Globally, family planning (FP) is recognised as a critical aspect of public and reproductive health, with the potential to deliver optimal maternal and child health outcomes, reduce poverty, promote gender equality, and enhance the overall well-being of the population. Studies have also validated the impact of accessible FP services, which can reduce unwanted pregnancies by an estimated 80 per cent and decrease maternal medical emergencies and complications.
This underscores the World Health Organisation’s (WHO) call for accessible and quality maternal healthcare, along with the uptake of modern contraceptives, to reduce high maternal mortality rates in Nigeria. Findings indicate that countries with low contraceptive rates also have high maternal mortality ratios.
The WHO highlights several methods of modern contraception, including hormonal methods (oral contraceptive pills, injections, and implants), barrier methods (condoms and diaphragms), intrauterine devices (IUDs), and fertility awareness-based methods. Notably, recent research has identified hormonal methods as the most commonly used contraceptives among Nigerian women, with 12.3 per cent of women using them.
Low uptake of modern contraceptives
Despite the benefits of FP services, modern contraceptive use in Nigeria has remained consistently low. Numerous efforts by the government and development partners to increase uptake have not achieved much. Statistics from the Nigeria Demographic and Health Survey (NDHS) show only a slight increase in the use of modern contraceptive methods, from 4 per cent in 1990 to 12 per cent in 2018, over nearly three decades.
Figures from Statista further confirm this trend, indicating that 12 per cent of Nigerian women use modern contraceptive methods, while 16.6 per cent rely on traditional methods. A 2023 study on women of childbearing age in Nigeria recorded a contraception prevalence rate of 18 per cent, with the rate among married women at 21 per cent.
As worrisome as these figures are, they corroborate findings on the barriers to modern contraceptive use among grassroots women in the Ikorodu area of Lagos State. Many women in the area report adverse effects from hormonal and IUD methods, which have influenced their perceptions of family planning.
In interviews, women recounted various side effects they had experienced with injectables and IUDs, including irregular bleeding, weight loss, abdominal protrusion, bloating, and infertility after discontinuation. A common theme in their experiences was the lack of proper medical screening before contraceptive administration.
“I was menstruating bi-monthly after having a shoulder implant” – Okoro
Mrs Chinyere Okoro, a mother of four, shared how a hormonal implant inserted in her shoulder caused irregular bleeding, ultimately leading her to discontinue its use.
“I had a shoulder implant, but it didn’t suit my system,” she said. “I started menstruating every two weeks. It would last for five days, stop, and then start again after another two weeks. I almost died during that period, as the heavy flow weakened my entire body.”
A resident of Adamo in Ikorodu, Lagos State, Okoro explained her choice of the implant: “I was told it was better than the injection, so I opted for it. The duration was supposed to be three years, but due to the side effects, I had it removed after just one year.”
“IUD displacement led to surgery” – Okafor
For 39-year-old Mrs Teresa Okafor, a lack of awareness about the contraceptive method she was using led to a distressing experience.
“I lost so much weight that my veins became visible,” she said. “I never realised it was because the contraceptive coil had shifted out of place. I only found out when I returned to the hospital and was examined. They discovered the problem was with my IUD.”
The mother of two recounted how she had to undergo surgery to correct the issue. “After the operation, I remained in hospital for three weeks before being discharged. Given this painful experience, I doubt I will ever try family planning again.”
“I experienced bloating and a protruding abdomen after an injection” – Acholo
Mrs Christiana Acholo, a mother of two, described how her fear of unplanned pregnancy led her to a community health officer who recommended a two-month hormonal injection.
“The first month after the injection, I didn’t see my period,” she said. “It eventually came the next month, but it lasted for seven days instead of my usual five. After my second dose, I noticed my abdomen was protruding as if I were pregnant.”
Due to the heavy flow disrupting her daily routine, she discontinued the injections.
“Six years after stopping the IUD, I still haven’t conceived” – Adegoke
Mrs Pelumi Adegoke, a mother of three boys, shared how her desire to have a daughter led her to use an IUD, but since discontinuing, she has been unable to conceive.
“I already had three boys, so I opted for the coil implant,” she explained. “However, after removing it, I have not been able to conceive again. I waited for a year, then two, and now it’s been six years, but I am still not pregnant.”
“Fear of side effects led me to traditional methods” – Ukwudu
Mrs Chinasa Ukwudu told our correspondent how she relies on herbal concoctions as her method of oral contraception.
“I am afraid of experiencing side effects from hormonal or IUD methods, so I use herbs instead,” she said. Asked about the ingredients in her homemade concoction, she listed uziza seeds, uda seeds, lime juice, and dry gin.
Although she considers it relatively effective, she acknowledged some adverse effects. “Whenever I take it after intercourse during my fertile period, I don’t conceive. However, it sometimes makes me drowsy, so I have to take a nap before the effect wears off.”
Addressing the side effects of modern contraceptives in women
In an interview, Mrs Aromolekun, the matron in charge of Akanun Primary Healthcare Centre, stated that family planning services are available to residents, particularly those who have had three or four children and want to stop childbearing.
Explaining the process of selecting a suitable contraceptive method, she said, “When women come in, we collect samples to determine the best method for them.” However, she acknowledged the difficulty of changing the views of religiously conservative women: “There is nothing we can do to persuade those who strongly oppose family planning.”
Speaking exclusively with Pharmanews, Dr Hakeem Lawal, a gynaecologist at Duchess International Hospital, confirmed that most of the reported side effects—irregular bleeding, perceived weight gain, bloating, and abdominal protrusion—are common with hormonal contraceptives.
“These side effects occur due to the way hormonal contraceptives influence the endometrial lining and ovulation,” he explained.
Dr Lawal stressed the need for more education to dispel misconceptions and increase contraceptive uptake in rural communities. He recommended strategic engagement with local and religious leaders, as well as clear communication with grassroots women. “Many concerns stem from a lack of information,” he said, adding that it is crucial to educate women about common side effects, how they can be managed, and the overall benefits of contraception.
Beyond healthcare providers, organisations promoting FP services and products must also take responsibility for shaping public perceptions. However, efforts to obtain responses from representatives of two major global FP brands in Nigeria were unsuccessful, as they declined to comment before press time.
Given the personal testimonies shared in this report, it is evident that further research is needed to address the identified barriers. Additionally, strategic communication and community outreach initiatives are essential to raising awareness about the benefits of family planning and improving its uptake.
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