ACCESS TO FAMILY PLANNING SERVICES IN CONFLICT-AFFECTED AREAS: A STUDY IN STATE SPECIALIST HOSPITAL MAIDUGURI AND IDP CAMP CLINICS

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Access to family planning services constitutes a fundamental component of reproductive health rights, yet armed conflict and forced displacement represent among the most severe disruptions to the delivery of these services. In Nigeria's northeast, the protracted insurgency led by Boko Haram has resulted in widespread internal displacement, with an estimated 2.1 million internally displaced persons (IDPs) scattered across camps in Borno and neighbouring states (Anibueze et al., 2022). State Specialist Hospital Maiduguri (SSHM) and IDP camp clinics in Borno State serve as critical access points for displaced populations seeking reproductive health services, yet the structural and logistical conditions within these settings have severely curtailed effective service delivery.

Amodu et al. (2021) document extensive structural gaps in reproductive healthcare for women in IDP camps in northeast Nigeria, noting that existing government and humanitarian initiatives have disproportionately prioritised food, security, housing, water, and sanitation to the neglect of reproductive health, including family planning. This neglect is evidenced by alarmingly low contraceptive prevalence rates in camp settings, with one study in Abuja recording only 18.1% contraceptive prevalence among women of reproductive age in Wassa camp at baseline, rising to 26.2% only after the delivery of a mobile technology-based family planning intervention (Sampson et al., 2023). Similarly, Anibueze et al. (2022) found in a quasi-experimental study of 470 IDPs that visual multimedia counselling significantly enhanced knowledge and intention to use modern family planning methods, underscoring the importance of context-sensitive service delivery strategies.

The Nigeria Demographic and Health Survey data indicate that family planning needs among displaced women remain grossly unmet, partly due to financial barriers, lack of spousal consent, distance to health facilities, and cultural norms that restrict reproductive autonomy (Oluwakemi et al., 2021). Research by Sampson et al. (2023) further demonstrated that the major reason for family planning refusal at baseline in IDP camp settings was lack of spousal consent, which reduced from 29.5% to 7% after targeted mobile intervention, illustrating that demand-side barriers are equally significant as supply-side constraints.

This study is conducted against this backdrop, examining access to family planning services as experienced by women of reproductive age attending State Specialist Hospital Maiduguri and associated IDP camp clinics. The intersection of conflict, displacement, institutional capacity, and social norms creates a uniquely complex setting that demands rigorous scholarly investigation.

1.2 Statement of the Problem

Despite the critical reproductive health needs of internally displaced women in northeast Nigeria, access to family planning services at State Specialist Hospital Maiduguri and IDP camp clinics remains inadequate, fragmented, and under-researched. Available data show that between 2019 and 2021, approximately 17,053 babies were born to displaced persons in IDP camps in Borno State alone, a figure suggesting that contraceptive uptake remains critically low (Anibueze et al., 2022). Yet the drivers of non-use, including structural, financial, socio-cultural, and institutional barriers, have not been comprehensively examined in the context of SSHM and associated camp facilities.

Research addressing sexual and reproductive health in IDP settings in north-central Nigeria has found that women often rely on herbal concoctions and traditional birth attendants due to the absence of adequate family planning services in camps, with barriers including financial constraints, spousal disapproval, and distance to facilities (Okonkwo et al., 2024). This evidence from comparable settings underlines the urgency of investigating the specific determinants of family planning access at SSHM and IDP camp clinics in Maiduguri.

Furthermore, the broader literature on post-conflict family planning in Sub-Saharan Africa consistently identifies fear of contraceptive side effects, provider attitudes, inadequate health worker training, and insufficient commodity supply as compounding barriers (Mwanja et al., 2015). Without a thorough investigation into the operationalisation of these barriers at SSHM and IDP camp clinics, evidence-based programme design and policy formulation cannot be adequately supported for this setting.

1.3 Objectives of the Study

The main objective of this study is to assess access to family planning services among women of reproductive age at State Specialist Hospital Maiduguri and IDP camp clinics in Borno State, Nigeria.

The specific objectives are to:

1. assess the level of awareness and knowledge of modern family planning methods among women of reproductive age attending SSHM and IDP camp clinics;
2. identify the barriers limiting access to family planning services in conflict-affected healthcare settings in Maiduguri;
3. examine the utilisation patterns of family planning services among displaced and non-displaced women at SSHM;
4. evaluate the effectiveness of existing family planning delivery models at SSHM and IDP camp clinics; and

1.4 Research Questions

The following research questions guide this study:

1. What is the level of awareness and knowledge of modern family planning methods among women of reproductive age at SSHM and IDP camp clinics?
2. What are the barriers to accessing family planning services at SSHM and IDP camp clinics?
3. What are the utilisation patterns of family planning services among displaced and non-displaced women at SSHM?
4. How effective are the current family planning delivery models at SSHM and IDP camp clinics?

