Increased spending on contraceptives should go with increased health spending

The minister of health, Isaac Adewole, assured the international community, in the just concluded London submit on family planning, that the federal government would scale up access to contraceptives. The minister says the federal government would increase its annual allocation for contraceptives to $4 million.This is laudable but not enough.

There is no doubt that Africa’s staggering growth is fueling migration crisis in Europe and keeping millions in poverty. This is partly because of constant pregnancy. This explains why international donors are willing to support family planning in Africa.

But Nigeria’s underfunded healthcare sector would need more investments in order to cope with the consequences of increased use of contraceptives.

One reason for this is that most women cannot control their fertility through contraception alone, even when using some of the most effective methods. Thus, family planning, in the real sense, is contraception and abortion – which could be late stage and costly.

For instance, the British Pregnancy Advisory Services (BPAS) reported that one in four women who had abortion in 2016 were using the most reliable methods contraception. And they often spotted their pregnancy late because they hadn’t expected their contraception to fail.

And because hormonal contraceptives, such as pills and patches, could mask early symptoms of pregnancy because they may cause light or irregular periods, many women who became pregnant found out late. Mostly after 20 weeks, the BPAS reports.

Nigeria’s underfunded healthcare sector,which is still facing high maternal mortality rate, would find it extremely difficult to deal with complications from late stage abortions, unless something is done to improve its quality.

There is another reason for abortion: though oral contraceptive pills and the long-acting methods (LARCS) – which include contraceptive injections, implants and intra-uterine devices (IUDs) or systems (IUSs) –have proved to be effective, they could fail when not properly administered or when devices move or fall out.

It is not all bad news for contraceptives. It has improved the quality of life of many women and, of course, the lower doses of hormones in birth control pills have reduced well-known side effects.

However, a study published in Lancet – one of the most prestigious medical journals – reports that long-term use of oral contraceptives could be a cofactor that increases risk of cervical cancer by up to four-fold in women who have human papillomavirus infection. (There are other long-term side effects that have been published in Catholic journals, but these are still subjects of contention.)

Ordinarily, cervical cancers are the easiest type of cancer to treat when detected early. And in developed countries, women are always reminded about keeping their Pap smear test up to date.

But not in Nigeria. Many educated women in Nigeria, who are sexually active, have never heard of the Pap test, not to speak of doing one. A recent study published in the Nigerian Journal of Basic and Clinical Sciences confirms this.

Increased contraceptive use should be accompanied with investments in cervical cancer awareness. It will not be out place to also make cervical screening tests compulsory for women above 21 years as it is done abroad. All these will cost money.

It is not enough to get supplies of tons of contraceptives –such as the sub-cutaneous Depo Medroxyprogesterone Acetate injections the minister is advocating. For Nigeria to enjoy the benefits of these contraceptives, they should be accompanied with huge investments in women’s healthcare.