Beyond the health care setting : Exploring the intersections of gender, culture and religion and their influence on utilization of family planning services in Northern Nigeria

Bashir, Nasir and Limmer, Mark (2022) Beyond the health care setting : Exploring the intersections of gender, culture and religion and their influence on utilization of family planning services in Northern Nigeria. PhD thesis, Lancaster University.

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Abstract

Everyday Nigeria loses about 145 women of childbearing age as a result of pregnancy related complications, making it the second largest contributor to maternal deaths globally. About 74% of these deaths could be partly averted if all women had access to services that allow them to avoid unintended pregnancies. Despite investments to improve utilization of family planning services, Nigeria’s contraceptive prevalence rate (CPR) remains low (17%), with significantly poorer coverage in North-West (6.2%). The study aimed to explore the beliefs and perceptions of lay men and women of reproductive age about family planning and how gender norms and expectations, cultural practices and religious beliefs exert influence on utilization of modern family planning services in northern Nigeria. An integrative review approach to systematic review of mixed-methods studies revealed knowledge gaps relating to the ways by which culturally assigned masculine gender roles and cultural promotion of large families in the context of extreme poverty influence women’s ability to utilize family planning services. There was also lack of a clearly-defined rational for prohibition of family planning on religious grounds. These knowledge gaps guided the design of this qualitative research. It draws on data collected through focus group discussions and in-depth interviews with 65 participants, comprising of current users and non-users of family planning services, traditional and religious leaders identified using stratified purposeful sampling. The findings suggest that culturally influenced, gendered construction and segregation of power allow men to exert control over women’s contraceptive use, though some women passively resist power imposition through covert contraceptive use to regulate their fertility. Other women decline contraception due to reliance on procreation as a means of self-empowerment where large number of children could improve marriage stability. The study also revealed cultural preference for large families, competition for children amongst co-wives, poor spousal communication that stifles women’s voices, men’s capitalization on public’s mistrust of modern contraceptives and the religiously legitimized performance of masculinity to enforce non-use of modern contraceptives despite conflicting beliefs on prohibition of permanent methods contribute to low uptake. Thus, improving CPR in northern Nigeria will require a change in policy and practice that focuses heavily on social and behaviour change communication strategies to foster long-term sustainable and normative shift in culturally and religiously influenced gender dynamics that promote practice of family planning without disempowering women.