1.5 Research Hypotheses

The following null hypotheses are tested in this study:

H01: There is no significant difference in the level of awareness of family planning methods between displaced and non-displaced women at SSHM.

H02: Financial barriers do not significantly influence access to family planning services at SSHM and IDP camp clinics.

H03: There is no significant relationship between spousal consent and the utilisation of family planning services among women at SSHM and IDP camp clinics.

1.6 Significance of the Study

This study contributes to a growing body of literature on reproductive health in humanitarian and conflict-affected settings, with particular relevance to northeast Nigeria. The findings will be of significant value to the Federal Ministry of Health, Borno State Ministry of Health, the United Nations Population Fund (UNFPA), and non-governmental organisations involved in delivering reproductive health services in displacement contexts. By identifying the specific structural, socio-cultural, and institutional barriers at SSHM and IDP camp clinics, the study provides actionable evidence to inform the design and implementation of context-sensitive family planning programmes.

Academically, this research addresses a notable gap in the literature, as few studies have specifically examined SSHM and its associated IDP facilities as a unit of analysis. The study therefore offers original empirical data from a clinically relevant and policy-significant setting.

1.7 Scope and Limitations of the Study

This study is delimited to women of reproductive age (15–49 years) attending State Specialist Hospital Maiduguri and select IDP camp clinics in Maiduguri metropolitan area of Borno State. The study focuses on the utilisation of, and barriers to access for, modern family planning services. The study period covers a twelve-month data collection window.

Potential limitations include: restricted access to some IDP camp areas due to security considerations; the sensitivity of reproductive health topics in a conservative cultural context, which may introduce social desirability bias; and the cross-sectional nature of the primary data, which limits causal inference.

1.8 Definition of Terms

Family Planning: A range of services, practices, and information that allow individuals and couples to decide freely and responsibly the number, spacing, and timing of their children, including the use of modern contraceptive methods.

Internally Displaced Persons (IDPs): Individuals who have been forced to flee their homes due to armed conflict, violence, human rights violations, or natural or man-made disasters, but who have not crossed an internationally recognised national border.

Conflict-Affected Area: A geographic zone that has experienced significant disruption to normal social, economic, and institutional functioning as a result of armed conflict, insurgency, or related violence.

Reproductive Health: A state of complete physical, mental, and social well-being in all matters relating to the reproductive system, its functions, and processes, extending beyond the mere absence of disease or infirmity.

Contraceptive Prevalence Rate (CPR): The proportion of women of reproductive age who are currently using, or whose sexual partners are using, at least one method of contraception.

Unmet Need for Family Planning: The proportion of women who are fecund and sexually active but are neither using contraception nor want to become pregnant, yet are not using any method of contraception.

IDP Camp Clinic: A health facility specifically established or adapted to provide primary and basic healthcare services to internally displaced persons residing in an IDP camp.

Modern Contraceptive Methods: Scientifically developed methods of family planning including but not limited to oral contraceptive pills, injectable contraceptives, intrauterine devices (IUDs), implants, male and female condoms, and emergency contraception.

References

Amodu, O. C., Salami, B. O., Richter, S., & Okeke-Ihejirika, P. (2021). Reproductive healthcare for women in IDP camps in Nigeria: An analysis of structural gaps. Global Public Health, 16(4), 563–577. https://doi.org/10.1080/17441692.2020.1810296

Anibueze, A. U., Ugwuanyi, J. C., Ikwuemesi, C. K., Onuora, C., Ugwuoke, J. C., Apuke, O. D., & Gever, V. C. (2022). Impact of counselling visual multimedia on use of family planning methods among displaced Nigerian families. Health Promotion International, 37(3), daac060. https://doi.org/10.1093/heapro/daac060

Mwanja, M., Wandabwa, J., Kiondo, P., & Wandabwa, J. N. (2015). Perceptions, attitude and use of family planning services in post conflict Gulu district, northern Uganda. BMC Women's Health, 15(1), 1–9.

Okonkwo, E. M., & Ajuluchukwu, C. R. (2024). Exploring sexual and reproductive health needs, barriers, and coping strategies of internally displaced women of reproductive ages in north-central Nigeria: A qualitative analysis. BMC Women's Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623787/

Sampson, S., Oni, F., Ayodeji, O., et al. (2023). Addressing barriers to accessing family planning services using mobile technology intervention among internally displaced persons in Abuja, Nigeria. American Journal of Obstetrics and Gynecology Global Reports, 3, 100250. https://doi.org/10.1016/j.xagr.2023.100250

United Nations High Commissioner for Refugees (UNHCR). (2022). Nigeria situation report. UNHCR.