Factors Underlying the Use of Long-Acting and Permanent Family Planning Methods in Nigeria: A Qualitative Study

Long-acting and permanent methods of contraception (LA/PMs)-the intrauterine device (IUD), the hormonal implant, and female sterilization and vasectomy-are safe and cost-effective for women who desire to delay or limit births, yet they are often underutilized. In Nigeria, these methods contribute only about 10% of all modern contraceptive use. This is regrettable, considering that LA/PMs could help to significantly reduce unmet need for family planning in Nigeria.

Qualitative research conducted by RESPOND partner Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU•CCP) reveals some of the attitudes and beliefs that hinder demand for LA/PMs in Nigeria and identifies the myriad challenges associated with provision of LA/PMs there.

Selected Findings

• Despite general awareness about family planning methods, considerable misinformation about specific LA/PMs persists. For example, there was a widespread belief that the IUD makes the user more prone to sexually transmitted infections (STIs) and infections of the pelvis. This belief was common not only among community members but also among service providers.
• A key factor hindering family planning use is fear of side effects. For example, the implant was perceived by many of those who were aware of the method to cause excessive weight gain or weight loss and amenorrhea.
• Female sterilization is generally perceived as a method that a woman would select not out of choice, but rather out of necessity, in cases where another pregnancy could threaten her life or when other methods had failed. Male sterilization was likened to castration; men who had undergone the procedure were believed to be incapable of enjoying sex or satisfying a woman sexually.
• Method-related attributes that study participants deemed important included requiring relatively few visits to a health facility, having minimal side effects, being easy to use, and not interfering with sexual relations. Efforts to promote LA/PMs in Nigeria should emphasize that such methods meet many of these desires.
• Study participants felt that husbands often resist the idea of modern method use because they lack knowledge about such methods, believe myths and negative rumors about them, and associate family planning with women's infidelity. The results suggest that programmatic efforts to strengthen women's skills at negotiating contraceptive use may be useful and that women need to learn how to use convincing, evidence-based arguments to counter their husbands' resistance to contraceptive use.

The use-dynamics study in Nigeria is part of a multicountry qualitative research effort designed to contribute to the global evidence base on the dynamics of contraceptive use or nonuse, with a special focus on LA/PMs.

We invite you to learn more about the RESPOND Project Study Series: Contributions to Global Knowledge and the Nigeria use-dynamics study.

Download the full report (PDF, 2.1MB).