MARCH 2025

Country context: Taking stock of family planning and reproductive health

Nigeria is the most populous country in Africa. The population of 229.2 million in 2024 is projected to reach 400 million by 2050 and make it the third-most populous country in the world. In the second stage of its demographic transition, birth rates remain high—with a national total fertility rate of 4.8 as of 2023—while lifespans are increasing. This combination of trends presents opportunities but also significant challenges to Nigeria’s long-term socioeconomic development, and to supporting the health and well-being of its large, aging, and growing population. Nigeria’s state-led family planning efforts date back to at least the 1980s, but a complicated history of colonization, civil war, and more recent politicization of the benefits of population control policies have contributed to undermining public trust in sexual and reproductive health services.

Underpinning the challenges facing Nigeria’s health systems—and the delivery of family planning services specifically—are its size, and the diversity both of its landscape and its population. Nigeria is home to over 250 ethnic and linguistic groups, settled across 36 states and the federal capital, and administered by 774 local government jurisdictions. Over half the rural population lives below the poverty line, and health outcomes, including those relating to family planning and reproductive health, vary dramatically based on geography, ethnic and religious identity, and the urban/rural divide. In addition, long-running conflicts afflict significant portions of the country, including the ongoing presence of Boko Haram in the northeast, violence in the Niger Delta, pastoralist conflicts, and disputes between Christians and Muslims over resources and power. As a result, delivering high-quality, affordable, accessible family planning services to all who need them is a complex challenge, resulting in unmet needs and requiring a high level of multistakeholder collaboration and coordination across the public, nonprofit, and private sectors.

Expanding modern contraceptive prevalence

In 2023, the modern contraceptive prevalence (mCPR) among married women was just 15 percent, compared to 38 percent among sexually active unmarried women. While the use of modern methods is increasing, progress is slow, growing from just 4 percent in 1990 to 15 percent in 2023. Among married women, data suggests that implants and injectables are the most commonly used modern methods, at 6 percent and 4 percent usage, respectively, whereas unmarried women most commonly use condoms (26 percent), while the less-effective withdrawal method (9 percent) is also relied upon. Unmet need for family planning remains relatively high, at 21 percent among married women and 36 percent among unmarried women, increasing the chances of unintended pregnancies, unsafe abortions, and unsafe spacing of pregnancies, all of which can have catastrophic outcomes for maternal and child health.

Barriers to contraceptive uptake in Nigeria are varied and manifold. Many women struggle to access information regarding the range of methods, and which options might be most suited to their family planning goals or lifestyle. In addition, cultural or religious preference for large families, myths and misconceptions—such as that contraceptives cause infertility or cancer—gender inequity, inadequate access to services, and poor quality of services all prevent contraceptive use. Indeed, the 2023 Demographic and Health Survey (NDHS) found that among married women with five living children, a quarter wanted another child. In addition to these demand-side challenges, supply side challenges persist in Nigeria, including supply chain bottlenecks, lack of funding for family planning commodities, and poor availability of the full range of contraceptive methods.

The 2018 NDHS, for example, found that 65 percent of health care facilities have service providers trained to administer LARCs, but only 36 percent of facilities provided LARCs. Meanwhile a 2023 survey of health facilities in Delta state found that almost one-third did not carry five or more modern methods of contraception. Service provider bias may be another barrier to contraceptive and family planning access: a 2017 study found that health care providers in six states were more likely to give service preference to women who were married or over 24 years old. Addressing the full range of demand- and supply-side barriers to modern contraceptive prevalence is critical to supporting Nigeria’s SRHR goals and thus its long-term sustainable development.

Ensuring access to family planning and reproductive health care

Maternal mortality remains a significant challenge in Nigeria: In 2022, the maternal mortality ratio was estimated at 545 deaths per 100,000 live births, a significant drop from the 2020 high of 1,047 deaths, but still higher than the maternal mortality ratio recorded in the 2018 NDHS of 512 per 100,000 live births. Indeed, Nigeria is one of six countries that account for more than half of all global maternal deaths. This challenge persists despite interventions to improve access to antenatal care and increase the number of births in health facilities. Entrenched gender inequity contributes to the high rate of maternal morbidity and mortality. Marital rape, child marriage, and polygyny are commonplace, and large families remain the cultural norm, all of which contribute to inadequate spacing of pregnancy and risks to the mother’s health.

