This is not the best of times for sex workers, adherents of safe sex and couples who no longer desire to have children following the unprecedented rise in the cost of basic contraceptives like condoms, and oral family planning pills among others.
Fears abound that the situation may escalate not the only challenge of overpopulation but also increase Sexually Transmitted Infections, STIs, poverty, unwanted pregnancies and unsafe abortion, which may lead to maternal deaths and the overall health of Nigerians.
The situation has become more worrisome with the worsening economic hardship occasioned by the fall of the naira to the dollar and other major currencies.
As a result, basic commodities of survival such as food, medicines, petroleum products, and even contraceptives are priced out of the reach of the average Nigerian.
With a population of over 200 million people, Nigeria is the most populous country in Africa and the sixth most populous country in the world.
There are projections that, if current trends continue, Nigeria will be positioned to become the third-most populous nation in the world by 2050.
Unfortunately, basic birth control measures needed for safe sex and a guard against unwanted pregnancies and infectious diseases are no longer affordable.
Even access to contraceptives at healthcare facilities has also shrunk, leaving users to either struggle for them, search for alternatives, or engage in raw sex.
Findings by Sunday Vanguard reveal that the prices of the cheapest condom brands have doubled or tripled in recent years.
A pack of three condoms on sale at shops on Lagos mainland costs between N600 and N1, 500 depending on the brand and location of the shop.
Even most of the shops visited either have one brand or do not have any at all.
While some of the emergency family planning pills sold for less than N1, 000 last year, they are now sold for between N1, 400 and N2, 500, depending on the area of purchase.
The prices of other family planning pills popularly known as Combined Oral Contraceptives, COC, have also increased by 50 per cent.
Although many factors influence the prevalence and transmission of sexually transmitted infections (STI), some studies say the high cost of condoms is a barrier to their use, especially among low-income and vulnerable populations. They also noted that it may increase the risk of exposure to STIs such as HIV, syphilis, gonorrhoea and chlamydia.
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Going natural
According to a report by IndexBox, the average condom import price in Nigeria was $11 per thousand units in 2022, which is higher than the average price in Africa ($9.3) and the world ($8.9)3.
The report also stated that the Nigerian condom market surged to $X in 2022, with an increase of X% against the previous year.
Experts say the current situation in the country has become an emergency and needs to be addressed to prevent unwanted pregnancies, unsafe abortions, an increase in STIs and a possible baby boom.
Most affected by the astronomical cost of these products are sex workers, couples who adopte condoms and pills for their family planning needs, and other lovers of safe sex like Mr John Uche.
When John, a father of five, went to purchase a pack of extra-strength synthetic condoms, he was stunned to discover the price had gone up for the third time within two weeks.
“The last time I purchased a pack, it was around N5, 000, but when I went to check at the pharmacy, it was now sold for N8, 500, almost a 100 per cent increase in a space of two weeks,” he lamented.
John said the increase forced him to pick a pack of Gold Circle.
“Even though the price of Gold Circle is also climbing, it is a little cheaper. If the situation continues, many of us may be forced to go natural,” he said.
Another man who spoke to Sunday Vanguard on grounds of anonymity said the wife’s condition forced him to use condoms, lamenting that the price increase is affecting his pocket.
“I cannot afford to jeopardise the health of my wife because of sex, and this is one of the reasons I come to buy condoms. We have tried other contraceptives like pills but the result was not good”, he told Sunday Vanguard.
“I am afraid that if the situation continues, men like me will be forced out of sex.
“Again, I cannot have sex with another woman without protection”.
Keeping safe
A female sex worker who identified herself as Janie lamented that she was spending more on pills.
“I have been using pills for a long time as most of my clients pay more when they go raw with me”, she narrated.
“Pills have been keeping me safe from unwanted pregnancy. Even the prices of the antibiotics I take have also gone up.
“The soaring prices of these medications are gradually forcing me to default in adherence to the guidelines for the family planning pills”.
According to her, while patronage for her business is going down due to economic hardship, the high cost of contraceptives and condoms has dealt her a second blow.
“I’m tired of having no stable income. I have been managing my condition with two children in secondary school since I lost my husband but these days, things are tougher”, the sex worker added.
“I’m already rejecting some clients who are ready to pay higher because I cannot afford to be spending more on pills”.
Ms Tobi, 28, who also went to a nearby pharmacy to purchase a card of Postinor 2 pills, was amazed when she discovered the pills had doubled in price.
