When a young person is under the age of 24, they often move through a period of total dependency to partial dependency on their caregivers. In Nigeria, orphans, vulnerable children, and young people (OVCYP) are the largest at-risk group amongst the population. A vulnerable child is below the age of 18 who currently or is likely to be exposed to adverse conditions, thereby being subjected to significant physical, emotional, or mental distress–resulting in inhibited socio-economic development. These conditions can emanate from climate change, government insecurity, hunger, poverty, or a lack of sufficient parenting leading to an increased risk of unwanted pregnancy that some often describe is from the lack of love and sense of belonging.
According to the World Health Organization, a young person is between the ages of 15 to 24 years. This is a unique stage of human development and an important time for laying a foundations for good health and well being. In Nigeria, adolescents and young people have a strong need for family planning (FP) services, which is inadequately being met compared to other low and middle-income countries (LMICs). This need is even worse among the OVCYP in Nigeria who have challenges accessing health care services, including establishing an informed choice to help address their family planning needs.
Although several reasons can be attribute to the need for increased access to family planning services by OVCYPs, my experience as a midwife in the healthcare system in Nigeria for the past six years has made me buttress that healthcare professionals are the major vehicle to realistically achieving increased access to FP methods for OVCYPs. Non-governmental organizations (NGOs) and governments play a co-stewardship role in supporting healthcare professionals to provide quality SRH services. One of the root causes of poor uptake of family planning services among young people is the approach of the family planning service providers to these groups, we need to actively play our roles in supporting the family planning needs of OVCYP.
The approaches often used over the years to make FP accessible and acceptable by young people include:
It is clear that a lot of resources have been channelled into the technial demand generation to drive family planning uptake among adolescents and young people (AYP) but these seem to be almost insignificant practices. Healthcare professionals are our major asset to stir change amongst OVCYPs. The to ask ourselves question is, what exactly are we getting wrong? Once efforts are made to give the prevention methods, is it always easily embraced by our young people?
In 2020, I held a capacity strengthening awareness campaign on COVID-19 and Tuberculosis. During my intervention, I visited one of the most popular public secondary schools in a suburban area in one of the Nigerian states. After the session with the students, I asked them if they had any questions to clarify the topics I had covered. After the session, a student met me outside the class to discuss her unrelated concerns with me.
During my intensive discussion with this student, she told me that she was 16 and sexually active, and her sexual partners were 30 years and older. She expressed that due to their age discrepancy, she had poor bargaining power when it came to practicing choice. Although she was aware of the dangers associated with unprotected sex, like unwanted pregnancy, and the risk of contracting sexually transmitted diseases, her partners refused the use of a condom, despite her request; as her socio-economic vulnerabilities had led her to exchange sex for money. The few who agreed to accept the use of a condom demanded she provide it herself. The young teen made an attempt to request condoms from a health facility, but was shunned by the healthcare professional she met, who even threatened to inform her guardian if she ever requests them again in the future, as she was only seen as an adolescent, but not as a young teen vulnerable to health risks.
This girl went on to disclose to me that she has frequently been treating infections using over-the-counter medications without a proper diagnosis and treatment from a healthcare professional. Breaking down in tears, she explained she has experienced several abortions with horrible memories. This girl is one of 95 percent of OVCYP who do not receive any type of medical, emotional, or socio-economic assistance in Nigeria. She is part of 428 million children age 0–17 years who live in extreme poverty, one of 150 million young teens who have experienced sexual abuse, and one of 218 million children who have engaged in various forms of exploitative labor.
The story of the girl was empathetic, and it would be cold if I had left her without a helping hand. Having observed that she did not want her guardian or school authority to know what she was going through, I had to see if she had a teacher whom she confides in, and when she said yes, I linked her up to the teacher as a mediator. I ensured that her health care status improved by providing her with comprehensive sexual education, including her choice and right to family planning services. This approach is expected of healthcare professionals in caring for Orphans, Vulnerable Children and Young People. Health promotion, disease prevention, and provision of family planning services irrespective of the client’s age and status quo are important pieces of service provision. Moreso, the provision of family planning services for OVCYP by trained family planning providers should not be hospital-based only. It should be extended to orphanages and identified hotspots where these OVCYPs live, through regular visits by trained healthcare providers. This visitation to the orphanages will allow room for early comprehensive sexual education, while also providing family planning services to prevent unwanted pregnancies and sexually transmitted infections.
Non-governmental organizations are not left out of this intervention. The thorough development of programs that can address OVCYP with more genuine interest in their sexual and reproductive health and rights, especially family planning, is a step in the right direction. NGOs must implement projects that will address empowerment in choice and meaningful engagement with OVCYPs by implementing remote delivery of health care services. Providing all round family planning services to OVCYPs cushion the effects of health epidemics and health-related challenges encountered by the larger population.
The Government should be a driving force behind training healthcare professionals. The deployment of government-funded healthcare professionals to OVCYP hotspots would be a great innovation, especially in LMICs. These healthcare professionals should also be provided with adequate commodities for modern family planning services, and trained on the best practices to deliver healthcare services to OVCYPs without discrimination or biases.
Bridging the gap in the availability of family planning and sexual health services for OVCYP will not only reduce sexually transmitted infections and unwanted pregnancies, but it will also improve their sexual and reproductive health, and bring about increased economic productivity.