Family Planning: Why Hormonal-IUD is the game changer

The Federal Ministry of Health (FMoH) says it is ready to expand the family planning method mix available for Nigerians with the introduction of the Hormonal-IUD Introduction and Scale-Up (H.I.S) Project. Recently, stakeholders met to design social behavior communication strategy for the campaign in Abuja.

For the next 12 months, at least 36,000 women and girls of reproductive age from Oyo, Plateau, and Delta states will benefit from a new introduction to Nigeria’s family planning method mix through the Hormonal-IUD Introduction and Scale UP (H.I.S) Project.

That is not all; the targeted women will have access to a new family planning contraceptive, which will not just serve the purpose of planning a family but also help women improve general health. There will also be the services of highly trained community mobilizers and primary health care officials who will assist the beneficiaries with the required medical eligibility criteria, to help them make an informed choice.

A new Family Planning method is essential  

Even though there are several family planning method mix currently in circulation, Nigeria failed to meet her global target to achieve a Modern Contraceptive Prevalence Rate (MCPR) of 27 percent among all women by 2020.   

According to Track20, Nigeria only managed to achieve 11.9 percent modern contraceptive coverage for all women by the deadline for the FP2020 target and in 2022, the rate has only increased to 12.9 percent.

But this still falls way below the ambitious goal of FP2030 where Nigeria made a commitment that: “By the end of 2030, Nigeria envisions a country where everyone including adolescents, young people, populations affected by crisis and other vulnerable populations are able to make informed choices, have equitable and affordable access to family planning and participate as equals in society’s development.”

According to officials, the Nigerian government with the help of stakeholders is determined to hit the goal of its FP2030 target. And despite the various family planning method mix, the government is constantly looking to increase the options available for families.   

“The Federal Ministry of Health (FMoH) and other stakeholders are committed to ensuring we have an expanded mix of family planning methods, the reason is that everybody should have a method that suits them, Gabriel Ortonga, a deputy director, Family Planning Services at the FMoH said.

He was speaking at a two-day co-creation workshop organised by the implementing partner of the Hormonal-IUD Introduction and Scale UP (H.I.S) project in Nigeria, Centre for Communication and Social Impact (CCSI).

The workshop aimed to develop social behavior change materials that will be deployed to the targeted states during the campaign implementation with participants drawn from a targeted audience, religious leaders, implementing partners, and the government.

According to Babafunke Fagbemi, the Executive Director of CCSI,  “The workshop aims to jointly develop evidence-driven messages and materials for Hormonal IUD from the existing array of government-approved Family Planning SBC materials and incorporate the input from other implementing partners working in the same space so as not to reinvent the wheel.” 

The H.I.S project itself is funded by the Catalytic Opportunity Fund (COF) and administered in Nigeria by Clinton Health Access Initiative (CHAI) with the strategic goal of creating “demand for the scale-up of Hormonal-IUD (H-IUD) in three project states; through an integrated strategy that employs a combination of community engagement and mass media,” says Adaora Uzoh-Ntiwunka, the project lead at CCSI.

However, while there are about 15 other family planning method mixes in the country, the H.I.S project has some specific behaviour change goals, which include creating awareness for Hormonal-IUD within the general modern FP methods mix; dispelling myths and misconceptions about Hormonal-IUD. 

The project will also generate demand for and provide support for the continued use of Hormonal-IUD; eliminate provider behaviour bias towards the provision of Hormonal-IUD;  build the confidence of clients to make an informed choice to use Hormonal-IUD within the modern FP method mix and engender social and spousal support for the use of Hormonal-IUD, within the modern FP method mix.     

Amina Jafaar, a Senior Associate at CHAI believes that the H-IUD has a lot more health benefits than just a contraceptive, and more women should accept and use it. “Hormonal-IUD has additional health benefits outside of it being just contraceptives; it’s something that has lesser side effects.

“It reduces bleeding, which helps with anemia and helps some women who have endometriosis as well.  It helps with the shrinking of fibroid as well so there are other benefits aside from being just contraceptive,” she said.  

A Media Mix Strategy for Demand Generation

The behaviour change campaign for demand generation in the three implementing states will include a mix of community engagement and mass media campaigns. The goal, according to Fagbemi, is to ensure no stone is unturned in getting the message out and ensuring that by the end of the project, demand generation for Hormonal-IUD has increased. 

Apart from community engagement, CCSI will also be building the capacity of the stakeholders, including state and local government health promotion officers and other family planning providers.

Perhaps more interesting is the use of mass media in the project states. Trained family planning providers would co-host radio talk shows that would enlighten the people on the benefits of the Hormonal-IUD.  

“CCSI has a track record of excellence in social behavior change communication across many thematic areas and our family planning portfolio include eight projects across 17 states. So, I am really excited about the opportunity to also bring our experience to bear on the H.I.S campaign,” Fagbemi said.

Though the federal capital territory is not included in the targeted state, Ossai Dorothy, the Deputy Coordinator for Family Planning in the FCT said the Hormonal-IUD is already available in the capital city but would need the partnership with CCSI to create awareness and increase demand.   

“The reception in the FCT has been okay even though we need to do more awareness on it. We only talk to the people that walk in about Hormonal-IUD, but we need mass mobilization. I am going to be recommending to the board that we should give our all to CCSI. They have to work with us to train providers who are yet to be trained. We also need to have the commodities in our hospitals as well,” Dorothy said after the co-creation workshop.

However, while campaign in three states may be a drop in the ocean, the stakeholders are optimistic this is a good start. Jafaar said: “At the moment, I think there is a gap that exists for family planning as a whole and Hormonal IUDs specifically, the aim is to build the materials and foundation that will be used to fill that gap.

“The hope is that as a country we are able to find additional funding, be it from funders or within ourselves to fill this gap. A lot of work is being done towards that, it is not necessarily been fully achieved now but it is a work in progress.”   

Ortonga agrees with her: “The CCSI is starting with three states but with more funding, this could be scaled up to more states.  The reasons for choosing the three states are obvious like the training has taken place in those states; we know services on H-IUD are already happening.  We also try to look at the geographical spread.

“The development of these materials is a very huge success, how quickly we spread the information depends on funding so we need other partners to come on board and support what CCSI has started, Nigeria is a very large place so we need everybody to come and help us scale up this intervention.”