Poor-quality maternal and antenatal care remains a challenge: 4.2 percent of health facilities internationally acceptable standards for obstetric care, and two-thirds of women still deliver without the attendance of a medical professional. Similarly, barriers to access and uptake of contraception lead to unsafe spacing of pregnancies, which can drive maternal morbidity and mortality. In addition, unsafe abortion is thought to be a major contributor to the high maternal mortality ratio: Across Nigeria, Ghana, and Burkina Faso, it is estimated to contribute to 12 percent of maternal deaths. Abortion is illegal in Nigeria, with exceptions only when the mother’s life is at risk.

Preventing and managing reproductive cancers and diseases

Nigeria has a cervical cancer mortality rate of 14.3 deaths per 100,000 cases, while the mortality rate for breast cancer is at 26.8 deaths per 100,000. Given that breast and cervical cancers are the top two causes of cancer-related death, Nigeria’s National Strategic Cancer Control Plan 2023-2027 includes targets aimed at reducing the incidence and mortality of each, including attaining 50 percent coverage for the HPV vaccination by 2027. Meanwhile, Nigeria has implemented an HIV/AIDS control policy since 2000, but the incidence of HIV remains high. Nigeria has the highest number of annual HIV infections among children in the world, accounting for 14 percent of the global total, and adolescents are a particularly high-risk group for transmission. Contributing to this challenge, only 30 percent of women and 22 percent of men aged 15 through 24 have comprehensive knowledge of HIV prevention, and around two-thirds of men and women have never been tested for HIV. Increasing SRH education, including a focus on HIV/AIDS, within schools, and encouraging the achievement of secondary and tertiary education can support better reproductive health outcomes, including preventing pregnancies involving the maternal-child transmission of HIV.

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Policies and programs: Assessing multistakeholder efforts

Family planning services are offered as part of Nigeria’s primary health care offering, and health services are intended to be financed by a combination of federal, state, and local governments, although in practice these costs are supplemented by international donors and the private sector. Even then, funding gaps persist, and planned budget allocations may not be appropriated or distributed, let alone spent on delivering reproductive health services. Indeed, while Nigeria seeks to achieve universal health coverage (UHC), its achievement is hindered by significant financing and capacity gaps. As a result, health care services, particularly in rural areas, are often provided by the private sector, which can lead to untenable out-of-pocket costs for some of the country’s poorest citizens due to insufficient insurance coverage.

Family planning policy is currently guided by the government-driven National Family Planning Blueprint 2020-2024, which seeks to increase the mCPR for all women to 27 percent by 2024, including through supply- and demand-side interventions such as strengthening commodity security throughout the country, and increasing demand for contraceptives through education and communication strategies. Nigeria is also a part of FP2030—its commitments align with and support the goals of the Blueprint, and include goals to integrate family planning into UHC, and, crucially, improve financing by allocating a minimum of one percent of national and state health budgets to family planning. Several local and international actors work alongside the government to provide access to family planning services, including through supplying commodities, providing health care services, and training workers. UNFPA is also a major actor in Nigeria, and has committed to spending USD 145.1 million between 2023 and 2027 to achieve family planning goals in alignment with the National Family Planning Blueprint.

Funding and coordinating family planning and reproductive health

The wide range of actors within Nigeria’s family planning ecosystem requires a high level of coordination and collaboration to address gaps and prevent duplication of activities. Recognizing this need, in December 2024, Nigeria held its 8th Family Planning Conference, which brought together stakeholders from across different sectors to make financing and service commitments, share best practices, and identify areas for growth. To address demand-side challenges, government-led efforts focus on communication, information, and education strategies, largely guided by the National Family Planning Communication Plan, which was developed in consultation with public health officials, marketing experts, and the general public. Notable aspects of the Communication Plan include the development and deployment of a national family planning logo—The Green Dot—which designates trusted service providers and commodity brands, to make service choice easier and safer for the public. The Communication Plan also provides guidance for media companies to integrate family planning messaging into their programming and recommends promoting sexual and reproductive health and rights via community influencers, such as mothers, mothers-in-law, religious leaders, and health care providers.

