US embassy cable - 04LAGOS1247

UNCLAS SECTION 01 OF 03 LAGOS 001247 
 
SIPDIS 
 
FOR S/GAC 
 
E.O. 12958: N/A 
TAGS: TBIO, SOCI, ECON, PGOV, NI 
SUBJECT: INITIATION OF EMBASSY EST&H REPORTING: 
FINDINGS OF THE 2003 DEMOGRAPHIC AND HEALTH SURVEY; 
FERTILITY, FAMILY PLANNING, HIV/AIDS: PART I OF III 
 
 
1. Introduction.  This report is the first of what will 
become regular reports by the officer responsible for 
environment, science, technology, and health (EST&H) at 
Embassy Abuja.  Pending the assignment in Abuja of such 
an officer, the Mission's economic officers, assisted 
by USAID colleagues, will produce the initial reports. 
For the foreseeable future, the thrust will be on 
Nigerian developments relating to the President's 
Emergency Plan for AIDS Relief (PEPFAR). Readers should 
expect most of the reports to address the social and 
economic factors that influence the spread of this 
disease. The reports will be geared toward the needs 
and interests of officials within the Office of the 
Global AIDS Coordinator, as well as other interested 
parties within the interagency community.  End 
introduction. 
 
2.  Summary.  The findings below and in the two cables 
that follow are lifted from the executive summary of 
the 2003 Nigeria Demographic and Health Survey.  The 
findings provide baseline data that much of our 
subsequent reports will reflect.  This one presents the 
most recent aggregate data on Nigerian fertility, 
family planning, and HIV/AIDS and other sexually 
transmitted infections.  The second report addresses 
women's health and social status.  The third centers on 
malaria control, and child health and nutrition.   We 
will follow the evolution of the relevant indicators 
closely, not only because of their importance to 
PEPFAR, but also because of their relationship to the 
Millennium Development Goals.   End summary. 
 
3. The 2003 Nigeria Demographic and Health Survey (2003 
NDHS), published in April 2004, is the third national 
demographic and health survey conducted in Nigeria. The 
2003 NDHS is based on a nationally representative 
sample of over 7,000 households. All women 15-49 years 
of age in these households and all men aged 15-59 in a 
sub-sample of one-third of the households were 
individually interviewed. The survey provides up to 
date information on population and public health in 
Nigeria.  The 2003 NDHS records current information on 
fertility levels and preferences, awareness and use of 
family planning methods, maternal and child health, 
breastfeeding practices, nutritional status of women 
and young children, childhood mortality, use of anti- 
malaria bed nets, female circumcision, marriage, sexual 
activity, and awareness of and behavioral responses to 
AIDS and other sexually transmitted infections in 
Nigeria. 
 
FERTILITY 
 
4. Fertility Levels, Trends, and Preferences.  The 2003 
NDHS established that the total fertility rate (TFR) in 
Nigeria was 5.7 in 2003.  This means that, at current 
fertility levels, the average Nigerian woman who is at 
the beginning of her childbearing years will give birth 
to 5.7 children by the end of her lifetime. (In other 
words, for every 10 Nigerian women who are at the 
beginning of their childbearing years, 57 children will 
be born during the women's lifetime. Multiplying the 
birth data below by a factor of 10 will yield whole 
numbers.) Compared with previous national surveys, the 
2003 survey shows a modest decline in fertility over 
the last two decades: from a TFR of 6.3 in the 1981-82 
National Fertility Survey to 6.0 in the 1990 NDHS and 
5.7 in the 2003 NDHS. However, the 2003 NDHS rate of 
5.7 is significantly higher than the 1999 NDHS rate of 
5.2, which underestimated the level of fertility then 
prevailing in Nigeria. 
 
5. The 2003 NDHS shows that, on average, rural women 
will have one more child than will urban women (6.1 and 
4.9, respectively) during their childbearing years. 
Fertility varies considerably by region of residence, 
lower rates being recorded in the south and higher 
rates in the north. Fertility is also strongly 
correlated negatively with a woman's educational 
attainment. 
 
6. Most Nigerians, irrespective of their number of 
living children, want large families. The ideal number 
of children was 6.7 for all women and 7.3 for currently 
married women at the time of the survey.  Nigerian men 
want even more children than do women. The ideal number 
of children for all men was 8.6 and for currently 
married men 10.6. Clearly, one reason for the slow 
decline in Nigerian fertility is the desire for large 
families. 
 
7. Birth Intervals. A 36-month interval between 
deliveries is best for mother and child. The median 
birth interval in Nigeria was 31 months in 2003. The 
median interval was lowest among mothers aged 15-19 (26 
months) and highest among mothers 40-49 years of age 
(39 months). While there was no difference in birth 
intervals between urban and rural women, birth 
intervals varied considerably by region of residence. 
Women in the South West have the longest median birth 
interval (37 months) and women in the South East the 
shortest (27 months), a difference of almost one year. 
 
8. Initiation of Sexual Behavior and Childbearing at 
Young Ages. One-third of women between the age of 25-49 
reported they had had sexual intercourse by age 15. By 
age 20 more than three-quarters of women and by age 25 
nine-tenths of them had had sexual intercourse. One- 
quarter of the teenage women surveyed had given birth 
or been pregnant. Early childbearing occurs more often 
in rural areas: 30 percent of rural women aged 15-19 
had begun childbearing compared with 17 percent of 
urban women in the same age group. The median age at 
first birth is nonetheless rising. Whereas median age 
at first birth was less than 19 years among women over 
age 35, it was 20.3 years among women aged 25-29. 
 
FAMILY PLANNING 
 
9. Knowledge of Family Planning Methods. About eight in 
ten women and nine in ten men knew of at least one 
modern method of family planning in 2003. The pill, 
injectable contraceptives, and the male condom are the 
most widely known modern methods among both women and 
men. Mass media is an important source of information 
on family planning. Radio is the most frequent source 
of family planning messages: 40 percent of women and 56 
percent of men said they had heard at least one radio 
message about family planning during the year preceding 
the survey. Conversely, however, more than half of the 
women (56 percent) and 41 percent of the men had not 
been exposed to family planning messages by a mass 
media source. 
 
10. Current Use. Thirteen percent of currently married 
women were using some method of family planning during 
the survey, including 8 percent using a modern method. 
The most common modern methods are the pill, injectable 
contraceptives, and the male condom (used by between 
1.6 and 3.4 percent of all women sexually active). 
Urban women are more than twice as likely as rural 
women to practice contraception (20 percent versus 9 
percent) and its use varies significantly by region. 
Thirty-three percent of married women in the South West 
practiced contraception compared with just 4 percent of 
women in the North East and 5 percent of women in the 
North West. 
 
11. Source of Family Planning Methods. Fifty-eight 
percent of users had obtained their contraceptives from 
private health care providers.  Less than half as many 
had gotten them from the public sector (23 percent). 
The private sector is the most common source for the 
pill (74 percent) and male condoms (59 percent). The 
provision of injectable contraceptives for current 
users was shared equally by the private sector and the 
public sector (8 percent each). 
 
12. Unmet Need for Family Planning. While most women 
want large families, a minority want to limit their 
family size or wait some time before having their next 
birth although they are not using contraceptives. 
Seventeen percent of currently married women were in 
these two categories and had an unmet need for family 
planning. 
 
13. Contact of non-users with family planning providers 
is important for determining whether family planning 
initiatives are effective or not. During the year 
preceding the survey, only 4 percent of non-users 
reported they had been visited by a family planning 
service provider at home; 6 percent of non-users had 
visited a health facility and discussed family planning 
with a provider; and 24 percent of non-users who had 
visited a health facility had not discussed family 
planning. These data indicate missed opportunities for 
increasing family planning acceptance and use. 
 
HIV/AIDS AND OTHER STIs 
 
14. Knowledge. Almost all men (97 percent) and most 
women (86 percent)participating in the survey reported 
they had heard of AIDS. Considerably fewer knew how to 
prevent transmission of the virus; men were better 
informed than women. Sixty-three percent of the men and 
45 percent of the women reported knowing that condom 
use protects against HIV/AIDS. More respondents (six in 
ten women and eight in ten men) reported knowing that 
limiting the number of sexual partners may prevent 
HIV/AIDS. Less than half of the sample population knew 
that mother to child transmission of HIV is possible 
through breastfeeding. Fewer people (less than one in 
ten) knew that a woman living with HIV can take drugs 
during pregnancy to reduce the risk of transmission. 
 
15. HIV Testing and Counseling. Six percent of the 
women and 14 percent of the men had been tested for HIV 
and received the results of their test. During the 12 
months preceding the survey, only 3 percent of the 
women and 6 percent of the men had been tested and 
received test results. About 25 percent of the women 
had received counseling or information about HIV/AIDS 
during an pre-natal care visit. 
 
16. High-risk Sex. A much higher percentage of men than 
women reported having had sex with a non-marital, non- 
cohabiting partner during the year preceding the survey 
(39 percent of the men versus 14 percent of the women). 
Less than half of the former (47 percent) and less than 
one-quarter of the latter (23 percent) reported having 
used a condom the last time they had had sex with a non- 
marital, non-cohabiting partner. Fifteen percent of the 
men who were then married or cohabiting reported having 
had high-risk sex in the prior 12 months. 
 
17. Sexually Transmitted Infections (STI). Five percent 
of both men and women reported having had a sexually 
transmitted infection or an associated symptom during 
the 12 months preceding the survey. The never-married 
population of both men and women were most at risk. 
Eight percent of never-married women and 7 percent of 
never-married men reported having had an STI or STI 
symptom. Of these, 68 percent of the women and 83 
percent of the men had sought treatment for their STI 
or STI symptom; however, not everyone had gone to a 
health professional. 
 
KRAMER