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Rebecca Ejifoma reports how six nursing mothers in Alimosho area of Lagos State adopted various methods of post pregnancy family planning to avoid unplanned, and unwanted pregnancies, especially in this COVID-19 pandemic eraPost pregnancy family planning is a one-way ticket to preventing unplanned pregnancies, and population explosion.

Experts have argued that with this, women will have ample time to regain lost strength and blood, and the population will be contained.Before the global pandemic struck, and brought with it months of lockdown accompanied by many choking rules, the use of modern contraceptives was a challenge for some women in Lagos after pregnancy. This was heightened by the lockdown, which came so suddenly, leaving no time for adequate planning, but improvisations.

Despite the suddenness of the lockdown, many new mothers refused to throw caution to the wind- whether the method of contraceptive suited their body or not was no longer an issue, so long it stopped pregnancy, they embraced it.For these women, part of their fears were: their husbands would be home 24 hours of seven days like never before; everything was bound to happen including exclusive bonding, and unwanted pregnancies.

Mrs. Rachael Sunday

One of such women is 30 years old Mrs. Rachael Sunday. Since she had her first baby about 11 months ago, she has never used any method of family planning even though she desires to.

According to 2018 findings by the Nigeria Demographic Health Survey (NDHS), it shows unmet need for family planning increased by three per cent for married women nationally since 2013. With this increase in demand for family planning, Rachael isn’t part of the figures because her husband and her mother forbade her from joining the list of Nigerian married women using one form of modern contraceptives.

She narrated her experience. “My husband and my mother kicked against it strongly. That is why I can’t do it.”According to this mother of one, her mother’s opinion has more weight in her nuclear home; she would only allow Rachael take up family planning when she is done with childbirth.

“I was given a year plus for maternal leave. I tried to convince her that I want to avoid another pregnancy when my baby is still months old, still she refused,” Rachael expressed.

But for her husband and her mother, Rachael wishes to take up a family planning method to take her mind off unplanned pregnancy while still breastfeeding.

On how she prevents pregnancies, Rachael reveals, “My husband and I try to control ourselves. Not that we are not doing”, she chuckles , “We just try to control ourselves so that I don’t get pregnant”.

Although her husband and her mother have firmly cautioned her against the idea, Rachael has made up her mind to take up a method this year. “That should be this year by the grace of God,” she said clearly, “I will do family planning without my husband’s approval. I want to space my second pregnancy with three years gap. My husband and I want to have three babies only”.

Mrs. Excellent Aliu

While Rachael could afford to dot her i’s and cross her t’s during sexual intercourse with her husband, 30 years old Mrs. Excellent Aliu traded hers for relief.

As a new mum, Excellent’s baby is about three months old, but she has taken up a method already. This was because after childbirth in September, this first time mum could not go near her husband because they were both scared of unplanned pregnancy.

“After the first month of childbirth, I remembered the first time we wanted to have sex, we were so cautious and scared. My menses had returned; anything was bound to happen. After spending the time together, it was as if we didn’t do anything. Since we were not too sure and he doesn’t like using condom, I popped up the idea of family planning. He quickly gave the go ahead,” says Excellent.

As a career woman at 32, Excellent wants a space of two years for her babies to enable her be more productive, and healthy.

“By next year, I want to try and fix something for myself. I don’t want a situation before next year I’ll be pregnant again and before you know it, time is running out.”

Excellent has chosen implant to help her achieve her plans in life. “I have done implant. I can remove it after two years.”The good news for her is that getting implant is not pricey compared to you not doing it at all and getting pregnant.

“The little one you are carrying is still wearing diaper and yet you have started nursing another one again. Why not do the N3,000 implant?” she poses a question.Although this excited mum admitted that she bled for some days after she took up the implant, “I told a friend and she said it’s just for some time; it’s the body system trying to adjust but it has stopped.”

Mrs. Goodness

Now, while Rachael is still indecisive, and Excellent confident in her decision, another 30-year-old mother, who chose to be simply identified as Goodness A., had made up her mind right from the word go.

Today, Goodness is nursing her six weeks old baby girl, and she has taken up a family planning method already.

