Community Leaders\' Perception of Reproductive Health Issues and Programmes in Northeastern Nigeria

Abstract

Context: A faith-based NGO wanted to expand its reproductive health programmes to Northeastern Nigeria in view of its poor reproductive health indices compared to the other parts of the country. In order to make the programme more acceptable, accessible and successful, a rapid needs assessment was conducted. Objective: To assess the perception and acceptability of the various components of reproductive health among community and religious leaders in northeast Nigeria. Study Design. Setting and Subjects: A community-based qualitative study. One community leader and one Islamic religious leader each were interviewed in Ganjuwa, Dass and Shira local government areas of Bauchi state. Similarly, a community leader and a religious leader each were interviewed in Maiduguri, Konduga and Gwoza local government areas of Borno state. In Yobe state, one religious and one community leader were interviewed. Results: The community/religious leaders perceived reproductive health problems as prevalent and contributing to maternal morbidity and mortality. They believe women should seek healthcare services for preventive and curative care preferably from female providers. They suspect reproductive health programmes as Western agenda for population control. They have very strong feelings against the provision of elective abortion services. The only acceptable indications for elective abortion include death of the fetus in utero, gross congenital anomaly incompatible with life and serious maternal health risk. A committee of trusted, and preferably Muslim, Godfearing, doctors should assess and confirm these indications. They accept that women with complications of spontaneous abortion should seek care. The provision of contraceptive services to adolescents or married couples is not acceptable. In case of married couples, the only acceptable indication is on serious maternal health grounds. Even then, only harmless methods of contraception may be used specifically coitus interruptus or calendar method with prior spousal consent. The use and promotion of condoms as a barrier method or for the prevention of STIs is not acceptable. The prevention and care of those with HIV/AIDS is acceptable with emphasis on pre-marital abstinence and faithfulness among couples. Conclusion: The varied perceptions, cultural and religious barriers to reproductive health services need to be articulated in order to structure appropriate strategies that will inform and sensitize people about reproductive health programmes and services. Advocacy, monitoring and involvement in programme planning, implementation and social mobilization are useful strategies for addressing this issue.