The shortfall in the availability of Family Planning commodities and consumables across the primary health facilities in Akwa Ibom State, especially those in the rural communities, has heightened the health risks of women and girls of reproductive age.
A visit by our correspondent to some local government areas in the state revealed an increase in maternal mortality rate, teenage unwanted pregnancies, unsafe abortions, with the attendant poverty rate in those communities.
Data from the Nigeria Demographic and Health Survey, 2018, showed Akwa Ibom as one of the States with an increased rate of teenage pregnancy standing at 12% and with the highest rate of abortion among young people of reproductive age.
The data also showed Maternal Mortality Rate (MMR) in the State standing at 520 per 100,000 live births.
Worried by the ugly trend, a family head in Ikot Ebom Itam, Itu Local Government Area of the state recounted how they recently lost two mothers of three and four to childbirth respectively, and cases of many other teenage girls getting pregnant and dropping out of school.
The family head, who identified himself as Eteidung Akpan, said he encourages his people within the reproductive age to take up family planning services to forestall some of the problems highlighted, even avoiding having Vesico Vaginal Fistula (VVF), commonly caused by early childbirth, which according to him is emerging.
His words, “Yes, I’m aware of family planning and I always encourage people to take up the services. We are losing our daughters to childbirth complications and we are not happy about that. Just recently, we lost two women.
“Family planning reduces health risks to women and gives them more control over their reproductive lives. With better health and greater control over their lives, women can take advantage of education, employment, and civic opportunities.”
Interaction with some young persons in the communities showed that the lack of FP commodities in the facilities and the demand for money from service providers before access hinder them from taking up the service.
At the Primary Health Care Centre, Ikot Oku Usung, Ukanafun Local Government Area, the situation revealed the existing gaps in family planning services as the facility lacks various types of FP commodities to enable clients make a choice.
Akwa Ibom
One Abasiofiok, who accompanied his wife for antenatal visit at the facility, expressed willingness for the wife to take up FP service after delivery but expressed dissatisfaction over the non-availability of many options that the nurse highlighted.
Also, Abasifreke, a teenager and expectant mother who came for antenatal clinic, said she just got to hear about FP services and mooted plans to take up one as she said she was planning to go back to school.
The Officer-in-Charge and Family Planning provider at the Health Facility, Mrs. Edimek Emason Akpaitam, while speaking, said there was great improvement in family planning uptake in the area and attributed it to the efforts of The Challenge Initiative (TCI) creating awareness and outreach mobilisation in communities around the health facility and in the LGA at large.
She said due to the prevailing economic situation, many people in Ukanafun are taking up FP services but regretted the inadequate commodities and consumables, saying that the issue should be addressed urgently to enable more women embrace the service.
At the Primary Health Care Operational Base, Mkpat Enin Local Government Area of the state, Mrs. Asindi Joseph, a mother of five who just obtained the implanon method at the PHC, recalled that after counselling, she chose the method which has been perfectly working for her.
“It was my husband who brought the idea of family planning and now I’m enjoying it because I feel stronger, healthier, and living well. It is not the number of children that you have but how you are able to train them would give you satisfaction in life. It is the best decision to take; it enhances child spacing, allows planning, and enables me, the wife, to contribute to the family upkeep,” she added.
However, there are vulnerable and mentally deranged women roaming round the streets of Uyo, pregnant, who may still need FP services. One of them, in her early thirties, who traverses around Wellington Bassey Way, Ibom Plaza, and environs, has fallen prey to heartless men who impregnate her almost on a yearly basis, and the whereabouts of the babies are unknown.
Another mentally unstable lady, popularly known as Eka Udo in Uyo, but lives with her family, who gave birth to her third child, could not identify the father of all her children. When asked about the identity of the person that got her pregnant, she casually replied using Ibibio language, “the road is open, and anyone can enter.” That is to say that anyone can take advantage of her vulnerability and have carnal knowledge of her. Though it was gathered from her family members that she was later taken to PHC to access family planning.
Meanwhile, The Challenge Initiative (TCI), a donor agency for FP services in Akwa Ibom, has described family planning as a reproductive health right for every individual.
The Executive Director of TCI, Dr. Taiwo Johnson, said every individual, regardless of age and status, has the autonomy and access to how to plan his or her family, advocating that women should be empowered with the right information and resources for their choices to reproductive health.
Executive Director of TCI, Dr. Taiwo Johnson
Uchenna Ajike of MSI Nigeria Reproductive Choices said, “We do not believe that FP is only for married couples but a right for every human whether they are married or not. Let us not think that when an adolescent wants to access contraceptive services they are committing a sin. It’s just like their right to access services in the cure of malaria, tuberculosis, etc.”
A visit to some health centres in the state revealed low access to FP services. This could be due to poor sensitisation and lack of adequate commodities and consumables in some facilities.
According to the FP Coordinator in the State, Mrs. Enobong Eshiet, Akwa Ibom has 32 percent of unmet need for family planning.
According to her, “Unmet need means there are women who have need for family planning services but most of them don’t know where to access them. We need all hands to be on deck to ensure these needs are met.”
She said family planning services in Akwa Ibom are highly donor dependent in that most of the commodities available in the health facilities are being provided by donor partners.
The question is, what will be the fate of the clients and the prospective ones if these donor agencies withdraw their support or exit from the country as some of them had announced? The government, therefore, is required to step into its responsibility to bridge this gap.
