Cablegate: Initiation of Embassy Est&H Reporting:

This record is a partial extract of the original cable. The full text of the original cable is not available.

180827Z Jun 04




E.O. 12958: N/A

1. Introduction. This report is the first of what will
become regular reports by the officer responsible for
environment, science, technology, and health (EST&H) at
Embassy Abuja. Pending the assignment in Abuja of such
an officer, the Mission's economic officers, assisted
by USAID colleagues, will produce the initial reports.
For the foreseeable future, the thrust will be on
Nigerian developments relating to the President's
Emergency Plan for AIDS Relief (PEPFAR). Readers should
expect most of the reports to address the social and
economic factors that influence the spread of this
disease. The reports will be geared toward the needs
and interests of officials within the Office of the
Global AIDS Coordinator, as well as other interested
parties within the interagency community. End

2. Summary. The findings below and in the two cables
that follow are lifted from the executive summary of
the 2003 Nigeria Demographic and Health Survey. The
findings provide baseline data that much of our
subsequent reports will reflect. This one presents the
most recent aggregate data on Nigerian fertility,
family planning, and HIV/AIDS and other sexually
transmitted infections. The second report addresses
women's health and social status. The third centers on
malaria control, and child health and nutrition. We
will follow the evolution of the relevant indicators
closely, not only because of their importance to
PEPFAR, but also because of their relationship to the
Millennium Development Goals. End summary.

3. The 2003 Nigeria Demographic and Health Survey (2003
NDHS), published in April 2004, is the third national
demographic and health survey conducted in Nigeria. The
2003 NDHS is based on a nationally representative
sample of over 7,000 households. All women 15-49 years
of age in these households and all men aged 15-59 in a
sub-sample of one-third of the households were
individually interviewed. The survey provides up to
date information on population and public health in
Nigeria. The 2003 NDHS records current information on
fertility levels and preferences, awareness and use of
family planning methods, maternal and child health,
breastfeeding practices, nutritional status of women
and young children, childhood mortality, use of anti-
malaria bed nets, female circumcision, marriage, sexual
activity, and awareness of and behavioral responses to
AIDS and other sexually transmitted infections in


4. Fertility Levels, Trends, and Preferences. The 2003
NDHS established that the total fertility rate (TFR) in
Nigeria was 5.7 in 2003. This means that, at current
fertility levels, the average Nigerian woman who is at
the beginning of her childbearing years will give birth
to 5.7 children by the end of her lifetime. (In other
words, for every 10 Nigerian women who are at the
beginning of their childbearing years, 57 children will
be born during the women's lifetime. Multiplying the
birth data below by a factor of 10 will yield whole
numbers.) Compared with previous national surveys, the
2003 survey shows a modest decline in fertility over
the last two decades: from a TFR of 6.3 in the 1981-82
National Fertility Survey to 6.0 in the 1990 NDHS and
5.7 in the 2003 NDHS. However, the 2003 NDHS rate of
5.7 is significantly higher than the 1999 NDHS rate of
5.2, which underestimated the level of fertility then
prevailing in Nigeria.

5. The 2003 NDHS shows that, on average, rural women
will have one more child than will urban women (6.1 and
4.9, respectively) during their childbearing years.
Fertility varies considerably by region of residence,
lower rates being recorded in the south and higher
rates in the north. Fertility is also strongly
correlated negatively with a woman's educational

6. Most Nigerians, irrespective of their number of
living children, want large families. The ideal number
of children was 6.7 for all women and 7.3 for currently
married women at the time of the survey. Nigerian men
want even more children than do women. The ideal number
of children for all men was 8.6 and for currently
married men 10.6. Clearly, one reason for the slow
decline in Nigerian fertility is the desire for large

7. Birth Intervals. A 36-month interval between
deliveries is best for mother and child. The median
birth interval in Nigeria was 31 months in 2003. The
median interval was lowest among mothers aged 15-19 (26
months) and highest among mothers 40-49 years of age
(39 months). While there was no difference in birth
intervals between urban and rural women, birth
intervals varied considerably by region of residence.
Women in the South West have the longest median birth
interval (37 months) and women in the South East the
shortest (27 months), a difference of almost one year.

