A Closer Look at The Human Cost of Contraceptive Shortages in Edo State
Usman Aliyu (Guest Writer)
Access to family planning services has become a struggle for many couples in Edo State. For the Isibors, the consequences of this shortage were devastating. After having three children, the couple agreed to take a break due to the economic strain of raising a family. However, when Mrs Isibor visited the Edaiken Primary Healthcare Centre (PHC) in Egor Local Government Area (LGA), she was shocked to find out that there were no family planning commodities available.
“It is not easy raising many children these days. So, my husband and I agreed to take a break for a while. Perhaps, when the economic situation improves, we may have one or two more,” Mrs Isibor explained. When they couldn’t afford the out-of-pocket expenses for family planning services, they turned to the withdrawal method as a last resort, but this method failed, resulting in Mrs Isibor’s fourth pregnancy.
The Isibors’ experience is not an isolated one. According to the 2023/2024 Nigeria Demographic and Health Survey (NDHS), 21% of currently married women and 36% of sexually active unmarried women have an unmet need for family planning. This translates to a significant proportion of women who are not using any form of family planning, leaving them vulnerable to unintended pregnancies and related health risks.
The United States Agency for International Development (USAID) estimates that almost 923 million women worldwide wish to avoid or delay pregnancy, and only about three-quarters of these women are currently using a modern contraceptive method. In Nigeria, 15.7 million is the estimated number of women of reproductive age who want to avoid pregnancy. The lack of access to family planning commodities is a significant contributor to this gap.
A Peculiarity in Edo
In Edo State, the shortage of family planning commodities has been worsened by the state government’s long-term failure to procure these essential supplies. For instance, in 2023, the State Government reportedly approved approximately N27 million for the procurement of family planning commodities, but surprisingly, these funds were not utilised. Dr. Stephenson Ojeifo, Director of Public Health in the State’s Ministry of Health attributed the setback to bureaucratic bottlenecks such as a delay or inability to secure the release of the approved funds. This inaction has resulted in PHCs lacking the necessary supplies, forcing women to seek alternative, often unreliable methods.
Furthermore, this trend continued in 2024, with the state government approving a similar amount in April, but once again, the funds were not utilised in a timely manner, with the state Ministry of Health only making the procurement in November, several months after the initial approval. This situation can be described as a shortfall in upholding people’s sexual and reproductive health rights. The African Charter on Human and Peoples’ Rights, which Nigeria has ratified, recognises the right to health, including reproductive health. Article 16 of the Charter specifically states that “every individual shall have the right to enjoy the best attainable state of physical and mental health.”
Since 2020, the state has partnered with organisations such as The Challenge Initiative (TCI), Edo State Primary Healthcare Development Agency (EDSPHCDA), and DKT Nigeria. Under these partnerships, TCI provides technical support and planning for outreach programmes in 42 communities across 14 LGAs, and the EDSPHCDA approved the use of primary health facilities for these outreach programmes.
Additionally, DKT Nigeria trains nurses to become family planning ambassadors, while the state’s Ministry of Health is responsible for providing family planning consumables and commodities. However, the state government has been unable to provide these essential supplies in a timely manner, hindering the effectiveness of this partnership.
Dr Mobolaji Akinrinmade, a sexual and reproductive health expert, underscored the importance of making family planning commodities available and affordable, especially for rural and underserved communities, asserting that non-availability or high cost of family planning services, such as Intrauterine Devices (IUDs), could be a significant barrier for many women
According to her, making the services available, free or affordable, is not only a right but also a measure to curb maternal mortality and morbidity arising from unwanted pregnancies. She called for government support through yearly budget allocation and procurement of these commodities and services in public hospitals.
“Assuming the service is rendered for N500 in our hospitals, many women will surely rush for it but charging more than N5,000 for the service is only discouraging in this economy. Amounting to a denial of the sexual and reproductive right,” Dr Akinrinmade explained.
Distribution based on demand
In an interview, Dr. Ojeifo, the director of public health, noted that the ministry had procured the commodities for 2024. Nonetheless, he said the distribution of the procured commodities in 2024 would be upon requisition from the health facilities.
“For distribution, we have a process, we don’t just distribute. The commodities are in medical stores. When the facilities need the commodities, they send their requisition,” Dr Ojeifo said. The director insisted that this process was in place to prevent the diversion of the commodities, claiming that any facility in need of the commodities understands the process of requisition.
“We don’t just supply them. They know the process; they send their requisition. The requisition is that you send what you need to the medical store. If we just supply them, people can sell them,” he explained.
To address these challenges, Muazu Maiwada, a procurement expert, recommended implementing an electronic procurement (e-procurement) system to enhance transparency and accountability in public expenditures.
Maiwada described e-procurement as the process of purchasing goods, works, or services using electronic systems, such as the internet or other digital platforms. The procurement expert said the system used technology to facilitate and streamline the process, from requisition to payment.
According to him, this system would enable the government to track procurement processes, reducing delays and mismanagement. Dr. Akinrinmade said strengthening the supply chain for the commodities was crucial to ensuring timely and efficient delivery. This, she said, was achievable through improved logistics, storage, and distribution systems.
She also urged the government to implement contraceptive security initiatives to prevent stockouts and ensure steady supplies of the commodities. According to her, the initiative involves forecasting demand, managing inventory, and establishing emergency funding mechanisms.
“At the same time, regular monitoring and evaluation of family planning commodity supplies would help identify gaps and challenges, informing policy decisions and ensuring effective resource allocation” Dr. Akinrinmade stated.
She continued: “Establishing accountability mechanisms, such as reporting requirements and auditing processes, would help prevent corruption and mismanagement. Regular audits of the commodity supplies and procurement processes would also ensure transparency. Building the capacity of healthcare providers and logistics personnel through training programmes, workshops, and initiatives is also necessary to ensure that family planning commodities are managed and distributed effectively,” the sexual reproductive expert said.
By implementing these measures, the Edo State Government could boost accountability in the supply of family planning commodities, reduce procurement delays, and prevent mismanagement and corruption.
