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COMMENTARY
NORPLANT: AN UNMET CONTRACEPTIVE NEED IN ENUGU, NIGERIA
Dr Ibekwe, Perpetus Chudi FWACS
Department Of Obstetrics & Gynaecology Ebonyi State University Teaching Hospital - Abakaliki, Nigeria. (Formerly -Department Of Obstetrics/Gynaecology University Of Nigeria Teaching Hospital Enugu, Nigeria) Nigeria has one of the highest maternal mortality 1 Norplant, as a family planning method, became available for use at the University of Nigeria contraceptive prevalence rates in Africa .
Teaching Hospital (UNTH), Enugu in 19921 .
contraceptive prevalence in Nigeria ranges between clients had relied on intrauterine contraceptive device (IUCD), depots of norethistherone enanthate and coupled with the very high total fertility rate (above medroxyprogestrone acetate (Depo-Provera), oral 6.0 in the area of study)6 has led to a renewed vigour contraceptives, tubal ligations and other non- in effecting solutions through a pervasive family prescriptive methods like condoms and foams.
planning programme, not only in Nigeria but in other developing countries. It has been opined that if At the family planning clinic of the UNTH, clients family planning services were more widely available, receive group counseling on all methods of up to 42% of maternal deaths could be averted in contraception from the health nurses. Private counseling is thereafter provided by the doctors that approximately 300 million couples in the before a decision on the most appropriate method is reproductive age range did not want more children, reached. Norplant acceptors are informed about the but were not using any method of contraception. benefits and side effects of the implant. They are One of the factors that have contributed to this low contraindications before insertion. Norplant implant, contraceptive prevalence and high birth rate is that a consisting of six silastic capsules of levonorgestrel, is large percentage of the population lives in rural inserted by doctors in the upper non-dominant arm, areas, where family planning services may not be about four- finger breath above elbow.
available. In addition, the low socio-economic status of the people combined with high rate of infant and An eight-year review of Norplant use at the Family child mortality, religious and cultural factors and planning clinic of the UNTH, Enugu (January 1996 - changing pattern of social organization may all December 2003) showed that Norplant was in negatively influence motivation8-1 .
sporadic supply throughout 1997 and major parts of male opposition, low availability and accessibility 1998, and totally out of stock for eleven months in were reported as commonest reasons for non-use of 2000. From 2001, high financial commitment was requested from clients desiring Norplant, thus creating problem of affordability. Also, the product It has been accepted that reproductive health of was in short supply between 2001 and 2003. All other women can only be enhanced if they are provided products mentioned above were available throughout with an opportunity to plan their reproductive lives through provision of various contraceptive methods that are relatively safe, available, accessible and Correspondence: Dr. PC. Ibekwe P.O. Box 1019 Abakaliki - email: [email protected]
Dr Ibekwe, Perpetus Chudi FWACS
In spite of these problems of availability and it as a contraceptive method and its acceptance rate. affordability, Norplant enjoyed an acceptance rate of Government and donor agencies are called upon to 8.5%. Were the products more readily available, it formulate appropriate strategies to meet this very would have compared favorably with an acceptance important contraceptive need of women.
rate of 12.4% recorded in Lagos, Nigeria13. Experience from other parts of the World has also REFERENCES
demonstrated a high acceptance rate of norplant14, 15. High Rate of Maternal Deaths in Nigeria is a cause This method of family planning may therefore be for Alarm. Communiqués from the 38th Annual fulfilling an unmet need for a long term, efficient, Scientific Conference of the Society of reversible form of hormonal contraception for women Gynaecology and Obstetrics of Nigeria (SOGON), who have achieved their desired family size, but for Makurdi, Benue State, Nigeria, November, 2004. fear of the unknown, do not want the permanence of Trop J obstet Gynaecol.2005; 22: 100. Federal Office of Statistics. Nigeria Demographic With the, continuation rate of 95% at one year and a n d H e a l t h S u r v e y 1 9 9 0 . I R D / M a c ro 89% at three years, lowest observed failure rate of International: Columbia, M.O., 1992. of the most effective reversible contraceptive Oye-Adeniran BA, Adewole IF, Odeyemi KA, methods. It is also a suitable option for lactating Ekanem EE, Umoh AV. Contraceptive Prevalence women when effective non-hormonal methods are among young women in Nigeria. Journal of contraindicated or not acceptable19. Sexually Obstetrics and Gynaecology 2005; 25: 182-185. transmitted diseases are prevalent in Nigeria2 many sub-Saharan African countries and this may Population Reference Bureau. World Population make Norplant a more appropriate contraceptive Data Sheet. Demographic data and estimate for the method than IUCD for clients with high risk of countries and regions of the world. 2005. acquiring sexually transmitted diseases such as Oye-Adeniran BA, Adewole IF, Umoh AV, etal. There is a great need therefore for strong advocacy Sources of Contraceptive commodities for users in for regular and efficient supply of Norplant, all year round in all family planning units. It is known that successful implementation of any family planning Egwuatu VE Child bearing among the Igbos of programme depends on the ease of access of Nigeria. Int J. Obstet Gynaecol 1986; 24: 103 111. contraceptive services and the availability and WHO. Community Based Distribution of accessibility of Norplant are very important as it was Contraceptive, A Guide for programme Managers. observed, very obviously, that the sporadic nature of the availability of Norplant and the cost constraint imposed on the product at a time, adversely affected Norplant: An Unmet Contraceptive Need n
i Enugu, Nigeria
La dip o OA. Soci o-cu ltural b arriers to Contraceptive Method Characteristics. Outlook Contraception. Trop J Obstet Gynaecol 1998, 13: Fraser IS, Tiitinen A, Affandi B. et al. Norplant Ojo OA. A history of the development of family consensus statement and background review. planning in Nigeria. Trop J. Obstet Gynaecdol Soledad Diaz. IPPF Medical Bulletin 2001, 35 (2) : Susu B, Ransjo-Aarvidson AB. Family Planning Practices before and after childbirth in Lusaka, Zambia. East African Med J 1996; 73: 208-213. Osoba AO. Sexually transmitted diseases in Nigeria: a review of the present situation. West Fakeye O, Babaniyi O. Reasons for non-use of family planning methods in Ilorin, Nigeria: male opposition and fear of methods. Tropical Doctor Elstein M. Training in Family Planning. Br Med Ozumba B, Chukudebelu W. Snow R Norplant as a contraceptive device in Enugu, Eastern Nigeria. Advances in Contraception 1998; 14:109 119. Ogedengbe OK, Giwa Osagie OF, Adeboye M, Usiofoh CA. The Acceptability and Role of Norplant as a Long-acting Contraceptive in Lagos, Nigeria. Trop J Obstet Gynaecol 1997; 14: 28 33. Martey JO, Turkson SO. Clinical Evaluation of Norplant in Kumasi, Ghana. East African Med J Davie J, Hirematu K, Glasier A. The introduction of a new contraceptive: Two years experience with Norplant. Health Bull. Edin 1996; 54: 314 22. Ozumba BC, Ibekwe PC. Contraceptive use at the family planning clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria. Public Health

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