INTERVIEW: Why Nigeria must increase domestic funding for family planning

In this interview with PREMIUM TIMES, Koessan Kuawa, Deputy Country Representative of the United Nations Population Fund (UNFPA) Nigeria, discusses the challenges of limited access and availability of family planning tools, the misconceptions and hesitancy surrounding birth control, and the urgent need to increase domestic funding to support Nigeria’s family planning programmes.

Excerpt

PT: Nigeria has the highest population in Africa, with a high fertility rate and significant unmet needs for family planning. What factors contribute to these unmet needs?

Mr Kuawa: The unmet need for family planning is primarily due to a lack of financial resources. Unmet need means that people want access but do not have it. Unmet needs for family planning are usually caused by a lack of contraceptive commodities or limited knowledge about where to obtain them. In some cases, financial constraints prevent people from accessing these family planning tools.

However, the primary reason for the unmet need for family planning is the insufficient availability of commodities in the country, largely due to inadequate funding.

PT: There are myths and misconceptions about family planning in Nigeria.

Mr Kuawa: Yes, there are many misconceptions about family planning. One such myth relates to the effectiveness and safety of different methods.People use various family planning methods—some opt for traditional techniques, while others rely on medical approaches. However, some mistakenly use antibiotics or other medications not intended for contraception. This is a dangerous practice, as these medications do not prevent pregnancy, despite common misconceptions. Worse still, they can lead to serious health complications and negatively impact women’s reproductive health in the long run.
A major contributor to these false beliefs is the lack of proper information and education, particularly among young people.

PT: Which group would you consider the most vulnerable and that UNFPA prioritises when addressing limited access to family planning tools?

Mr Kuawa: At UNFPA, we adopt a human rights-based and gender-transformative approach, ensuring that access to family planning is recognised as a fundamental human right. It is not a luxury, nor is it coercive—it is a right that every individual should have. Our goal is to make family planning services and supplies as widely accessible as possible, guided by the principle of leaving no one behind.
Our priority groups include women and girls in deprived and remote communities, internally displaced persons (IDPs), and people living in hard-to-reach areas. We also extend our focus to individuals with special needs, such as persons with disabilities and those facing financial barriers that prevent them from accessing family planning services.

PT: So, how does UNFPA reach these people?

Mr Kuawa: We provide the services using a community-based approach, whereby community workers provide the information and access. We also offer contraceptives that can be self-injected, which allows people who cannot access health facilities or who are too far from health facilities to administer the tools themselves when they need to.

We also advocate for states to make family planning part of their basic services. That way, people can access some family planning tools at no cost at the primary health facility level.

PT: Are there specific states that UNFPA prioritises the most?

Mr Kuawa: No, we do not prioritise specific states or regions. Instead, our programmes are guided by the level of need and the vulnerability of the population. Areas with higher vulnerability drive our focus, ensuring that family planning services reach those who need them most.
Our programme covers the entire country, but in some regions, other partners are already actively working. To avoid duplication of efforts, we may not intervene in those areas. However, we do not prioritise any particular zone over another.

PT: How would you describe the hesitancy toward family planning in different parts of the country?

Mr Kuawa: In terms of reluctance for the uptake of family planning, I think it all has to do with beliefs and social norms. It all comes down to having the correct information. I will not say it is particular to Nigeria, but there are still some misconceptions about family planning, about even its reversibility. Some people believe that if you use it, you will be unable to have children when you want to have them later. This is why education and public enlightenment are important. Providing the right information at all levels to youths, women, and men in Nigerian communities will help resolve this.

PT: What measures has the organisation implemented to enhance public awareness of family planning?

Mr Kuawa: What we do at UNFPA is work with our partners. We work with the Ministry of Health and the Ministry of Education to provide accurate information to the public. We prioritise information for the youth and hard-to-reach communities so they can make informed decisions about their health, knowing what works and what doesn’t.

