SPECIAL REPORT: How COVID-19 lockdown impacted Family Planning schemes in Nigeria

SPECIAL REPORT: How COVID-19 lockdown impacted Family Planning schemes in Nigeria

On a Friday in May 2020, the second month into the restriction of movement announced by the Nigerian government to curtail the spread of the then-novel coronavirus infection, the cloud thickened in preparation for a downpour.

Joy Caleb and her husband, Fidelis, had almost finished their weekend tasks for the day and their three children were already fast asleep.

With the cold weather and cosy atmosphere as an incentive, the couple ditched their next chore to have an intimate time together.

The session was going on smoothly until Mr Caleb reached for a condom at their bedside drawer.

He ran his left hand through the drawer but felt nothing. He checked a second time, still nothing. He then paused and stood up from the bed to search properly. That was when he realised they had exhausted their stock of condoms.

He immediately dashed to a nearby pharmacy. Unfortunately, the health facility was out of stock.

The two other pharmacies in their area of Kubwa, Abuja, were shut and he could not search further due to the restriction of movement.

President Muhammadu Buhari first ordered the lockdown in the Federal Capital Territory and a few other states on March 29, 2020. This was later extended to other states with flight restrictions that lasted until September 2020.

Though health facilities were exempted from closure, the difficulty in accessing public transportation and products forced many to shut down during the period.

While the lockdown lasted, the scarcity of condoms forced the Calebs to adopt the “fertility awareness method.” This involves calculating the fertile time of the wife’s menstrual cycle; and should they experience a slip, she could use a morning-after pill.

But this was a difficult choice for Mrs Caleb. She said they opted for condoms because other contraceptives gave her hormonal imbalances and uncontrolled weight gain.

However, by the second week of July, Mrs Caleb noticed her period had been late for two months. The pregnancy test kit indicated she was pregnant. She visited the hospital where it was confirmed. This news was a mixed grill for the family; good news at an unexpected time.

“I know I should not be saying this because having a child is a thing of joy, but the truth was that we were sadder than being happy. Abortion was not an option because my faith abhors it. So we started preparing for the new arrival,” she said 

Meanwhile, while it was a lack of condoms for Mrs Caleb, for Yuskhalifa Muhammad who also lives in Abuja, the issue was a price increase for condoms.

“During the lockdown, I wanted to buy a ‘Kiss’ condom in the estate where I live but I could not find one. So I trekked for about 20 minutes to other pharmacies in the neighbourhood but still could not get any. At the fourth shop I checked, I noticed that the price had increased by more than 30 per cent, and the money on me could not buy one.”

Nakoje Lucious, a student of the University of Abuja, said a higher price and scarcity of condoms discouraged him from sex during the lockdown.

He said a pack of Gold Circle brand he used to buy for N80 initially increased to N120, and then “suddenly, the price jumped N200.”

“I also use the ‘Kiss’ brand which was N200 but now it is N300. Since I couldn’t buy it regularly like before and I am afraid of unprotected sex, I decided to abstain,” Mr Lucious told this reporter on the telephone.

Sharing her experience with this reporter, a sexologist and founder of perhaps Nigeria’s first sex-positive community – RevaginatedNG, Sanasi Amos, said she received many inquiries suggesting increased use of contraceptives during the lockdown.

Why scarcity?

Findings by this reporter revealed that the ban on international flights and restrictions on cargo vessels across many countries created supply chain problems for contraceptives such as condoms.

Concerned by a possible population explosion, the United Nations Population Fund (UNFPA), in a 2020 report titled ‘Condoms and lubricants in the time of COVID-19’, lamented that border closing, restrictive measures, delays in processing shipments affected transportation and production of condoms.

UNFPA noted that scarcity would lead to “increased incidence of HIV, STIs and unintended pregnancies” which are described as risks that affect women and young people.

The global agency, therefore, emphasised the need to ensure the flow of condom supply, distribution, and promotion.

Also in April 2020, Miah Goh, the chief executive officer of Karex, the world’s largest condom manufacturer and supplier of one-fifth of the world’s condom output, warned of a looming global condom shortage as a result of the pandemic.

“The world will definitely see a condom shortage. It’s challenging, but we are trying our best right now to do whatever we can. It is definitely a major concern- condom is a piece of essential medical advice. While we are fighting the COVID-19 pandemic, there are other serious issues that we need to look at,” Mr Goh had said.

Dependence on Imports

Health experts warned of dire consequences for countries like Nigeria that depend on the importation of contraceptives.

A pharmacist in Ogun State, Gbenga Toye, said his facility almost ran out of stock of condoms during the lockdown “because purchase spiked.”

He said a major importer of ‘Kiss’ and ‘Fiesta’ brands of condoms in the country experienced difficulties at the port during the lockdown.