“I bought a few days ago at N1, 250, but I am being told at the same shop that the price is now N2,000,” Tobi noted.
A housewife, Gladys Olatunde, was also worried about the non-availability of contraceptives in the health facilities.
“I am on a five-year method. I have been to some centres after the five-year expiration but was told it was out of stock. It has been a struggle for me. I cannot afford pills,” the mother of four said.
350 per cent rise in price
Like other medications, the major factor causing the astronomical increase is the declining value of the naira.
A random check of prices in some pharmacies and the open market in Lagos shows that the prices of all the popular brands have gone up by between 100 and 350 per cent in the last few months.
Brands like sensitive latex condoms cost as much as N500, variant, super-sensitive latex N600, and extra strength synthetic condoms N850.
Some other brands cost over N1, 000.
Old brands like Durex Extra Safe condoms cost over N2, 000, depending on the area of purchase.
No IUD, implants
Confirming the skyrocketing prices, Pharm. Felix Ndiukwu, National Publicity Secretary of the Pharmaceutical Society of Nigeria, PSN, said the Kiss condom, which was N200 a week ago, is now 300.
“We don’t do IUDs and implants but Postinor 2, which cost N1, 400 three weeks ago, now goes for 2,100″, Ndiukwu said.
“Postpill was N1, 000, but now N1, 900. However, the prices depend on the area”.
He said although the patronage for both doesn’t seem to have abated, the fact remains that users are being overstretched financially.
Also confirming the situation, President of the Healthcare Providers Association of Nigeria, HCPAN, Pharm. Abiola Paul-Ozieh, said there has been a constant rise in the cost of all medicines across the board.
Stating that these products were fairly affordable before now, Paul-Ozieh said popular condoms such as Gold Circle and Kiss condoms, which are usually affordable, were going for N150 early last year but today they are sold for N300.
She said some of the emergency family planning pills that were less than N1, 000 last year are now sold between N1, 400 and N2, 500, depending on the area of purchase.
Paul-Ozieh said the prices of other high-end condoms like Durex have also increased.
Apart from one particular variant selling for around N600, according to her, most Durex brands now sell between N1, 900 and N2, 500 and above depending on which variant.
“Needless to say those users of condoms should keep up the good practices of protecting themselves and partners by using condoms for prevention of unwanted pregnancies and sexually transmitted infections”, she said.
“The modest achievement to curtail the spread of HIV/AIDs must be sustained. The mantra ABC of prevention of sexually transmitted infections should be held – A- Abstinence, B- Be faithful to one partner, and C – Condom use.”
Consequences
Meanwhile, family planning experts say the consequences of this development could be devastating as there would be a high rate of unprotected sex, disease explosion (STI) and unplanned pregnancy including unsafe abortion and even death.
In a chat with Sunday Vanguard, South West/Regional Coordinator of the Planned Parenthood Federation of Nigeria, PPFN, Mrs Abimbola Elizabeth, who confirmed the unavailability of contraceptives across the country to reach out to the needs of the population, warned that due to contraceptives’ unavailability to the last mile (consumer), there would be a high rate of unprotected sex as well as disease explosion (STI) and unplanned pregnancy including unsafe abortion.
Elizabeth said the PPFN, in collaboration with UNFPA and the Federal Government, provides condoms for free in various healthcare facilities across the country.
According to her, plans are on the ground to ensure last-mile (consumer) distribution in the next couple of months.
Throwing light on the situation, she said: “Usually in the country and right now, contraceptives just like other goods are affected by inflation.
“Various marketers who deal in contraceptives have increased their sales but I believe that with the plan the government and UNFPA have on the ground, it will be affordable.
“In PPFN, we do not sell contraceptives but only charge for services and the cost of the consumables used to provide those services. I believe that if not for government and UNFPA intervention in Nigeria, contraceptives would not be affordable for the common man before now.
“For the service charges, PPFN has not reviewed the charges in line with the Foreign Exchange, FX, situation but continues to understand the need to reach out to vulnerable people and we also have vulnerability criteria that allow us to provide this service completely free to a vulnerable client.”
She expressed hope that the government efforts would lead to ensuring the distribution of contraceptives to the last consumer.
Way out
She said the current situation can be salvaged through collaborative efforts by various tiers of government and UNFPA to ensure procurements of contraceptives and distribution to the last mile (consumer).
