Oluwole Oludipe, male motivator, talking to a pregnant woman and her husband about pregnancy and proper nutrition. Photo: Chris de Bode/Panos/UNFPA
ILESHE, Nigeria — Prophet Adebisi is an imposing man. A middle-aged community leader here in Ileshe, a rural town in southern Nigeria, he has a deep voice and square build that seem to command authority. And he is putting that authority to use, directing a group of younger men from the town on seating arrangements.
Once their semi-circle of white chairs is complete, Mr. Adebisi launches into a long speech, his voice rising, his chair barely able to contain his frame as his enthusiasm rises. He is lecturing his audience about a newly popular subject here in Ogun State – the importance of using condoms.
Mr. Adebisi is not just a community leader; he is also a male motivator, trained by the Nigerian Ministry of Health and UNFPA, the United Nations Population Fund. He is one of a hundred men, spread across the many communities of Ogun State, who counsel their friends, relatives and neighbours about the dangers of HIV and AIDS and the value of family planning. In brief, he works to increase the popularity of contraceptives and condoms among his people.
High fertility increases risks for mothers and children
"People now want less children, so they can take care of them."
In Nigeria, that is a very important task, as unprotected sex is a risky proposition. Almost 4 per cent of the country’s adults are HIV-positive. Women in Nigeria have a very high fertility rate, averaging 5.7 children per woman, yet poor access to proper obstetric care makes each birth a risky experience. The large number of children in this, one of the 20 least-developed countries in the world, also makes it difficult to provide each with a decent life – or even a life at all. Nearly one in five Nigerian children die before reaching their fifth birthday, according to UNICEF, the United Nations Children’s Fund. Here, condoms and other forms of contraception can save the lives.
When surveys revealed an unusually low level of contraceptive use in Ogun State, the Ministry and UNFPA decided to take action. They realized they needed an approach tailored to the particularities of Nigeria, where sexual relationships, like society in general, are male-dominated. Thus, in November 2005, local communities were asked to send one man each to a training session in reproductive and sexual health, with a particular focus on the importance of contraception.
Targeting decision-makers in a male-dominated society
Baale (king) Abdulai Abuyakode, standing. He is the traditional leader of Ajegunle Community.
“The idea was that men would have to be sensitized and persuaded if contraceptive use was to be taken up,” says Bola Lana, UNFPA Adviser in Ogun State. “Contraceptives were sensitized by saying look—women are dying, they are bleeding to death. Children are not being cared for. How can we stop this?”
After the training the men returned to their communities to spread what they had learned. Their work seems to have made a difference: Since the training session in 2005, contraceptive prevalence in Ogun State has increased significantly.
“Before the training, it was difficult to convince men of the importance of contraceptives,” says Abdulai Abukayode, the baale (traditional leader) of Ajengule, one of the communities in Ogun that sent a representative to the training. “Once they knew more, that changed…People now want less children, so they can take care of them.”
Indeed, if there is an obstacle that the motivators have run up against here, it is not that they have trouble making use of their training, but that they could use more of it. The male motivators were trained simply to persuade their fellow men of the importance of safe sex and family planning. Yet in the middle of Prophet Adebisi’s explanation, he found himself facing a more technical question.
The next step: bringing health services to communities
“Fine, we are sensitized,” said one of the young men who formed his audience, standing up to ask his question. “But who is going to come and teach us how to use a condom?”
UNFPA and the Ministry are working with the Inter-African Committee, a Nigerian NGO, to train members of local communities to help provide for the maternal and reproductive health needs of their family, friends and neighbours.
Prophet Adebisi, a male motivator trained by UNFPA and a traditional community leader, speaks to younger men about HIV and the importance of condoms. Photo: Chris de Bode/Panos/UNFPA
This community-based development (CBD) programme takes regular men and women and educates them in the basics of contraceptive use and prenatal health care. Like the male motivators, they are then sent out into their communities to spread what they have learned. Unlike the motivators, they are charged with more than just persuasion. The CBD agents function as mobile health workers, persuading women to have prenatal check-ups, advising on proper nutrition, and explaining and distributing contraceptives, including condoms. Each CBD worker carries a shoulder bag loaded with basic medicines and contraceptives that they sell at low prices to their communities. A percentage of the money from those sales is kept by the workers themselves, providing them with income for their work.
Yet even with these more technical skills, the most important thing the CBD workers is talking: convincing Nigerian men about the importance of proper reproductive health care and explaining how to access it.
“I tell the husband and wife that the wife should attend prenatal clinics,” explains M.A. Bangbaiye, one of the CBD workers in Oloshe. “The wife should not do strenuous work. We are in a changing world—the husband should help the wife.”
Convincing others that this is the case is not always easy, the workers say. So when necessary, they are prepared to give their neighbours ‘the hard sell’.
“I go their home to counsel the wife and the husband,” says Alh Sarry, a CBD worker, when asked what he would do to persuade a resistant listener. “I say that it is the duty of the husband, that you must use a condom, you must space your children. This way your wife will not die, your child will not die. Both will have good health. There is no need to hurry things up—take it easy!”
Thanks to the efforts of Mr. Sarry and others like him, a great many more people in Ogun State are choosing to do just that.
— Arthur Plews