“The pandemic really affected a lot of commodities including condoms. This was due to the fact that Nigeria depends so much on imports. Most brands of condoms are imported and there were lockdowns in major cities of the world.

“Factories were shut down for weeks and even months. The few that were able to ship down to the country had issues to deal with at the Nigerian ports. That also contributed to the hike and scarcity of contraceptives. We were told the reason for the port issues was because there was a long line of cargo to be cleared with few hands available,” he said.

According to him, his facility gets a monthly supply of condoms but they started noticing the scarcity around May and June 2020.

“There was a huge drop in supplies, as high as 60 per cent. In fact, there was no Gold Circle brand in circulation. Also on demand were oral contraceptives,” Mr Toye said.

Ogechi Onuoha, Head of Marketing and Communications, Marie Stopes International Organisation Nigeria (MSION), a family planning organisation, said the law of demand and supply caused the increased price and shortage of condoms during the lockdown.

Increased post-lockdown birth deliveries

During the lockdown, health facilities also stopped a lot of their operations. Consequently, several health issues, including family planning services, were temporarily abandoned.

A UNFPA study updated in March 2021 suggested that if the pandemic continues to disrupt contraceptive use, in 115 low and middle-income countries, about 12 million women may be unable to have access to family planning services, resulting in a possible 1.4 million unintended pregnancies.

Another analysis by Global Financing Facility and the World Bank’s Development Research Group Health Management Information System (HMIS) further recorded that “family planning services in Nigeria decreased by 10 per cent or more in April and 15 per cent in May.”

Odunola Olabintan, a medical health trainee at Ekiti State University Teaching Hospital, said all the health resources were diverted to emergencies.

“The only unit that ran for a while was the emergency unit. Services were reduced. Family planning would have taken the back seat in anyone’s mind even up till now.”

Iyanu Bankole, who was then a Medical Doctor at Ekiti State University Teaching Hospital, corroborated Ms Olabintan; adding that the facility recorded low patronage, although they gave times for visits.

“People who came for antenatal services during lockdown greatly reduced because the visits were spaced out. If usually, someone comes every four weeks, the doctor will tell the person to come after eight weeks, unless there is a complaint,” Mr Bankole said.

“Nigerians felt hospitals were storehouses for the virus, as a result, people used more condoms. But post-lockdown, the number of antenatal visits increased which likely means that contraceptives or family planning failed.”

Mr Bankole estimated that antenatal visits at his hospital post-lockdown rose from 40 per cent to 90 per cent.

Similarly, at the National Hospital, Abuja, family planning services such as counselling, procurement and change of contraceptives were limited during the lockdown, Amina Ismail-Are, a gynaecologist at the hospital, said.

“The clinics were not running during that time, so people did not have access to family planning services. But afterwards, when the lockdown was eased, we started seeing patients,” she said.

A public health practitioner, Angelina Uzor, said her hospital at the Defence Intelligence Agency in Abuja witnessed a rise in birth deliveries from the beginning of 2021, which she linked to the lockdown.

“Now, there is a surge in the number of people that come into the hospital due to the pandemic. There are more pregnancies. A lot of people are coming for antenatal services and more people have given birth this year. We can trace all that to the lockdown.

“Even around me, I have seen many people put to bed recently. People that got married during the pandemic took in almost immediately. The amount of births from February till now has really increased,” she said.

While some hospitals had spaced visits, many patients refused to go to the hospital for fear of contracting COVID-19.

Statistics versus realities of family planning

Data obtained  from the Federal Ministry of Health on this subject do not tally with findings from interactions with medical experts and sources.

Data collated from hospitals across the country by the ministry showed higher birth deliveries between June and December 2020 with 796,228 births, compared to the first six months of 2021, which reduced by 30,813 births.

Robert Daniel, an official at the Health Ministry’s Family Health Department, however, faulted the data, citing inadequacies in reporting rates from states.

“We want to start going to states to conduct data quality assessments to really know what is happening. The births are more than what was indicated,” he said.

This inconsistency was further confirmed by data from the National Hospital, Abuja, where births in June 2021 were two times more than the figure given by the ministry.

Local contraceptives

When Kemi Adeyemi was told of the shortage of condoms in her area by her husband, she recalled a discussion with her former neighbours in Kano State that castor oil seeds prevent conception.

She then went to the market to purchase the seeds. She said she has been using the seeds since the lockdown and they work for her.

At some point, she said, she forgot to ingest the seed and feared she would get pregnant but she did not. She also introduced the seeds to her sister-in-law in January who, she said, has testified to its effectiveness.

“I have not discovered any side effects. My monthly menstrual flow has been regular. I have not had any issues that I know of. I get it in the market from women that sell herbs. I peel the outer part and eat it. I was told one castor oil seed is durable for a year.”