She said development partners such as NGOs should also embark on massive outreach interventions to reach out to the masses in the hard-to-reach areas for adequate coverage of the vulnerable.
Gynaecologists react
In a conversation, a Consultant Gynaecologist with the Bridge Clinic, Lagos, Dr. Babatunde Oguniran, noted that contraception was a method of preventing pregnancy not just for couples alone but also for young men and women who don’t want to get pregnant or risk acquiring STIs, saying shortage in supply has huge implications because when people are not practising safe sexual intercourse, there is the risk of acquiring STIs.
Oguniran, who is a senior fertility specialist at the Bridge Clinic Lagos, said the risk of having sex brings about unplanned pregnancies even for families who want to space their children.
The expert was of the view that condoms and other contraceptives need to be more readily available and a lot cheaper for users to have access to.
He said the country risks population explosion and increased risk of STIs.
“If people are not protecting themselves, especially, you know that injections and pills don’t protect against sexually transmitted infection and the best method is using protection”, Oguniran said.
“So if it’s not readily available, you are increasing the risk of having sexually transmitted infections.
“And when they occur and they are also poorly treated or not identified, it can also have impacts on fertility in the future.”
According to him, pelvic infections like pelvic inflammatory disease can lead to tumour damage and eventually lead to infertility challenges.
“Sometimes it may lead to tube damage, for some women who have pelvic infections that are not properly treated; it will lead to even pregnancies happening where they are not meant to be”, Oguniran said.
“So if pregnancies are not within the womb, they are going to tubes, this leads to what we call ectopic pregnancies that could rupture and lead to surgeries to remove the tube.
“It still leads to infertility. If we’re not looking at the big picture; we are increasing the burden of infertility. We’re also increasing the burden of having to deal with a population whose resources are not available. And if a family cannot take care of the children, it’s also increasing to crime rates”.
He said there was a need for the country to tackle the problem now before it becomes something big that they cannot handle.
Withdrawal method
Oguniran said the withdrawal method is not safe and has the highest failure rates when it comes to the prevention of pregnancy.
The expert said most times a lot of people believe that when they don’t ejaculate, it means there’s no challenge, explaining that a little semen that comes out is actually very rich in sperm.
On her part, a Public Health Specialist, Women’s Reproductive Health, Dr Adenike Jagun, said the effect of economic hardship on contraception revolved around supply and demand, adding that the situation has put women on a spot to make difficult choices between buying contraceptives and buying food, while there is a bit of stock out on the supply side.
“Secondly, the cost of contraception and even moving the commodities from one point to another, which is driven by the price of fuel in the country, means people who are restocking, for example, every month may have to start rationing it and restock maybe on a quarterly or six-monthly basis”, she said.
“Of course, that already worsens a situation where you already have stock out of commodities.”
Jagun lamented that the current situation generally will lead to a dramatic rise in the complications from unwanted pregnancies, which could be unsafe abortion to women having more children than they planned.
“There will also be an impact on their health. Somebody who is having six or seven children, we all know that the uterus at that time is not as elastic or as resilient as it would be if you just had a baby. If you just had two or three children, for example, they are at a higher risk of postpartum hemorrhage”, the expert said.
She expressed fear that it may even aggravate the malnutrition rate in the country as the nutrition of the mother is going to be affected.
“If she has to buy food at a more expensive rate, the variety with which she ideally should be eating while she’s pregnant will reduce. She’s also at risk of the very least, micronutrient deficiency and the baby too”, Jagun said.
Nigerians, according to her, should also expect conditions such as puerperal sepsis in the facilities or perforations among others.
“You will tend to see a bit more of STIs in people with multiple partners and increasing family size. In the health facilities, or private centres, there will be limited choices as regarding the different types of contraceptives”, the expert said.
Jagun stressed that government needs to look at what can be done about the pricing of contraceptives. “If contraceptives are not among medication with import waivers, it’s a policy recommendation because if you waive the import duty, then it comes in at a cheaper price”, she said.
“The forecasting for commodities at the facility level will have to be a bit more robust. Instead of forecasting for three months, you can now forecast for six months instead. Just to ensure that you have a steady supply and mitigate the effect of expensive cost of logistics, transportation and all that to facility level.” She said there was a need to up with innovative ways to make sure commodities get to the facility, adding that awareness about the importance of contraceptives should continue especially at this time.
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