Even though more women in northeastern Nigeria are beginning to use contraceptives to prevent pregnancy, many women still have misconceptions about their use and some will not consider it because of their cultural and religious beliefs.

But Maryam Yakub, the family planning officer at Yerwa Clinic in Maiduguri, Borno State, said through advocacy and awareness initiatives, there had been an increase in the number of woman who visited the health facility.

“Last year only four to five women a day visited the family planning clinic. Now we see 15 to 20 women coming every day, which means we are helping as many as 600 women a month.”

Yakub said some of the women went to the clinic without consulting their spouse. But it was important for husbands to agree to family planning and the decision to use contraceptives should be taken by both parties.

She said since there had been more awareness initiatives, many women now attended the clinic with their husbands – or at least with their knowledge and support.

She urged women to be extra careful when buying over-the-counter family planning drugs and said they should consult an expert for advice before doing so.

She said “child spacing” should also be part of family planning and that a mother should wait for at least 18 months before getting pregnant again.

Appropriate child spacing could reduce the risk for poor birth outcomes, such as preterm birth and low birthweight.

Hadiza Sani said she had given birth to four children in seven years.

“I went to the clinic with the full support of my husband so that we can start family planning.”

She had not known about contraceptives until her neighbour had told her about the clinic and had suggested she go there.

“We cannot afford any more children. We do not have enough money and sometimes even now we struggle to put food on the table every day.”

Another mother, Fatima Muhammed, said she and her husband had decided to use contraceptives because they wanted to be able to clothe, feed and school their two children properly. More children would just mean more expense.

The low uptake of contraceptives, aid agencies said, could be the result of low access to healthcare facilities, the patriarchal nature of communities and a lack of knowledge about contraceptive options.

The United Nations International Children’s Emergency Fund (UNICEF) said this was particularly so in overcrowded internally displaced persons’ camps.

A study released by the Women’s Refugee Commission (WRC) in 2020 said the use of contraceptives helped to prevent unintended and high-risk pregnancies that often led to the deaths of mothers and babies.

Some religious and cultural norms, as well as myths and misconceptions, discouraged women from taking contraceptives. Often people believed taking contraceptives would result in health problems and even permanent infertility.

It said there was a critical need for sexual and reproductive health services, including contraceptive services, for displaced people.

Conflict-affected and forcibly displaced women and girls faced increased risks of maternal morbidity, mortality and gender-based violence (GBV); higher risks of sexually transmitted infections (STIs); greater risks of unintended pregnancy; and heightened risks of unsafe abortion and its associated complications.

The WRC said one of the areas most seriously affected by the insurgency in northeast Nigeria was Borno State where internally displaced women were most in need of contraceptives.

“We found that despite women and girls wanting to avert unintended pregnancy, huge barriers remain across the region to contraceptive access, especially for adolescent girls and unmarried women, who report high levels of stigma, which can deter them from seeking the often lifesaving care they need,” said Sarah Rich, WRC’s senior adviser for sexual and reproductive health.

The study showed that in addition to community stigma, barriers to contraceptive methods and services – as well as post-abortion care – included health provider turnover and shortages, lack of skilled providers and commodity shortages.

Despite Nigeria’s strict abortion laws, which allow for abortion only to save the life of a woman, abortion was common but often dangerous, with women and girls resorting to unsafe – often life-threatening – abortions.

“The high maternal mortality rate underscores the need for government agencies to work with community health partners and humanitarian organisations to better ensure access to the full scope of contraceptive methods,” Rich said.

On Friday, September 3, the Federal Ministry of Health urged the media to create more awareness on family planning to enable Nigeria to achieve a better modern contraceptive prevalence rate by 2024.

Dr Kayode Afolabi, the ministry’s director, made the call during an online media training for health reporters and feature writers.

“The media platform is easily accessible to disseminate key information and create awareness on the use of family planning,” he said.