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
TDN P HEADLINE NEWS • 10/6/12 • PAGE 23 of 23 • thoroughbreddailynews.com Technology in much of the industry is seriously Letters to the Editor cont. dated, other participants noted. Some of the largestentities in racing, including the Japan Racing I have been training for over thirty years and feel thatAssociation, the HKJC and Australia's Tabcorp, rely onif we do not cl
Prof. Dr. V. Mall Publikationsliste in print 1. Jung NH, Delvendahl I, Pechmann A, Gleich B, Gattinger N, Siebner HR, Mall V . Transcranial magnetic stimulation with a half-sine wave pulse elicits direction-specific effects in human motor cortex. BMC Neuroscience 2. Jung NH, Janzarik WG, Delvendahl I, Münchau A, Biscaldi M, Mainberger F, Bäumer T, Rauh R, Mall V . Impaired in