Idowu Abdullahi
Maternal health experts have explained why Nigerian women give birth to many children, revealing that many of them place a premium on having children.
Aside from placing a premium on children, the physicians linked the high fertility rate to choice for Nigerian women, adding that having many children is a decision by anyone who desires it.
The gynaecologists clarified that the high fertility rate doesn’t mean that Nigerian women were genetically predisposed to it or were more fertile than women from other countries.
The fertility rate is the number of children born alive to women during the year as a proportion of the average annual population of women of the same age. Nigeria’s fertility rate, which is said to be 5.3 births per woman, is one of the highest in the world.
In 2024, there are six countries, all in Sub-Saharan Africa, where the average woman of childbearing age can expect to have around six or more children throughout their lifetime.
The six African countries include Niger with 6.6, Chad 6.03, the Democratic Republic of Congo 5.99, Somalia 5.98, the Central African Republic 5.74, and Mali 5.71. Nigeria ranked eight with 4.99, according to data from Statista.
With a fertility rate of almost seven children per woman, Nigeria is the country with the highest fertility rate in the world. Of the 20 countries in the world with the highest fertility rates in 2024, Afghanistan is the only country not found in Sub-Saharan Africa, according to data from Statista.
Speaking exclusively with PUNCH HealthWise, a seasoned Professor of Obstetrics and Gynaecology, Oluwarotimi Akinola, explained that high fertility rate among Nigerian women could be linked to several reasons.
He said that a high fertility rate remains a decision taken by people who want to have many children despite the availability of contraception to ensure proper family planning.
He said, “High fertility rate among Nigerian women could be for several reasons. I know for example certainly that it’s not because they want contraception and they can’t get it but the bottom line is that those in the rural areas want more children and because they are poor people, they farm and they need more hands at the farm and they give birth to more.
“Sometimes, they give birth to more children because they don’t know how many that would survive. Like I said, plenty of children were good on the farm if you are into agriculture but then, that is no longer holding because the economic situation now is also constraining people.”
According to him, some women also give birth to more children because they may be afraid that some might die because of the under-5 high mortality rate.
He also argued that the high fertility rate could be a blessing or otherwise depending on several factors. “It has its upsides and downsides even though I think the downsides overshoot the upsides,” Akinola, who is the Head of the OncoGynaecology Unit at the Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, said.
The expert explained that the high fertility rate contributes to the maternal mortality rate, adding that having more children exposes women to complications of maternal mortality.
“High fertility rate contributes to maternal mortality rate. If you are not pregnant, you cannot have maternal mortality. Of course, the more children you have, the greater your exposure to all those complications that cause maternal mortality, so there’s no doubt about it that high fertility rate is directly proportional to maternal mortality rate. But then, there are variables that you can modify like improving skilled birth attendants, emergency obstetric care to ensure the high fertility rate does not culminate in maternal deaths,” the don said.
On his part, an Obstetrician Gynaecologist at the University College Hospital, Ibadan, Oyo State, Prof. Christopher Aimakhu, explained that high fertility among Nigerian women may be linked to early pregnancy.
“Nigerian women choose to have a lot of children and they get pregnant very early. I think the number of children per woman in Nigeria is quite high and I think women put a premium on children in Nigeria. Although there are far more women than men in Nigeria, then you tend to see women who are married and those who are not married wanting to have children.
“Women put a high premium on children and that is why they have a lot of them. Of course, women don’t use contraceptives or family planning and always want to have a boy when they already have two girls or vice versa and a lot of women want to have more children.”
According to the expert, it is a choice and not as if they are more fertile than other women anywhere.
“They just have as many children as they want. Nigerian women start having children early and they don’t stop till they are old. Women can have children for like a period of 20 years because they just want to have four or five children. A Nigerian woman can start having her first child when she is 20 and by the time she is 40 she’s still having children and it is not as if they are prone to having a lot of children, it is by choice.
“The contraceptive use among Nigerian women is low and for those that already had children, when you recommend or advise them on use of contraceptives, they’d say ‘no leave me o’ and despite that, they still continue to have sex and that leads to more children. But it is not as if Nigerian women are genetically predisposed to having a lot of children, it is just a choice. And many people embrace the fact that they want to have many children,” the don said.
Aimakhu, who is the Second Vice President of the Society of Gynaecology and Obstetrics of Nigeria, said despite the early introduction of free family planning, many Nigerian women didn’t embrace contraception.
“If you ask Nigerian women why they don’t want to embrace contraception, they’d say ‘Oh, they don’t want to be barren in their next life’. Those that have many children just choose to have them but they’re also those who are battling infertility in the sense that there are still plenty of women who are still looking for children,” the expert said.
Asked if the high fertility rate is a blessing or a curse, he said, “I wouldn’t commit myself to saying it is a blessing or curse. But we must look at its demerits because population explosion will come with unemployment, there won’t be jobs, prostitution rate would be higher and crime rate will also skyrocket and also there would be an issue of housing shortages.”
The don, however, differed on high fertility rate leading to maternal mortality rate, arguing that Nigeria has one of the worst mortality rates because a lot of women don’t go for proper antenatal care.
“The number of women who go for proper natal care is still about 30-35%. Even in places where there is free natal care like Lagos, some women don’t still embrace coming to the hospitals, they’d rather go to traditional birth attendants or other sources. It is only when pregnancy becomes complicated that they come to places like teaching hospitals and others. Also, access to healthcare is poor and facilities are also not there. Awareness is also not that high.”
Also, a consultant obstetrician and gynaecologist, Dr Joseph Akinde, linked the high fertility rate among Nigerian women to early marriage.
“The high fertility rate is due to the fact that Nigerian women tend to marry at an early age and continue procreation till very late with very low contraceptive usage. The contraceptive prevalence rate is just 15 percent. In addition we place a premium on childbearing and child-rearing,” the expert said.
According to the former Chairman of the Society of Gynaecology and Obstetrics of Nigeria, Lagos chapter, low contraceptive usage, low literacy levels and religious beliefs contribute to high fertility rate amongst Nigerian women.
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