“I took family planning method on December 1. It is good for child spacing; it helps the mother take care of the ones she already has before giving birth to another,” she expressed with her tender baby girl clinging in front of her.Luckily for her, her husband holds no grudges against family planning. “My husband I are okay with two years spacing. And we have decided to have three children. I am taking Jadelle.”Mrs. Blessing ErukubamiAnother married woman benefiting from modern contraceptives despite already having three children aged nine, seven, and four is Mrs. Blessing Erukubami, who said: “I have been on implant since 2014 after I had my second child. I removed it after three years and did another one”.

During the COVID-19 lockdown, she rushed to get another implant when she realised the one she had expired already. “I was never scared of getting pregnant. I’ve been on implant although it’s during the COVID-19 lockdown I did this one.

”Although 30 years old Blessing is constantly on implant, she added, “After this, I would like to have two girls. My three children are all boys”.On the myths and misconceptions clouding the minds of many couples in Lagos, Blessing attested that, “no I’m not getting fat. I used to hear awful things before I did mine, but none of those things are true. The matron who did mine counselled me very well. I’m enjoying it”.

Mrs. Damilola Adebayo

23 years old Damilola Adebayo is a young mum of one actively using Jadelle family planning method.She recalls, “I used to attend antenatal at Emmanelle Hospital in Idimu when I was pregnant. My matron used to say ‘As soon as you deliver, you can get pregnant’. She told us about family planning so whenever I come for antenatal, I do tell her that if I give birth I would do family planning.

”Damilola’s reason for taking up a method is because she still has many things to do with her youthful life.“I don’t want to give birth to another child for now. I did jadelle, and it will last for five years. Even my husband accepted it. I don’t have any complaints about it; it’s okay,” says the young mum.

Mrs. Ejiro Peter

The case of 34 years old Mrs. Ejiro Peter, with a six-month old baby boy, shows reactions of some husbands to any method of modern contraceptives.Although she is yet to take up a family planning method, she has made up her mind to go for it now she is done with exclusive breastfeeding.

“I knew about family planning after my marriage three years ago. And I used to watch it on TV even before I got pregnant. I just finished exclusive breastfeeding, so I will take up implant next week during immunisation. It will be for two years since I want two years spacing between my children. I will go to the private facility next week where I had my baby.”

Ejiro has no plans of informing her husband. “Whether he accepts it or not, I will do it. I deliberately refused to tell him because he will discourage me with ancient myths of how his friend’s wife or neighbour used it and it was not good. I know him.”

Role of Family Planning ProvidersIn a visit to Santa Maria Hospital in Egan area of Lagos, the family planning providers enlightened the nursing mothers during immunisation on how to use the female condom.Not clear to a few of the women, they feared that the condom may fall into their bodies, and cause harm. The female providers, however, took time to clear their anxiety.

Before this general talk, there was the lockdown, which deprived them of such benefits. Many things happened in many homes including unplanned and unwanted pregnancies; thus, some women sought for abortion.According to 2012 studies by the NDHS, one of the factors contributing to Nigeria’s maternal mortality rate (MMR) is unsafe abortion. It accounts for 20 to 40 per cent maternal deaths in the country.

In 2012 alone, same study shows that 1.25m induced abortions were recorded in Nigeria. That is 33 abortions of every 1,000 pregnant women aged 15 to 49.

Sadly, NDHS findings also show that of every 100,000 pregnant women, 512 die during pregnancy or child delivery in the country.

At Santa Maria, the matron, Deborah Dominic and family provider at the clinic detailed her experience. “During the lockdown it was a bit difficult because everyone was afraid to come out and also come to the hospital for fear of contacting the COVID-19.“Thank God we had this technology where by we were able to make calls on phone and get in touch with most of our clients on phone and during the lockdown.”

At her facility, the matron and her team created a WhatsApp group and added all the nursing mothers, pregnant women, and others who had no interest in conceiving anymore.

“I saw two cases that came back with pregnancies during the lockdown and I told them that we’ve been telling you people at the ANC clinic about family planning but there’s nothing we can do but just to have the baby.“One of them has a six months old baby, and she is already pregnant. She comes for antenatal, and they are monitoring the other baby. The other one did not return because she wanted a DNC which we don’t do in this hospital, not for millions.”Another statistics by the NDHS of 2012, reveals that more than 60 per cent of women with unplanned pregnancies did not use contraception, just like the two women at Santa Maria Hospital.

