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. 2020 Jul-Aug;61(4):196-200.
doi: 10.4103/nmj.NMJ_54_20. Epub 2020 Aug 4.

The Rise and Fall of Female Sterilization in Jos, Nigeria: A Cause for Concern

Makshwar L Kahansim  1 , Victor C Pam  1 , Josiah T Mutihir  1
Affiliations

The Rise and Fall of Female Sterilization in Jos, Nigeria: A Cause for Concern

Makshwar L Kahansim et al. Niger Med J. 2020 Jul-Aug.

Abstract

Background: Female sterilization is a permanent form of contraception offered to women who have completed their family size. Other methods are all temporary and meant to be reversible. A high-quality female sterilization service was introduced in Jos with the assistance of training in counseling and minilaparotomy under local anesthesia in May 1985. After training, female sterilization became available for couples desiring it on completion of family size.

Materials and methods: This was a retrospective study of all clients who had female sterilization for contraception between 1985 and 2019. The clinic register was retrieved and evaluated for acceptances of all contraceptive methods within the period and trends observed.

Results: Over the 35 years, a total of 29,167 new clients accepted modern family planning methods. Out of these, a total of 5167 were female sterilizations, constituting 17.7% of the new acceptors. The temporary methods of contraception constituted 82.3%. The other methods used were the intrauterine device 8357 (28.7%), the oral pills 5125 (17.6%), the injectables 5235 (17.9%), and the contraceptive implants 5283 (18.1%). Although female sterilization was 4th among the five methods studied, there was however a gradual decline in its acceptance from a peak of 36.1% in 1992 to 1.4% in the year 2018.

Conclusion: The acceptance of female sterilization rose to a peak in 1992 and declined to the lowest level in 2018, occasioned in part by the introduction of varieties of contraceptive implants providing long acting, reversible, and cheap contraception.

Keywords: Contraceptive implants; Jos; Nigeria; contraceptive methods; female sterilization.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The trends in cost and number of female sterilization over the 35 years' period of review. The cost of female sterilization within the period has just been a token for the procedure. It ranged from being free at inception (zero Naira from 1985 to 2004, N500 from 2005 to 2011, N1,000 from 2012 to 2015, N2,000 in 2016–2019). The cost is heavily subsidized by the institution, being a training institution where regular and routine posting of residents takes place including the family planning clinic. The cost of contraceptive implants remained consistently higher than the female sterilization in the period under review
Figure 2
Figure 2
Female sterilization amongst other contraceptive methods 1985–2019. The acceptance rates of the contraceptive methods were very similar considering the whole duration of the study between 17.6% and 17.9%. Only the intrauterine devices showed a higher level of acceptance within the period, 28.7%. However, the yearly trends showed fluctuations in acceptances, except the intrauterine devices which showed relative consistency in trend
Figure 3
Figure 3
The trend of the contraceptive method mix in Jos showing the rise and fall of female sterilization. Female sterilization was more accepted compared with the Norplant implant. But with the introduction of more varieties of implants (Implanon, Jadelle and Implanon NXT), acceptance now was in favor of the implants. The cross-over is shown in 2006 with the introduction of the new implants
Figure 4
Figure 4
Comparative acceptance of female sterilization compared with intrauterine devices and hormonal contraceptives (Implants, Oral Pills and Injectables). Female sterilization started off lower than both the hormonal contraceptives and the intrauterine devices. But by 1992, the female sterilization became higher then both of them. Between 1992 and 2004, the acceptances were relatively similar. After 2004, female sterilization began to decline reaching very low acceptance levels by 2018
Figure 5
Figure 5
The acceptance of female sterilization compared with other methods of contraception in the facility. Female sterilization fared well among all the other contraceptives between 1985 and 2005, but plummeted thereafter to become the lowest by 2018. The oral contraceptive pills also declined markedly but became higher than female sterilization
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