Sexual and Reproductive Health in Emergency: The Plights of Adolescent Girls and Women in Northeast Nigeria

In the Northeastern (NE) Nigerian states of Borno, Adamawa, and Yobe (BAY states), about 1.7 million people have been displaced and about 8.47 million people in need of humanitarian assistance since the insurgency began in 2009. The ongoing prolonged conflict coupled with the COVID-19 pandemic has strained an already weak health system, lowered the quality of Sexual and reproductive health and HIV (SRH/HIV) service delivery, overstretched the health facilities, and put more women and girls (WaGs) at risk of adopting unhealthy sexual behaviour and procuring diseases including STIs and HIV. Reports from the Nigerian AIDS indicator Impact Survey (NAIIS 2019) show that the key situation of WaGs includes low personal risk perception, multiple concurrent sexual partners, poor healthcare-seeking behavior and inadequate access to and poor quality of healthcare services, entrenched gender inequalities and inequities, chronic and debilitating poverty, and persistence of SRH services related stigma and discrimination. In addition, according to the survey by the Federal Ministry of Education, 21% of the Upper 3 Primary School pupils surveyed indicated that they had been involved in sexual intercourse. A study conducted by the Campaign Against Unwanted Pregnancy (CAUP) revealed that due to their poor health care and information-seeking behavior, young people contribute to more than 60% of unsafe abortions and contribute significantly to new HIV infections in Nigeria.

Women and girls in Northeast Nigeria are at risk and continue to suffer a number of interconnected structural impediments and operate on unequal terms with men. The proportion of women and girls who are likely and willing to access and use SRH and HIV services has continued to decrease due to patriarchal socialization, religious fundamentalism, and gendered social roles and expectations. These issues stated are from the empirical evidence from the USAID-funded “Strategic Response to HIV and AIDS Project” Task order 3 (SHARP-TO3) which tackled HIV/AIDS in Yobe by providing HIV prevention, care, retention and treatment services as well as reducing social and structural drivers of the epidemic and strengthening health systems sustainability (SHARP-TO3 Project Document 2020).  Although adolescent girls in this region are highly vulnerable, they also hold tremendous potential in transforming their lives and communities when their rights and protection are fulfilled, as witnessed by a recent Plan International report on adolescent girls in the region (Plan International report on Adolescent Girls in Northeast Nigeria). In addition, In July 2018, Plan International undertook a major consultation with girls covering the Lake Chad Basin (Nigeria, Niger, and Cameroon) entitled ‘Adolescent Girls in Crisis: Voices from the Lake Chad Basin’. The following are some of the key outcomes of the Plan International report:

• Adolescent girls mentioned difficulty accessing SRHR services, relevant information on appropriate services, and financial barriers. About 8.5% of surveyed adolescent girls reported receiving unwanted attention, kissing, and touching in the previous month, and 84% of perpetrators were adolescent boys. Half of all incidents occurred on the roads and 35% in schools. Another recommendation from adolescent girls was to conduct regular safety audits with the girls while sharing the outcomes and information with stakeholders.

Compared to their male peers, most of the WaGs have more domestic duties to complete, less autonomy in making decisions, less mobility, and are restricted from seeking knowledge and information about sexuality and reproduction. These facts continue to stigmatize and diminish their ability to access SRH and HIV/AIDS services. WaGs living with HIV, using drugs, LGBT, who sell sex, and those living with disability continue to face special exclusion in addition to stigma and other harmful social problems. 

With this, there is a need to strengthen partnerships and consolidate efforts to support vulnerable, hard-to-reach, and conflict-affected women and girls.