IMPORTANCE OF FAMILYPLANNING IN ARSH AND

MCHStella Akinso

State Team Leader

NURHI, Ibadan

FAMILYPLANNING , AN IMPERATIVE TO THE ACHIEVEMENT OF THE MDGs

• Introduction• Review of some Nigerian Demographic status• ARSH, MCH, and Link to FP• Benefits of Family planning• Barriers to Access RH/FP services• NURHI- Bridging the Contraceptive gaps• Conclusion

USAID | Health Policy Initiative, Task Order 1Futures Group International

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INTRODUCTION

• ‘Every year, 9.2 million young children (including 3.7 million newborns) and 536,000 mothers die during pregnancy and childbirth, while approximately 76 million unintended pregnancies occur worldwide. The need for strengthened family planning efforts is imperative if the MDGs are to be achieved

INTRODUCTION

• Several researches have indicated that It family planning may indeed be one of the most cost-effective development investments particularly in the achievement of the MDGs

• FP offer one major solution to the problems of unwanted/unintended pregnancies among adolescent is access to comprehensive information, that enables young people to make informed decision to use contraceptives

NIGERIAN DEMOGRAPHIC SITUATION

• Total Population Mid-Year 2009 estimated at 152.6 million and rate of population increase is 2.6%/year

• Married Women of Reproductive Age estimated at 25.7 million-

• Contraceptive Users estimated at 4.3 million for all methods

• Unmet need according to 2008 DHS is 20.2%• Total contraceptive prevalence is 14.6% (all

methods)• 72% of all women and 90% of all men know at least

one contraceptive method.

DEMOGRAPHIC/ FP SITUATION IN NIGERIA

• Maternal mortality ratio according to the 2008 NDHS is 545,000/100,000

• Total fertility rate is about 6 with many women desiring more children

• Nigeria has more than 10% of all global under five death and carries a disproportionate burden of childhood mortality

• HIV/AIDS prevalence 4.0%

Millennium Development • The millennium development goals are eight

important, time-bound goals agreed to by member states of the United Nations and international development institutions and aimed at improving general standards of living globally :They are

• Eradicate extreme poverty and hunger • Achieve universal primary education • Promote gender equality and empower women • Reduce child mortality • Improve maternal health • Combat HIV/AIDS, malaria, and other diseases • Ensure environmental sustainability • Develop a global partnership for development

FP AND MDGs- the link• Many studies and reports have confirmed

that improving access and use of family planning programs will help to achieve the MDGs, particularly goals 4 and 5

• If access to family planning services increases, then unmet need for FP could be met, therefore slowing population growth and reducing the costs of meeting the MDGs.

FP and Goals 4 & 5• In addition to saving cost through effective

family planning programs, improving FP unmet needs can contribute directly to the MDGs 5&6 to reduce child mortality and improve maternal health; family planning helps reduce the number of high-risk pregnancies that result in high levels of maternal and child illness and death.

• Prevent mortality and morbidity among adolescent resulting from clandestine abortion

• In a multi-country study titled “Achieving the Millennium Development Goals by USAID: The Contribution of Family Planning,” looks at how one strategy— ‘meeting the need for family planning—can reduce population growth and make achieving the MDGs more affordable in Nigeria, in addition to directly contributing to the goals of reducing child mortality and improving maternal health. ……….

FP NEEDS of young people• Many adolescent are ambivalent about sex

and contraceptive• High level of risky sexual behaviour• High incidence of unwanted pregnancy and

consequences• Of the over 600,000 annual abortion, over

60% are attributable to young unmarried girls• Young people need reliable information about

access to contraceptives in order to protect themselves from STIs, including HIV/AIDS, and unintended pregnancies. Information about contraceptives is important for all young people whether they are abstaining from sex or are sexually active.

FP and some benefits • Family planning programmes are organized efforts

in the public and private sectors, to provide contraceptive supplies, services, and information to couples and individuals who want to delay, space, or limit their children

• Helps couples to achieve their desired birth spacing and family size

• Offers protection against reproductive tract infections (condoms)

• Promotes marital union

• Prevent unwanted pregnancy, with its attendant risk of abortion, morbidity/mortality and high risk pregnancies

Challenges

• FP programme largely donor driven, all commodities donated largely by UNFPA since 1998.

• Inadequate resources for procurement of quality contraceptives, capacity building of service providers on Contraceptive Technology Update and Long term methods IUD and Implants.

• Stock out of contraceptive commodities• Religious and Socio-cultural inhibitions

Challenges of Access to FP in Nigeria

YEAR AMOUNT• 2010 $8,569,072• 2011 $10,635,37• 2012 $11,813,922• 2013 $14,076,128• 2014 $18,430,640• 2015 $17,081695

About $6.5 m mobilized for 2010 from UNFPA,DFID and USAID

Challenges contd.• Inadequate demand creation activities.• Poor attitude of health workers.• Inadequate Male involvement.• Low status of women.• Geographical and financial access.• Weak LMIS reporting.• Non inclusion of Private sector in the

distribution system• Lack of information, misconception• Socio-cultural and gender dimensions

NURHI -Who are we? NURHI is funded by the Bill & Melinda

Gates Foundation (BMGF)

And Implementing Consortium made up of

John Hopkins University/Centre Communication Program (JHU/CCP)

John Snow International (JSI)

Association for Reproductive and Family Health, Nigeria (ARFH)

Centre for Communication Programs, Nigeria (CCPN)

• Our vision is a Nigeria where supply and demand barriers to contraceptive use are eliminated.

