By: BridgetAkudo Nwagbara, Chair of the Youth Health Workers Advocates, Nigeria – MNCH
“I had a dream to be the best that I can at anything I want to be….I couldn’t because I became a mother at 15 years. I never wanted the baby. Now, I have to cope with the demands of being a mother without going to school. That is not the life I wanted”…*Anne
“I thought it was cool to have as many girlfriends as I wanted. Nobody ever told me what to do to keep them from getting pregnant. Today I’m living with HIV and I also have a child. I get all the blame. That’s not the life I wanted”…*Bayo
“I envy women who have gone to school….they have cars and wear nice dresses…I can’t because I got married at the age of 13 years and now I have 6 children at 25 years…..Now I want a better life. How do I get it?”…*Surraya
These voices echo those of Nigerian youths who don’t have access to basic reproductive health choices today. They were never told what contraceptives were all about, where to get them, how to get them and how to use them. Then, the big question is: Why are they denied the right to decide freely and responsibly when to start having sexual relationships, when to have children, and how many children they want? The answers are not far-fetched and it is important we bring them to fore this week to celebrate World Contraception Day.
Although Nigeria has about 31% of its 150 million people between 10-24 years, political commitments to protect their sexual and reproductive wellbeing are not tangible. The National Adolescent Health Policy was developed in 1995, followed closely by the National Adolescent Reproductive Health Strategic Framework in 1999 to provide technical guidelines that will facilitate translation of the policy into actionable plans. Ironically, the National Health bill which will create an auspicious atmosphere to actualize these policies and action plans is still gridlocked in executive bureaucracy – this only mirrors poor legislative protection of young people’s rights to contraceptive education and service provision.
Financial indifference to reproductive health services is congruent with existing lack of political will since these policies and action plans are yet to be matched with investments. Presently, public health expenditure in Nigeria is below 2% of the GDP, giving a picture of how poorly financed reproductive health services are at the moment. Dwindling donor funds dedicated to sexual and reproductive health, particularly family planning, has only worsened the scenario in the past decade. Consequently, there are very few facilities on the ground to deliver basic contraceptive services and supplies in most parts of the country. Over the years, government hasn’t scaled up on the 9 youth friendly reproductive health centers in the country being provided by Planned Parenthood Federation of Nigeria. With too few youth friendly services, young people have to travel far distances to get contraceptives.
Another germane issue denying young people access to comprehensive contraceptive care is the critical shortage of health workers. Africa has only 3% of the world’s doctors, nurses and midwives. Reaching adolescents at the grassroots will require health care task sharing with well trained and motivated community health extension workers to educate and mobilize young people to accept contraceptives. This is particularly important in hard to reach areas with very few skilled professional health workers. In turn, they should be supported by qualified doctors and midwives housed in health facilities to help achieve universal access to contraceptives. But with very few health workers across all cadres coupled with existing inequities in their distributions, the outlook for Nigerian youths is gloomy. Moreover, personal assumptions, cultural and religious ideologies prevent health workers from being friendly to youths when they come forward to ask for contraceptives. Young people are not at ease coming to health facilities and discussing their life’s circumstances/choices with such health workers.
Religious, cultural and social norms maintain a recondite view of sexuality. Youths who are outspoken about their sexuality are stigmatized and labeled “amoral or promiscuous.” To conform to these perceived standards of morality, young people refrain from discussing and sharing information on contraceptives. Parents and adults equally shy away from providing life-skills mentoring for young people on sexual and reproductive health issues. A “Pro-Life” stance by some religious organizations openly prohibits the use of contraceptives including condoms. “Abstinence only” educational programs are promoted without equipping young people with adequate information and alternatives to make sexual and reproductive health choices. For instance, Zip Up, an abstinence promoting advert targeted at youths ran on Nigerian TV and radios for years without giving young people enough education on how to maintain abstinence, financial autonomy and alternative avenues to exert their creative energy. Worse still, other forms of contraceptives and basic information on Sexually Transmitted Infections were not promoted on the same scale. This is substantiated by the fact that at the time this advert was running only 57% of Nigeria’s young people had adequate information on how HIV spreads and the rate of adolescent pregnancy didn’t reduce.
Other prevailing issues that fight against young people’s access to contraceptives in Nigeria include child marriage, transactional sex, gender based violence and stigmatization of people who are lesbian, gay, bisexual and transgendered. About 16% of adolescents in Nigeria are married. Child marriage is permitted by most cultures in Nigeria and young people are forced into marriage for economic reasons. Early marriage perpetuates the inability of women to make autonomous reproductive health decisions as it limits access to schooling, social networks, financial independence and other resources that a woman needs to exercise her sexual and reproductive rights. Young Nigerian women living slightly above or below the poverty line are forced into transactional sex daily to improve their economic circumstances and meet their daily needs. Such transactional sexual relationships deny women the right to negotiate safe sex. A cloak of silence has been placed on gender based violence despite advocacy by human rights groups on the pervasive nature of the problem in the Nigeria. Policymakers, health professionals and donors are yet to effectively integrate gender based violence into family planning programs in Nigeria, making it difficult for survivors to get basic information and access these services. Vulnerable groups like people who have sex with same sex are left out in the design and implementation of most contraceptive services for religious, cultural or political reasons, denying them access to contraceptive education and services.
At this point, where we have only 4 years left to achieve the Millennium Development Goals and the World’s population hits 7 billion, we need to make concerted efforts to ensure that issues which affect young people and deny them the rights to achieve their full potential and live fulfilled lives are addressed using evidence-based and multidisciplinary approaches. Our government should assert their leadership and ownership of adolescent reproductive health care by establishing more Youth Friendly Centers manned by well-trained and youth-friendly health workers to deliver contraceptive guidance to young people. Nigerians need to dispel religious and cultural barriers that hold young people at ransom when it comes to contraceptive choice. Steps should be taken to make sure that young people get all the information they need on contraceptives before sexual debut. Measures should be taken to protect young people from early marriage, gender based violence and stigmatization.
EMPOWER YOUNG PEOPLE IN GREEN AND WHITE TO LIVE THEIR LIVES, KNOW THEIR RIGHTS AND LEARN ABOUT CONTRACEPTIVES.
*not their real name
BRIDGET IS THE CHAIR OF THE YOUTH HEALTH WORKER ADVOCATES, NIGERIA-MNCH.