By Moses AMADI
In Nigeria and some other parts of the world, discussions around family planning and population control have always generated controversies. It is a fairly delicate subject, especially when linked to capturing political and fundamental right issues, culture, religion, resource allocation, among others.
As a result, family planning has been given various definitions such as: an idea of the modern man; trying to hinder what God says concerning multiplication; advocacy to reduce Nigeria’s population; the ability to manage a given number of children, among others. Sometimes, the leadership is sensitive to the views and beliefs of the people in this regard.
A lot of people’s lives, especially in Nigeria, revolve around their cultural and religious beliefs. Some believe that their religion mandates them to have multiple wives and multiple children. Others cling on to the patriarchal system that makes them have numerous children in their search for the elusive male child.
However, we occasionally focus too much on the impact of religion and culture in family planning. A research done by the Gates and Melinda Foundation shows that religion is no more the major impediment to family planning; the major barriers are myths and misconceptions which pose a lot of danger.
In otherwise enlightened quarters, the views have been expressed sometimes shockingly that population management is a device by the Caucasian race to decimate the black race. The idea is born out of the belief that the Caucasian race might in the future, in terms of actuarial projections, thin out, and the black race will populate the entire world. For this reason, suspicions arise when population programmes are being funded by the Caucasian race.
Nevertheless, deliberations around population and particularly the number of children a family should have, are controversial. There was an attempt to legislate family planning in Nigeria in view of the capacity of government to provide for the people, and the overall quality of life for families. Under the Babangida administration, there was a policy that limited family size to four children. In China, there was also a policy that the family size be cut down to one or two kids but now, a review of the policy has allowed some flexibility.
A large number of rural families in Nigeria are classified as poor or extremely poor; majority of them having large family sizes that they cannot provide for and support. Revelations from the Association for the Advancement of Family Planning give an insight into the magnitude of what we are dealing with.
“By 2050, the projection is that the Nigerian population will be 400 or 450 million, and that those who will make that happen are already born. Even if all of us that are adults stop today to have children, the youth that we have right now who have not gotten married, who have not gotten babies, will drive our population. That’s why we are saying that the young people must be the focus. We call them very visible but hard to reach. If we don’t give them the appropriate information whether they are married or unmarried, to make sure that they don’t get pregnant unless it’s necessary, then we are all in trouble.”
The story of Nigeria with regard to efficient population management leaves much to be desired. This issue can be attributed to a number of cross-cutting subjects. Government has not shown the leadership quality needed to identify and solve many family planning problems. Service delivery imperatives that speak to how women and men get family planning services are not satisfactory. The current weak governance structure cannot address family planning matters. Industry watchers believe that the federal government’s efforts are not complemented at the sub-national level, as health is on the Concurrent List. It is such lethargy at the sub-national level that has been responsible for the near absence of health on their budgets’ line item. About two years ago, an analysis showed that some states increased their budgetary allocations in health to almost 15 per cent but what was released was not more than 4.5 per cent.
The consequences of lack of family planning could be dire, and such outcomes manifest in different ways.
The depressing infant and maternal death statistics give cause for worry, with the UN Population Fund confirming that maternal mortality rate in Nigeria is one of the highest in the world. This is corroborated by government figures which show that Nigeria has as much as 512 maternal deaths per 100,000 live births. The Minister of Health, Dr. Osagie Ehanire, recently revealed that the Nigerian woman has 1 in 22 lifetime risks of dying from pregnancy, childbirth, postpartum incidents or cases of abortion, whereas the lifetime risk for women in other parts of the world is put at 1 in 4,900. Records from family health advocates also indicate that more than 30 per cent of women are at risk of unintended pregnancy. World Health Organisation (WHO) report shows that in 2019, infant mortality rate in Nigeria was as high as 17.2 per cent per 1,000 live births. These figures are indicative of not only deficit in health care delivery, infrastructure at both national and sub-national levels, but also failure of Nigerians to plan for their families.
There is a link between fertility rate and population growth rate. Nigeria has a big population with a high fertility rate, and the number of women taking contraceptive measures to manage and plan their families is very small. What this shows is that we are almost in a demographic crisis. According to the Association for the Advancement of Family Planning, Nigeria has a youthful bulge, as 70 per cent of the population is under the age of 30; 45 per cent under the age of 50, and the elderly 3.5 per cent is above the age of 65.
This suggests that there is a large youth population but opportunities are not forthcoming in the same proportion. The reason is partly because population growth does not align with economic growth. Economic growth is lagging behind population growth. In other words, the emphasis is the connection between population and prosperity, as what the economists connect is that GDP annual growth rate must outstrip population growth rate.
Sociologists have argued that the reverse is responsible for the restiveness of the youth. These have created certain tensions following the emergence of the OPC, Niger Delta militants, IPOB, Bakassi Boys, Boko Haram, herdsmen, among others. These groups are known to have carried out various acts against the state including killing, kidnapping, banditry, among others.
