Teenage Mothers in Nigeria: A Look at Health System Failures

On a Thursday morning in March, in the Agbowo area of Ibadan, Oyo State, 17-year-old Bisola sat outside her house with her baby strapped to her back. She bent over to adjust the baby while reading for her West African Senior School Certificate Examination.

Two years ago, Bisola almost lost her life while giving birth. "I wasn’t ready," she said.

At 15, she was dating a boy her age. Worried about getting pregnant before finishing school, she tried to get contraception at the nearby Agbowo Primary Health Centre.

Contraception includes methods to avoid pregnancy, like condoms, birth control pills, injectables, implants, and IUDs.

After days of gathering courage, she walked into the clinic alone, hoping for private advice. Instead, she faced questions before any help.

"Who brought you here? Are your parents aware?" she recalled the health worker asking where others could hear.

She was told to come back with her mother or another adult. "I felt embarrassed," she said. "After that day, I didn’t go back."

At home, talking about sex or contraception was seen as shameful for an unmarried girl. She feared punishment from her parents, so she forgot the idea.

Months later, she found out she was pregnant.

The boy denied he was responsible, and while many classmates were preparing for life after secondary school, Bisola was learning how to care for a newborn.

During this interview, she was studying for the same exam she should have finished two years ago, this time with a baby on her back.

Her story might seem like just another case of teenage pregnancy. But this investigation found something more serious.

Bisola did not become a mother because she ignored the risks. She became one after the system failed her even when she tried to prevent pregnancy.

Across Southwest Nigeria, this investigation found that young girls seeking family planning often face a health system that is unreliable or hard to reach. Some clinics lack contraceptives, others face long delays in supplies, while some require adolescents to return with parents, even though national guidelines promise confidential reproductive healthcare.

Despite billions of naira sent to states for primary healthcare in the last six years, these issues remain.

Data from the National Primary Health Care Development Agency (NPHCDA) shows that from 2019 to the second quarter of 2025, the federal government transferred N17.45 billion to Ogun, Ondo, Osun, and Oyo states to improve primary healthcare.

Yet, more than half of the primary healthcare centres (PHCs) in the Southwest do not offer family planning services.

According to NPHCDA data reviewed for this investigation, only 1,491 out of the region’s 3,446 PHCs provide family planning services.

The impact goes beyond healthcare.

Nigeria’s 2024 Demographic and Health Survey found that 77 girls per 1,000 aged 15 to 19 have started childbearing. Also, only 39.7 percent of women who need modern contraceptives can access them.

For many adolescent girls, the issue is not a lack of awareness about early pregnancy; it is finding a health system that can help them avoid it.

More than 220 kilometres from Ibadan, another teenager faced the same situation.

She wasn’t alone

Janet was 16 and sitting for her WASSCE exams when she found out she was pregnant. Unlike Bisola, Janet never looked for contraception.

She did not know such services existed.

A friend introduced her to an older man she thought was single.

"I trusted my friend," she recalled. "I didn’t know he already had a wife."

When she told him about the pregnancy, he refused to take responsibility.

Her parents invited him to their home, hoping he would explain himself or support the pregnancy.

Instead, he sat in silence.

"My parents sent me to school," Janet said. "But all I brought back was pregnancy."

Janet’s experience reveals another gap found in this investigation.

While some girls feel discouraged after seeking reproductive health services, others never seek help because they don’t know such services exist or think they are only for married women.

"I thought family planning was for married women," Janet said.

Field visits across Ogun, Ondo, Osun, and Oyo states suggest these situations are not unique.

They show weaknesses in PHC facilities that should provide, among other things, confidential reproductive health services for adolescents.

Inside the PHCs

At Oke Mapo PHC in Owo, Ondo State, contraceptives were neatly arranged behind the pharmacy counter during this reporter’s visit in April. Injectables, implants, and pills made it look like a clinic with a working family planning program.

But that impression quickly faded. "When did these commodities arrive?" this reporter asked.

"Last year," a health worker, who did not want to be named, replied.

"When will the next supply come?" She shook her head.

"I don’t know."

This uncertainty was not just at Oke Mapo.

At Akungba PHC, nurse Titi Adekoya said government supplies come irregularly, forcing clinics to borrow contraceptives from each other to keep services going.

At Iwaro-Oka PHC, health worker Onijuni Joshua said many adolescents do not return after facing stock-outs because they think the service is not available.

For teenagers, many seeking contraception without telling their parents, one failed visit may be their only chance.

The pattern continued beyond Ondo State.

Back in Agbowo, Ibadan, where Bisola tried to get help, another client, Bukola, shared a similar story. She said she went to the PHC for contraceptives but found the family planning nurse not there.

She was told to come back another day.

She never returned.

"It is stressful to keep going back and not getting help," she said, adding that many women eventually go to private pharmacies and clinics despite the higher cost.

Across the facilities visited for this investigation, access to family planning often depended less on national policy and more on whether contraceptive supplies were available and trained staff were present.