These government-led communication strategies are bolstered by public-private partnerships, and work by NGOs. A web series based in Nigeria was created through the collaboration of MTV, PEPFAR, the Bill and Melinda Gates Foundation, and MSI, for example, to disseminate messaging around contraception and STI prevention. A World Bank study found that six months after the series in Nigeria aired, viewers were twice as likely to get tested for HIV tested than non-viewers, and chlamydia infections dropped by 58 percent among women. This type of creative project, when well designed and targeted, can be helpful for raising public awareness and encouraging behavioral change, and therefore could be impactful if adapted and replicated in other countries with unmet need.

Non-governmental actors also work with community influencers to spread messaging and information regarding family planning services and contraceptive choice. For instance, the Nigerian Urban Reproductive Health Initiative (NURHI), a collaboration between Johns Hopkins University and the Gates Foundation, distributes booklets to religious leaders which use relevant passages of scripture and a focus on the health benefits of family planning, while MSI Nigeria similarly engages with traditional and religious leaders to address engrained social norms.

However, demand generation needs to be supported by an adequate supply of family planning services and commodities. Funding gaps, stock-outs, and inadequate numbers and training of service providers all impact Nigerians’ ability to access family planning and reproductive health services. Family planning commodities are distributed centrally from the federal capital and must travel to states and then to the last mile, a logistical set up that creates supply chain bottlenecks, gaps, and vulnerabilities. In an interview with FP Analytics, Joachim Chijide, Family Planning/Reproductive Health Commodity Security Specialist for UNFPA Nigeria, noted that visibility is crucial when it comes to ensuring an adequate supply of commodities. While commodity logistics are tracked via the Nigeria Health Logistics Management Information System (NHLMIS), sub-optimal data quality and limited overall capacity for data demand and use are issues the government and its partners are contending with. According to Chijide, UNFPA is working to improve usage of the NHLMIS, to ensure the ability “to track any given commodity from its point of entry until it is dispensed at the last mile . . . this enables us to hold those who are responsible for managing these commodities a lot more accountable.”

In addition to challenges in distributing contraceptive supplies, financing for family planning commodities is unreliable. For example, in 2019 and 2020, the federal government’s budget for family planning commodities dropped by 90 percent, and in FY2023 there was a USD 23 million shortfall for commodity procurement. Despite Nigeria’s FP2030 commitments, in 2024, the federal government allocation of NGN 2.2 billion (USD 1.4 million) represents only 0.15 percent of the health budget—compared to the target of 1 percent—and state government commitments are similarly low. These financing gaps are traditionally supplemented by donors such as UNFPA, but shifts in the international donor landscape have impacted UNFPA’s work in Nigeria. UNFPA Nigeria estimates that in 2025 it will face a USD 27 million shortfall for commodity financing, a gap that has grown every year since 2020 due to lowered contributions by traditional donors such as USAID and FCDO.

Given changes in the international donor landscape, increasing domestic financing of family planning will be critical to the long-term sustainability of Nigeria’s SRHR program. Interventions such as The Challenge Initiative (TCI), which operates in Nigeria and across the globe, indicate a potential pathway to increasing domestic financing. Under the initiative, state governments receive funding to match their own budget allocations for family planning, with the match funding—supplied by a range of donors, including the private sector—provided tapering downward each year as the state government contribution increases. To qualify for the initiative, state governments must supply a financial plan over multiple years and then evidence of its enactment. Between 2018 and 2022, 13 Nigerian states received USD 5.6 million from TCI to fund family planning services and commodities, indicating that there is room for this partnership to spread throughout the country.

Strengthening maternal and newborn care

Delivery of maternal and newborn health remains a challenge due to various cultural factors, and lack of capacity for service provision. There are an estimated 22 million child brides in Nigeria, and half of all women ages 25 through 49 had their first child by the age of 21. Early marriage and pregnancy carry risks of maternal morbidity and mortality, gender-based and sexual violence, STI transmission, and a lack of choice surrounding the timing, number, and spacing of births. Increasing the number and improving the training of community health workers (CHWs) represents a critical avenue for supporting family planning and improving maternal and newborn health outcomes. Existing policies aim for each pregnant woman to receive antenatal health care on at least four occasions, either in health facilities or through community health care workers. However, as of 2023, only half of all women received this level of care for their most recent live birth. Non-governmental and international organizations are providing crucial support to increase the coverage and training of CHWs, according to a Nigeria-based family planning and reproductive health practitioner, including by training them in administering medium- and long-term contraceptives such as injectables. Meanwhile, Canada’s International Development Research Centre has run training courses for CHWs in maternal care, as part of its development support to Nigeria. Better integration of family planning services with maternal and neonatal care can help improve overall health outcomes via life course approach for women and adolescent girls.

