Nigeria is one of the most rapidly growing countries on the African continent, with a total fertility rate of 5.3 live births per woman and 46 million women of reproductive age. The modern contraceptive rate among married women, however, is low at 16.6% nationally, despite efforts to increase contraceptive uptake, and unmet need remains high at 18.9. Both supply and demand side factors contribute to low demand and high unmet needs. A 2022 systematic review in Nigeria identified health service-related barriers to FP including the cost of services, difficulty accessing services, procurement difficulties, long distances of sources, poor service of family planning clinics, facility dependence on donor organizations for supply of FP materials, and stock outs. The study also identified client-related barriers including education, desire for more children, uncertainty about the need for family planning, partner disapproval, previous side effects, religious beliefs, culture disapproval, ignorance, and embarrassment. Solutions that can address combinations of supply and demand-side barriers to FP are urgently needed in Nigeria.
Three promising high-impact practices (HIPs) that have recently emerged in the field of family planning include expanding contraceptive choice and access through pharmacies and drug shops, leveraging digital technologies for social and behavior change, and leveraging digital technologies to improve time and resource efficiencies in FP systems. At the intersection of these high-impact practices sits a potential game-changer: the e-pharmacy. In the same way that private pharmacies and drug shops are often the first line of health care in low- and middle-income countries, particularly for underserved populations, e-pharmacies have the potential to meet these needs through widespread distribution models, bulk purchasing to reduce costs, and private delivery to homes and pick up points. Additionally, e-pharmacies have a unique digital platform that can be leveraged to generate awareness and demand for FP and provide counseling and other FP services. Finally, e-pharmacies sit atop digital systems for procurement, distribution, and inventory management, which create opportunities for efficiencies that reduce costs, improve data visibility and quality, and support scale.
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