Sources of Contraceptive Commodities for Users in Nigeria

BACKGROUND: Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. METHODS AND FINDINGS: A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15–49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15–24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. CONCLUSION: Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills

Promoting Sexual and Reproductive Health and Rights in Nigeria through Change in Medical School Curriculum

Significant developments have occurred in the field of sexual and reproductive health and rights (SRHR) globally in the last decade. However, this is yet to translate into improved status of SRHR in developing countries. One of the strategies recognised worldwide for addressing the poor status of SRHR is human capacity building at all levels. A pilot work conducted in two federal university medical schools identified a major gap in knowledge among medical students on issues related to SRHR. This called for a review of the curriculum to enable the incorporation of relevant and topical issues. This article describes the processes leading to the adoption of the Nigerian medical schools' sexual and reproductive health and rights curriculum. The exercise culminated in the identification of internal and external stakeholders and needs of the Nigerian medical schools in teaching reproductive health. The participation of lecturers (bottom-up approach) brought about a sense of ownership of the document and promoted the broad consultation and participation of all participants. It also identified capacity building and the need for evaluation as a basis for further review. (Afr J Reprod Health 2004; 8[1]:85-91) RÉSUMÉ Promotion des droits de la santé et sexuelle de reproduction au Nigéria à travers la modification du programme scolaire medical. Il y a eu des développements importants dans le domaine de la santé et les droits sexuels et de reproduction (SDSR) dans le monde entier au cours de la dernière décennie. Pourtant ceci n‘a pas encore été tradiut en une meilleure condition de la SDSR dans les pays en voie de développement. Une des stratégies reconnues dans le monde entier pour aborder le statut faible de la SDSR est le renforcement de capacité humaine à tous les niveaux. Une etude pilote menée au sein de deux écoles médicales des universités fédérales a identifié un écart important dans la connaissance chez les étudiants en médicine sur des questions liées à la SDSR. Ceci nous a obligé de revoir le programme afin d‘inclure des sujets pertinents et d‘actualité. Cet article décrit le processus menant à l‘adoption du programme de l‘ école médicale nigériane sur la santé sexuelle et les droits de reproduction. Le projet a abouti à l‘identification des partenaires sociaux internes et externes et les besoins des écoles médicales nigérianes dans l‘enseignement de la santé de reproduction. La participation des enseignants (l‘approche de bas en haut) a provoqué un sens de la propriété du document et elle a encouragé de grandes consultation et participation de tous les participants. Elle a également identifié le renforcement de capacité et la nécessité d‘une évaluation comme base pour d'autres examens. (Rev Afr Santé Reprod 2004; 8[1]:85-91

The knowledge and use of misoprostol among women in a Nigerian population

Background: Increasing the availability and accessibility of misoprostol in low resource settings has been advocated to reduce maternal deaths from primary postpartum haemorrhage (PPH). WHO recommends a strategy of antenatal distribution of misoprostol to pregnant women, for self-administration for the prevention of PPH, in settings where women are likely to give birth outside of a health facility or in the absence of skilled health personnel. The success of such strategies depends on the current knowledge and acceptability of misoprostol among women in such population. The aim of this study was that we assessed the knowledge and use of misoprostol among Nigerian women.Methods: It was a prospective cross-sectional population based survey in which 16445 consenting women, from randomly selected households and communities across the 20 local government areas (LGA) of Lagos state, had in-depth interview with the aid of an interviewer administered structured questionnaire to assess their knowledge and use of misoprostol. Data obtained were presented in frequency and proportions.Results: Thirteen per cent and 6.5% of the respondents were aware of drugs that could be used to terminate pregnancy and stop bleeding following childbirth, respectively. Only 5.2% of the women were aware of misoprostol, two-third (67%) of which knew it could be used to terminate pregnancy and 5% of women aware of misoprostol knew it could be used to reduce or stop bleeding following childbirth. Only 2.3% of the entire study population admitted to personal use of misoprostol.Conclusions: Knowledge about the safe, life-saving and effective use of misoprostol among Nigerian women is low. There is need to disseminate information about misoprostol especially in settings where women are likely to give birth outside of a health facility or in the absence of skilled health personnel.

Induced Abortion in Nigeria: Findings from Focus Group Discussion

Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning, unwanted pregnancy, abortion, adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects, high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier. (Afr J Reprod Health 2005; 9[1]: 133-141

Characteristics of Abortion Care Seekers in South- Western Nigeria

This prospective hospital-based study was carried out to understand the characteristics of abortion care seekers in south-western Nigeria. Information was obtained from a total of 1876 women seeking abortion at hospitals using a questionnaire. The results show that majority (60%) were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7%. Most (63.2%) of the respondents were unmarried, but married women also constituted a significant proportion (30.2%) of the abortion care seekers. Students were the single highest group, while the predominant economic activity was trading (26.7%). Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. Most (35.5%) of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 27.4%. It is obvious from the results that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education especially in view of the current HIV/AIDS pandemic. (Afr J Reprod Health 2004; 8[3]: 81-91

Community-Based Survey of Unwanted Pregnancy in Southwestern Nigeria

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion. (Afr J Reprod Health 2004; 8[3]:103-115