Opening the Door for Family Planning in Nigeria

The Expanded Social Marketing Project (ESMPIN), funded by USAID, improved the health of women and children in Nigeria by increasing use of modern family planning methods and child health. To achieve this, a team, including Society for Family Health (SFH) along with the Association for Reproductive and Family Health (ARFH), BBC Media Action (BBCMA) and Population Services International (PSI) worked to: increase access to family planning (FP), reproductive health and child health products; increase use of health products and practice of health behaviors; generate support from all sectors for social marketing as an important part of a total market approach; and improve the viability of local manufacture of key health products.

Below is a story from the project.

Ba shiga, meaning “no entry,” is one of the most popular inscriptions you see on people’s doors in northern Nigeria. it is often used as a code to prohibit anyone, mostly men, from entering a household without consent from the head of the house. This practice is in accordance with the Islamic religious injunction that male non-relatives aren’t allowed into that home or household uninvited, especially if there are married women or unmarried youth present.

In one of the suburbs of Abuja, Nigeria, an inter-personal communication agent (IPCA) came into contact with Malam Kabiru, who had the ba shiga inscription in front of his door, and this made it tough for agents to relay health messages to him and his family. The IPCA pair who covered Kabiru’s section of the community were men and as such could not gain entry into Mala Kabiru’s household.

Malam Kabiru, who resides in Ushafa (a suburb), but works as a security guard in town, has two wives and 11 children. He was unaware of family planning and couldn’t be bothered. As the intervention commenced, the IPCA pair attempted to engage Malam Kabiru on his way to work, but he always seemed to be in a hurry. Nevertheless, having heard of the testimonies of others who benefited from the IPC intervention, Malam Kabiru invited the IPCAs over to his house for a session.

“Health matters are a solution to our problems which God offers; why then should we deny ourselves and remain in ignorance?” he asked.

Throughout the session, Malam Kabiru wished he had allowed a few minutes to listen to the IPCAs earlier. He even attempted to blame the IPCAs for not having come earlier to enlighten his wives, particularly on the child spacing component.

The IPCA explained to him that omitting his residence from their earlier visits wasn’t an oversight but out of respect for the sign at the entrance door. After the session, Malam encouraged both wives to receive the health facility family planning referral forms and they both visited the clinic the following day. A follow-up call to the home revealed that both women had adopted the injectibles  method. They had even started talking to family members with unmet needs and succeeded in convincing a visiting member who also took up a method. Despite these successes, a remarkable outcome from all of these events was the changed entrance door inscription the IPCAs met at the follow-up call. Malam Kabiru had actually erased the old inscription and replaced it with another saying: Ba shiga, sai dai ta dali lin kiwon lafiya, meaning “no entry, except for matters of health.”

Did it work?

As the five-year project comes to a close, the program has been exposed to rigorous measurement and evaluation. A one-off analysis of the impact of demand creation on malaria objectives was randomly done for Bauchi State, which charted the Intermittent Preventive Treatment uptake trend and Akwa Ibom State, researching Rapid Diagnostic Test use. The comparison was for six months before a select intervention period and six months into the intervention period. Health facility intermittent preventive treatment uptake results from Bauchi showed an average of 34% increase in Intermittent Preventive Treatment 1 uptake and 61% increase for Intermittent Preventive Treatment 2 uptake. Similarly, Rapid Diagnostic Test use in Akwa Ibom recorded an average increase of 391% within the intervention period.

As for demand creation using interpersonal communications agents, a total of 15,123,844 interpersonal communication contacts were recorded through the entire Cycles 1-10 of ESMPIN (at 102% of planned target) along with 598,037 redeemed family planning referrals (similarly at 80% of target).

For more information about the methods, standards, materials and outcomes of ESMPIN, please find the following online resources: