PRB

Funmilola OlaOlorun is a Ph.D. candidate in the department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. She is a participant in PRB’s 2012-2013 Policy Communication Fellows Program, funded by USAID through the IDEA project. This article was written as part of the Fellows Program.

(February 2013) Throughout the world, women ages 35 and older are often left out of conversations on contraception. Many of these women do not think they are at risk of pregnancy because of infrequent sex, marital disruption, the lack of a regular partner, or their perception that they are infertile—and thus they do not see the need to use contraception. Even though women in this age group are less likely to get pregnant, age on its own is not a contraceptive. Researchers have grouped these women as a special population for family planning.¹

Women over 35 who remain sexually active and are not menopausal continue to be at risk of pregnancy, and thus require contraceptive information and services. But this message, while extremely important for women and couples who have had all the children they want, is rarely delivered.

A Nigerian national survey showed that six in 10 women ages 35 and older reported that they had sex in the four-week period preceding the survey, a figure no different than younger women included in the survey.² However, family planning programs are often focused on teenagers, women seeking antenatal or postnatal care, women who bring their babies to the well-baby clinic, and men.

Nigeria’s Population Risks

Nigeria is a sub-Saharan African country of special interest because, according to the United Nations, it was the 10th-largest country in the world in 2010, and will be the sixth-largest by 2050. Women ages 35 to 49 represent 13 percent of all females and 6 percent of Nigeria’s total population.³

The figure shows the fertility planning status of Nigerian women who took part in a national survey in 2008 and had births in the five-year period preceding the survey. Older women (ages 40 to 49) were more than twice as likely as younger women (ages 15 to 34) to report that they wanted no more children at the time the birth occurred. Contraceptive use among older women must increase for Nigeria to achieve universal access to reproductive health (Millennium Development Goal 5).

Fertility Planning Status of Nigerian Women, 2008

Source: Nigeria National Population Commission and ICF International, Nigeria Demographic and Health Survey 2008 (Calverton, MD: ICF International, 2009).

With Nigeria’s large population and the risks of childbirth, unintended pregnancies pose special complications for women in this age group, starting from conception.⁴ Compared with younger mothers, an older mother may suffer complications from preexisting conditions such as high blood pressure or diabetes; excessive bleeding during and immediately after birth; or higher risk of death during labor and delivery. The baby may suffer from congenital abnormalities, low birth weight, or higher risk of death within the first month of life.

Little Knowledge of Older Women’s Perceived Risk

Little is known about how older women perceive their risk of pregnancy, their need for contraception, and whether existing family planning services and counseling are meeting their needs. Evidence is needed that provides a better understanding of the perspectives of women 35 and older, not only to improve their health but also to improve the health of all Nigerian women. Research suggests that these older women may have some influence on the contraceptive choices of other women, such as their teenage daughters and sisters-in-law.⁵ 

Research Project

My ongoing research seeks to fill this gap, at least in part, by talking to women in two major cities in Nigeria (Ibadan and Kano). Group discussions will be held with men who have partners ages 35 and older to better understand how these men perceive their partner’s risk for pregnancy and need for contraception. In Nigeria, men are an important part of a woman’s decision to use or not to use contraception. When the male partners are educated, the women are more likely to use contraception.⁶ However, research suggests that women who have more decisionmaking power can choose to use contraception even if their partner opposes its use.⁷

Additionally, very little is known about how family planning providers will respond to older women seeking family planning services in a culture that stipulates abstinence once a woman becomes menopausal. Older women who have had all the children they want may feel uncomfortable approaching a health worker for contraception, since this inevitably means that they are still having sex.

Beyond the data, this study will provide the contextual depth that may help us better understand how perceived needs, biology, social networks, and the health care system may influence a woman’s contraceptive decisions or restrict her choices. Data from Ibadan, the site in the Southwest, are currently being analyzed and should be available shortly. Data collection will commence in Kano, the site in the northwestern part of the country, in February/March 2013.

References

1. Anitra Beasley, “Contraception for Specific Populations,” Seminars in Reproductive Medicine 28, no. 2 (2010): 147-55; Christy A. Sherman, S. Marie Harvey, and John Noell, “Are They Still Having Sex? STIs and Unintended Pregnancy Among Midlife Women,” Journal of Women and Aging  17, no. 3 (2005): 41-55; and William J. House and Nasiru Ibrahim, “Childbearing by Older Women—a Forgotten Issue?” Reflection (Suva, Fiji: UNFPA Country Support Team; 1999).
2. Nigeria National Population Commission and ICF International, Nigeria Demographic and Health Survey 2008 (Calverton, MD: ICF International, 2009).
3. United Nations Population Division, World Population Prospects: The 2010 Revision (New York: UNFPA, 2011).
4. Bo Jacobsson, Lars Ladfors, and Ian Milsom, “Advanced Maternal Age and Adverse Perinatal Outcome,” Obstetrics and Gynecology 104, no. 4 (2004): 727-33; and Ihab M. Usta and Anwar H. Nassar, “Advanced Maternal Age. Part I: Obstetric Complications,” American Journal of Perinatology 25 (2008, efirst): 521-34.
5. F. Riphagen, J.A. Rafael- Fortney, and S. Koelb, “Contraception in Women Over 40,” Journal of Biosocial Science 20, no. 2 (1988): 127-42; and M.K. Konaté, A. Djibo, and M. Djiré,The Impact of Family Planning on the Lives of New Contraceptive Users in Bamako (Research Triangle Park, NC: Centre d’Etudes et de Recherche sur la Population pour le Développement and Family Health International, 1998).
6. A.T. Beekle and C. McCabe, “Awareness and Determinants of Family Planning Practice in Jimma, Ethiopia,” International Nursing Review 53, no. 4 (2006): 269-76.
7. Gebremariam Woldemicael, “Women’s Autonomy and Reproductive Preferences in Eritrea,” Journal of Biosocial Science 41, no. 2 (2009): 161-81.