Nigeria: A Tale of Two Nigerias

When The Economist published the article titled “Why the fertility gap between north and south Nigeria matters“, it seemed to be a timely discussion, especially as the 8th Nigeria Family Planning Conference (NFPC) is getting underway in Abuja. Surprisingly, the article barely made a ripple in the headlines, failing to generate widespread public discussions or political debate about the issues raised or their implications.

A missed opportunity for a national debate

This muted response is concerning, considering The Economist’s rigorous analysis and global reach, which brought attention to an often-overlooked topic in Nigerian media. The fertility gap between northern and southern Nigeria is a pressing issue with far-reaching implications for education, economic development, and gender equity. An article like this should have sparked in-depth discussons, bringing a subject into the national discourse, that when raised in Nigeria, can be quite a contentious discussion. Instead, it highlighted a broader challenge, ensuring critical issues like this not only receive the visibility they deserve, but also drive the necessary policy actions and societal engagement to address them effectively.

However, perhaps we must ask ourselves, are we still acting like the proverbial ostrich, burying our heads in the sand, pretending ignorance about the “elephant in the room“? Our unsustainable population growth is a pressing issue we have addressed in the past, yet it remains one of those topics that rarely sparks a response, almost as though there is a national conspiracy of silence. When The Economist took on the topic, one might have expected there would be wider public discourse. Instead, what followed was more of the same: silence.

Counting our population is long overdue

Nigeria has not conducted a reliable census in years, but current estimates place Nigeria’s population at approximately 227 million in 2023, with an annual growth rate of about 3.7%, according to World Bank. These figures represent national averages However, the article in The Economist disaggregates the fertility rate by state, revealing stark disparities between northern and southern Nigeria in key development indicators of development such as child nutrition, school enrolment and literacy rates.

These regional disparities are especially evident when you look at the female illiteracy rates and the varying levels of financial inclusion across states.

While it is easy to jump to conclusions about the correlation between these factors, let us focus on the one globally recognised correlation, the link between fertility rate, defined globally as the average number of children per woman, and the Human Development Index (HDI). The HDI serves as a comprehensive measure of average achievement in key dimensions of human development, providing a meaningful context for understanding the broader implications of fertility rates.

At the heart of the article is the premise it puts forward:

As populations become better educated, families shrink. Instead of wanting lots of extra hands to toil in the fields and support their parents in their dotage, people start wanting fewer kids, so they can put them all through school. Educated mothers tend to have fewer and better-educated children. Smaller, better-educated families save more, and park their savings in banks.

Initiatives addressing the divide in sub-national fertility rates

Considering the disparities in fertility rates, the article points to the difference between northern and southern Nigeria. It shows that “of the 19 northern states six have a fertility rate over six”, while most the 17 southern states, have rates below four. The first thing to note, is that these figures, while they are averages, they are high and concerning. Both cannot be sustained, especially when compared to Nigeria’s GDP growth rate, which optimistically stand at 3% per annum. The pressing question, however, is how effectively are these frameworks are being implemented at the state level.

Nigeria is not lacking in policies, having signed on to the FP2030 commitments and adopted the Nigeria Family Planning Blueprint. However, the critical question remains, how effectively are these frameworks guiding implementation at the state level?

Challenges in the uptake of family planning services and commodities have been well-documented, prompting numerous inititiaves aimed at addressing these issues. Efforts have targeted both the supply side, such as improving service provision in health facilities and ensuring access to family planning commodities in hard-to-reach communities. Initiatives like IntegratE have increased access through community pharmacists and proprietary patent medicine vendors (PPMVs). Similarly, projects like the Nigerian Urban Reproductive Health Initiative (NURHI) have worked to tackle both supply and demand barriers.

Despite the variety of initiatives, progress remains slow. The modern contraceptive prevalence rate (mCPR) currently stands at just 15.3%, according to the latest Nigeria Demographic Health Survery (NDHS), emphasising the need for more effective strategies to move the needle and achieve meaningful change. While we are not short of initiatives, the collective impact of the various initiative has yet to produce the desired results.

What should the most affected states do about this?

Firstly, is not to ignore the challenge. There is no example globally of any country that has developed economically while sustaining a fertility rate as high as six. So, if we really want to take our people out of poverty and offer our societies the opportunity of prosperity and good health then we have to do what other societies have done and enable everyone, especially our girls, the opportunity of an education.

In addition to the data, the article in The Economist brings the data to life by sharing the stories of three women, illustrating the circumstances that keep them poor, unhealthy and vulnerable. This vicious cycle can be broken, but only through a concerted effort at all levels of society, especially decision makers at the state level prioritising this as a developmental agenda.

For instance, Kano State recently launched its family planning strategic plan, aiming to raise the mCPR from 10.6% to 27.2% by 2030, an ambitious but essential target. Achieving this goal will require innovative approaches. Increasing the use of modern contraceptives calls for solutions grounded in methodologies like the Pathways Segmentation framework, which help to better understand women’s health vulnerabilities, and designing tailored interventions.

But, there is hope, at the recently concluded Sector-Wide Joint Annual Health Review (JAR), led by the Coordinating Minister of Health and Social Welfare, Professor Muhammad Ali Pate, this issue was put squarely on the table with the launch of the Maternal and Newborn Mortality Reduction Innovation Initiative (MAMII), aimed at reducing maternal and neonatal mortality rates.

Importantly, MAMII has the potential to serve as a vital conduit for sustaining and expanding access to family planning services, reinforcing efforts to improve health outcomes for women and let’s hope, reduce the nationwide disparities in uptake of family planning services.