Community Gate Keepers Involvement for Promoting Adolescent’s Access to Contraceptive Services in Rural Communities in Ede, Nigeria
Among adolescents in rural areas of Ede community in Osun State, Nigeria, contraceptive use is very low, resulting in high prevalence of undesired pregnancies, unsafe abortions and hence, high abortion related morbidity and mortality. Pregnancies and births to adolescents in these communities were found to be higher than the national average. Between 2010 and 2014, 40.4% of all births in this community were to adolescent mothers. Most schools in this community do not teach population, family life education and sexuality education, despite inclusion in secondary school curricula. Parents and other stakeholders tend to withhold reproductive health and sexuality information from their young children largely due to traditional and socio-cultural beliefs. Therefore most of the young people in this community have limited access to relevant reproductive health services, where available, unfriendly nature of facilities deters utilization.
The broad objective of this campaign was to break the traditional and socio-cultural barriers preventing adolescent’s access to contraceptive services in rural communities in Ede, Nigeria. Those in the urban areas in Ede community have greater access and greater chances of utilizing health services than rural counterparts in rural areas despite high rate of sexual activity and wide spread knowledge of contraceptive methods, leading to unintended pregnancies and unsafe abortion.
HOW THE OBJECTIVES WERE ACHIEVED
Our objective was achieved through evidence-based advocacy visits and training of community gate keepers who are traditional leaders, religious and community based leaders on youth friendly programs. Qualitative interviews were firstly performed by the campaign team where two focused group discussions each were held with traditional, religious and community-based leaders from the various communities in the campaign area. We also conducted a cross sectional survey among adolescents and family planning providers to determine the socio-cultural barriers limiting their access to contraceptive services.
A total of 60 community gate keepers who are traditional leaders, religious and community based leaders within the age of 25–60 years were selected and trained on adolescents access to contraceptives service. Trained traditional leaders were encouraged to educate other traditional leaders to promote adolescents access to contraceptives service during town or house of chiefs meeting, religious leaders (Islam and Christianity) discussed the issue with parents during religious activities while community based leaders also discussed this with community members during community development meetings. All the trained community gate keepers jointly developed information and communication materials (Drama, handbills, posters) with local language.
Utilization of contraceptives service among adolescents 15-19 years of age increased from 5.8% to 51.2% within 3 months and 82.9% after 6 months. The number of pregnant adolescents decreased from 65.9% to 4.3% after 6 months. The rate of unsafe abortion decreased from 56.8% to 12.8% after 6 months. Open discussion on family planning among parents and their children were now socially and culturally accepted.
The time spent on the recruitment of community gate keepers especially the religious leaders (Islam and Christianity) who were trained during this campaign even after several evidence-based advocacies to them because they belief that adolescents should not have access to contraceptives service that this will make them promiscuous. However, this was overcome through persistency. It was also observed that contraceptives that are constantly advertised are more in use among adolescents than the unfamiliar ones that are not advertised. Therefore education is needed to ensure a balance in the use of contraceptives and to make them understand the different uses it is put. There is also the need to establish youth friendly health centres to encourage more utilization and exposure to health information but this was not possible due to finance.
This campaign promoted community involvement in family planning services for adolescents and also significantly reduced high rate of unwanted/unplanned pregnancies and unsafe abortion therefore reducing maternal morbidity and mortality. Informing community leaders about adolescent care and involving them in decision-making played an important role towards addressing adolescents’ reproductive health needs.