For young people, this inconsistency can mean the difference between preventing a pregnancy and becoming a teenage mother.

Gaps in services

Findings from the NPHCDA show that 56.7 percent of PHCs in the Southwest do not offer family planning services at all.

The four states in this investigation perform below the regional average.

Ondo has 596 PHCs, but only 202 provide family planning services, the lowest in the Southwest at 33.9 percent.

Osun has the most PHCs in the region with 885 facilities, yet only 323 offer contraceptive services. Ogun and Oyo states have coverage of 44.6 percent and 43.6 percent, respectively.

For a young girl seeking help, the odds are against her before she even reaches a clinic.

The results show up in national data.

Nigeria’s 2024 DHS found that adolescent birth rates are among the highest in sub-Saharan Africa, while fewer than four in ten women who need modern contraceptives get them.

The contradiction is striking in southwest Nigeria.

This region has Nigeria’s lowest under-five mortality rate, the highest school attendance, and some of the best primary healthcare indicators.

Yet behind these good numbers lies another truth.

The children survive, but many of their mothers were still children themselves.

The question then became why the system was failing.

To find out, this investigation looked at federal health transfers, state budgets, and implementation reports.

These documents showed that while governments publicly support family planning, their budgets often tell a different story.

Following the money

Records from the NPHCDA indicate that from 2019 to the second quarter of 2025, the federal government gave N17.45 billion to Ogun, Ondo, Osun, and Oyo states through the Basic Health Care Provision Fund (BHCPF) to strengthen primary healthcare services.

While the federal government backs PHCs in states, findings show that the four southwest states do not provide dedicated funding for family planning activities.

A review of state budgets found that dedicated funding for family planning has steadily disappeared or, where it exists, is often not spent.

The four states budgeted less than N163 million for family planning between 2019 and 2025. Some of those funds were never released.

Ogun, which received N4.07 billion in federal funds, had no dedicated family planning budget in 2024 or 2025. The only reproductive health allocation, N25.8 million, was for training equipment, not contraceptives.

Ondo, which got N3.40 billion, also had no family planning budget for 2024. Although the state allocated N45 million in 2025 for “Preventable Maternal Mortality,” the documents did not specify how much, if any, was for family planning services.

In Oyo, the situation was different but still concerning.

The state budgeted N40 million for family planning and N20 million for reproductive health in 2024. However, records show no spending under either line. In 2025, both budget lines were gone entirely, even as the health budget rose from N38 billion to N58.5 billion.

Osun had perhaps the clearest example of the gap between government promises and reality.

The state received N5.06 billion in federal funds. It budgeted N97.55 million for family planning commodities and N25.5 million to set up 100 contraceptive kiosks in markets.

But the fourth-quarter Budget Implementation Report showed zero naira released for the kiosks. They were only on a government spreadsheet.

To check the records, this reporter visited markets in Iree and nearby communities in April 2026, but found no kiosks.

Traders said they had never seen or heard of the project.

The only family planning message found during the investigation was a poster in Iree PHC encouraging women to seek professional advice before an unplanned pregnancy.

For girls who never enter a clinic, even that message goes unseen.

The findings show a broader trend: money keeps flowing into PHCs, but dedicated investment in family planning has either gone down, disappeared, or failed to translate into services that adolescents can access.

National priorities

The gaps found in the four states reflect a wider shift in Nigeria’s national funding priorities.

An analysis by the development Research and Projects Centre (dRPC) found that the federal government’s specific family planning budget dropped from N3.6 billion in 2018 to zero in 2022, even as overall health spending rose.

Funding returned in 2023, but only N20.7 million was allocated, less than one percent of the amount budgeted five years earlier.

This trend suggests that while governments keep investing in primary healthcare, family planning has slowly moved down the priority list.

The result is a gap between policy and reality: billions of naira flow into the health system, but frontline facilities still struggle with unreliable contraceptive supplies and limited access to services.

For young women like Bisola and Janet, these funding choices are felt not in budget papers, but in interrupted education and lives changed by unplanned pregnancies.

Policies that exist only on paper

The investigation found that many barriers facing young girls do not arise from a lack of laws but from poor implementation of existing policies.

Nigeria’s National Standards and Minimum Service Package for Adolescent and Youth-Friendly Health Services says young people should receive confidential reproductive healthcare.

The National Health Act and the National Reproductive Health Policy also prioritize adolescents while international agreements signed by Nigeria promise access to reproductive health information and services.

Yet what girls receive often depends on the clinic they visit.

At Oke Mapo PHC in Ondo State, a family planning provider said adolescents under 18 are usually asked to return with a parent, pastor, or another trusted adult before getting contraceptive services.

The provider, who asked to remain anonymous, said the facility sees over 10 adolescents each month, many coming only after unsafe abortions or unplanned pregnancies.

"When they come after an abortion, we don’t chase them away," she said. "We treat them first, then offer family planning free of charge."

She paused before adding another observation.

"If they don’t take family planning after an abortion, many of them return with another pregnancy."