We also work to support the state governments in making modern methods of contraception available where they are unavailable. This is so that they feel less need to explore alternative methods that are not recommended.

We also have several sources of information made available, especially to the youth now. We have various platforms. We recently launched a platform called SoftLife 247 in October. It is funded by UNFPA and UNESCO and allows youth to have a self-paced education. You go in at your own pace, you can learn about the subjects, and you have access to information in anonymity and confidentiality. We also have other platforms that provide similar information to the youth. We have a chatbot called YouPlant, where youth can send text messages on WhatsApp to a chatbot that will provide them with reliable information.

PT: Nigeria has one of the highest adolescent pregnancy rates in sub-Saharan Africa. What are the measures being implemented to improve sexual education and reproductive health for teenagers?

Mr Kuawa: I think this is a very important and good question. You know, adolescents and youths are at the core of our programmes. So what we do is work with government authorities, civil society organisations, community and religious leaders to design what we call comprehensive life education and comprehensive sexual education that provides accurate and correct information to the youth.

We also make sure to provide culturally appropriate information and use age-appropriate language. It is important to consider the age of the people our information is addressed to. We want the schools to be involved.

These are key tools that we are using to start addressing this because a lack of information or knowledge leads to some of the situations that I have mentioned.

PT: In culturally restrictive environments where early sexual activity is common, how can access to family planning for young girls be effectively improved?

Mr Kuawa: There are different ways that we are approaching this problem. One is that we train the health workers to be able to provide youth-friendly services to young girls and young boys. Again, here we are talking about a human rights-based approach, so it is their right to request those services. We also work with a number of health facilities. We create what we call youth-friendly centres, where those people who provide the information or support the provision of the services are equally youth. They are people who understand their peers and have been, let’s say, subjected to this kind of resistance or barrier.

These centres are sometimes in health facilities, sometimes in community facilities, and sometimes in school facilities. The goal is to ensure they provide young people with the correct information and direction on how to access the appropriate services.

PT: What is the success rate in areas where these centres were created?

Kuawa: I would not be able to give you some figures just on top of my head now, but I know, and it has been proven, not only in Nigeria but in many countries, that the fact of providing the correct information and making the friendly services available can help reduce teenage pregnancies, which are often unwanted. It has proven to be a high-quality and effective intervention that we encourage to be implemented across the board.

PT: You mentioned earlier that one of the challenges for family planning programmes in Nigeria is the lack of funding. How can we address this gap as a country and ensure sustainable funding for reproductive health initiatives?

Mr Kuawa: Yeah, the gap in family planning financing has been something we have been dealing with for a while, including the authorities. Several initiatives are underway; ultimately, the solution relies on local domestic resource mobilisation.

The government itself has to increase its investments in family planning. I am saying investment, not expenditure, because the return on this investment is significant. It’s very high, not only in terms of health but also in terms of economic impact and the very, very important impact on the overall health outcome.

Now, the government of Nigeria has been stepping up its contribution. Last year, it contributed $4 million to procurement of commodities. We also advocate at the state level, because the $4 million I mentioned is at the federal level. State governments have also been making funds available to procure family planning commodities to fill or reduce the gap that we are experiencing. We are also working with the private sector because this is another important source of contribution.

On our own side, we work with our donor communities to continue contributing to our basket fund for family planning and not to reduce their contributions. So, I think it is a work in progress. We have seen some results, but the gap is still there, and we still have a long way to go.

PT: Can you highlight these gaps?

Mr Kuawa: Yes, if my memory serves me well, last year, for example, we had an estimated need of almost $30 million for family planning commodities. However, there was a gap of around $13 million. You see, this is a significant shortfall. The problem is that the gap keeps increasing because there are more people who want the services, who are more aware and who are willing to take the services or commodities. This is good news, but it requires additional funds. So, every year, the need is increasing, and even though the resources are also increasing, the gap is still there.

