Volume 38 - Article 12 | Pages 287–308  

Factors explaining the North–South differentials in contraceptive use in Nigeria: A nonlinear decomposition analysis

By Stella Babalola, Olamide Oyenubi

Response Letter

16 February 2018 | Response Letter

Involving men in family planning programming

by Irit Sinai

We read with interest the manuscript on factors explaining the North-South differentials in contraceptive use in Nigeria (Demographic Research 38(12):287-308). We applaud the authors for exploring this important issue, and for their thoughtful consideration of programmatic implications of their findings.

As the authors demonstrate, there is a significant difference in contraceptive uptake between regions in the northern and southern parts of Nigeria. Through quantitative analysis of Demographic and Health Survey data, the authors identified sociodemographic and socioeconomic characteristics, conjugal relationship dynamics, intimate partner violence, ideational variables, and Islamic culture, as important contributors to North-South disparities in contraceptive use. However, to design programs for increasing contraceptive prevalence in Northern Nigeria, it is important to understand more in-depth the nuances of why couples in the region choose to not use contraceptives.

Supply-side interventions to increase contraceptive uptake are meaningless, as long as couples desire many children. No matter how comprehensive and high quality family planning services are, if couples want more children they will not attend them. A recent literature review (Sinai et al., 2017), showed that indeed couples in northern Nigeria desire many children, because:

• Muslims (religious majority in the North) follow the religious injunction to procreate;

• There is a prevailing belief that children are gifts from God, so should not be refused;

• Men want their lineage to continue through their (many) children;

• More children mean higher prestige; and

• In polygamous marriages, wives compete with each other to have the most children, believing that the more children they have, the more their husband would love them, and so that their children would get a larger part of the inheritance; in monogamous marriages, women want to have many children, so that their husbands will not want to take a second wife.

When couples do want to space or limit their children, perceived societal opposition or disapproval inhibit contraceptive use. Women who use contraception are often perceived to be promiscuous; men who allow their wives to use contraception are considered weak.

The literature review further confirmed that Islam in Northern Nigeria is not just a religion, but a complete way of life that governs behaviours both inside and outside the home; and that many women in Northern Nigeria do not go out, socialize, or work without their husband’s explicit permission.

These cultural aspects of Northern Nigerian society must guide any programs designed to increase contraceptive use in the region. We agree with the authors’ recommendation for programs which involve religious leaders and promote small family norms and women’s self-efficacy to negotiate contraceptive use with their husband. However, in our opinion, the key to success would be working with men. Men in Northern Nigeria are the decision makers, and their wives consider this the natural way of things. Therefore, men must be considered in any demand-side programming in Northern Nigeria.

Irit Sinai, Ph.D. and Olugbenga Oguntunde, MD

Reference

Sinai, I, Anyanti J, Khan M, Daroda R, and Oguntunde O. (2017). Demand for women’s health services in Northern Nigeria: a review of the literature. African Journal of Reproductive Health 21(2):96-108.

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