Why does uptake of family planning services remain sub-optimal among Nigerian women? A systematic review of challenges and implications for policy

Background Over the years, family planning uptake in Nigeria has remained low and this is as a result of the various challenges and barriers faced by women. The aim of this study was to systematically review studies on family planning services undertaken in Nigeria in order to understand the challenges to uptake of the services and the policy implications. Methods A PubMed search was performed in June 2020 and studies that investigated challenges of family planning uptake in Nigeria published in English between 2006 and 2020 were sought. A combination of the search terms family planning, contraceptives, challenges, barriers, Nigeria was used. Review articles, case reports, and case studies were excluded. Studies that did not report barriers or challenges to family planning or contraceptives were excluded. Result Twenty seven studies carried out in Nigeria which provided sufficient information were identified and used for this review. The Uptake of family planning recorded in the reviewed studies ranges from 10.3 to 66.8%. Challenges that are client related include education, desire for more children, uncertainty about its need, partner disapproval, previous side effects, religious beliefs, culture disapproval, age, marital status, and wealth index, residence, ignorance, embarrassment, domestic violence and sexual factor. Health service related factors identified include cost, difficulty accessing services, and procurement difficulties. Recommendations for family planning propram and policy include targeting of health service delivery for improvement, focus on gender issues and male involvement, involvement of religious leaders, targeting of younger women for better education and counseling, and continuous awareness creation and counseling among others. Conclusion The review has shown that uptake of family planning remains low in Nigeria and challenges abound. We recommend that strategies that are multi-sectoral should be applied to address the multi-pronged challenges facing uptake of family planning services.