PT: How would you predict the country’s future in this aspect?

Mr Kuawa: It is very difficult to predict. What I can tell is that there is a positive trend. A positive trend in the sense that there are more and more people who understand the usefulness, the benefits of family planning for the overall good of their families.

There are people who more and more understand that you need to have the number of children you can take care of, and there are methods that can help you to make that decision. More people understand that nobody will force you to have fewer or a lot more children. You decide how you want it. So, I see that positive trend.

The other good thing that we have observed when we visit the field is that we have seen men also taking their spouses to the hospital for all the antenatal care and counseling. More and more men are part of it, so they understand and are more supportive of their women. So, I think there is some positive trend, and I hope this will lead to a bright future for our country.

PT: Do you think the US aid freeze can worsen the situation?

Mr Kuawa: The family planning programme that we have in the country, at least the part that is managed by UNFPA, is not impacted per se. It is not directly impacted, but the global landscape is changing. It is not just about a particular donor, it is the whole landscape that is changing, and as everybody is saying, this is a wake-up call for all of us, especially in our country. This is a call to step up our game and see how much more we can do ourselves. So, I will say that since it is a wake-up call, I hope that we all step up and do more than we have been able to do so far, so that we can continue to achieve the result that we set for ourselves.

PT: Nigeria’s population is projected to exceed 377 million by 2050, which is just 25 years from now. Do you consider this a welcomed development, or does it pose any challenge to the country?

Mr Kuawa: I think population growth can be an opportunity, but it can also pose a number of challenges. It depends on how well we are able to navigate and manage it because population growth could be a source of economic growth for a country. However, it will only be a positive factor when we have a healthy, well-educated population that contributes to the country’s productivity.

What will make the difference is really the investments that the country is able to make in health, education, and job creation. If we are able to make the necessary investments in the education of the youth, in the health of the people, in job creation, and especially to make sure that women, girls and youth become a productive workforce, that will be positive for the country. But if we fail to do that, it becomes a challenge because then there will be more people relying on the country’s smaller wealth, which will be a source of some other challenges, including some form of insecurity, some unemployment, and difficult living conditions for the people. It could be something good if it is well managed.

READ ALSO: Trump considers third-term presidential bid despite constitutional provision

PT: The UNFPA plays a key role in reproductive health advocacy. Can you highlight some major ways the UNFPA has collaborated with the government to improve access and awareness in this area?

Mr Kuawa: Yes, there are various ways that we have been doing advocacy in general, starting by working with the authorities and the health workforce to educate them so that they can understand and relay information to the public. But we also work with the communities. We have a community—the CSO community-based organisations that we work with—including faith-based and community leaders who, when they understand and champion this, can be very, very powerful vectors of change.

PT: Based on the UNFPA’s groundwork, are there some specific types of family planning programmes that people are more inclined to support?

Mr Kuawa: Yeah, that is a good question, but my technical team is better at answering this. Anyway, women are demanding a little more of the reversible methods. That means methods that they can use, which have some effect for a period of time but can be reversed easily. Not methods that are definite, like those that will prevent future occurrences or stop them from having children in the future.

From my understanding, reversible methods are in demand—also those that can be renewed with less frequency. Depending on the need, some methods last for three months, others for a longer period, but then they can be reversed as soon as they want to have more children.

PT: Does the organisation also provide sensitisation on emergency contraceptives

Mr Kuawa: When talking about emergency contraceptives, this usually means the person did not adopt a method in advance of intercourse. That’s why education is so important—people need to know what methods are available and the benefits of each one.

It is crucial to ensure that this information is widely accessible. This includes spreading awareness through various means, such as mass communication, sensitisation efforts, and community outreach.

In some states, we even have community health champions who go around providing this information, helping people understand that they can take preventive measures instead of relying on emergency contraceptives.

This approach helps. Once education is combined with the availability of contraceptives, it should ideally reduce the use of emergency contraceptives.