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| DKT Bee Lydia, a community health worker, gives Iya Lekan a Sayana Press injectable contraceptive at her house. She has five children and does not want any more, at least for now. |
This was originally published on Global Health TV on September 27, 2016.
LAGOS, Nigeria — Lydia, a community health worker for DKT
Nigeria, steps carefully as she navigates the grimy streets of Makoko, one of the worst slums
of Lagos. She is trying to avoid mud or something worse. The sanitation is
abysmal. But Lydia is on a mission — to bring contraception to some of the most
disadvantaged women in Nigeria.
This day, she calls on Iya Lekan. Although neither Iya, 36
years old, or her husband have regular work or specific sources of income, they
have five children to look after.
“I don’t know how many times I have given birth,” she says
in Yoruba, the local language here. “I’m tired.”
Iya told Lydia she was ready to start practicing family
planning. Lydia presented various options, and Iya chose a three-month
injectable called Sayana Press. Lydia immediately gave
her the injection in her upper thigh.
Some people think Sayana
Press could be a
game-changer. It’s a new version of the well-known Depo-Provera injectable
contraceptive, but contains 30% less of the active ingredient and can be
administered by lesser-skilled health workers. The United Kingdom has already
approved it for self-injection.
Last month, I spent an afternoon with Lydia, a member of the
DKT Bees, a group of community health workers (CHWs) who focus on family
planning in some of the grittiest parts of Lagos. DKT calls their CHWs “bees”
because they are like the hard-working insects that go from flower to flower
spreading pollen. But instead of pollen, DKT Bees go house to house counseling,
educating and dispensing contraceptives.
The road to greater contraceptive use in Nigeria has not been
smooth. It’s shocking that the percentage of married women using modern
contraception in Nigeria is
only 9.8 percent (Nigeria Demographic & Health Survey 2013). That
figure is lower than all countries in West Africa except Gambia, Guinea and
Mauritania, according to the 2016 World Population
Data Sheet, and has has hardly changed in the last ten years. Nigeria has a
population of 187 million, making it the seventh largest country on earth. If
current trends continue, it will be tied for third, with the United States, in
2050.
Clearly, family
planning has stagnated in Nigeria since 1999. The reasons are many but
certainly family planning myths and misinformation play a huge role. A DKT outreach
worker told me that some of the most common questions she gets from Nigerian
women are:
- What are the side effects of each method?
- Does family planning result in infertility?
- Does family planning increase body weight or make me fat?
- What do I do if bleeding occurs?
- Does contraceptive use predispose me to cancer?
The good news is that 16.1% of married women in Nigeria who
are not using family planning want to start using it. The figure is even higher
among sexually active unmarried women: 21.8 percent of them want to use
contraception.
World
Contraception Day on Sept. 26 provides a good opportunity to reflect on the
current situation and what we can do to improve it in places like Makoko, so
that every Nigerian woman who wants contraception can access it.
Decades of research have shown that modest investments in
family planning can save lives and improve maternal and child health. And consider
that family planning has been proven to be one of the most cost-effective
health interventions. In short, family
planning improves the economic well-being of families, communities and nations.
DKT Bees are one of the programs of DKT Nigeria, an
affiliate of DKT International. DKT
came to Nigeria in 2013 to help change the family planning paradigm. Using
social marketing, it launched Kiss
and Fiesta condoms, Postpill emergency contraception, Levofem oral contraceptive, Sayana Press injectable, Implanon NXT and Jadelle implants, Lydia
intrauterine devices (IUDs) and Miso-Fem (Misoprostol). After only three years,
it contributed
14% of Nigeria’s contraceptive prevalence rate in 2015.
Dimos
Sakellaridis, the country director of DKT Nigeria, says he wants to make
affordable contraceptives as easily available in Nigeria as Coca-Cola.
“Like
women’s beauty products or hairstyles, modern family planning should be
consumer-oriented and easy to understand, access and use,” he says. “When a
woman wants to feel beautiful, she walks to a nearby store and buys a beauty
product or service. Family planning should be obtained for the same consumer
benefits — to enable women to feel beautiful by allowing them to manage their
fertility and life.”
DKT Nigeria launched a new family planning communications
campaign that coincides with World Contraception Day on Sept. 26. The target
audience of its campaign is young
women ages 18-34 (primary) and young men ages 20-34 (secondary) in the
lower middle and working classes of southwest Nigeria. A new website, Honey and Banana, will serve as the
central hub of the campaign and will be the destination for other traffic
sources, such as Facebook, Twitter and Instagram.
The theme of the campaign is “Be Sharp.” The phrase is
common slang that resonates with the target audiences. It means be smart, not
dull. It means making the right decisions, especially concerning birth control
and contraception, to avoid unwanted surprises.
Almost one in five people living in sub-Saharan Africa is a
Nigerian. If enough girls and women are motivated to adopt contraception, the
government will meet its goal of reaching 36% contraceptive prevalence rate by
2018, and their health will improve. It all comes down to community health
workers like Lydia and the DKT Bees, going from house to house, taking one step
at a time, to meet the needs of disadvantaged Nigerian girls and women.
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