A tall glass of lime and soda – a refreshing drink for sure, but an effective form of contraception?
Last year, I was in Lagos conducting a study into the family planning needs of women, when my counterpart from Ipsos Nigeria told me that this was a common method used by unmarried teenage girls. “Finishing the deed and jumping out of bed quickly” was another cited method which caught my attention. These contraceptive myths may induce a smile for their innocence, but their prevalence is a real concern.
According to the latest UNFPA data, effective contraceptive use remains low whilst teenage pregnancies continue to be high in Nigeria27 . This is especially problematic because an unplanned pregnancy is almost always a catastrophic event for an unmarried adolescent girl or young woman in Nigeria. In conservative Nigerian society, pregnancy or childbirth out of wedlock is frowned upon, leading to social marginalisation, being forced to drop out of school and, in many cases, being unable to achieve financial empowerment. Further, in a country where abortion is largely illegal, many women are forced into risky and unsafe abortions. Two-thirds of all abortions in Nigeria last year were categorised as being in the least safe criteria (i.e. outside health facilities and not using appropriate medication), and the majority of abortions were among those ages 20-2428 .
The prevalence of contraceptive myths is a real concern
So why, in a country like Nigeria where modern methods like implants, injections and pills are widely available, are they not filtering down to these young women who need them? The answer lies within the health system.
Implicit bias at work
Many women in Nigeria first hear about the different methods available to them from nurses and other healthcare professionals. Over my career in health research, I’ve spoken to many nurses across Sub-Saharan Africa and Southern Asia and generally found them to be highly motivated and dedicated professionals, often working in very challenging settings. Yet, like the rest of us, healthcare providers are not immune to implicit bias, in which we make unconscious judgements about someone. Marital status appears to be a key bias at play here.
When asked to recall details of family planning counselling with healthcare providers in both countries, it is evident that married women are experiencing the health system differently to unmarried women. In Nigeria, 58% of married women who are using modern contraceptives report that they were informed about other potential options by the healthcare provider compared to just 31% of unmarried women. 52% of married women were informed about side effects of modern hormonal methods by the healthcare provider, compared to just 24% of unmarried women.
Married women are therefore being better informed by healthcare providers to select a contraceptive method which works for them. It is therefore not surprising to learn that unmarried women are much more likely to have experienced an unwanted pregnancy over the past five years, according to the PMA, a global family planning performance monitoring agency – 44% of unmarried compared to 29% of married women29 .
Healthcare workers are a vital source of information for women globally. In Nigeria and beyond, healthcare workers should be trained specifically to recognise implicit biases to better support unmarried women with their contraceptive choice.
Other channels and interventions such as MTV Shuga, an edutainment media platform targeted at younger audiences, should also be pursued to help educate younger women about contraception. And women should be advised to save the lime and soda for when they are thirsty!