Mrs. Joseph Luisa is the matron and family planning provider of Emmanuelle Hospital, Idimu. Dressed in her lemon green uniform that morning, she shared her in-depth knowledge of the subject.

“During the lockdown, so many things changed, especially the attendance of the antenatal. Most of them were not coming and we were all worried about the fact that they were locked inside with their husbands.“So many unwanted pregnancies would have come. So, we reached out to our patients by calling and telling them to follow their cycle and the way they can prevent it,” she highlighted.But one strategy the facility put in place immediately after the lockdown was announced a week ahead, “We shared condoms to our patients so that they will have something to rely on”.Sadly, one patient, who had stopped childbirth became pregnant during the lockdown.“We have this patient that was very disappointed because she was to come for her injection during the lockdown, but never showed up, because she travelled. By the time she came back, she was already pregnant. This is someone that doesn’t want to have any child again. She had no choice, but to keep it. She was around for antenatal.”At Emmanuelle, the matron says there is an increase now in the uptake. “It is now we see an increase. So, we take time to enlighten them on the various methods.”Partnership with PPFPMeanwhile, some of the knowledge the providers pass on to the women today they received from the Post Pregnancy Family Planning (PPFP) project operating within the private sector in Lagos state.“PPFP has been wonderful, and very good friendly staff. We enjoyed most of their seminars frequently. When we get back to our facility we train other people. They visited the hospital and did a makeup room, which is very fantastic,” the matron disclosed.Like Santa Maria, Emmanuelle Hospital boasts of the intensified training PPFP equipped them with.“We knew about family planning not that we are not doing it, but the way they made us understand it now is in-depth. During COVID-19 period, they assisted us with some of the preventive equipment and they are always there whenever we are in need. I’m happy about the partnership,” Luisa said.Efforts by Lagos State GovernmentFrom the narration of the providers, it shows that Lagos State is indeed making progress following its approval of N92m budget allocation for family planning in June to train health workers, establish youth-friendly centres, and procurement of family planning consumables and supplies.According to the Reproductive Health Coordinator, Lagos State Ministry of Health, Dr. Victoria Omoera, it has been a wonderful year with COVID-19.For a lot of client wanting to access not just family planning services, but services across board, there has been this fear to come to the health facility “That exposure to COVID-19 increases”.Omoera did not only assure nursing mothers that at the family planning clinic, they are ready to receive them, she also noted that they have stagnated appointment to ensure that they maintain some social and physical distancing for the safety of all.“More importantly, our health care workers, family planning providers have PPE. We guarantee we can maintain infection prevention, and ready to work.“We are open for service because the clinics didn’t shut. We are doing stagnated appointment; we render services. We don’t do sitting down together to have general talks to them – as you come in, we see you, and you go.”For the Lagos State government, its partnership with private health facilities on post pregnancy family planning is part of its efforts to purge the state of unplanned pregnancies, abortion, and increase in maternal mortality in the state.With its efforts, nursing mothers are gradually exuding confidence, adopting post pregnancy family as the soothing panacea to unplanned pregnancies.FindingsThe National Population Commission and the Federal Ministry of Health May 2019 findings released their 2018 Demographic Health Survey findings which showed that contraceptive prevalence rate (CPR) for married women aged 15 and 49 using both traditional and modern methods slightly rose from 48.3 to 49.4 between 2013 and 2018.Other states with increase in CPR are: Adamawa State recorded the highest increase at 470; Gombe followed with an impressive 325 per cent increase (from 4 to 17). While Kebbi State had 169 increase, Benue got 63 per cent, Plateau had 49 per cent rise; Ogun got 24 per cent rise; Niger had 15 per cent increase; and Lagos had two per cent.Whereas states like Kwara decreased by 44 per cent; Oyo decreased by 40 per cent; Kaduna slashed by 26 per cent; Nasarawa slashed by 18 per cent; and Cross River went down by 17 per cent.Although Nigeria set a goal to increase the modern CPR to 27 per cent of all women, it is still at 15 per cent. This shows that Excellent and Goodness are among the total number of married women using modern contraceptives in Lagos State, which contributed to the two per cent increase.