There have been many salient issues that we at Nigeria Health Watch have drawn to our audience’s attention in the span of 2016. As the year draws to a close and we look forward to continuing to lead the charge in 2017 for a more efficient and responsive health sector for Nigerians, we felt it a necessity to highlight a lingering concern that seems to have been given little public attention in the discus of health sector challenges; Nigeria’s explosive population growth. This “elephant in the room” affects every sector of Nigerian life, and without concerted efforts to address it, will pose a critical roadblock to efforts to improve the living conditions of the average Nigerian. Nigeria Health Watch Public Health Analyst Dr. Ifeanyi Nsofor in this week’s Thought Leadership piece evaluates the scope of the problem the “elephant in the room” poses to not just the health sector but nation building as a whole, and raises the question of why one of the most logical interventions– family planning – does not seem to currently be effective in Nigeria, and what needs to be done to change this.
In 1960 Nigeria’s population was estimated to be 45.2 million people. In 2015, the estimated number of people in Nigeria had grown to 182.2 million, a 300% increase in 56 years. Nigeria is estimated to be the third most populous country in the world by 2050 with a population of 399 million people. In all ramifications, Nigeria’s population is growing faster than development can cater to, faster than resources to maintain it, faster than the best attempt at any type of population control.
Why is this of critical importance? Explosive population growth affects our ability as a country to plan for adequate resources to meet the needs of every Nigerian. For the health sector, this is incredibly problematic, especially in light of the paucity of current resources. How can an already ailing health sector even begin to address the needs of a population whose growth is spiralling out of control? Addressing the challenge needs to happen on several fronts and one that is closely tied to health is the front of family planning.
Family planning allows couples to decide the number of children they desire and empowers them to ensure those children are given the proper environment to thrive by spacing pregnancies accordingly. It is achieved through use of contraceptive methods and the treatment of infertility. Some developmental benefits for family planning include reduction of maternal mortality, giving more girls access to education, and improving the economic wellbeing of women, families and nations. If accepted and practiced widely, family planning could be a potential game changer in the long run to the unprecedented population growth that Nigeria now faces.
There are two key indicators used to measure family planning; Total Fertility Rate (TFR) and Contraceptive Prevalence Rate (CPR). The TFR is a measure of how many children a woman would give birth to at the end of her childbearing years. The 2013 Nigeria Demographic and Health Survey (NDHS) shows a TFR average of 5.5 births per woman. In Nigeria, TFR is higher among rural populations at 6.2 than urban populations, where it stands at 4.7 births per woman.
The CPR is the percentage of women who, with their sexual partners, are practicing any form of contraception. It is usually measured for married women ages 15-49 only. Nationally, the CPR increased marginally from 14.6 in 2008 to 15.1 in 2013. The use of contraceptives in Nigeria is not encouraging; ranging from a high of 38 % in the South West to a low of 3% in the North East. Contraceptive use in urban areas is three times that of rural areas. Also, contraceptives use is higher among people who are educated.
Three facts are evident from the chart above:
- Contraceptive use improves with education;
- Contraceptive use is higher in southern Nigeria and;
- Contraceptive use is higher in urban centres in Nigeria.
There is no State in the North-West zone of Nigeria that records modern CPR of up to 2% (ARFH/ESMPIN). It is therefore not surprising that the 2013 NDHS shows the North-West zone as having the highest TFR of 6.7%. Simply put, a woman of child-bearing age in Jigawa, Kano, Katsina, Kebbi, Sokoto and Zamfara States has an average of approximately seven children. It is not uncommon for women in this region to give birth to more than 10 children.
While contraceptive use is low in Nigeria, knowledge of contraceptive methods is high. Across all geopolitical zones, knowledge of contraceptive methods is higher among men than women. One pertinent question that development experts and government must ask is, With this level of knowledge of contraceptive methods across all geopolitical zones, why is the use of contraceptives so low? It appears efforts to increase knowledge have not led to a corresponding change in behaviours towards use of contraceptives. This disparity is the core of the challenge that faces those working to improve family planning practices in Nigeria.
To unpack Nigeria’s unprecedented population growth, it is imperative to compare changes in the populations of the United Kingdom and Nigeria between 1960 and 2016. In 56 years, the population of the United Kingdom grew by 20% while Nigeria’s population increased by more than 300%. In contrast, 2015 GDPs of United Kingdom and Nigeria were $2.849 trillion and $481 billion respectively.
With limited availability of resources and overwhelming needs, family planning and child spacing must be brought to the front-burner of national discourse. We just cannot keep dodging the issue and expect to leapfrog development in Nigeria. By 2050, these six countries are expected to exceed 300 million in population: China, India, Indonesia, Nigeria, Pakistan, and the USA. The difference will lie in whether the resources available to each country can effectively take care of its citizens.
The 2017 budget presented to the national assembly by President Muhammadu Buhari is the largest ever budgeted in the country. Yet, if the 7.298 trillion naira budgeted is shared equally amongst 182 million Nigerians, each person would get a measly 40,000 naira. With today’s exchange rate of 450 naira to 1 dollar, 40,000 naira equals approximately $89. There are simply not enough resources to cater for Nigeria’s burgeoning population, which unfortunately is a time bomb waiting to go off.
The current average TFR of 5.5 births per woman is too high. There needs to be open and honest conversation about the correlation between the high TFR and continued population expansion, with clear commitment on measures to tackle the problem. Due to cultural and religious sensitivities surrounding family planning, people tend to become politically correct when it is discussed. Yet it is unhelpful to shy away from acknowledging the deleterious effects of an uncontrolled population explosion on our ability to plan and manage our limited resources.
Women in rural areas lack access to contraceptive #health services even when they want CS methods #ESMPIN #NgHlth pic.twitter.com/m3xAaLEKRv
— Nigeria Health Watch (@nighealthwatch) December 5, 2016
Knowledge of contraceptive methods is high in Nigeria; how can this be translated into actual use of contraceptives and practice of family planning? International development agencies such as ARFH, Marie Stopes International, Society for Family Health, FHI360, and NURHI, to name a few, are doing what they can to implement family planning programs in various parts of the country. But is it enough? Government and partners have been looking at family planning purely from a health standpoint, but this fails to take into account that population size and growth is a multi-sector issue that affects not only health, but availability of jobs, urban planning, climate change and the economy.
It is imperative to develop a multi-sectoral approach to family planning. Government should bring the budget and planning, environment, finance, agriculture, water and sanitation ministries to the table to jointly tackle this “elephant in the room” that is Nigeria’s explosive population growth.
If uncontrolled, this explosive growth can lead to competition for scarce resources, civil strife, population displacement, wars and eventual population migration. The discourse on family planning should no longer be the exclusive preserve of health workers.
It is time to change the narrative. Population expansion is the “elephant in the room” in Nigeria and we must confront it if we must improve the health and wellbeing of Nigerians.