Fear and Misconceptions Keep Family Planning Out of Reach for Millions in Nigeria

Twenty-seven-year-old Simi Adewale (not her real name) and her husband, based in Abuja, North-central Nigeria,  eagerly planned to embrace family planning immediately after their marriage. However, this plan faced opposition from friends and family members.

“I felt that contraceptive was the only option for women who don’t want to give birth yet, so I decided to use it, but I was scared at first because there was a lot of controversy surrounding it,” she told HumAngle.

Simi was dissuaded from using any birth control due to widespread beliefs that contraceptives could lead to severe complications, including infertility.

A study by Health Think, an Abuja-based health think tank, highlights that inadequate access to family planning contributes to Nigeria’s growing population rate, making it one of the most populous countries globally, particularly in the northern region. The study identifies several barriers to effective family planning, including religious beliefs, spousal disapproval, widespread misconceptions about contraceptive methods, and substandard service quality, which collectively hinder the adoption of family planning practices nationwide.

The infertility myth 

Dr Abdullahi Usman, a Senior Registrar in the Department of Obstetrics and Gynecology at the University of Maiduguri, refuted the widespread belief that contraceptives cause infertility. He explained that contraception is the scientific means of delaying conception by spacing the number of deliveries to limit the number of children. 

He noted that couples who do not conceive after adopting family planning may have chosen a permanent method. “We have to understand what form of contraception is to be practised. It could be a permanent or temporary contraception,” he stressed.

Dr Abdullahi elaborated on the types of permanent contraception, such as tubal sterilisation for women and vasectomy for men. Tubal sterilisation blocks the fallopian tubes, preventing eggs from meeting the sperm, while vasectomy involves cutting and sealing the tubes that carry the sperm. 

Determined to delay the goal of raising children right after marriage, Simi decided to seek counsel from her doctor despite the claims. 

“I was not ready to get pregnant after marriage, so I consulted my doctor for guidance on contraceptive options,” she recounted. “I wanted to go for the pills, but he advised me not to use them because it was hormonal and could last in my system longer than I expected.”

According to Dr Abdullahi, the administration of contraceptives varies among women. For instance, women who are nearing menopause do not require contraceptives due to ceased ovulation. He also mentioned that a woman’s health status and profile are vital in determining the appropriate contraception method.  “Women with a high body mass index, hypertensive or diabetic women are not usually given an oestrogen base, so you can give them other options like progesterone, which include implants and injectables,” he said. 

Dr Abdullahi also noted that contraceptives could serve as treatment for certain conditions, such as endometriosis, highlighting that not all contraceptives suit every woman. 

He emphasised that contraceptives are readily available at Nigeria’s primary, secondary, and tertiary healthcare facilities, as well as in private centres. Couples seeking contraception can receive guidance on various methods, including natural, surgical, and medical options. The natural method involves timing intercourse around a woman’s fertile period, while medical options encompass hormonal contraceptives, injectables, and Intrauterine Devices (IUDs). Surgical methods provide permanent solutions.

Despite the availability of contraceptives, the United States Agency for International Development (USAID) reports that approximately 218 million people worldwide have unmet family planning needs, with African countries like Nigeria showing alarmingly low contraceptive usage amid rising maternal and infant mortality rates.

“The utilisation of these contraceptives is affected due to taboos, norms, and beliefs as well as lack of adequate knowledge.” Dr. Abdullahi lamented. He highlighted the need for greater awareness to dispel fears surrounding contraceptive use, noting that misconceptions often discourage women from exploring their options.

A survey published in the African Journal of Reproductive Health indicated significant barriers to accessing quality reproductive health and family planning services in Nigeria. Of the 3,080 women surveyed across Jigawa, Katsina, Yobe, and Zamfara States, only 43 per cent had heard of contraception and  7 per cent of currently married women reported using any method of contraception.

“These people don’t believe in contraceptives, so they hold onto the fact that it is God who brings children, so as long as it comes, they will just take it in,” he said.

Of side effects 

After consulting her doctor, Simi was advised to use an IUD, a small contraceptive device that is inserted into the uterus. “After the IUD was inserted, I then started having cramps and was experiencing severe bleeding compared to my usual menstrual cycle,” she said.

Dr Abdullahi acknowledged that while side effects vary among individuals, long-term complications are rare when contraceptives are administered correctly by a qualified professional. “The only long-term complication is among young women who opted for a permanent form of contraception. Studies have shown that young women who opt for bilateral tubal ligation tend to regret it in the future, especially women within the age of 35,” he said.

Hajara Bashir Ibrahim, a former Director of Nursing Services in the Nigerian Air Force, confirmed that common side effects, such as nausea, headaches, and breast tenderness, can occur. However, she reassured that women could stop using contraceptives at any time, with many being able to conceive within months.

Simi’s IUD lasted a year before she and her husband decided to remove it. Now expecting her first child, she plans to consider a different contraceptive method post-delivery. “I think I would prefer the implant on the arm since the IUD came with cramps and bleeding,” she told HumAngle, adding that she views the side effects as a manageable price for family planning, especially in light of Nigeria’s rising inflation.

A looming population crisis 

Nigeria’s rapidly growing population and economic struggles driven by inflation signal a potential rise in poverty unless population growth is better managed. 

In 2023, the World Bank estimated that 38.9% of Nigerians—around 87 million people—live below the poverty line, positioning Nigeria as one of the largest impoverished populations globally. As the population increases, the strain on resources and opportunities is expected to deepen hardships for millions.

Compounding the issue, limited job creation and constrained entrepreneurial prospects hinder the absorption of roughly 3.5 million Nigerians joining the labour market annually, which has led to mass emigration. The United Nations Population Fund projects that by 2050, Nigeria could be the third-most populous nation, with 400 million people. Such population growth will likely worsen health disparities and social vulnerabilities, particularly in rural areas.

Family planning, according to the World Health Organization, is critical to achieving sustainable development, fostering economic growth, expanding educational opportunities, and empowering women. Yet, as of 2021, only 40% of Nigerian women use contraception, as reported by UNICEF. Increasing access to family planning could be critical in mitigating the impacts of Nigeria’s population boom.

Dr Abdullahi urges couples to dismiss myths surrounding contraceptives. “You can go to a family planning unit where you will be advised properly on which form of contraception to take, and with that, there won’t be any regret,” he stressed.  

He also spoke on the role of men in family planning. “Even if a woman wants to use contraception, if the husband says no, then she won’t do it, so this means that the husband has a major role to play here. Family planning is key for a good and healthy family in terms of adequate provision for the children,” Dr Abdullahi said. 

He mentioned the need to educate couples on family planning so that society will benefit from it at large. “The community leaders have to be carried along in influencing decision making, and husbands should be encouraged to go with their wives to antenatal where they will be educated effectively,” he added. 

Hajara also echoed this position. “A lot is lacking in ensuring the accurate information on contraceptives is passed on to the average Nigerian woman,” she said. “Everyone needs to be involved in spreading the right message.”