Lafiya Sisters Expand Contraceptive Access for Women in Hard-to-Reach Jigawa Communities

Mahdi Garba (Lead writer)

Ikhlas Yusuf Yaqub, a full-time midwife at Dutse General Hospital, still finds time to volunteer with Lafiya Nigeria, an international non-governmental organisation (NGO) working to increase the uptake of family planning commodities in Jigawa State to reduce maternal mortality.

Since 2022, she has been a member of the Lafiya Sisters, a group of like-minded female health workers advocating for women’s access to Medroxyprogesterone Acetate, commonly known as Sayana Press, a self-injectable contraceptive. Through the NGO, the group consisting of 43 trained nurses, midwives and Community Health Extension Workers (CHEWs) serve as last-mile delivery agents for contraceptives across the state.

“Each day I come across someone, I tell them about the benefits of the Sayana Press. I also tell them to refer other women who might need it to me,” Ikhlas explained. “I cannot give exact numbers but on some days I introduce it to five women, while on other days, I convey it to ten women,” she added.

Access to modern contraceptives in Jigawa State remains limited due to low awareness, socioeconomic challenges, inadequate supply in healthcare facilities, and cultural and religious barriers. Traditional values, along with spousal and community disapproval, further limit women’s ability to obtain and use contraceptives.

As of February 2024, Jigawa State’s modern contraceptive prevalence rate (mCPR) stood at just 3.5%, one of the lowest rates in the country, compared to the national average of 15.3% among married women and sexually active unmarried women aged 15–49. Both figures remain far below the 2024’s coverage target of 27%.

To this effect, the NGO provides the Lafiya Sisters with Sayana Press, pregnancy test strips, and mobile phones for collecting and entering service data. “I believe that the introduction of Sayana Press has made more women aware not just about the commodity but about family planning in rural areas across the state,” said the Lafiya Sisters.

Contraceptives to the last mile

A single jab of Sayana Press protects a woman from pregnancy for up to three months. Each woman is entitled to four doses of Sayana Press a year, which can be administered by a provider or self-injected. Women who choose self-inject are given three additional doses to take home, saving them the stress of returning to the facility or searching for a Lafiya Sister to administer it.

Zainab Umar, a 32-year-old mother of five, explained “since my neighbour introduced me to Sayana Press three years ago, I have used the self-injectable contraceptive 12 times. Unlike the implants I used in the past, I have not experienced any [side] effect.” Her husband supported her. “Before I went to the clinic to collect it, I first told my husband. He agreed before I started. He is comfortable with it,” Umar said.

Murja Yawale, 27, another Sayana Press user, recalled that since she heard about the family planning commodity from one of the Lafiya Sisters, she has been using it for four years. “So far, I can say that this is a positive change for me. I enjoy using Sayana,” the mother of four noted. “I want to call on other women to use it too. It is taken to any house where a woman expresses her interest. They will teach you, administer the first one for you, and give you the rest to continue using it,” Yawale added.

Zainab Ahmad Adamu, Senior Programme Officer at Lafiya Nigeria who oversees the organisation’s activities in Jigawa, recalled that Lafiya Nigeria was first piloted in Kazaure Local Government Area (LGA), for a few months. Later, it expanded to 13 additional LGAs, with a Lafiya Sister assigned to each LGA.

“From then, we scaled up to 43 Lafiya Sisters across the 27 LGAs, supporting 43 facilities,” Zainab explained. According to her, Lafiya Nigeria has distributed 72,000 doses that translate to 18,000 CYP and 137 deaths averted throughout the year. She added that the organisation collects data from the Lafiya Sisters through mobile phones provided to them using Survey CTO, a digital data collection tool.

The Sisters first counsel patients, and once they have given full consent to use the product, the contraceptive is made available to them. They also use the form to indicate whether a beneficiary accepted the contraceptive and sends SMS reminders. Zainab added that they track usage to identify those not taking their doses and follows up to understand the reasons and providers support where needed.

Minimal side effects

According to Zainab, testimonies from the beneficiaries show the impact of their work. “The last time I went for a spot check, I met with a beneficiary who told me Sayana Press is a lifesaver for her because a doctor advised her not to get pregnant again. However, [when] she used other family planning methods, it gave her many side effects and they were not effective for her,” she recounted, adding that, “prior to [using Sayana Press], she had moved from one facility to another to abort her pregnancy because other methods did not work for her.”

Community buy-in and patient satisfaction are key factors behind the contraceptive’s success in Jigawa State. According to Ikhlas, bleeding after using the contraceptive are rare, and when it does occur, it is usually resolved with Excluton, a drug used to manage gynaecological complications such as bleeding.

Adapting to reduced USAID funding

Klau Chmielowska, Co-founder and Executive Director of Lafiya Nigeria, noted that the organisation has been affected by the United States Agency for International Development (USAID) funding cuts, reflecting the broader challenges faced by the entire family planning ecosystem in the country.

“The USAID cuts, alongside a broader tightening of family planning funding, has made it harder for organisations like ours to scale proven solutions,” she said. “Demand is growing, but without fresh investment across the ecosystem, progresses [are at] risk of slowing just when it should be accelerating,” Klau added.

Since the introduction of Sayana Press in Nigeria in 2017, there have been efforts by organisations such as DKT International, Society for Family Health (SFH) and Association for Reproductive and Family Health (ARFH) to increase uptake. However, more organisations need to step up to promote and expand uptake of Sayana Press across the country.

The defunding of family planning programmes has further widened the access gap, and calls for government reinvestment and collaboration with development partners to avert the consequences. There is an urgent need for state-level funding, private-sector partnerships, and robust domestic financing to sustain Nigeria’s Family Planning (FP) 2030 goals.

Building capacity and expanding reach

Zainab explained that one of the challenges the NGO faces is the skills gap among some of the Lafiya Sisters, as not all are familiar with data tools. She noted, however, that plans are in place to provide additional training to make their work more efficient.
 
Another challenge they faced, according to Zainab was non-compliance. Some women stopped using the contraceptive, before completing the recommended doses. However, the introduction of SMS reminders, has significantly improved adherence.

However, the challenge that persists remains reaching women in hard-to-reach communities. Despite this, Zainab expressed optimism that despite the challenges, Lafiya Nigeria plans to expand from 43 to 100 facilities, with 100 Lafiya Sisters across the state. She emphasised the importance of stakeholder engagement, noting that it has been key to Lafiya Nigeria’s success in Jigawa.