Anticipating and targeting demographic blind spots

Nigeria is currently experiencing a significant youth bulge. As of 2022, almost two-thirds (63 percent) of the population is under 25 years of age. Realizing the potential socioeconomic gains of this demographic, and to secure their health and well-being, investments in education, health, and family planning and reproductive rights services are critical and need to be complementary. Addressing entrenched cultural norms and ensuring that adolescent girls have accurate, age-appropriate information regarding family planning, contraceptives, and sexual health will be vital to strengthening their health and well-being across their lifespan. In acknowledgement of the importance of this demographic, Nigeria has for decades implemented successive adolescent health plans, the most recent of which is the National Policy on the Health and Development of Adolescents and Young People in Nigeria: 2020-2024. Data-driven targets for the policy include increasing the use of condoms, increasing STI testing, and reducing the adolescent pregnancy and maternal mortality rates by 2024.

Ensuring that all adolescents are aware of their right to access family planning services and contraceptives—and of the choice of contraceptives available—is key to not only preventing unwanted pregnancies but also to mitigating maternal morbidity and mortality among adolescent girls. Nevertheless, a Nigerian government analysis found that while unmarried adolescents were able to access condoms and emergency contraception with relative ease, significant barriers remained to accessing longer-term and more reliable forms of contraception, such as implants, IUDs, and injectables. Closing this gap will require developing and disseminating youth-friendly and youth-targeted information and health services, as well as addressing cultural norms toward marriage and childbearing at a young age.

One additional demographic in need of targeted support comprises those living within conflict-affected regions. UNFPA Nigeria estimates that 80 percent of the population displaced by conflict and in need of humanitarian support are women and girls, all of whom are in need of family planning services. Compounding their vulnerability, studies have found that women and girls living through conflict are more likely to marry—or to be married off—young and as quickly as possible, as perceptions persist that husbands may afford them security. Such trends exacerbate and interact with the existing risks of child marriage and young age-at-first-birth outlined above. It is imperative that humanitarian aid therefore includes family planning services, including for adolescent girls and unmarried and married women.

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Looking ahead: Pursuing untapped opportunities and key priorities

Amid its demographic transition, Nigeria and its citizens could benefit greatly from strong, accessible, affordable family planning and reproductive health services, but significant challenges remain to making this a reality. Sustainable financing for family planning services and commodities remains a critical challenge. In late 2024, the federal Ministry of Health, UNFPA, and other stakeholders came together to develop an investment case and sustainability plan for family planning in Nigeria, laying out the benefits of long-term investment in these services and seeking to chart a path forward. Ensuring that these recommendations result in action will require concerted multistakeholder effort. Building political will at the federal, state, and local levels for family planning financing will be critical to this work, as will securing sustained investment from international donors, including through innovative arrangements such as The Challenge Initiative’s match funding approach.

On the demand side, more must be done to encourage the uptake of family planning services and commodities, and to shift attitudes toward healthier and safer decisions regarding childbirth and family sizes. Bringing male partners into decision-making processes is one avenue for normalizing the use of family planning and supporting the spread of accurate information. A 2021 study undertaken in Nigeria found that women who made family planning decisions in discussion with their partners were three times more likely to be either currently using or intending to use contraceptives than those who did not. Similarly, outreach to community influencers is key: A 2018 study found that 40 percent of Nigerian women reported being exposed to family planning messaging from their religious leaders in the past year, leading to higher contraceptive uptake. Working with traditional medicine providers may be another avenue for influence and service provision, particularly as many women still do not to give birth in health facilities. Traditional healers could help increase uptake of family planning and reproductive health care, and thereby improve the health and well-being of Nigerians, today and in the future.