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Measurement, Learning & Evaluation of the Urban Reproductive Health Initiative:

Nigeria 2012 Midterm Survey

Executive Summary

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Your resource for urban reproductive health

MEASUREMENT, LEARNING EVALUATION PROJECT

FOR THE URBAN REPRODUCTIVE HEALTH INITIATIVE& Topic Paper

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MLE Topic Paper 2-2013

www.nurhitoolkit.org

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The following is the executive summary from: Measurement, Learning & Evaluation (MLE) Project; National Population Council (NPC). Measurement, Learning & Evaluation of the Urban Reproductive Health Initiative: Nigeria, 2012 Midterm Survey [TWP 2-2013]. Chapel Hill, NC, USA: Measurement, Learning & Evaluation Project; 2013.


65 percent of baseline EAs). All the householdsin the selected EAs in study cities where awoman from the baseline sample was surveyedwere included at midterm. Women from thesehouseholds make up the longitudinal sample.Prior to the women’s longitudinal survey and themen’s cross-sectional survey, a householdsurvey was undertaken with the head of thehousehold to learn about housing conditions andhousehold assets. The men’s midterm survey is across-sectional sample of men aged 15-59 yearsin the selected EAs of two of the cities (Ibadanand Kaduna).

Results

Household Population Distribution: Overall,74 percent of all women were found at eithertheir baseline location or a new location withinthe study cities. A total of 4,331 women in theselected EAs were re-interviewed at midterm,giving an overall response rate of 65 percent. Atotal of 2,451 men were interviewed during themen’s cross-sectional survey at midterm — a 96percent response rate. The age distribution wassimilar across all cities with the majority of boththe women and men aged 20-39 years. Many ofthe female respondents had formal education(primary or higher); however, 10 percent ofwomen in Kaduna reported having only Quraniceducation. This is similar for men though only 5percent of men in Kaduna reported having onlyQuranic education. The majority of allrespondents in all cities are Muslims except forAbuja where the majority of the women areChristians. About two-thirds of the women andhalf of the men are married or cohabiting with apartner.

Family Planning: There are increases in theknowledge of family planning methods frombaseline to midterm across all cities for bothmen and women (see summary table of keyindicators). More than 98 percent of men andwomen have correct knowledge (spontaneous orprobed) of at least one family planning methodat midterm. The largest increases were observed

Executive Summary Background

The benefits of family planning go beyond theprevention of maternal and child mortality andextend to poverty alleviation, women’sempowerment, and environmental sustainability.The Bill & Melinda Gates Foundation is devotedto improving access to quality family planningservices through its Urban Reproductive HealthInitiative (URHI). The URHI aims to increasethe use of modern family planning methods andservices in select urban areas in Uttar Pradesh,India; Kenya; Nigeria; and Senegal. To garnerscientific evidence for the expansion of URHI,the Measurement, Learning & EvaluationProject, led by the Carolina Population Center atthe University of North Carolina at Chapel Hill,is conducting the impact evaluation of thecountry-specific URHI programs.

The Nigeria URHI (NURHI), being led by theJohns Hopkins University Center forCommunication Programs, aims to increasemodern contraceptive use significantly in sixurban cities in Nigeria: Abuja (FCT), BeninCity, Ibadan, Ilorin, Kaduna, and Zaria. Thebaseline household survey was conducted in2010/2011 and focused on the data collection ofkey reproductive health indicators. The midtermsurvey was conducted in 2012 with the aim ofproviding information on the status of theNURHI program indicators.

Methodology

Prior to the midterm survey, all the women inthe baseline survey were re-visited using thecontact information provided at baseline, aprocess referred to as “tracking.” This trackingexercise was performed in preparation for boththe midterm and endline surveys to minimizeloss to follow up. The midterm householdsurvey was conducted from September toNovember 2012 in four of the six study cities:Abuja, Ibadan, Ilorin, and Kaduna. A randomsample of the baseline enumeration areas (EAs)were selected for the midterm survey (N=225;

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2MLE Topic Paper 2-2013


summary table). The majority of the increaseswere among women in the lower wealthquintiles. The most commonly cited reasons fornonuse of contraceptive methods among womenare fertility-related reasons (e.g., no orinfrequent sex/want more children). Fewerwomen reported negative attitudes orpartner/family opposition towards familyplanning as a reason for nonuse at midterm thanbaseline. Comparing midterm to baseline, morewomen reported that they intend to use a modernmethod in the next 12 months in all cities; anincrease of approximately 8 to 10 percentagepoints in each city.