Less than 150 kilometres away, health workers at Ewekoro PHC in Ogun State described another approach.

"If they come, we are glad to attend to them," one provider said, explaining that adolescents are not turned away because of their age.

The difference highlights a key finding of this investigation: access to reproductive healthcare often depends less on national policy and more on where a girl lives, the health worker she meets, and whether contraceptive supplies are available that day.

Not every facility visited showed system failure.

At Omi Eran PHC in Osun State, this reporter checked daily service records showing regular distribution of condoms, injectables, and implants for adolescent patients.

Records at Boripe Local Government PHC also documented teenagers accessing long-acting contraceptives, showing that youth-friendly family planning services can work with consistent support.

For policy analyst Abdullateef Ahmed, these inconsistencies point to a deeper governance problem.

"In many states, policymakers prefer projects that are politically visible while family planning is hidden under broader health programs," Mr Ahmed said.

"That makes tracking spending difficult and carries little political cost."

He described the disappearance of dedicated family planning budgets in some states and the failure to implement approved projects in others as signs that reproductive healthcare has fallen on the government’s list of priorities.

"Every naira not spent on family planning today multiplies into future fiscal and social costs," he said.

"It leads to more unplanned pregnancies, higher maternal mortality, and deeper poverty."

He called for specific family planning budget lines, regular public reports on commodity availability, and adolescent-friendly service protocols that ensure privacy, no matter where young people seek care.

Research shows that children born to young mothers face higher risks of developmental delays, worse health outcomes, and limited education, meaning the cycle does not end with Bisola or Janet; it starts again with their children.

The immediate loss is a young woman's education and economic potential. The long-term cost is a generation that stays dependent on the same overstretched public systems that failed their mothers.

Official assurances, different reality

Despite the findings, government officials insist that contraceptive services are available in public health facilities.

In response to a case of a newborn abandonment in Ondo State earlier this year, the state’s Commissioner for Women Affairs and Social Development, Seun Osamaye, urged sexually active women and girls to use the free family planning services in government hospitals.

But this investigation found that only 33.9 percent of PHCs in Ondo provide family planning services. Health workers at some facilities also reported waiting over a year for new contraceptive supplies.

To get the government’s side, this reporter submitted a Freedom of Information (FOI) request to the Ondo State Ministry of Health on 28 July, asking for records on family planning budget allocations, reproductive health commodity procurement, and federal primary healthcare transfer utilization from 2023 to 2025. The ministry acknowledged receiving the request.

Earlier, on 23 July, this reporter also sent questions to the Ondo State Ministry of Health and the Ondo State Primary Health Care Development Board (OSPHCDB), outlining the investigation’s findings and inviting both to respond before publication.

Neither the ministry nor the board replied by the time of this report.

In Ogun State, the Executive Secretary of the Ogun State Primary Health Care Development Board (OGPHCDB), Elijah Ogunsola, disputed the budget findings, saying reporters should confirm the figures with the Ministry of Budget and Planning.

"There must have been an error somewhere," he said.

He insisted that the state trained over 120 health workers on postpartum family planning in the last two years and that contraceptive services remain free in government facilities.

"The one that people walk up to the clinic is still ongoing, and it is free at the hospital," he said.

On the budget figures showing no dedicated family planning allocation in 2024 or 2025, he argued that capital expenditure does not reflect the state’s total investment in family planning.

"Let us also look at the recurrent, where salaries and imprests are taken care of," he added.

The Osun State government was given a chance to respond to the findings of this investigation.

On 28 April 2026, this reporter submitted an FOI request to the Osun State Ministry of Health, copying the Executive Secretary of the Osun State Primary Health Care Development Board (OSPHCDB).

The request sought records on family planning budget allocations, the implementation of the state’s proposed 100 contraceptive kiosks, commodity delivery records, and the use of reproductive, maternal, newborn, child, and adolescent health funds between 2023 and 2025.

As the ministry does not have a working public email for FOI requests, the application was submitted through its official online contact portal, which confirmed receipt.

Neither the ministry nor the board responded or provided the requested records by the time of this report.

Similarly, the Oyo State government did not respond to repeated requests.

On 24 July, this reporter submitted an FOI request to the Oyo State Ministry of Health, copying the Oyo State Primary Health Care Development Agency (OYSPHCDA). The request sought records on family planning budgets, spending, contraceptive supplies, and federal health transfer use.

Earlier, on 23 July, this reporter emailed the ministry and OYSPHCDA, explaining the investigation’s findings and asking for clarification on the removal of family planning budget lines, PHC spending records, and service gaps found during the investigation.

Neither the ministry nor the agency responded by the time of this report.

The contraceptives were on the shelf when Bisola walked into the clinic.

The nurse was there.

Nigeria’s policies said she should have received confidential care.

Instead, she left embarrassed and never returned.

Today, she is studying for the exam she should have finished years ago, her baby strapped to her back.

Before she could finish school, the system had already let her down.

Editor’s Note: *The names marked with asterisks have been changed to protect the privacy and identities of vulnerable individuals featured in this report.