How Faith Is Reshaping Contraceptive Choices in Enugu

The woman sitting across from Esther Edeh had come to the clinic before, and left without the implant she now wanted in her arm. Fear had stopped her the first time but now, something had changed.

“My pastor told me to try it,” she said.

Esther, a health worker in Nkanu West, Enugu state, who has spent years counselling women on modern family planning, said this happens more often than people might expect. Women who have spent months avoiding a conversation about contraception will walk in within days of hearing their religious leader endorse it.

“People are more likely to listen when a ‘man of God’ tells them to do something,” Esther said. “They believe their religious leader more than even medical practitioners.”

But the same influence that reassured this client has, for others, done the opposite.

Before she got married, Mercy Onochie*  heard warnings about family planning from the pulpit that an implant or injection could damage a woman’s womb, or leave her unable to have children after it was removed. “I felt bad and was afraid initially,” she said.

It was only after her first child that Mercy decided to try it anyway. She has now used contraception twice, and says neither experience resembled what she’d been told to fear. “I’ve seen it. I’ve tested it. And I saw that there’s nothing wrong with it,” she said. 

Now a mother of two, Mercy said her experience has made her less fearful of family planning. She believes trusted voices could also influence people who remain hesitant.

Her experience captures something MSI Nigeria has been working to harness for over a decade: the influence religious and community leaders carry over how people think about contraception. 

According to the 2023–24 Nigeria Demographic and Health Survey, the modern contraceptive prevalence rate among married women in Nigeria sits at just 15%, compared to 38% among sexually active unmarried women. Implants account for only 6% of modern contraceptive use among married women; injectables, 4%. Among unmarried women, the male condom remains the dominant method, at 26%.

MSI Nigeria began engaging community stakeholders in Enugu State in 2012.

“Because we needed to promote the use of modern contraceptive methods, we began engaging stakeholders, including religious stakeholders, to reach out to people given Nigeria’s religious inclination,” the organisation’s Southeast regional manager, Ogoamaka Aginam explained.

Religious leaders who went through MSI’s training were connected directly to health workers and services. 

MSI Nigeria speaks to congregants about family planning. Photo credits: MSI Nigeria

“Some of them that we have trained, that have the information, often find a way to talk to their people,” the manager said. In some cases, MSI’s teams would go directly into churches “to do a health sensitisation on family planning and child spacing,” Ogoamaka said. 

Pastor Ifeanyi Ofili is one of those leaders. He says his counselling has changed minds in his congregation, including people who once treated any talk of family planning as a rejection of faith.

“I’ve counselled people that believe that giving birth is a gift from God. Yes, it is a gift from God. But what about if you give birth to the ones you cannot take care of, and you see them in the streets, bringing a bad image to you? How would you feel about it?”

That reframing, he said, is often what moves people. “They themselves now come to conclude that it is better they do what they can carry than what they cannot carry. So a lot of people buy into the idea of modern family planning, saying, ‘I will give birth to two, three, or four, as the case may be.’”

Not everyone who adopts family planning is responding to the pulpit, though. For Chiamaka Peter*, a mother of three, she decided to take up modern contraceptives when she could no longer afford to meet their children’s needs. But the decision almost tore her family apart. 

Chiamaka’s father-in-law wanted her to have five children and pressed her to remove the implant; her husband and mother-in-law wanted another grandchild too. Eventually, she gave in. “They all want me to remove it. My father-in-law said he is expecting five grandchildren from me and that I’ve only given him three. So I had to remove it because I don’t have another husband and I don’t want trouble with my in-laws.”

Her husband works as a mechanic while she is a stay-at-home mother. Her eldest child just turned five and when she talks about what comes next, there’s a weariness to it.

Her story is one MSI Nigeria has run into again and again: a woman can be fully convinced, informed, and willing, and still find that her husband’s family holds the final word. It’s part of why the organisation’s push to involve men directly, not just women, has grown in recent years, recognising that a religious leader’s endorsement, however persuasive, still has to compete with what happens inside a marriage once the sermon ends.

That reach now extends well beyond MSI’s own clinics. The organisation has built out outreach teams, a network of community-based providers known as MSI Ladies, partnerships with private and public health facilities, and a contact centre for confidential counselling and referrals. Across Nigeria, MSI says it runs five centres and 24 outreach teams, works with more than 300 MSI Ladies, and supports over 2,700 public health facilities.

The outreach model is built specifically to reach underserved and rural communities that clinics alone don’t cover, while the contact centre offers women a way to ask questions and get referred to care without having to do so in person. MSI also trains healthcare providers in quality counselling, with informed choice at the centre of its approach. 

Religious leaders fit into that same logic. They’re trusted and MSI has placed a bet on that trust What the organisation still can’t tell you is how much of Enugu’s contraceptive uptake actually traces back to a pastor’s words, versus everything else happening around it at the same time. 

The regional manager however, remains confident that although the has organisation has “not segmented its data to track the uptake, the work these religious leaders are doing, is really working.”

*Names have been changed to protect their identities 

This report was commissioned with support from Nigeria Health Watch under a solutions journalism initiative funded by MSI Nigeria.