Goodness** (name changed to maintain anonymity) is a young woman in south-eastern Nigeria living with a hearing disability. Unlike most of her friends who also live with impaired hearing, her family supported her education. While waiting to gain admission into the university, Goodness got pregnant. For her and other young Nigerian women in similar situations, the chances of getting support to finish school are limited. Most will probably have to leave school to marry and start a family earlier than anticipated, or to live as a single mother with the associated stigma. If she had access to contraception and accurate information about her sexual and reproductive health, her story may have turned out differently.
Contraceptive use by young people flies against the generally held belief Nigerians hold that boys and girls between the ages of 15-19 are not having sex. The traditional Nigerian parent cringes at the mention of sexual and reproductive health when it comes to their children, and the educational system struggles to properly teach adolescents about sexual health, especially with regards to the use of contraception.
The reality is that many young people in Nigeria are confronted with situations where they are put under pressure to engage in sexual activity. According to the United Nations Population Fund's (UNFPA) Adolescents and Youth Dashboard for Nigeria, data culled from the 2013 National Demographic Health Survey (NDHS) shows that nationally, 43.5% of girls between the ages of 15-19 have ever had sex, and 29% of them are sexually active. This number is higher for girls living in rural areas, where 55% have ever had sex and 39.9% are sexually active. Jigawa State had the highest percentage of girls between ages 15-19 who had ever had sex, at 78.4%. Osun State had the lowest at 14.9%. The data is overwhelming that young people are engaging in sex. Yet, according to the recently launched Nigeria Nutrition and Health Survey 2018, only 4.8% of adolescents aged 15-19 are using modern contraceptives. These statistics belie the critical need for young people to be accurately taught about sexual and reproductive health and given access to contraception.
New data released by the Guttmacher Institute shows that 36 million young women aged 15-19 in developing countries are sexually active, and that they desire to avoid pregnancy, but a majority of them do not use modern contraceptives. From the report, approximately half of the 9.6 million pregnancies among this group each year are unintended, and about half of these unintended pregnancies result in abortion - most of which are unsafe.
Beyond investments in quality education which improves young people's capacity and chances of gainful employment, Nigeria must make significant investments in young people's health, especially sexual and reproductive health (SRH). A lack of investment in effective SRH means that young people are denied accurate information and are disempowered, leaving them vulnerable to exploitation, an inability to complete their education as a result of unwanted pregnancies, and a consequent limitation in their future.
SRH Tech solutions: A game-changer for Nigerian boys & girls?
Access to accurate information is a prerequisite for access to quality services, especially in SRH. Organizations that understand challenges that young people face when accessing SRH services are creating tech solutions, adapted to an increasingly digital world where we use mobile phones to connect, communicate and share information every day.
Mobile Medics and Wellvis make use of web-based platforms to anonymously provide a wide range of health information including sexual and reproductive health information. DKT International makes use of a helpline and a web platform called Honey and Banana to provide informational services on reproductive health. Marie Stopes International Nigeria provides counselling and support services on various sexual health issues through a contact centre.
Education as a Vaccine (EVA), a non-governmental organisation, uses multiple channels to reach young people with SRH information. Three mobile applications called LinkUp, Frisky and DIVA help connect users to youth-friendly health centres using their location. Another service called My Question Service enables young people in urban and rural areas without access to the internet or smartphones to send questions about SRH to a short code (38120). The messages are free for users of MTN, GLO and Airtel networks in Nigeria.
At the backend, trained counsellors receive the messages and respond to questions from the young people. A programme officer at EVA, Osagie Itamah, said messages from all the platforms, including WhatsApp, are programmed so they can receive and respond to them from one platform.
My Question Service was initially called 'Learning about Living Nigeria', and launched by OneWorld in 2007. It started as an SMS-based question and answer service to provide young people with anonymous, accurate and non-judgemental SRH information and services from trained counsellors. The project was handed over to EVA and the HIV/AIDS unit of Nigeria's Ministry of Education to continue operation in 2012. Over 900,000 text messages, 28,433 voice calls and 800 emails/web entries have been received since 2007.
Mobile applications and use of peer marketers to spread the word about their services are some of the latest innovations by EVA. Chinelo Okonkwo, a Programme Manager at EVA, said the numbers of young people that reach out to them daily shows that the yearning for SRH knowledge is quite high.