8. Initiation of Sexual Behavior and Childbearing at
Young Ages. One-third of women between the age of 25-49
reported they had had sexual intercourse by age 15. By
age 20 more than three-quarters of women and by age 25
nine-tenths of them had had sexual intercourse. One-
quarter of the teenage women surveyed had given birth
or been pregnant. Early childbearing occurs more often
in rural areas: 30 percent of rural women aged 15-19
had begun childbearing compared with 17 percent of
urban women in the same age group. The median age at
first birth is nonetheless rising. Whereas median age
at first birth was less than 19 years among women over
age 35, it was 20.3 years among women aged 25-29.


9. Knowledge of Family Planning Methods. About eight in
ten women and nine in ten men knew of at least one
modern method of family planning in 2003. The pill,
injectable contraceptives, and the male condom are the
most widely known modern methods among both women and
men. Mass media is an important source of information
on family planning. Radio is the most frequent source
of family planning messages: 40 percent of women and 56
percent of men said they had heard at least one radio
message about family planning during the year preceding
the survey. Conversely, however, more than half of the
women (56 percent) and 41 percent of the men had not
been exposed to family planning messages by a mass
media source.

10. Current Use. Thirteen percent of currently married
women were using some method of family planning during
the survey, including 8 percent using a modern method.
The most common modern methods are the pill, injectable
contraceptives, and the male condom (used by between
1.6 and 3.4 percent of all women sexually active).
Urban women are more than twice as likely as rural
women to practice contraception (20 percent versus 9
percent) and its use varies significantly by region.
Thirty-three percent of married women in the South West
practiced contraception compared with just 4 percent of
women in the North East and 5 percent of women in the
North West.

11. Source of Family Planning Methods. Fifty-eight
percent of users had obtained their contraceptives from
private health care providers. Less than half as many
had gotten them from the public sector (23 percent).
The private sector is the most common source for the
pill (74 percent) and male condoms (59 percent). The
provision of injectable contraceptives for current
users was shared equally by the private sector and the
public sector (8 percent each).

12. Unmet Need for Family Planning. While most women
want large families, a minority want to limit their
family size or wait some time before having their next
birth although they are not using contraceptives.
Seventeen percent of currently married women were in
these two categories and had an unmet need for family

13. Contact of non-users with family planning providers
is important for determining whether family planning
initiatives are effective or not. During the year
preceding the survey, only 4 percent of non-users
reported they had been visited by a family planning
service provider at home; 6 percent of non-users had
visited a health facility and discussed family planning
with a provider; and 24 percent of non-users who had
visited a health facility had not discussed family
planning. These data indicate missed opportunities for
increasing family planning acceptance and use.


14. Knowledge. Almost all men (97 percent) and most
women (86 percent)participating in the survey reported
they had heard of AIDS. Considerably fewer knew how to
prevent transmission of the virus; men were better
informed than women. Sixty-three percent of the men and
45 percent of the women reported knowing that condom
use protects against HIV/AIDS. More respondents (six in
ten women and eight in ten men) reported knowing that
limiting the number of sexual partners may prevent
HIV/AIDS. Less than half of the sample population knew
that mother to child transmission of HIV is possible
through breastfeeding. Fewer people (less than one in
ten) knew that a woman living with HIV can take drugs
during pregnancy to reduce the risk of transmission.

15. HIV Testing and Counseling. Six percent of the
women and 14 percent of the men had been tested for HIV
and received the results of their test. During the 12
months preceding the survey, only 3 percent of the
women and 6 percent of the men had been tested and
received test results. About 25 percent of the women
had received counseling or information about HIV/AIDS
during an pre-natal care visit.

16. High-risk Sex. A much higher percentage of men than
women reported having had sex with a non-marital, non-
cohabiting partner during the year preceding the survey
(39 percent of the men versus 14 percent of the women).
Less than half of the former (47 percent) and less than
one-quarter of the latter (23 percent) reported having
used a condom the last time they had had sex with a non-
marital, non-cohabiting partner. Fifteen percent of the
men who were then married or cohabiting reported having
had high-risk sex in the prior 12 months.

17. Sexually Transmitted Infections (STI). Five percent
of both men and women reported having had a sexually
transmitted infection or an associated symptom during
the 12 months preceding the survey. The never-married
population of both men and women were most at risk.
Eight percent of never-married women and 7 percent of
never-married men reported having had an STI or STI
symptom. Of these, 68 percent of the women and 83
percent of the men had sought treatment for their STI
or STI symptom; however, not everyone had gone to a
health professional.


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