The Coordinator had attributed inadequate commodities in FP clinics to lack of funding, saying that of all the approvals for FP services in successive budgets of the state, government has not made a single release.
Her words, “Family planning services are more partner dependent. We’ve been having approved budgets in the state but no releases. When we found out the gap there, we constituted an advocacy core group and that core group is working out modalities to policy makers so that they see reasons to release funds allocated to family planning services. With these releases we can sustain our programmes.
“We were given a mandate in 2022 for states to start procuring their FP commodities because the national basket was no longer as rich as it used to be, as partners were withdrawing. Akwa Ibom State is yet to contribute to the basket, and I hope before the year runs out something will be done so that if we request, for instance, 100 commodities they will give us, but now when you request for 100 Jadelles we may get 40. The quantity ordered shows what the state needs and the quantity supplied shows what the FG can give. They have to ration to other states, but if we contribute, we will have in full.”
Women Resort to Traditional Contraceptive Amid Risk
The saying, ‘when the desirable is not available, the available becomes desirable,’ has played out among women of reproductive age in the state, following the paucity of FP commodities, as a good number of them have resorted to the traditional method.
The increasing use of this method of family planning, despite its associated health risks, has raised a lot of concern. There have been reported cases of permanent infertility or destruction of vital organs in the body due to prolonged or abusive use of this method.
Traditional method of family planning, according to FP Coordinator, Mrs. Eshiet, entails the unscientific method women adopt to prevent pregnancy. This method involves the drinking of herbal concoctions, deployment of withdrawal methods during sex, or in extreme situations, engaging in unsafe abortions if unwanted pregnancy occurs.
Giving an overview of Akwa Ibom State family planning current indices and trends, Ekomobong Oton, the Research, Monitoring and Evaluation Technical Support Lead of TCI, expressed worry over the rise in the use of traditional method of family planning.
She said from the data made available by the Nigeria Demographic and Health Survey (NDHS), six in every ten women within 15–49 years are not using any form of family planning, while traditional method users increased by more than 20% from 2018 to 2024.
She further stated that the 2023/2024 survey showed that users of traditional methods stood at 26.1%, while only 17.29% used modern contraceptives.
“Similarly, the users of modern contraceptives during the 2018 survey was 18.3, while between 2023/2024 it came down to 17.2 which indicates a shortfall of 1.5%,” she observed.
However, the decline in the use of modern contraceptives for traditional methods in Akwa Ibom is not unconnected with the stock-outs or non-availability of FP commodities in various health centres in the state.
The women, it was gathered, embraced the option (traditional method) due to both lack of adequate information on the dangers and reduced availability of modern FP commodities in the centres across the state.
From the Quality Implementation Assessment Supplies Checklist of TCI sighted by our correspondent, the last quarter indicated that 13 out of the 15 assessed facilities across the eight (8) LGAs experienced stock-outs.
The most commonly unavailable method was Microgynon, followed by IUD, female condom, male condom, Jadelle, implanon, among others.
The few commodities found in some health centres in the state were gotten through the support of some partners which may withdraw their support at any given time.
It’s a known fact that the United States Agency for International Development (USAID), which played a significant role in funding family planning commodity procurement, has severed its funding ties with African countries, Nigeria inclusive, thereby bringing to the front burner the need for State governors to take up funding of family planning commodities in their States.
Meanwhile, 11 States of the federation have implemented the State Funded Procurement Guidelines on family planning in 2024 to align with Nigeria’s FP2030 commitments.
The States that have implemented the guidelines by funding FP procurements include: Delta – N30 million, Osun – N30 million, Edo – N27 million, Rivers – N40 million, Adamawa – N22 million, Ondo – N20 million.
From the foregoing, Akwa Ibom, an oil-producing state with huge revenue from FAAC, has not contributed to the national pool for the procurement of FP commodities, neither has it released money directly for the procurement of commodities and consumables.
It was gathered that there were approvals for procurement of FP commodities in the Akwa Ibom State budget over the years, but there was no release.
Giving an insight on this, the FP Coordinator, Eshiet, said: “We had intentionally proposed a budget last year, about N100 million, but by the time the approved budget was out, I was told that N10 million was approved for family planning services over the years, but no release.
“Recently, in 2022, the Federal Ministry of Health, with support from UNFPA, came to Akwa Ibom and they disseminated guidelines for state procurement of family planning commodities and consumables and support for distribution.
“Akwa Ibom adopted that document and we have been presenting the document and forecasting the quantification of FP commodities for 2023 and 2025. That document was submitted to the then Commissioner, Ministry of Health; till that period elapsed, we didn’t have any release for procurement.
“Most states have contributed to the national basket fund or the states procure themselves by employing private sector organisations to help do the procurement.
“In the South-South zone, three states have contributed and Akwa Ibom State is not part of it. I feel the governor is not yet aware of this; we are trying to see how to reach out to him to ensure that he buys in.”
Akwa Ibom Govt Makes a U-turn, Promises More Attention to Family Planning
Meanwhile, the Akwa Ibom State government, through the Ministry of Health, has promised to live up to expectation by giving adequate attention to procurement of FP commodities and services. He said funds for the State’s contributions into the National Basket Fund for family planning would be first captured in the next budget.
The Commissioner for Health, Dr. Ekem Emmanuel, had expressed optimism that the Governor, Pastor Umo Eno, being a man that prioritises health, would ensure release of the approved funds in the budget, even as he noted that the Ministry will play a key role to ensure a follow-up.
