Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy

Abstract

Background Over the years, family planning uptake in Nigeria has remained low and this is as a result of the various challenges and barriers faced by women. The aim of this study was to systematically review studies on family planning services undertaken in Nigeria in order to understand the challenges to uptake of the services and the policy implications. Methods A PubMed search was performed in June 2020 and studies that investigated challenges of family planning uptake in Nigeria published in English between 2006 and 2020 were sought. A combination of the search terms family planning, contraceptives, challenges, barriers, Nigeria was used. Review articles, case reports, and case studies were excluded. Studies that did not report barriers or challenges to family planning or contraceptives were excluded. Result Twenty seven studies carried out in Nigeria which provided sufficient information were identified and used for this review. The Uptake of family planning recorded in the reviewed studies ranges from 10.3 to 66.8%. Challenges that are client related include education, desire for more children, uncertainty about its need, partner disapproval, previous side effects, religious beliefs, culture disapproval, age, marital status, and wealth index, residence, ignorance, embarrassment, domestic violence and sexual factor. Health service related factors identified include cost, difficulty accessing services, and procurement difficulties. Recommendations for family planning propram and policy include targeting of health service delivery for improvement, focus on gender issues and male involvement, involvement of religious leaders, targeting of younger women for better education and counseling, and continuous awareness creation and counseling among others. Conclusion The review has shown that uptake of family planning remains low in Nigeria and challenges abound. We recommend that strategies that are multi-sectoral should be applied to address the multi-pronged challenges facing uptake of family planning services.

COVID-19 pandemic and unmet need for family planning in Nigeria

“…Those with tertiary education have lower unmet need for family planning than others. This finding corroborates previous research that lower unmet need for contraceptive use is recorded among women with more than secondary education [ 7 , 40 , 41 ], and further indicates that the need for higher education is key to attending met need for family planning. This is because it equally inspires the right decision making towards contraceptive especially in developing countries where access to modern contraceptives is generally low [ 15 , 17 , 42 , 43 ].…”

“…Those with 1-4 children have higher unmet need for family planning than those without children. Previous studies reported that women with two or more children have higher contraceptive use than those with only one child [ 36 , 40 ].…”

Household Structure and Contraceptive Use in Nigeria

“…The government of Nigeria and development partners in the country are making efforts to address supply-side issues related to contraceptive use and ensure that it becomes more widely acceptable both for spacing and limiting the number of children among women of childbearing age. Studies have shown however that demand-side challenges for family planning persist across the country and may be more difficult to tackle ( 27 – 32 ). This article is an attempt to contribute to the body of knowledge in identifying some household characteristics that may contribute to the demand-side challenges for family planning acceptance and use.…”

Modern contraceptive use among unmarried girls aged 15–19 years in South Western Nigeria: results from a cross-sectional baseline survey for the Adolescent 360 (A360) impact evaluation

“…Similar studies with girls in Ghana have shown no association [ 22 , 26 ], whilst a study in Tanzania showed higher contraceptive uptake associated with increased knowledge [ 12 ]. However, there is extensive evidence from Nigeria that misconceptions about contraception have a negative effect on contraceptive uptake [ 29 , 30 ].…”