Women’s Use of Family Planning Increases through Integrated Health Services in Northern Nigeria
By Nasir Bashir, Samaila Yusuf and Ann LoLordo
With each pregnancy, Malam Abubakar Maikudi worried about the health of his wife, Hadiza. The father of three children, Maikudi feared that another baby, born too soon, would further weaken her and make it harder for her to care for the children. But what could he do? A visit by a community health counselor helped this Nigerian father attend to the needs of his family.
Ali Ibrahim, a male counselor who is part of a U.S. Agency for International Development (USAID)-supported program to enhance reproductive health services in northern Nigeria, explained to Maikudi the benefits of properly spacing future pregnancies. He discussed several family planning methods for the couple and referred them to the Kiru Comprehensive Health Centre.
“Your visit to my house has taken a big burden out of my life,” Maikudi told the counselor. “I am very much satisfied with the information you have given me on how to plan my family and where to get services.”
After meeting with a health provider at the center, Hadiza and Maikudi decided that an intrauterine contraceptive device (IUD) was their preferred method of family planning.
The couple is just one of thousands of families who have been helped through a comprehensive program supported by USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), managed by Jhpiego and partners to strengthen reproductive, maternal and family planning services in three states in northern Nigeria. An estimated 30,000 women die annually from complications of childbirth in Nigeria. The program began under the ACCESS Program and is being continued by MCHIP.
Through its cooperation with the Nigerian Ministry of Health over the past four years, MCHIP in Kano, Katsina and Zamfara States has achieved steady and significant gains in women’s visits to antenatal care clinics, skilled birth attendance, active management of third stage of labor, essential newborn care and use of long-term family planning. Through this initiative, 164,040 women have received family planning and reproductive health counseling.
“We are partners in progress because from the time when they came and started the activities in this state, we have made a tremendous progress,” said Dr. Bello Buzu, the chairman of the Health Services Management Board in Zamfara State.
The goal of the program has been to strengthen health systems and improve the quality of care in the community and health facilities to reduce the deaths of women and newborns. In northern Nigeria, women have an average of five to seven children. Program partners launched a multi-tiered approach that targeted 57 health facilities in more than two dozen local government areas, and relied on community health counselors and mobilizers to reach women in their homes and villages. The program focused on strengthening emergency obstetric and newborn care and family planning services.
Key accomplishments of the program have included:
- Health facilities using active management of third stage of labor increased from about 30 percent to more than 60 percent in the three states in northwest Nigeria;
- The number of facilities performing newborn resuscitation nearly doubled;
- Use of family planning among postpartum women in the areas served by the program increased from one percent to 15 percent of households; and
- More than 8,000 women chose injectables as the preferred form of contraceptive during a one-year period, an increase over the estimated 6,000 women seen at the start of the program.
As part of the project, health care providers were educated in emergency obstetric and newborn care skills, and family planning methods and e-learning opportunities were strengthened to build capacity in these areas. Beyond community education and facility improvement, a key strategy was to integrate health screenings with immunizations, newborn care and well-baby visits so as not to miss an opportunity to address women’s health and family planning needs.
“We have a reason for being in northern Nigeria. If you look at the demographic characteristics, many indicators are very poor in northern Nigeria compared to southern Nigeria,’’ said Prof. Emmanuel Otolorin, Jhpiego’s Country Director. “Our household-to-hospital continuum of care approach aimed to eliminate the delays to accessing health care delivery such as ignorance of the danger signs in pregnancy and childbirth and/or inappropriate customs. It also aimed to address delays in reaching the point of care due to lack of appropriate transport or poor roads and geographic terrain, as well as delays in receiving care after arriving at the health facility because of weak health systems—including a shortage of skilled birth attendants or lack of equipment and supplies.”
A network of community health volunteers taught pregnant women and mothers basic health care skills to prepare for childbirth and encouraged them to access health care services before and after delivery. Men were recruited to participate in outreach efforts to discuss the importance of pregnancy spacing and family planning with husbands, fathers and other male relatives. Savings clubs were organized for women, giving them the financial means to contribute to their families and develop leadership skills.
A Jhpiego-pioneered quality assurance approach, Standards-Based Management and Recognition, was shared with health care providers and administrators in an effort to improve services at facilities; measurable progress was made. In addition, health facilities were renovated and equipment upgraded.
“In terms of capacity building, systems strengthening and physical infrastructure, ACCESS, followed by MCHIP, has really supported Kano State government,” added Dr. Ashiru Rajab, Deputy Director of Primary Health at the Ministry of Health in Kano State.
But there’s more work that can be done.
“While there is an increase trend in the uptake of family planning services in Kano, a large number of women still have an unmet need for family planning,” said Dr. Yusuf Munkaila, Medical Director of the Sir Muhammad Sanusi Specialist Hospital. “There is a need to step up engagement of the religious and traditional leaders to understand the health benefits of family planning so that they can actively participate in advocacy efforts and disseminating messages that promote family planning as a means to improve maternal and newborn health.”