ADOLESCENT SEXUAL REPRODUCTIVE HEALTH BACKGROUND IN NIGERIA

Nigeria is the most populous country in Africa. Its population is one of its most significant and distinctive features. With an estimated population of 140 million, Nigeria represents about 20% of the total population of sub- Saharan Africa.

The country’s adolescent sexual and reproductive health profile reveals that Nigerian women give birth to an average of nearly 6 children in a life time. With an annual population growth rate of 2.8%, Nigeria’s population is expected to double by 2015 (to nearly 260 million) requiring a doubling of all infrastructures to maintain the present low standard of living. The current modern contraceptive prevalence rate (CPR) is just 9.8% with little change. Women and girls are the most vulnerable through unintended pregnancy, unsafe abortion, and complications of pregnancy and childbirth (a Nigerian woman’s lifetime chance of dying from pregnancy or childbirth is 1in 13). Low educational attainment further compounds the picture for women and children. Higher education levels often correlate with higher levels of contraceptive use and lower mortality rates, contraceptive use and lower mortality rates among children.

It was estimated that a one year increment in mother’s education leads to a 7-9 % decline in less than five mortality providing incentive for higher contraceptive use. While 78% of Nigeria’s children age 6-12 attend primary school, at least 1.5 million fewer girls than boys enroll in Nigeria’s primary schools. Just 39% of primary 6 school pupils made it to JSS1 in 2002. Adolescent account for a large proportion of the population, up to 23%. By age 19, 70% of all adolescents are sexually active, and most encounters are unprotected. Thus, there is a high rate of teenage pregnancy and a correspondingly high level of unsafe abortion. About 80% of all abortion complications reported in hospitals is with adolescents.

In the last 23 years, since the first AIDS case was reported in 1986 estimates now indicate that the HIV sero-prevalence in Nigeria has increased by more than 3.0% to 5.0% in 2003, with much higher rates reported among high- risk groups. HIV and AIDS epidemic is poised to expand rapidly with women more vulnerable than men, while young women between 15-24 years are the most vulnerable group. The bulk of HIV infections in Nigeria are primarily transmitted through heterosexual sex. Several social, economic, and cultural factors contribute to the spread of HIV and AIDS in Nigeria. Some of these socio-cultural norms and values around sex, sexuality and gender relations. Most communities define a set of ideals that drive norms, through unwritten policies. In most instances, these “policies” are very powerful in shaping the sexual and health seeking behavior or lack of it among the community members.

Other determinants driving the epidemic are poverty, livelihood choices, inadequate access to quality prevention information, skills and care products /services and finally the failure of Nigeria’s leadership (though with few exceptions,) to recognize the seriousness of adolescent sexual reproductive health problem and make it a priority issues, it needs to be in terms of attention and investment.

POLITICAL CONTEXT
Nigeria operates a federal system of government modeled more after American model. The federal government is responsible for giving overall policy direction in key sectors including SRH, HIV and AIDS. They are expected to do this with the active participation of the state. Nigeria has 36 autonomous states that are technically responsible for conceptualizing the policy direction of sectors like SRH and HIV and AIDS thematic areas in their states. In an ideal setting, this conceptualization should be fed upfront into the federal government such that the final product reflects the heterogeneity of the 36 states. Evidence however suggests that this has been a challenge. The approach tends to be one forcing the conceptualization after the policy has been agree and signed off at the centre. This is one of the critical bottlenecks why ASRH are poorly implemented at state levels. The political arena is further complicated in that the Nigeria constitution recognizes 774 local government units. There is ongoing debate on whether local government is a constituent part of the state or whether it represents a 3rd tier of government. As presently constituted they are semi-independent elected structures like the states; they also agree their priorities and state; they also agree their priorities and invest in them, as they deem appropriate. This has a major implication in the efficiency of policy formulation and implication process.

LEADERSHIP & ASRH ISSUES
Despite Nigeria are signatories to different declarations such as UNESCO which states that states should allocate 26% to education, MDG’6 states that state should combat hiv, even the declaration done in the land of the self acclaim giant of Africa; the Abuja + 5 which states that African states should allocate 15% of the national budgetary allocation to health, Nigeria has never allocated up to 10%, though other states are counting down to 2001 UNGASS declaration to universal access to prevention, treatment care and support we are not exceptional to evaluate areas our leaders has done excellently well and were needs improvement A key area where leadership has not been displayed at all is in verbal commitment. Most leaders shy away from talking openly about the root cause of ASRH problem and behavior modification needed to scale down infection rates. There are little resources allocated to ASRH at all levels, especially at state and local government levels. There is a lack of distinct ASRH lines in their appropriation budget, and in general, the state & local government depend on donor funding for most of their activities in the ASRH sector. This is responsible for the slow build up of the response all over the country. Experience of some NGO’s working with government as partners indicates that even where fund is budgeted by government for ASRH bureaucratic process makes the actually allocated fund very difficult to be release.

ECONOMIC CONTEXT
Nigeria presents a paradox in terms of poverty; it is an oil producing country that is wealthy in human and natural capital, but is widely agreed that the incidence of multiple forms of poverty and deprivation are high. Nigeria is the 8th largest oil producing country in the world. The Nigerian economy lacks diversification and is dependent on the export of oil and other raw materials whose prices are low and determined from outside. The most commonly quoted statistics suggests that there has been a rising proportion of the population living below the poverty line. In addition, income inequality has increased. Nigeria is among the 20 countries in the world with the widest gap between the rich and poor.

It is a worldwide phenomenon and particularly so in most of the third world countries that women constitute the larger percentage of poor people, they however remain seriously disadvantaged in terms of access health, education, financial and agricultural extension services owing to legal, use of regulatory, cultural and structural barriers. Gender inequity in access to resources contributes to the rising problem of commercial sex work in the country. Studies done in Nigeria indicate that FSW are in the trade mainly because of poverty; requiring income to meet basic needs. This is compounded by the fact that many also lack needed skills to find alternative employment.