Nigeria: Expanding Access to Sexual and Reproductive Health Services and Rights to Vulnerable Populations

Sexual and Reproductive Health and Rights (SRHR) underpins the rights women and girls have to make informed decisions about their sexual and reproductive health. However, women and girls, especially in fragile, conflict-affected and vulnerable settings (FCV) and persons with disabilities do not have the freedom to make decisions about their bodies and face poor access to services that meet their sexual and reproductive health needs.

Sustainable Development Goal 3.7 seeks to expand access to SRHR by ensuring universal access to sexual and reproductive health-care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes by 2030. For this to happen, inclusivity is key. This means that whatever sexual and reproductive health services are provided for some, must be provided for all, while making certain that all needs are considered. No one must be excluded from accessing services.

The subject of exclusion and ‘Expanding Access to Sexual and reproductive Health Services and Rights to Vulnerable Populations’ was the focus of the Knowledge CafĂ© organised by Marie Stopes Nigeria, in partnership with the Federal Ministry of Health (FMoH) and Nigeria Health Watch in November 2022. The webinar featured two sessions during which, access to SRHR for adolescents and Persons Living with Disability (PLWD) was discussed.

Making SRHR a reality

The World Health Organization (WHO) states that in order for SRHR to become a reality, it is necessary to provide comprehensive and people-centred services that address the different elements of SRHR. These services need to be supported by an enabling environment, quality health systems, and meaningful community engagement.

Marie Stopes Nigeria works collaboratively with the government at the national, state, and local government level to support and strengthen healthcare delivery in both the public and private sector in all 36 states, including the FCT. They offer comprehensive sexual and reproductive health services that enable women all over Nigeria to choose their reproductive health future through the various service delivery channels they offer.

In her remarks, Dr Salma Ibrahim Anas-Kolo, the Director, Family Health Department in the Federal Ministry of Health, stated that the federal government is committed to ensuring that women have access to quality sexual and reproductive health services, at all levels of healthcare, especially at the community level.

Creating an enabling environment for adolescent girls

In the first session, Dr Jennifer Anyanti, the Deputy Managing Director at Society for Family Health (SFH), gave an overview of SFH’s approach to adolescent sexual and reproductive health in Nigeria. SFH’s goal is to create an enabling environment for adolescent girls to make informed decisions about their reproductive health. It is critical to achieve this in Nigeria, where the adolescent birth rate is 107.3 per 1000 women between the ages of 15-19.

The three levels of intervention SFH adopts to create this enabling environment are individual, community, and facility. Adolescents 360 is a programme implemented at individual level. A cohort of youth friendly health providers, both old and young, are trained and supervised to provide youth-friendly family planning services. Girls can access individualised counselling by walking into health facilities for these services, through the Life, Love, and Health (LLH) or Life, Family and Health (LLH) classes which SFH organises. These skill building classes take place during the weekend in health facilities, 3 or 4 times a month. Family Planning commodities are distributed in these classes as well.

Reach-Out is a modified outreach strategy where facilities within highly populated locations that generate low uptake for services at the healthcare providers’ facilities are identified. Adolescent girls are reached during outreach programmes and are referred to the health facility to receive services. Mobilisers are usually members of the host community. This model is being implemented in the Federal Capital Territory (FCT), Nasarawa, Akwa Ibom, Delta, Lagos, Ogun, Osun, Kano, and Jigawa State.

Education also plays a vital role in scaling adolescent sexual and reproductive health. However, Nigeria still grapples with sociocultural issues that make it difficult to have these conversations. To mitigate this, Dr Anyanti recommended that sensitive cultural needs should be addressed so that adolescent girls have the tools they need, to make informed decisions about their sexual and reproductive health.

According to Toyin Chukwudozie, Executive Director, Education as a Vaccine Nigeria (EVA), some of the intergenerational norms that impede SRHR among adolescents and young people include:

Socio-cultural ambivalence about the sexual and reproductive health and rights of adolescents and young people

A lack of understanding among adults of the transitions adolescents experience

A lack of understanding of the rights of adolescents and young people

Ignoring the evidence and the realities

She advocated for the inclusion of young people in the planning, implementation, and monitoring of SRHR interventions “if we are to ensure a positive shift that includes adolescents and young people”.

Expanding access to SRHR to women with disabilities

The WHO Global Report on Health Equity for Persons with Disabilities states that 1.3 billion people — or 16% of global population experience a form of disability. The 2011 World Report on Disability estimated that 15% of every country’s population has persons with disabilities. This means that in Nigeria, with a population of over 200 million, there are over 30 million persons with disabilities, including women and children.

Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) stipulates that persons with disabilities must be provided with the same range, quality and standard of free or affordable health care and programmes, as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.

Speaking on the subject, ‘Expanding Access to SRHR to Persons with Disabilities (PWDs)’, with a focus on women with disabilities (WWDs), Patience Ogolo Dickson, Head of Women and Gender at the National Commission for Persons with Disabilities (NCPWD) first dispelled the common notion that persons with disabilities do not have the same sexual and reproductive needs as those without disabilities. She stated that persons with disabilities face several barriers to the realisation of their sexual and reproductive health rights, some of which are a lack of accessibility to the physical structures in health facilities and inaccessibility to sexual and reproductive health (SRH) information, especially for deaf women and discriminatory SRH care

.

The National Policy on Sexual and Reproductive Health Rights for Persons with Disabilities was signed into law in 2018 and is domiciled at the Federal Ministry of Health. It was developed by related Ministries, Departments and Agencies (MDAs) and organisations of persons with disabilities (OPDs). The policy has 5 thematic areas highlighted below:

Increased knowledge and awareness around SRHR for persons with disabilities.

Increased access to SRH services, i.e., information, education, ease of movement/access to health facilities.

Inclusion in government. This means mainstreaming WWDs into government programs and policies, and inclusive budgets that specifically address SRHR for persons with disabilities.

Promotion of research and monitoring and evaluation (M&E).

Partnerships, collaborations, and capacity building for all stakeholders.

Ms. Dickson made some key recommendations for the effective implementation of this important policy.

Technology driven SRH programmes for persons with disabilities.

Data Collection. Develop an app that records SRH needs using disability type.

Provision of quality services, after care, and confidentiality.

Training of health workers on disability inclusion.

Promotion of positive outcomes for women and girls with disabilities regarding pregnancy, birth, maternal health etc.

Education of WWDs on family planning.

Empowerment of persons with disabilities including in SRH, and their rights to their bodies.

In his closing remarks, Emmanuel Ajah, Country Director, Marie Stopes Nigeria, said that Marie Stopes International will continue to look out for opportunities for partnerships to ensure that women and girls have access to the information and services they need to make safe choices regarding their sexual and reproductive health.

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