Almost everyone of reproductive age (about 4.3 billion people) will not have access to at least one essential reproductive health intervention over the course of their lives, according to the World Health Organization (WHO). In Nigeria, over 14 million women already lack access to modern family planning methods in 2024 according to Guttmacher, indicating a substantial unmet need. An alarming statistics given the country's high fertility rate, with an average of 5 births per woman.
The unequal distribution of modern contraceptives is a significant contributor to the high fertility rate, resulting in far-reaching social and economic consequences that affect not only households, but hinder national development and progress.
The country's current economic situation also adds another layer to this unmet need. The high inflation, currently at 33.69 percent, weakens household purchasing power which disproportionately affects low-income families who are already struggling to afford out-of-pocket costs for contraceptives. Even if contraceptive methods are 'free' through government programmes, the expense of transportation to obtain services leads to postponed follow-up appointments, which impedes the efficient administration of contraceptives and increases the risks of unplanned pregnancies.
Contraceptive now a luxury
A recent survey by the Development Research and Projects Center (dRPC) revealed that several reasons influence contraceptive uptake in Nigeria. Usage of contraceptives is severely hampered by its high cost, particularly at private and non-government facilities where supplies and consumables are relatively expensive.
In Nigeria, the cost of family planning can be a significant burden for many families, especially when compared with the country's minimum wage. A pack of three condoms costs between N500 to N2,000, depending on the brand and area of purchase. Similarly, emergency family planning pills cost between N1,600 to N2,700. For a country where the monthly minimum wage is currently N30,000, these costs can be prohibitive.
For clearer emphasis, for a worker earning the minimum wage of N30,000 per month, the price of condoms or emergency pills represents a substantial portion of their monthly income (approximately 9%). For instance, if a minimum wage earner needs to purchase a pack of condoms weekly, they could spend up to N8,000 a month, more than a quarter of their salary. Likewise, the occasional need for emergency contraception can further strain their finances.
This economic challenge influences the choices of families and mothers. Many are forced to seek alternatives, often at the expense of effective family planning. Traditional methods or abstinence might become more attractive, despite their lower reliability. This shift can lead to higher rates of unintended pregnancies, which in turn can strain family resources, impact overall health and well-being and further contribute to the growing population.
Moreover, the cost barrier can discourage the use of contraceptives altogether, leading to a cycle of poverty and health issues. As families expand, the financial burden increases, making it harder to afford even the most basic needs, let alone healthcare or further contraceptive measures.
"A tentacle of problems"
The problems surrounding family planning services in Nigeria have several consequences. The distance between clinics offering family planning services, the cost of transportation, and the fear of negative side effects also pose obstacles to follow-up treatment. One of the major obstacles to receiving follow-up care is also a lack of confidence in available contraceptive methods which is caused by the lack of availability of contraceptive options.
A family planning provider at a Sexual Reproductive Health (SRH) centre noted that, "the greatest disservice to FP (family planning) services in Nigeria is the inadequate supply, this forces us to make the women pay user fees even though the contraceptives are free. The current economic downturn has also increased these costs."
Despite the fact that public facilities are less costly than privately owned facilities, there are still issues with the availability of family planning commodities, which forces people to give up or use less efficient approaches. Although pricing at private facilities may be out of reach for many, availability is a concern in many facilities.
Another aspect of the problems facing contraceptives is that the decision to use them is highly influenced by both income and level of education, according to the research survey by dRPC. Women from low-income families may depend on their partners to allow them to buy contraceptives. Additionally, although people who use traditional procedures are aware of its inefficiency, they still perceive it as a less dangerous alternative.
Way forward
Addressing contraceptive accessibility amidst economic challenges requires an urgent multifaceted approach. Effective solutions will require comprehensive government interventions, education initiatives, and healthcare system improvements.
Increasing accessibility by making generic or inexpensive contraceptive options available will guarantee affordability for all people, regardless of financial level. To increase accessibility, the use of last-mile distribution techniques to reach outlying and underprivileged populations with contraceptives will be invaluable in addressing familiy planning gaps. The use of community pharmacists (CPs) and patent and proprietary medicine vendors (PPMVs) can help bridge the last-mile access challenges, by providing access in hard-to-reach communities, enabling the provision of a wider range of family planning services.
Nigeria could learn from Kenya and Rwanda which have highly effective distribution networks. Through the use of innovative technology, including drones for last-mile distribution, they can augment their highly effective private sector-driven programme for commodity distribution.
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Removing out-of-pocket payments for family planning services ensures that access to contraception and associated care is not impeded by financial limitations. Ensuring that there are enough family planning supplies at the service delivery posts is a major component of this. There is also a need to prioritise accountability in the delivery of family planning services, while establishing mechanisms to monitor and address gaps in service provision and quality.
Fostering sustainability by reducing dependency on donor funding for family planning programmes is also key to ensuring long-term access and continuity of services. A good start on this is the implementation of the FP 2030 commitments by the federal government, the main commitment being to improve financing for FP by allocating a minimum of 1% annually of the National and State Health budgets equivalent to N4.7 Billion and N6.9 Billion respectively and leveraging both existing and additional innovative domestic financing mechanisms to increase financing for FP by 2030.
The federal government should fulfill its commitments on this and lead to a revision of Nigeria's family planning blueprint, which is due to expire in 2024. For non-public facilities, the government needs to develop a strategy for regulating the commodities prices and look to local production of family planning commodities. Having a collaborative meeting with private sector providers and agreeing on a standardised user fee will help in this regard.