However, according to Encyclopedia Britannica, castor-oil plants produce oil-rich seeds which have poison ricin, considered as one of the most toxic substances. It warned that consumption of chewed seeds can be lethal.

Local herbs as possible solution to population crisis

Abdullahi Maidori, the acting spokesperson of the National Association of Nigerian Traditional Medicine Practitioners, said there are local herbal medicines for family planning.

He said the association has identified about 20 plants as local contraceptives, but they can only be used according to an individual’s blood group.

“Research is ongoing on these medicines at the University of Jos, ABU Zaria, Bayero University in Kano, and UNN. We are partnering with these universities. We have a national plan. There is one that someone can use just five seeds and it can last one for a year without conceiving,” Mr Maidori said.

He said the association presented a bill to the National Assembly for consideration and submitted some documents to the Ministry of Health.

“The bill is COVID-19 vaccine under traditional medicine. We want to present our herbal medicines for family planning. We have equally taken it to the states. For instance, in Plateau, we are already defending a bill at the Traditional Medicine Board.

“In Gombe, Bauchi and Kano states, we have a board for traditional medicine. In Abuja under the Ministry of Health, we have a department called the Council of Traditional Medicine. We want to create state operations of traditional medicines in Nigeria,” he added.

Health experts, however, said both the local methods and natural contraception do not prevent sexually transmitted diseases and are thus not medically endorsed.

Mr Bankole explained the required processes the plants must go through to be authenticated.

“Most of the drugs we prescribe for our patients, they go through three or more research studies to see how it will affect human beings and the research is done without any bias.

“Also, they need to know if it is reproducible such that other women can also use it and then it is made maybe into better materials like drugs or powder form.”

Asides from the local methods, some other recognised natural contraception methods are body temperature, cervical (vaginal) mucus discharge to determine ovulation, menstrual cycle, and calendar method. But Mrs Ismail-Are, the gynaecologist, warned that those have a high failure rate.

Funding challenges of contraceptives

Nigeria’s family planning sector has consistently lamented funding challenges and late budgetary releases.

Some of these commitments include counterpart funding to match grants from foreign donors and funding to improve family planning services

At a webinar organised recently Centre for Investigative Journalism (PTCIJ) and the Development Research and Project Centres’ (dRPC) experts indicated that in 2017, the Nigerian government committed to set aside $4 million (N1.2 billion then) annually from 2017-2020 to facilitate commodity procurement and distribution to respective states, but only N300 million of the agreed sum was released in 2019.

According to them, the constant delay and inconsistency in funds discharged has created a gap of N2.1 billion.

The Director of the Family Planning Branch in the Family Health Department of the Federal Ministry of Health, Lawrence Anyanwu, in July 2020, said over N2.6 billion had been spent on the family planning programme to procure and distribute birth control devices.

But Sakina Bello, Senior Program Advisor for Reproductive Health of Pathfinder International Nigeria, said while the Nigerian government has made remarkable progress, it needs to do more to address the funding deficit in the sector.

“Budgeted funds must be disbursed in a timely manner. In some states, the fund is released very late. They don’t do what they are supposed to do. They just rush to do activities they can do,” she said.

She canvassed alternative arrangements to provide adequate funding for family planning alongside coordination and involvement of all stakeholders, particularly the private sector.

Mrs Bello also endorsed local production of contraceptives as a solution to the scarcity of imported contraceptives.

“That is a conversation that we have been having for years now. Local manufacturing of our contraceptives has a lot of advantages. One, the cost will be less. Two, we will even have job opportunities for our people with government jobs not readily available,” she said.

More health experts proffer solutions

To prevent a repeat of contraceptives scarcity and limited health services during a global pandemic, the UNDP advised that condoms access be sustained through private sector outlets and community service points that support physical distancing and exploration of online ordering systems.

Mrs Onuoha of MSION advised the government to strengthen the distribution network of contraceptives at the facility level.

“It comes down to putting in place strategies to mitigate things like shortage of condoms or increased price of condoms, such that people can purchase contraceptives through e-commerce platforms and be delivered to them as against walking into pharmacies,” she explained.

Ms Amos, the sexologist, recommended that in the event of another health emergency, Nigerians can embrace the use of sex toys as it prevents sexually transmitted infections and unintended pregnancies.

For Olusina Ajidahun, a Registrar in Internal Medicine at the Federal Medical Center, Abeokuta, the government should invest in Primary Healthcare centres.

“The government should invest in more outlets, especially at the level of primary healthcare Centres. They are usually the first contact. If we have a lot of those centres, even if there is a pandemic, people can still access these centres to get contraceptives and increase supply.”

Mr Bankole called for more adolescent-friendly centres to increase the awareness of family planning at a young age.

(This article is part of ‘Covid-19 Response: Together for Reliable Information’; a project implemented by PAGED Initiative and supported by the EU & Free Press Unlimited).