Beyond cultural barriers: northern Nigeria’s positive shift in family planning meets supply chain roadblocks.

Authors: A guest post from Otuto Amarauche Chukwu, a Vanier Scholar and Doctoral Researcher in Health Policy at the University of Toronto; and Maxwell Adibe, a Professor of Clinical Pharmacy and Pharmacy Management and the Head of Department, at the University of Nigeria Nsukka.

Africa’s most populous country, Nigeria, records around 20% of global maternal deaths.¹ Research has shown that family planning reduces the number of pregnancies, thus reducing the proportion of high-risk pregnancies and births.²

Evidence suggests that using family planning services prevents millions of maternal deaths globally.³ Despite these benefits, an immense unmet need for family planning services remains. According to the World Health Organization, over 200 million women in need of family planning services in developing countries do not have access to a modern contraceptive method due to limited access to family planning services.⁴ In Nigeria, contraceptive use is only 16%, and this figure is even lower (4.9%) in some areas of the country.^5,6

To close the gap between contraceptive use and the proportion of people who express a desire to use contraceptives, the Nigerian Government has implemented several policies and plans. Some states in northern Nigeria, such as Kano state, have begun implementing these policies and plans to improve access to family planning commodities.

However, there are still challenges, including stock-outs and last mile distribution challenges pointing to supply chain gaps.

Family planning supply challenges

Forecasting and procurement difficulties for family planning commodities have led to poor service delivery at family planning clinics. Issues of poor-quality data from the service delivery points, incomplete reporting and the complexity of the healthcare supply chain reporting structures cause delays and inaccuracies in data needed to forecast demand. Manual data reporting methods are still common in Nigerian health service delivery, which increases the likelihood of errors and negatively impacts decisions in quantification and supply planning. There are also general health system issues of limited infrastructure and human resources for healthcare.

In our study,⁷ as part of the Department of Clinical Pharmacy and Pharmacy Management at the University of Nigeria Nsukka, funded by ARC – Africa’s public health supply chain institution – we examined attitudes towards family planning and assessed the challenges in distributing family planning commodities and the subsequent effect on accessibility in Kano state in northern Nigeria.

Despite other studies reporting sociocultural influence on the use of family planning commodities in northern Nigeria, one of our work’s most interesting new findings was the overwhelmingly positive attitude towards family planning – particularly from women.⁷ We also identified some of the main blockers to accessing family planning services. The blockers are represented by a shift in the perceptions around the importance of family planning and can help the healthcare authorities to ensure better that demand for these products is met.

Our study used a descriptive survey to explore last mile distribution hubs for family planning commodities in Kano state, a regional powerhouse. The study involved three tiers of service providers: primary healthcare centres, hospitals (general and teaching hospitals), and state/zonal stores.

Importantly, we also engaged recipients of care at the last mile. Over 2500 end users of family planning services were assessed to ascertain their attitudes towards these services.

Findings from the study

Our research showed that in Kano state, most of the end users of family planning products were female, had no formal education, earned less than USD 25 per month and lived in villages. However, 80% had positive attitudes towards family planning, while I identified stigmatising attitudes in only a small minority of respondents (5%). The high number of people with positive attitudes indicates an appetite for family planning products and services. Still, the challenge remains to provide for this demand.⁷

We found that only 16% of the facilities had all the basic infrastructure requirements, with the majority having inadequate human resource capacity for logistics and supply chain management of health commodities. The results showed that only a quarter of facilities kept a record of family planning commodities, with around half of these facilities reporting encountering stock-outs.⁷

These challenges disproportionately affect women as they bear the human and economic costs of family planning service deficiencies.

The insights provided by our study are valuable for the Nigerian Government’s healthcare supply chain planning and investment as it highlights the opportunity to expand family planning across the country, particularly in northern Nigeria.

References

¹ WHO. Maternal health in Nigeria: generating information for action. 2019. https://www.who.int/reproductivehealth/maternal-health-nigeria/en/

² Ross JA, Blanc AK. Why aren’t there more maternal deaths? A Decomposition Analysis. Matern Child Health J. 2012; 16: 456–63

³ Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet 2012; 380 (9837); pp. 111-125

⁴ World Health Organization. (2020). Family planning/Contraception https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception

⁵ United Nations, Department of Economic and Social Affairs, Population Division. Trends in Contraceptive Use Worldwide 2015 (ST/ESA/SER.A/349)

⁶ Sinai I, Omoluabi E, Jimoh A, Jurczynska K. Unmet need for family planning and barriers to contraceptive use in Kaduna, Nigeria: culture, myths and perceptions. Culture, Health and Sexuality 2020; 22 (11); 1253-1268

⁷ Chukwu OA, Adibe, M. Challenges in last mile distribution of family planning commodities: effects on product availability and accessibility in Nigeria. Int J Health Plann Mgmt. 2023; 38(5); 1268-1283. https://doi.org/10.1002/hpm.3650