Access to family planning (FP) services empowers women and girls by enabling them to have agency over their bodies. They can better plan a pregnancy and make more informed decisions about childbirth, allowing them to chart the course of their future according to their desires and ambitions.
When the 2023 Federal Government budget proposal was presented in October 2022, family planning advocates were especially interested because the budget for 2022 had not allocated funds for family planning. Nigeria's contraceptive prevalence rate (CPR) among women aged 15 to 49 years is one of the lowest in the world at 18% which underscores the importance of prioritising family planning in the national budget. Low CPR can be attributed to a variety of factors, including limited access to information and services, cultural and religious beliefs, and inadequate funding for family planning programmes.
Although a 20-million-naira budget line for family planning has been reintroduced in the 2023 budget estimate, it must be increased to meet the FP needs of a country of over 200 million people. This creates a funding deficit which has implications for women and girls who have an unmet need for family planning services as they are not using any contraception method because it is not available, accessible, or affordable for them.
The human capital of women and girls
Women and girls' human capital refers to the skills, knowledge, health, and other resources invested in them to enable them to achieve their full potential. When women and girls can access education, healthcare, and other opportunities, this empowers them to become productive members of society, increasing the opportunity for economic advancement. This is referred to as the "gender dividend".
However, the gender dividend can be impacted by an unmet need for family planning. When women and girls do not have access to contraception and other reproductive health services, they may have unintended pregnancies, unsafe abortions and may be at a higher risk of maternal and child health problems. For girls, this limits their ability to continue their education, work and pursue other economic opportunities. This can lead to a cycle of poverty and inequality as they have less control over their reproductive health, and this can perpetuate gender inequality.
"The Human Capital of Women and Girls: The Gender Dividend" was the theme of Brendan Hayes' presentation at the 7th Nigeria Family Planning Conference, which took place in December 2022. Mr Hayes is a Senior Specialist at the World Bank. He leads the Global Financing Facility's work on Sexual and Reproductive Health and Rights (SRHR).
It is critical to remain mindful of the salient points Mr Hayes shared as he, while not discounting the very real issue of financing challenges for expanding access to family planning, attempted to reframe the FP agenda as he discussed four key themes and "how they contribute, not only to the health and wellbeing of women and girls but, to economic development and the wealth of nations".
1.The role of human capital -- for women and girls in particular -- for accelerating economic growth: "Human capital...is the real wealth of nations," Hayes said adding that up to 70 per cent of the wealth in wealthy countries is from their human capital while in poorer countries, human capital accounts for only around 40% of their wealth, with most of the balance coming from natural resource wealth. According to the World Bank Human Capital Index, a global metric that evaluates critical components of human capital across countries, a child born in Nigeria today will be 36 per cent as productive in adulthood as they could be with complete education and total health.
He further discussed the gender dimension of human capital, where factors like distance to school, early marriage and pregnancy, cultural practises, gender-based violence and other gender-related norms limit investment in women and girls, limiting their economic opportunities.
2. What inaction on human capital and gender equality is costing countries: Inaction on human capital and gender equality can have significant economic, social, and political costs for countries. Maternal mortality is the leading cause of death for adolescent girls in particular. In addition, girls and women also suffer long-term health implications from unintended, poorly spaced, or too-early pregnancies. Countries cannot afford to overlook the significant economic and social consequences of long-term health implications from unintended pregnancies, maternal mortality, and other related causes.
According to Hayes, the World Bank estimated that in Africa, a man's earnings will increase by 11% for each additional year of schooling, while a girl who is invested in will see her earnings increase by 14%. "Neglecting our women and girls is costing those households foregone income and our country's foregone economic growth...In fact, in Nigeria, the lost earnings and the lost productivity due to early marriage is costing the economy up to $7.6 billion annually".
3. The importance of SRHR for supporting human capital accumulation for women and girls: There is a strong correlation between the total fertility rate and the human capital index. At 5.1, Nigeria's total fertility rate is among the highest in the world. This may indicate an unmet need for contraception which directly impacts the family's economic standpoint, increasing household consumption, limiting investment in human capital accumulation, and limiting investment in good nutrition, health and educational opportunities.
Hayes discussed the direct impact of early pregnancy, highlighting that it limits educational investments in girls and creates an intergenerational effect. "The children born to adolescent mothers have poorer health outcomes, they have lower rates of survival, and they also suffer from higher rates of nutritional stunting, which has significant cognitive impacts on those children and will limit their ability to accumulate human capital later in life".
He also discussed a study that clearly connected access to family planning and improvements in educational outcomes and human capital accumulation. The United States study found that girls who were offered modern methods of contraception during high school were 6% to 12% more likely to obtain a bachelor's degree later in life.
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4. What countries need to do to leverage this opportunity: What can Nigeria do to leverage the human capital of women and girls and accelerate the FP agenda? Hayes proffered the following recommendations Nigeria can adopt to meet the growing needs of women and girls for access to family planning.
- Increase funding for modern methods of contraception: Since access to modern methods of contraception plays a critical role in improving health outcomes for women, children, and adolescents, the government should allocate more funds to expand access to these methods.
- Prioritise investments in family planning: The government should prioritise investments in family planning programmes as they are essential for human capital and economic growth. The cost of inaction in this area is substantial, and policymakers should recognise this.
- Focus on a broader investment agenda: Family planning should be within a broader investment agenda. Countries that have reduced fertility but have not created opportunities for women and girls have seen limited benefits from a fertility transition.
- Strengthen primary healthcare systems: A strong primary health system can successfully address childhood immunisation, HIV programming, and malaria and expand access to modern family planning methods. The government should prioritise strengthening primary healthcare systems to ensure they can provide these services effectively.
- Build alliances: The government should collaborate with advocates and technicians to come up with the best approaches to integrated service delivery. The primary healthcare platform provides an opportunity to do so.
