Evaluating the impact of a family planning programme on women’s outcomes in Nigeria.

Nearly 80% of women in reproductive age (15-49), in Nigeria do not use modern contraceptives and despite the implementation of several family planning (FP) programmes, uptake and use of modern contraception in Nigeria remains constrained by a limited access and weak service delivery especially among the poorest. In 2009, the Nigerian Urban Reproductive Health Initiative (NURHI) was introduced in 6 Nigerian cities. The programme aimed at increasing the use of modern contraceptive in the programme areas. This thesis attempts to evaluate and measure the impact of the NURHI on modern contraceptive use in Nigeria between 2009 and 2014. We use data collected before and after the programme and the Nigerian Demographic and Health Survey(NDHS). We start the analysis by briefly describing our data and then assess the impact of the NURHI programme on two outcomes of interest. We also assess the effects of the programme on three key groups of women in both outcome of interests using a reflexive comparison approach. We then proceed to assessing the changes in modern contraceptive use in programme participants and the contribution of compositional changes to those trends. We use a binary variable adaptation of the Oaxaca decomposition method (Fairlie) and evaluate the contribution of socioeconomic and other individual factors to the changes in contraceptive use over time and finally we apply the difference-in difference (DID) estimation method to evaluate the causal effects of the programme of modern contraceptive use in Nigeria. Results show an increase in modern contraceptive use in the programme areas over time. Our reflexive analysis result also reveal that there is an impact of the programme on the outcomes of interest that we measure in certain groups of women. Our decomposition analysis also show that while wealth and education are important determining factors of modern contraceptive use pre-programme, their contribution post-programme reduces substantially. Pre-programme it is mainly women with higher education who use modern contraception because of greater autonomy, financial ability, social interaction and access to FP services however the programme appears to help close the socioeconomic gaps in modern contraceptive use over time. In particular, the NURHI reduces the strength of the link between contraceptive use, and education and wealth, and increases women’s empowerment and decision-making regarding contraception. Our impact analysis also show that even after account for other family planning and education programmes in Nigeria, the NURHI programme had a positive impact on the changes that we observe in modern contraceptive use in Nigeria. Overall, our findings suggest that the introduction of the programme is positively correlated to the changes in modern contraceptive in Nigeria and findings has certain implications for policy and programme makers in Nigeria and Sub-Saharan especiallyinregardstothefuture designing and implementation of family planning health programmes in the region.