• Our goal is to increase modern CPR in selected urban areas (by at least 20 percentage points).

• Focus on urban areas and the urban poor.

• Strategic focus on integrated and reinforcing supply, demand and advocacy and building on existing capacity and

resources.

Vision and Goal

• See family planning through the eyes of the consumer, the family and the community

• Take a holistic view of the supply side, to respond to the needs of the poorest and most vulnerable

• Use a theory-based approach, rooted in a social ecological model

Key Principles

• Committed to partnership, participation and capacity building

• Supply and demand side initiatives will be integrally linked. Demand will push supply and supply will rise to meet the challenge

• Build on what works while also discovering, testing and rewarding innovation

Key Principles (contd)

1. Develop cost-effective interventions for integrating quality family planning with maternal and newborn health, HIV/AIDS, post-partum and post-abortion care programs.

2. Improve the quality of family planning services for the urban poor with emphasis on high volume clinical settings.

3. Test novel public-private partnerships and innovative private-sector approaches to increase access to and use of family planning by the urban poor.

Objectives

4. Develop interventions for creating demand for and sustaining use of contraceptives among marginalized urban populations.

5. Increase funding and financial mechanisms and a supportive policy environment for ensuring access to family planning supplies and services for the urban poor.

Objectives

We believe that when we create demand, demand will drive supply. We will:• Create demand through innovative, consumer-first

campaigns and activities; • Incentivize supply with the tools, training, supplies,

and marketing support needed to meet demand and encourage continued investment in provision of quality FP services;

• Use advocacy to address regulatory, financing, systems and medical issues

• Focusing on increasing demand and incentivizing supply sets

market up for success, building long-term sustainabilityApproach will create new sets of social norms for both

consumers and providers

Strategic Approach

Why is NURHI Focused on Urban Cities

• It is estimated that about 47% of Nigerians live in urban environment and as a result more families live in cramped and unsanitary conditions.

• By 2035, 50% of Nigeria’s poor projected to be living in urban areas.

• This unique nature of urban poverty requires inclusive interventions and strategies that transform the challenges of urban slums into opportunities.

NURHI Project Sites

The Project has six operational sites in thecountry. These are:

1) Abuja2) Ibadan3) Kaduna4) Ilorin5) Zaria6) Benin City

Implementation Plan

Year One— Discovery

Years Two and Three—Implementation

Years Four and Five: Continued Implementation and Scale Up to New Sites

NURHI Discovery ActivityMLE Quasi - Experimental Design

Quasi-experimental design

– 4 intervention cities (Abuja, Ibadan, Ilorin, Kaduna); 2 comparison cities (delayed intervention) (Zaria, Benin City)

– Assessment of overall program cost effectiveness. Longitudinal study of women from each city

– Assessment of impacts by program activity by city

– Include approximately 3000 women per city

– Inclusion criteria – married & unmarried women ages 15-49; followed at two-year intervals (baseline, midterm, end-line)

NURHI’s contribution to the National Strategic Health Development Plan (NSHDP)

Strategic Area 2: Health Service Delivery

NSHDP Goal: To revitalize integrated service delivery towards a quality, equitable and sustainable healthcare

Indicator #30 (unmet need for FP) Baseline (21% NDHS 08) and Target (10% in 2015)

Indicator #35 (Contraceptive prevalence rate-modern) Baseline (9.7% NDHS 08) and Target (20% in 2015)

Indicator #36 (Health facilities experiencing stock-outs of key health commodities) Baseline (TBD) and Target (10% in 2015)

NURHI’s contribution to the National Strategic Health Development Plan (NSHDP)

Priority Area 7: Partnerships for Health

NSHDP Goal 7: To enhance harmonized implementation of essential health services in line with national health policy goals

Indicator #47 (proportion of states/cities implementing at least 4 new PPP initiatives per year

Priority Area 8: Research for Health

NSHDP Goal 8: To utilize research to generate knowledge to inform policy, improve health, achieve national and internationally health-related development goals to contribute to the global knowledge platform

Indicator #51 (proportion of research and evaluation studies undertaken on identified critical areas in the NSHDP framework (baseline TBD and 60% in 2015)

Observed Challenges to FP under the Integrated MNCH

• FP supply stock out in public health facilities at all levels

• No dedicated FP funding for improved MNCH by government at all levels

• FP/RH services currently not covered by NHIS

Expectations from Collaboration with Government

• NURHI collaborates with Government at three levels

Government to:• Provide the enabling environment for project success.

• Respond to the current gap in FP commodities and supplies to avoid a crisis situation of stock outs.

• Provide budgetary support to sustain FP/RH/MNCH programme at Federal/state/LGAs.

Expectations from THE MEDIA

• Diffusion of information• Play Strategic role in our advocacy strategy• Advocate particularly to government to

budget for RH/FP commodities• Provide correct information on FP to the

populace• Strategic Partnership

CONCLUSION

• By allowing women the freedom to control the number and spacing of their births, family planning helps women preserve their health and fertility and also contributes to improving the overall quality of their lives

• Because the effects of family planning are not immediate, long-term benefits would be see beyond 2015.

CONCLUSION

• Death due to abortion can be drastically reduced with effective FP programming

• Barriers to FP are well know and can be effectively managed with good programme

• Nation and state should put FP in their annual budget and rely less on donors

• There is no one way strategy to address barriers to access and utilization of FP , multiple strategies should be employed

USAID | Health Policy Initiative, Futures Group Internationall

Lets make motherhood safe together . Thank you