less than 50 per cent, yet Nigerians are demanding for more. So, 2015 will be a tight year. You know it is an election year for us, so you can imagine what is going to happen.

“You can imagine what will happen; crises upon crises. More women will be dying giving birth, survival of the child will minimize. I really don’t want to think about it. These are Nigerians we are calling on next year to come and vote, yet we are not investing in their health, especially women that will be mobilising for political parties.

The action right now is to get government to release the money,” Odeku said.

The implication of unreleased funds, NURHI State Team Leader in Ibadan, Stella Akinsan added, is the urge to demand fee for service, and where poverty is endemic, there would be increase in the level of unplanned pregnancies.

She said: “Let’s face it; poverty is still endemic in this country. I have seen a woman make a pot of stew with N200. Is it that kind of women you will ask to pay N2000 to access Intrauterine Device (IUD)? Even if she has, she will not use it on birth control commodity; telling you to go to hell. She will go and have an unwanted pregnancy, adding to the population that is already over-bloated,” she said.

Demographic implications

Demographers are unanimous that a nation in crises only needs three signs: an army of unemployed youths, skilled labour that are migrating and prevalent national strive. Citing these challenges are already with us, the Country Director of Jhpiego Nigeria, Prof. Emmanuel Otolorin said an increase in unwanted pregnancies and attendant swell in national population is one luxury Nigeria cannot afford right now.

Otolorin noted that the under-development of today should be blamed on failure to keep a moderate population size since independence. Indeed, Nigeria shares the same population size of 60m with Britain at independence. While Britain has increased by 25 million, Nigeria has grown by 114 million. The burden is already obvious in N1trillion spent on food import yearly; N356 billion on rice; N217 billion on sugar: N97 billion on imported fish yearly, 50 per cent of women is unemployed and the recent unpleasant case where one million youths were chasing 5000 Nigerian Immigration Service job. At the current high fertility rate of over six per cent, Nigeria population will be 441million by 2060.

“We are already producing more than we can employ and uncontrolled population is worsening poverty. While we will continue to advocate that Nigerians voluntarily embrace family planning to save lives, leaders and policy leaders, at all level, must show support and really invest in family planning.

“The implications of doing nothing are already with us: ritualism, kidnapping, armed robbery, quackery, insurgency, political thuggery, Internet fraud, miracle centres, incessant strikes and lately, stomach infrastructure,” Otolorin said. He had barely finished his talk when three deadly explosions went off in a mosque in Kano, killing over 150 people last Friday.

Dr. Akanni Akinyemi, in his lecture titled: “Opportunities and challenges for demographic dividends in Nigeria” at the conference noted that population is a tool for national development, if it can be enhanced to productive. But because Nigeria is currently not doing this, that is why she needs to up the ante on the unmet needs.

“If they are, four million unwanted pregnancies, one million abortions and 4.5m population increase would have been averted in 10 years. It is not entirely gloomy but we need to take a stand and do not drop the ball,” he said.

Source: The Guardian

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One comment

  1. Reblogged this on djenyva and commented:
    This is so important and can’t be overemphasized. We need to provide enough for the future. How do we do that when there are so many unwanted kids and when young people keep migrating to urban areas and leave farming. Who’s going to provide the food for this growth in population. Which is why so many futuristic movies show us lacking food. I believe its going to be a major problem if steps aren’t taken.