Uneasy conversations made easier with Tech
Twenty-seven-year-old Ayuba Yabu is a recent graduate of Federal College of Education in Zuba, Federal Capital Territory (FCT). He started using the platforms in 2017 when he joined the peer marketing group. He says he is more comfortable using the app to discuss his sexual health and relationship issues because of the anonymity it offers. He encouraged his sister to use the DIVA app to monitor her menstrual cycle and benefit from other informational services. "I can easily share my sexual health issues on the LinkUP app because I trust it. If I tell someone, I'm not sure what they will do with the information," Ayuba said. Another peer marketer, 22-year-old Patience Janga lit up when she described the Frisky app; "It is the best and very helpful!". She said it helped her teen sister ask questions and get answers to some of the things she was confused about. "A lot of people wanted to take advantage of her and she couldn't open up to our mum. There are a lot of things you can't discuss with your parents, especially sex issues. It's like an abomination when you talk about it".
Ifeoma Emmanuel said prior to using the app, she occasionally had reproductive health conversations with her elder sister because their mother had died some years ago, but it was never easy. With the app, it became easier for her to ask questions and get answers. Even though the challenge she has with the platform is data consumption, she still described it as fantastic because "When I don't have data, I send my message to the number  and get a response."
Young people in rural areas also use the service. Queen Peter, 20, lives in Shadaddi, a small village about a 15-minute bike ride from Kuje, a suburb of the FCT. She volunteers at the youth-friendly centre of the Kuje General Hospital where she learned about the mobile applications. Her supervisor, Precious Anselem, said Queen, as a result, is seen as being more informed in her village and some of the young people who don't have mobile phones meet her to ask questions and get answers about sexual and reproductive health.
Opportunities for Improvement
The major challenge highlighted by young people using the app is the data consumption when it connects to the internet. The storage space it consumes and the fact that it works more with high-end smartphones was another challenge raised by them. But this could be an opportunity for improvement says Precious. He said the app has been helpful to the young people he works with. He believes there are some young people in rural communities who have access to smartphones but may not have enough data to benefit from some of the features in the app like watching explainer videos. "The Frisky app is like a one-stop-shop for SRH information, but I wish it [Frisky] could be like the Encarta of sexual and reproductive health where everything is available offline," he said.
Listening to some of these responses, some might be concerned that the services take away interpersonal communication between young people and their parents or guardians. Kennedy Nwokedi, a youth counsellor, thinks otherwise. He said if young people find it hard to communicate sexual health matters with their parents, then the communication gap has always existed. "Building a true relationship with your children begins at birth and is sustained all through," he said. He explained that some parents also need help because "even the ones that have cordial relationships with their children lack the requisite skill to communicate sexual matters in the context that the teen will easily flow with".
Can Nigeria get it right?
Bill Gates was criticised for saying Nigeria isn't investing enough in the development of its young people. The Human Capital Index (HCI) project report 2018 launched by the World Bank in October 2018 backs Gates' statement with evidence. The index rated Nigeria 152 out of 157 countries. The HCI looks at health and education data for countries and calculates how much a generation may fall short of achieving their full potential, by combining five carefully selected indicators of health and education. Nigeria's HCI value stands at 0.34. This means that the 'business as usual' attitude of low investments in the health and education of young people will cost Nigeria 66% in productivity. World Bank president, Jim Yong Kim expressed his disappointment in this rating especially with all the support that the bank provides to the health sector.
A summary report by UNESCO shows how mHealth programming may be used to improve youth access to SRH services and information by examining the specific barriers that limit the access of young people. The explosion of mobile phone and internet coverage for the past two decades has brought with it an opportunity for new technologies that can empower young people, including hearing impaired young people like Goodness, with enough information to make informed choices about their reproductive health. These technologies have extra benefits because they provide reasonable privacy and confidentiality.
How well are we using these opportunities? The Federal Government should throw its weight behind these initiatives to reach more young people. EVA's work reaches many young people in North-Central Nigeria. Perhaps the Federal Government could work in partnership with EVA and the other organizations working in these areas in different states to scale these services across the country. Nigeria's potential to reap an incredible demographic dividend depends on how it invests in its youth today.
EpiAFRIC is organizing a hackathon which aims at developing tech-based solutions for sexual and reproductive health in South Africa, through an intensive, group-based, and collaborative two-day approach. The Health Meets Tech Hackathon will focus on improving the quality of services for sexual and reproductive health across South Africa. The hackathon is scheduled to hold between the 29th and 30th of November, 2018 in South Africa and will be streamed live on EpiAFRIC Facebook page (www.facebook.com/epiafric) Follow the hashtag #HealthMeetsTechSA for live updates on Twitter.
Do you know other NGOs providing tech solutions for sexual and reproductive health in Nigeria? What are your suggestions for dealing with these challenges? Please share with us in the comment section below. We would love to hear from you.