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Fears Removed, Lives Improved

Three Women Define Their Future With Aid of Family Planning
Mariam Aliyu recalls meeting a NURHI social mobilizer.

Mariam Aliyu spent most of her life pitying women who used family planning. An ardent believer that family planning prevents a woman from the ability to give birth, the thought of adopting such a practice never crossed her mind. In spite of this strong conviction she was personally terrified at the thought of another pregnancy – a fear that was discriminatingly straining her marriage.

The 28-year-old traditional hair weaver was not alone in her fear of family planning. In communities such as hers it is commonplace for myths and misconceptions about family planning to run rampant, many of which are tied to strong religious and cultural beliefs.

“I used to think that as God is the giver of children…he knows how to go about it,” admitted 26-year-old nurse, Amina Jimoh.

As a religiously diverse nation, a common theme runs through the belief systems of many Nigerians: children are a gift from their creator and therefore no matter how many children a family is blessed with, God/Allah will provide the means to take care of them.

Experts recommend spacing pregnancies at least two years apart to prevent adverse health outcomes for the mother and child. In its campaign messaging the Nigerian Urban Reproductive Health Initiative (NURHI) focuses on this recommendation, highlighting the benefits of child spacing rather than limiting the number of children a couple should have. Formative research conducted by NURHI found that while many Nigerians report only wanting the number of children they can “cater for,” it is considered taboo, especially in the North, to promote a specific family size. 

After Amina required a cesarean section to deliver her third child she was nervous about quickly becoming pregnant again, a premonition that hindered her sexual relationship with her husband. Amina’s outlook shifted when a NURHI outreach program visited her community. It was at this chance meeting that she uncovered the great potential that family planning had to help her recover properly from childbirth and allow her newest family member to grow up healthy.

In response to these social norms, NURHI has selected and trained over 375 community artisans between the ages of 18-35 to join the ‘Get it Together’ crew. These volunteers serve as on-the-ground mobilization agents educating community members on family planning/child spacing, engaging urban slum dwellers in conversations on the topic and referring individuals to local NURHI-affiliated health facilities where they can meet one-on-one with a quality family planning service provider.

Amina herself was so satisfied with the choice to adopt family planning that she was motivated to act beyond the walls of her own home. “I have not only become a family planning user; I have also enlisted as a family planning promoter with the ‘Get it Together’ social mobilization crew and have been involved in activities here and in other areas,” she bellowed.

Unfortunately many women remain who wish to limit their family size but continue to feel unable to do so. “My husband and I used to think of how we would control the number of children we have,” candidly stated Angela Abuganto, a 47-year-old mother of five. “I was not afraid of family planning because I had it in my mind that it is a good way of preventing pregnancy, but we did not have the courage to go to the hospital.”

Perceptions of community support for family planning can largely impact a woman’s decision to use contraceptives. The NURHI Midterm Survey reported that between 38.2% and 47.9% of women in project cities believe that some of their close relatives and friends use family planning. However, in northern cities, such as Kaduna, over 25% of surveyed women have heard a religious leader speak against family planning or child spacing in the past year.

It was not until a service provider at a NURHI-supported health center counseled Angela and her husband on their options that they decided to use modern contraceptives. The couple chose the injectable, an effective family planning method that lasts for two to three month intervals. Coyly Angela boasted, “Now we enjoy sex more without fear and problem! My mind is now at rest…I can do anything with my husband. I am very happy.”

As for Mariam, after a social mobilizer visited her own community she learned of the many family planning options available to her that were both safe and allowed intimacy with her husband without worry of unintended pregnancy. After three years of using the implant, a long-acting contraceptive method, she and her husband are ready to have another child.

“Now I can boldly tell people that family planning does not stop somebody from giving birth, but rather helps to control the children that you desire to have,” Mariam asserted. “We can send our children to school…thank God for family planning that has removed suffering from me.”

NURHI is a five-year project (2009-2014) funded by the Bill and Melinda Gates Foundation with the aim of increasing the contraceptive prevalence rate by at least 20 percentage points in six urban centers: Abuja FCT, Benin City, Ibadan, Ilorin, Kaduna and Zaria. NURHI’s strategy is driven by the premise that demand for family planning can drive supply, leading ultimately to market-driven sustainability.