Young educated Nigerians trained with Nigerian funds as well as non-highly educated young people are leaving the country. Some estimates show that 14 per cent of all the people that cross the “turbulent” Mediterranean Sea are Nigerians. This shows desperation to cross over to Europe. Last year, 44 migrants were attacked and killed in Libya. Nine of them were Nigerians. It is now clear to see what it means to have youth who have no jobs, who have little or no education, and who do not see a future.
Unless families are planned and timed, WHO and other family health advocates warn of imminent population explosion that could impact adversely on the well-being and living conditions of the people especially those in countries classified as high fertility risk areas such as developing countries like Nigeria.
In 2012, Nigeria committed to family planning initiative but the objectives of this scheme have not been fully realized. The delicate nature of discussing population issues in the country has always been on the table. It is time to place these issues on the front burner. People should begin to see the consequences of what we are faced with and therefore, deal with them without necessarily offending sensibilities.
Some persons argue that population is a huge advantage for us, as it provides a big market for trading activities. But today, we do know that we are facing population pressure.
The National Council of Health should put more emphasis on population management as a priority health item with feedback mechanism on the activities of the states. It is hoped that the federal government’s part-sharing communication strategy with about 22 states, will achieve positive results. Part of the public policy imperative is the Green Dot Logo, which is a sign that shows availability of free family planning services whose access reduces maternal mortality to up to 25 per cent according the UN Population Fund. Both married and unmarried youth need to have unbiased access to family planning, and this creates social acceptance.
From the sociological and medical points of view, Nigeria should be concerned about managing its population to fit its economic situation. The growth of the economy should not be outstripped by the growth of the population. The reverse is a decline in economic prosperity. It’s a matter of responsibility that population aligns with economic growth, which means that citizens will be healthy, educated and well positioned to contribute their own quota in the country.
The basic conversation should be about linking both economic and social growth. There is a benefit that comes from having a well-educated, productive pool in the labour market, taking care of the elderly, and those who for some reason, are not economically active.
The investments we make in these areas will driving opportunities for young people and Nigerians in general. Young people should be able to make their decisions to meet their aspirations; how they want their families to look like, how many children they want, among others. It’s about making informed decisions about their lives, getting job opportunities, and making contributions to the development of the country.
Women are often neglected in discussions about demographics. They need to make contributions. When many women don’t have access to education, and therefore, end up not being in the labour market, they are incapable of contributing meaningfully to the country and their communities. The country loses returns on investments that initially starts with educating the girl child.
The Malawian option comes to mind. At least, about two years ago, Malawi was taking family planning services to secondary schools where teenagers were counselled. That’s why the Malawian contraceptive prevalence rate is almost 50 per cent. But according to the health ministry, the modern contraceptive prevalence rate in Nigeria is 12 per cent even though its target was to hit 27 per cent last year.
There are narratives that have to change concerning how we uphold our cherished values. The resistance against sex education in schools amounts to hiding behind a finger. Parker Foundation did a study some years ago to ascertain the age bracket of victims of maternal mortality. The study revealed that 70 per cent of all maternal deaths at that time were children below the age of 18. Most of them were not married but they were getting pregnant and dying from abortion complications.
Another research has shown globally that in countries with comprehensive sexuality education, there is appropriate information base that reduces unintended pregnancies. The reality is that Nigerian teenagers are sexually active, and that speaks to the teenage rate of pregnancy in the country. This makes them drop out of school and end up becoming single mothers. The country loses out on the potentials that young girls can bring to the society.
Family planning is about preserving lives, ensuring that children are born because they are welcome into this world. It’s about ensuring that everyone in the community gives back and contributes to a healthy economic development of the country. It’s about constantly tearing down the barriers so that at the end of the day what we have on our hands could be manageable.
Families should produce kids they can manage and not children in excess of what their economic situations permits. This awakening should be sustained and taken to parents, decision makers, community leaders, among other stakeholders, who don’t see it as logically and rationally as economists do. The awakening is to stimulate new thinking, ideas and new attitude to family planning so that people can take responsibility. This is done to achieve economic, social and political stability.
Health experts put the unmet need of Nigerian women at 20 per cent. In other words, 20 per cent of Nigerian women want family planning services but they are not getting them. There is a need for advocacy for men to be supportive of their wives in terms of strategic approaches to upscale their awareness to the benefits of child spacing.
In terms of strategic communication component of population management and more specifically family planning, more emphasis should be on women. The woman carries almost all the burden. The outcome of targeted girl child education cannot be overemphasized. As the saying goes, ‘train a woman and build a nation.’
Moses Amadi is Managing Consultant, Legacy BookMedia, Lagos