The public sector remained the primary sourcefor the intrauterine contraceptive device (IUD)

in Kaduna — a 23 percentage-point increase forwomen and a 19 percentage-point increase formen. As shown in the summary table,spontaneous knowledge of any method issomewhat lower, at 87 percent or higher in allcities.

Among all women, there were substantialincreases in the midterm modern contraceptiveprevalence rate (CPR) as compared to baselinein all cities except for Abuja. The modern CPRremained about the same in Abuja (29.2 vs. 29.3percent), but increased from 29.2 to 32.8 percentin Ibadan, 21.3 to 29.5 percent in Ilorin, and16.3 to 27.9 percent in Kaduna. Slightly greaterincreases were observed for moderncontraceptive use among women in union (see

Executive Summary Table of Key Indicators at Baseline and Midterm Percent distribution of women for select key indicators, Nigeria 2010/2011, 2012.

Note: * Missing category includes women who were infecund, menopausal, or had undergone a hysterectomy.




media advertising/entertainment. Thesemessages promote use of FP methods and aretargeted to women in union. A greaterpercentage of respondents (both males andfemales) aged 25-44 years reported highexposure to program activities while a majorityof those aged less than 25 years reported noexposure to program activities. Education andhousehold wealth status are positively associatedwith exposure to program activities. In addition,respondents in union were more likely to beexposed to the program activities compared tothose not in union. The only difference inexposure to the NURHI program is across cities.A greater percentage of women in Ilorin,followed by those in Ibadan, reported exposureto NURHI program activities while a greaterpercentage of men in Kaduna reported exposureto program activities as compared to men inIbadan.

Contraceptive Use among Matched Sample:Since the NURHI program aims to improvemodern contraceptive use, a comparison ofbaseline to midterm CPR among the longitudinalsample of women was assessed. Within the two year follow-up period between baseline andmidterm surveys, approximately 12 percent ofwomen remained modern method users; 58percent remained traditional method users ornonusers; 12 percent discontinued a modernmethod; while 18 percent adopted a modernmethod. Women’s socio-demographiccharacteristics such as age and city of residencewere found to be associated withmethod switching between the surveys.

and injectables in all cities, while the mainsources of emergency contraceptives (EC) andmale condoms are pharmacies andchemists/patent medicine stores (PMS). Theneed for modern family planning among womenin union was assessed and it was found that theunmet need for spacing and limiting childbirthdecreased from baseline to midterm in Ilorin andKaduna, but increased in Abuja and Ibadan.

Maternal and Child Health: The integration offamily planning services with maternal and childhealth service visits such as child delivery, postnatal care, immunization visits, HIV services,and at pharmacies and PMS/chemists wasassessed. Integration of FP at delivery visitsincreased in all four cities evidenced by anincrease in the proportion of women reportingreceipt of FP counseling at their most recentdelivery visit. Similar results were found at thepostnatal, child-immunization, and HIV testingvisits. However, the proportion of women whoreport receipt of a modern method at any of thevisits decreased from baseline to midterm. Thereceipt of barrier methods (male condoms) at aHIV testing visit increased in all cities. Exposureto FP services (counseling, method, or referral)at pharmacies and PMS/chemists is low withover 90 percent of those who visited apharmacy/chemist/PMS in the past yearreporting no exposure to family planningservices.

Spousal Communication: One of the effectiveways of improving modern family planning useamong women is through male involvement,which can be achieved by encouragingcommunication between spouses/partners.Spousal communication on fertility desires andfamily planning was assessed at baseline andmidterm. Similar rates of spousalcommunication on family size desires and onfamily planning were observed at both baselineand midterm for both men and women.

Exposure to Nigerian Urban ReproductiveHealth Initiative Program: NURHI conductedmultiple activities to increase demand for familyplanning, which included the development ofkey themes for social mobilization and mass



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