Nigeria - Mainstreaming Access to Emergency Contraception in Nigeria
Publication date: 2018
About Nigeria Nigeria is the most populous country in Africa with an estimated population of 190,632,261, with approximately half living in urban areas.1 Contraceptive and EC Knowledge and Use 5.5 children per woman total fertility rate (4.7 cpw urban / 6.2 cpw rural) 11.1% of all women currently use modern contraception methods 16.1% unmet contraception need reported among all women Data Source: Demographic and Health Surveys, Nigeria 2013 Knowledge of Modern Contraception and EC Among All Women (DHS, Nigeria 2013) Modern Contraception 83.8% EC 30.3% EC awareness is a precursor to use, so it is noteworthy that only around a third of women know EC exists, according to 2013 DHS data, despite the fact that ECPs have been available in the marketplace in Nigeria for approximately two decades.2 The PMA2020 surveys in Nigeria found a similar result, with 29% of respondents being familiar with EC. DHS has not measured use since the 2008 survey, which found that 2.8% of women had ever used EC.3 Use at Any Time of Modern Contraception and EC Among All Women (DHS, Nigeria 2008) Modern Contraception 24.0% EC 2.8% PMA2020 surveys use different methodology to measure use but suggest similar overall results and show that EC is more likely to be used by younger and unmarried women.4 Policies ESSENTIAL DRUG LIST: Levonorgestrel-alone emergency contraceptive pills at the 0.75 mg dose were included in the National Essential Drug List in 2016. NATIONAL NORMS AND GUIDELINES: In 2017, National Guidelines for Emergency Contraception were developed by the Federal Ministry of Health, supported by a coalition of partners. WHO IS AUTHORIZED TO PROVIDE: The 2014 Guidelines on Task-Shifting and Task-Sharing state clearly that various cadres of health-care workers are authorized to provide ECPs, including community health extension workers (CHEWS).5 Product Availability Many brands of EC are available in Nigerian outlets, including two brands socially marketed by DKT and Society for Family Health. In 2016-17, the government began procuring EC for distribution in the public sector. Mainstreaming Emergency Contraception in Nigeria FEBRUARY 2018 Nigeria was among the first countries in the world with a socially marketed emergency contraception (EC) product, and EC is widely available in drug shops and pharmacies in urban centers. Social marketing organizations as well as the commercial sector distribute many brands of EC. Policies have improved considerably and are generally supportive of EC access. However, the majority of Nigerian women do not know of EC. N IG ER IA NIGERIA Recent EC Activities In Nigeria The International Consortium for Emergency Contraception’s (ICEC) mission is to expand access to and ensure safe and locally appropriate use of emergency contraception worldwide within the context of family planning and reproductive health programs, with an emphasis on developing countries. ICEC has been working in Nigeria with multiple partners since 2010 to increase access to EC, with a strategic approach focused on the policy, service delivery, awareness, provider, and community levels. A number of activities have received support: KEY OPINION LEADERS VIEWS ON EC Provider and key opinion leaders’ attitudes, beliefs, and practices around EC greatly impact access. The Population Council led an effort to learn more about these views, providing insights into the best entry points to mainstream EC in Nigeria’s health system. SURVEYS OF EC USE IN LAGOS While Demographic and Health Surveys provide good information about knowledge of EC, less Is known about how many women are using EC, and how they use it. FHI360 designed a study that intercepted women in shopping areas of Lagos, finding that 16% of women had used EC. Repeat use of EC was uncommon.6 ADVOCACY FOR INCLUSION OF EC IN NIGERIA’S ESSENTIAL MEDICINES LIST EC is included in the World Health Organization Model List of Essential Medicines, and was adopted by the UN Commission on Life Saving Commodities for Women and Children as a key commodity. However, EC was not listed in the Nigerian Essential Medicines List (EML), until a coalition of Nigerian advocates came together in 2016 to provide the recommendations and scientific evidence required to add EC to the EML. After EC had been added to the EML, a group of Nigerian family planning experts drafted national guidelines for EC in the Nigerian health system. INTEGRATION OF EC INTO “EDUTAINMENT” Radio, television, and other media play an important role in educating people about new health issues and technologies. Using well-tested entertainment- education strategies, Population Media Center (PMC) integrated EC storylines into two new radio series (in Hausa and Pidgin English). ICEC trained writers and provided technical assistance on EC to support PMC in incorporating correct technical information on EC within storylines. EC SUPPORT FOR PHARMACISTS AND DRUG VENDORS Virtually all EC used in Nigeria is obtained through private pharmacies and drug vendors; the staff of these outlets are the crucial “front line family planning providers” for EC. The Society for Family Health, a social marketing organization and key provider of EC, created detailing materials on EC that can be used for pharmacy staff. These materials will be widely distributed to outlets across Nigeria to increase the technical capacity of these important providers. TRAINING HEALTH CARE WORKERS IN EC The Nigeria Federal Ministry of Health recently started providing EC through the public sector. To support public sector staff, the Association for Reproductive and Family Health (ARFH) is developing national EC curricula and training materials that will complement Nigeria’s existing National Family Planning Curriculum. Stakeholders from all levels of the health system were involved in reviewing and finalizing the curriculum and field tests were conducted to ensure the trainer and trainee manuals supplemented the current family planning curriculum in Nigeria. DKT Nigeria introduced another socially marketed EC product, PostPill, in 2014. EC MATERIALS FOR HEALTH WORKERS To support the introduction of EC into public sector services to expand access to hard to reach populations of women, the Center for Communication Programs Nigeria (CCPN) is adapting an EC brochure into local languages to be contextually appropriate to the region. The brochure received input from various stakeholders and was field tested before finalization. These recent efforts to expand access to emergency contraception in Nigeria are expected to have an impact in 2018 and beyond. The next Demographic and Health Survey, to be conducted in late 2018, will provide a valuable opportunity to assess the impact of this work. References 1 CIA The World Factbook, Africa: Nigeria. Retrieved Jan. 10, 2018, from https://www.cia.gov/library/publications/the-world- factbook/geos/ni.html 2 Demographic and Health Surveys, Nigeria 2013. ICF Macro and the National Population Commission, Republic of Nigeria, June 2014. https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf 3 Demographic and Health Surveys, Nigeria 2008. ICF Macro and the National Population Commission, Republic of Nigeria, Jan. 2009, http://dhsprogram.com/pubs/pdf/FR222/FR222.pdf. 4 PMA2017, Nigeria, Round 2. Accessed at http://pma2020.org/ sites/default/files/NGR4-NATIONAL-FPBrief-v12-2017-08-03-sj- ep.pdf 5 Task-Shifting and Task-Sharing Policy for Essential Health Care Services in Nigeria. Federal Ministry of Health, Aug. 2014. http://www.health.gov.ng/doc/TSTS.pdf 6 Chin-Quee et al. Repeat Use of Emergency Contraceptive Pills In Urban Kenya and Nigeria. International Perspectives on Sexual and Reproductive Health, 2014, 40(3):127–134. N IG ER IA This fact sheet has been prepared by the International Consortium for Emergency Contraception and represents the best information we have been able to gather. We welcome your input for future revisions. Please contact us at firstname.lastname@example.org. Visit our website at www.emergencycontraception.org for more information on EC.