Pattern of Family Planning Utilization amongst Patients Who Underwent Successful Obstetrics Fistula Repair in Kaduna and Sokoto States

To enable Nigeria achieve the target of 36% Contraceptive Prevalence Rate (CPR) by 2018 as committed to by the Federal Government of Nigeria in the London summit of 2012, Family Planning (FP) services and information need to be provided to clients at every contact with the health system including post Obstetric Fistula (OF) repaired clients. Use of FP post OF repair is also of great economic importance in OF endemic areas of Northern Nigeria to prevent recurrence and breakdown and allow for livelihood and re-integration into communities for the multitude of affected women. This study therefore assessed the prevalence and trend of FP utilization amongst repaired OF clients and also identified suggestions for improvement of FP utilization by repaired OF patient. The study was a cross-sectional descriptive study conducted in two OF units of Zaria, Kaduna State and Sokoto North, Sokoto State. In depth desk reviews were conducted and available data from 2011-2015 in the hospital FP and OF admission registers were extracted and analyzed using SPSS version 20. Key Informant Interviews (KIIs) were conducted for all the 8 health workers in the units and the 18 repaired OF clients that were accessible in both units during the study period and analysed on Microsoft excel. The average FP prevalence in Sokoto and Zaria OF units was 30 percent. The commonest FP methods used in Sokoto and Zaria OF units were implants (44% and 78%) and injectables (48% and 9%) respectively while permanent methods were the least used in both units. Response from the OF client interviewed showed FP awareness of 70-87% while 12.5 60% were counselled on FP methods and the importance of child spacing. Though 75% of the post OF respondents in Sokoto OF units think FP is useful, none of them either liked it or used any method, while in Zaria 70% of respondents liked FP and 60% used FP methods (mostly Implants and Depo-Provera). Major reason given for not using a method was because they do not have any child alive. None of the interviewed health providers in the OF units in both hospitals had been trained on FP service provision but 88% of them counselled OF patients pre and postoperatively and referred them to FP clinics on discharge. Most respondents believed FP uptake in the units was low because most clients wanted more children having lost the index one, lack of FP training by staff, ignorance, religious / traditional belief and outright rejection of FP by clients. The higher level of CPR reported in the units as compared with the State average confirms the combined effect of information and the removal of physical and financial barriers on access to FP services. Suggestions for improvement include balanced counseling and improved training on FP service provision and counselling package especially for health workers in the fistula units. Citation: Audu Alayande, Hadley Ikwe, Fatima Mamman-daura, et al. (2017). Pattern of Family Planning Utilization amongst Patients Who Underwent Successful Obstetrics Fistula Repair in Kaduna and Sokoto States Page 2 of 8 www.scientonline. org Womens Health Gynecol Volume 3 • Issue 1 • 058 all methods more concerted interventions to increase access and utilization in States within the Northern region where CPR ranges between 3-16% for all methods is required [3]. These include the need to meet the huge unmet need and reduce missed opportunities. The link between high unmet need, maternal deaths and OF was reimphasised by the UNFPA Executive Director Babatunde Osotimehin [4]. There are about 400,000 800,000 women living with OF in Nigeria and about 20,000 more women develop this condition annually [5]. Although OF indicates a failure of safe motherhood especially emergency obstetric care, it is also an indication of survival from maternal mortality, quality of care and level of health facility delivery. A root cause of fistula is a lack of sexual and reproductive rights for women [6]. Thus the London FP2020 summit emphasized the principles of equity and nondiscrimination especially for marginalized women, including those who have had fistula repair, who are hard to reach and who may in addition face financial and social barrier that will prevent them from accessing FP services. Therefore their contact with health facility for OF management is an opportunity to provide them with the full range of RH services and information including FP. The States of Kaduna and Sokoto are located in Northwest Nigeria. These states are inhabited mainly by people of Hausa Fulani descent, but there are several other indigenous minority ethnic groups and settlers from within and outside Nigeria. The States each has a total projected population of 8,314,491 and 5,035,716 respectively as at 2016 respectively [7] (Table 1). Although these States are governed by modern democratic system, there still exist strong male dominated traditional feudal systems with stronghold at the community level. Virtually all aspects of the society are male dominated; politics, economy, commerce, education, culture and religion [8]. Most of the population are Muslims. With the exemption of the State capitals and Zaria city, the vast majority of the settlements are semi-urban or rural. Agriculture is the most important and commonest economic activity in these States. The working population is a mix of both skilled and unskilled workers engaged as civil servants, artisans and trading. The States have an average literacy level of 45% while about 60% of the population live below the poverty line [9,10]. The major Obstetric Fistula (OF) repair units in the States are located within Gambo Sawaba General Hospital (GSGH) Zaria and Maryam Abacha Women and Children’s Hospital (MAWCH) Sokoto. The GSGH OF unit is situated within the hospital in Zaria, Kaduna State. The city is second in size only to the State capital, Kaduna, and is about 78 kilometers from Kaduna town the State capital [11]. The unit was established in 1996. Although it is located within the general hospital, financially, it operates independently of the parent hospital. It however, receives support of staff from the hospital, as needed. It is staffed by four full time health workers 1 nurse and 3 attendants. Theatre staff and other supporting staff are drawn from the main hospital whenever surgical repairs are to be conducted. The unit has 1 theater, 40 beds in 2 wards, a rehabilitation/skills acquisition hall and a kitchen. Since 1996, over 1,500 fistula repairs have been carried out at the unit, with a success rate of over 90%. All repaired fistula survivors are referred to the main hospital’s family planning unit for counseling and FP services. Maryam Abacha Women and Children’s Hospital (MAWCH) in Sokoto State was founded by a former first lady as the first national hospital specifically for women and children. Amongst other services, it offers comprehensive emergency obstetric care and family planning services’ fifty beds are available to women undergoing fistula repair surgery [12]. Administrative data showed that the unit repaired 492 cases between 2013 and 2015. Most of the repairs were done by Dr. Kees Waaldjik supported by two resident doctors in the unit. The units receive support for fistula repairs and rehabilitation of survivors from United Nations Population Fund (UNFPA), Rotary International, The Japanese International Cooperation Agency (JICA) and individual philanthropists. Nigeria intends to improve its CPR from the present 15% to 36% in 2018 [2]. This target may be easier to achieve for Kaduna State which is expected to attain a CPR of 46.5% from its present 20% but poses more challenge for Sokoto State which will be expected to attain CPR of 20% from its present 1% [13]. These requires provision of FP services and information at every contact with the health system including the OF repair units.