Many Nigerian women remain sceptical of modern family planning methods, turning instead to traditional practices influenced by fear of side effects and stories shared by relatives and friends, SOLA ABE writes.
“There is nothing anybody can tell me about modern family planning that will make me do it,” Patience Onyinke said, her mouth tilted to one side as she shook her head in disapproval.
While explaining that the side effects of modern birth control methods were peculiar to different people, she narrated the story of her sister-in-law, who used the injectable method, almost bled to death, and warned her never to do it because “anything can happen.”
Onyinke said she had been using the traditional calendar method her pastor taught her, and even though she is very scared she could mistakenly get pregnant, she believes it is safer than injecting something into her body.
“Everything is in God’s hands. Mistakes can happen, but I prefer it. The only reason I’m scared of getting pregnant now is because I’m not happy with our standard of living.”
Onyinke, a mother of four, lives in a one-room apartment, popularly called ‘face me, I face you’ in Nigeria. A curtain divides the bedroom from the sitting room. A huge cupboard used for kitchen materials and a refrigerator sit on the right side of the bedroom.
A wooden table sits in the middle of the sitting room with two chairs. Though neatly arranged, it was obvious that the room was tight for the family.
A petty trader, Onyinke, gets help from her eldest daughter, who hawks after school, while her husband works as a tricycle rider.
The story of Onyinke reflects that of many Nigerian women, whose understanding of family planning or birth control is based on what they have heard from family and friends.
The World Health Organisation (WHO) states that family planning helps people achieve their desired number of children and plan the spacing of pregnancies. According to the WHO, family planning involves contraceptive methods and infertility treatments.
The 2013 Nigeria Demographic and Health Survey (NDHS) revealed that 85% of women and 95% of men knew at least one method of modern family planning, but only 15% were using it.
A decade later, awareness remains high, but the latest NDHS (2023–24) shows usage has only inched up to about 20% among married women. This gap between knowing and using contraception points to persistent barriers, from inconsistent access to high costs, fear of side effects, and a substantial unmet need for family planning.
According to the WHO, one of the reasons why women who want to avoid pregnancy are not using modern contraceptive methods is because of the fear or experience of side effects.
Damilola Adelakun, a mother of two, would like to take on a modern method, but she is scared because a neighbour who did it bled until she changed to another method.
“Some people tell me it will delay having another child. My mother told me not to do it, that it is not good. So, I use salt and water, and it is 100 per cent effective.”
In the coming years, Adelakun would like to have two more children.
Even though the advocacy for modern family planning has been around for a while, not many Nigerian women subscribe to its methods due to the fear of being victims of its side effects.
“My sister-in-law was tested at the hospital before they decided on which method would be the best for her, but she almost died due to bleeding,” Onyinke said.
Women interested in family planning are often not sure they will get the perfect method at the first trial. They rely on stories from family and friends who, despite being tested before settling on a method, still experienced complications later.
Despite the benefits of family planning, many Nigerian women remain uninterested in the procedure, preferring traditional methods, which may not be as effective as modern methods.
“It is after my second child that I can do the implant method because modern family planning causes secondary fertility or delay. But for now, I will do the withdrawal or calendar method,” Seyi Fatoki, a new mother, said.
Fatoki had been told about the types of family planning at the hospital, but the side effects of the procedures were explained to her by ‘advanced mothers.’
Helen Edet, a mother of five, had been told about family planning by her sister two years ago, but “I told her I was not ready because I still wanted to have more children.” Even though Edet’s family is struggling to live a comfortable life, she believes that family planning methods may prevent her from having her desired number of children.
Family Planning: Modern vs Traditional
Omolara Aluko, a family planning and contraception educator, explained that family planning is meant to safeguard women’s health, as they are advised to rest for at least two years between pregnancies according to the WHO.
“Pregnancy and breastfeeding take a toll on the health of a woman, so for you to be well-rested in between giving birth, there’s a need to put in place a method of family planning.”
Traditional methods include the calendar method, which is based on counting safe periods; the withdrawal method, where the man pulls out before ejaculation; and the breastfeeding method, where lactation hormones reduce the chances of ovulation.
Modern methods include pills, injectables, IUDs, diaphragms, implants, and condoms.
Despite fears about side effects, Aluko noted that modern methods are more effective because they have been tested and shown to have a higher success rate than traditional methods.
“Some women can’t count or monitor their ovulation period. Some men, in the process of withdrawing, drop a little sperm, which is enough to fertilise an egg. Some women even get pregnant while breastfeeding. That was why modern family planning came into place.”
Aluko added that the only modern method that prevents both sexually transmitted infections and pregnancy is the condom. Other methods only prevent pregnancy, and even then, none is 100 per cent assured.
“No method is 100 per cent. You have 95 or 97 per cent. The only method that is 100 per cent is abstinence. Abstain from sex so you won’t catch STIs and won’t get pregnant. Meaning that in a thousand women, you will have one who will use it and it will fail.”
Lilian Ugammadu, matron of the Blue Cross Hospital, explained that women still interested in having children should avoid the Depo Provera injectable because it sometimes takes the body a while to adjust, though this is not the case for everyone.
She also noted that tubal ligation in women and vasectomy in men are permanent methods, but many couples avoid them because they are irreversible.
Side Effects of Modern Methods
A major concern for many women is side effects, but Aluko explained that not all women experience them; it depends on body type.
She said side effects often occur during the adjustment period when the body is still getting used to the new method.
Common side effects include headaches, menstrual changes (such as bleeding or spotting), breast tenderness, and slight weight changes.
Aluko advised that women experiencing headaches should first check if they are caused by stress or hunger, but if linked to contraception, pain relief can help.
She explained that heavy bleeding means filling a pad in one or two hours, but other causes, like fibroids, could also be responsible.
For women who stop seeing their periods, Aluko said it could be because some hormonal contraceptives inhibit ovulation, which prevents the womb lining from shedding.
Weight gain or loss, often complained about, is usually small (around 3kg). If it is more, lifestyle and diet may be the cause.
Ugammadu noted that weight gain is one of the most common complaints, advising women to reduce fatty food intake, avoid heavy late-night meals, and exercise regularly.
Some women also react to condoms and diaphragms because they are made from latex.
“The side effects are not permanent; they usually happen during the adjustment period. Once your body gets used to it, you are fine,” Aluko said.
Both Aluko and Ugammadu stressed that women should always consult a doctor before adopting any method, instead of relying on what worked for friends or relatives.
Misconceptions About Family Planning
Aluko emphasised that family planning is for the benefit of women but suffers from many misconceptions.
She explains that family planning does not cause infertility. Once contraceptives are stopped, women can get pregnant again. She said implants and IUDs do not travel to other parts of the body, adding that contraceptives do not make women barren or cause birth defects.
Aluko said family planning does not encourage promiscuity. There are no hormones in any method that increase women’s sex drive.
“Family planning is meant to protect women, not harm them. What is important is for women to get the right method for their body by consulting trained health workers,” she said.