Nigeria Beyond the Headlines: Demography and Health [Part One]
“Nigeria is a country of marginalized people. Every group you talk to, from the Ijaws to the Hausas, will tell you they are marginalized,” said Peter Lewis, director of the African Studies Program at the Johns Hopkins University School of Advanced International Studies. Lewis spoke at an April 25 conference on Nigeria, co-hosted by ECSP and the Wilson Center’s Africa Program, assessing the country’s opportunities for development given its demographic, governance, natural resource, health, and security challenges. [Video Below]
Youth make up the bulk of society and yet are sidelined by a disproportionate unemployment rate. The vast majority of Nigerians (84.5 percent) live on less than $2 a day as the country’s growing wealth is concentrated in fewer and fewer hands. A changing climate, minimal services, and Boko Haram destabilize the country’s north, while environmental degradation, corruption, and resource mismanagement impede progress in the south.
Unmet Demographic Expectations
“Thirty years ago there was an expectation of better progress on demographic transition for Nigeria,” said Scott Radloff, the director of USAID’s Population and Reproductive Health Office. In 1982, he said, the United Nations Population Division estimated that total fertility rates (TFR) would fall from 6.8 children per woman to 4.7 by 2010, and that infant mortality rates would fall from 132 deaths per 1,000 live births to just 57 over the same time period. In reality, TFR fell to just 5.6, while infant mortality slid to 97.
For family planning in particular, Radloff said, “there’s been little to show for [the international community’s] investment. Modern contraceptive prevalence was measured in 2008 at just 10 percent, which is not very different from where it was 20 years ago, or 30 years ago for that matter.”
The country’s population growth will further strain its resources in the coming years, said Bolatito Ogunbiyi, an Atlas Fellow with Population Action International. Nigeria is already 1 of 15 sub-Saharan countries suffering from water shortages, she said, and climate change and population growth are projected to further constrain supply while boosting demand.
Those twin pressures will also make food security efforts more difficult as more people will have to feed themselves with less land and less reliable access to natural resources. “Looking at the effect of climate change with population growth…the situation could get worse in the future,” said Ogunbiyi.
“A Very Important Contradiction”
In recent years, an economic boom has accompanied Nigeria’s population boom, making it one of the fastest growing economies in the world, said the World Bank’s Volker Treichel. On the one hand, that growth is contributing to a small but growing middle class in the country, on the other, there remains “a very important contradiction in Nigeria” between greater prosperity and growing unemployment.
“While there is impressive GDP growth…that growth is not being distributed evenly through the economy,” said Anthony Carroll, vice president of the business consulting firm Manchester Trade, Ltd. “Growth is concentrated in fewer and fewer hands.”
While the boom benefits Nigeria’s wealthy, the country’s youth suffer disproportionately from rising unemployment, said Treichel, with more than 40 percent of the 15- to 24-year-old cohort unemployed. In order to get one of the few formal sector jobs available, youth “keep going back to school and adding another bachelor’s degree, another master’s degree,” he said, “and that’s so difficult, because those jobs just don’t keep growing at the pace that is necessary.”
Adolescent Reproductive Health and Family Planning
“Poverty predisposes adolescents to high risk behaviors and pushes parents to marry off their daughters,” said Adenike Esiet, executive director of Action Health Incorporated in Lagos. Further, “socially prescribed gender roles undermine young women’s agency and their ability to protect themselves.” Such perceptions must be altered she argued, if the country’s human resources are to be full realized.
Adenike Esiet on addressing adolescent health
“These are the young people who will govern Nigeria, with no education, and for the women, limited agency and a [limited] means of managing their own fertility.”
“When we say adolescent sexual and reproductive health, we mean the physical, mental, emotional well-being of young people – that includes the freedom from unwanted pregnancy, unsafe abortion, maternal death, sexual transmitted infections (including HIV), and every form of sexual violence and coercion,” she said.
In the north, more than two-thirds of girls marry before the age of 20, according to Esiet. “This violates the rights of these young women, because they can’t be consenting if they are minors. These girls are marrying men who are far older than them [and] who have multiple partners,” placing them at risk of contracting sexual diseases and leading to loss of schooling and livelihood opportunities, she said. For every one adolescent boy who is HIV positive in Nigeria, there are three girls.
In addition, “teenage mothers are twice as likely to die from pregnancy-related causes,” Esiet said, yet more than half of Nigerian girls bear their first child before the age of 20. These newborns are also more likely to die during infancy. “Teenagers are typically physically, emotionally, and economically, unprepared to take care of children because they are still children themselves.”
“A major driver [of poor health outcomes] continues to be the denial amongst adults of the fact that young people are not asexual,” said Esiet. “In the midst of all of these negative sexual and reproductive health indicators, adults will still rather believe that young people should not have access to services or information.”
“What people need is information to take more informed decisions,” said the Nigerian Urban Reproductive Health Initiative’s Kabir Abdullahi. “Incidentally, that is not what is provided.”
A dearth of facilities, transport, and family planning services, as well as the low priority this area receives in the government budget, has resulted in a shocking maternal mortality rate of 545 women per 100,000 live births, according to Abdullahi.
With a total fertility rate of almost six children per woman and a population set to double over the next 25 years, huge expansions in the health sector are needed even just to maintain the current level of services, he said.
Abdullahi, using data about correlations between wealth, geography, contraceptive use, fertility rates, gender preferences, and birthing practices asserted that improving services will require focusing on the most vulnerable.
He recommended making health insurance available to those at the community level and focusing on changing “the norm of secrecy around family planning” by encouraging traditional community and religious leaders to reflect on the impact of poor maternal health on their communities.
“Religious leaders have tremendous power of speech,” Abdullahi said. “Because they speak the same language, they understand them, they know them, [and] they have trust in them.”
Accounting for Diversity and Maintaining Commitments
Dr. Zipporah Kpamor, chief of party for the NGO Management Sciences for Health, said the extensive sub-national diversity in Nigeria is an important factor in the lack of progress on demographic and health indicators.
Kpamor explained that a large portion of national health funding is commonly allocated to high profile projects in teaching hospitals and major centers. These projects, she said, fail to benefit the diverse majority of Nigerians.
“The primary key,” said Esiet, “is understanding that when we say adolescents or young people, we’re talking about a diverse population. We have resources and we know what needs to be done, it’s the management of those resources that continues to draw us back as a country.”
All of the speakers explained at length that health solutions require a comprehensive approach, better information, better services, higher quality infrastructure, and a serious focus on gender relations. Yet, the heart of the problem is that the pledges being made have not converted into action.
“We like to say that Nigeria would sign every funky policy, any beautiful policy that comes up – we’re the first to sign,” said Esiet. However, “sticking by the letters of the documents we signed…truly becomes an issue.”
“The truth of the matter is that there’s progress that’s been made in Nigeria, it’s just that progress is just too slow.”
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