"I'm calling you from behind my house," a 17-year-old girl from Northern Nigeria frantically whispers into her cell phone. "I might be pregnant. What do I do?"
A common scenario: Young girls and women in Nigeria often have just one place to turn to when it comes to their sexual and reproductive health concerns—the My Question and Answer service. It's Nigeria's longest-running sex education and reproductive health hotline, started in 2007 by Nigeria's leading nonprofit focusing on adolescent health, Education as a Vaccine (EVA).
"Young people reach us through text, email, phone or our web portal, anonymously," explains Fadekemi Akinfaderin-Agarau, executive director and founder of EVA. "We answer a lot of really sensitive questions about emergency contraception, abortion services, sexual abuse, sexual orientation—that they can't ask anywhere else."
Akinfaderin-Agarau founded EVA in 2000, as a pre-med student at Wesleyan University in the United States. Her passion for adolescent health in Africa was sparked while she was researching HIV strains during a fellowship with the National Institute of Health in South Africa.
"Eight out of every ten blood samples were HIV-positive, and although the goal was to find those types of blood samples, it didn't sit well with me," she says. "Until then, I didn't know exactly how bad the epidemic [in Africa] was."
Akinfaderin-Agarau, who was 20 at the time, soon learned that the HIV/AIDS epidemic in Nigeria, where she was born and raised, was just as bad. This prompted her to shift gears away from med school to start her own non-profit.
The My Questions and Answer Service is one of EVA's most popular and impactful programs. Since its inception, the service has exchanged close to a million text messages with young Nigerians.
The phone hotline closes daily at 6 pm but chat, email and web portal are available around the clock with a guaranteed response time of 24 hours or less. The team of seven counselors speak the various Nigerian languages so nobody is turned away. The service can also be accessed nationwide in all the 36 states in the country.
The counselors, mostly university students studying health or medicine, receive rigorous training so they can accurately respond to a variety of sexual health concerns and provide as much factual information as they can. Akinfaderin-Agarau explains that empathy is just as important. "Most of the counselors are in their early 20s so they can connect well to the young people that contact us," Akinfaderin-Agarau says.
EVA Program Manager Eno-obong Ekwere, who has been with the My Question and Answer Service for seven years, became interested in sexual and reproductive health after a distressing encounter with a 13-year-old pregnant girl. "She told me she took contraceptives in the form of salt, water, and an antibiotic to prevent her pregnancy, which clearly didn't work."
According to Ekwere, girls as young as six sometimes call the service with basic questions about health and body changes. Girls hitting puberty between the ages of ten and 14 ask about body image, periods, pimples, and even about the size of their breasts. Fifteen to 24-year-olds ask mostly about romantic and sexual relationships and disease prevention.
"I am 14 years going to be 15 years [old] by next year, and I have breast buds but am still flat chested why? Am I abnormal?" asks one texter.
"How can I abstain from sexual intercourse? 15, female, Lagos," texts another.
The most popular questions the service gets are about preserving virginity and abstinence, while in the US, questions about birth control tend to flood in. The reason for that is clear: social stigma and a tremendous push from the Nigerian government to abstain from sex before marriage.
In 2004, the Nigerian government launched an abstinence-first campaign as a one-size-fits-all-solution to pressing concerns such as HIV infections, high teenage pregnancy rates, and even gender violence. They launched Zip-Up, a mass media campaign run by the Society of Family Health (SFH) that used television, radio and billboards to spread the message that sex should be delayed until marriage: "Zip Up. Sex is Worth Waiting For."
But clearly, the abstinence-only methodology is failing. Nigeria still has one of the highest adolescent birth rates in the world.
"More than 60 percent of new HIV infections in Nigeria are in the 15- to 25-year-old age group and AIDS is now among the leading causes of death in this group," Akinfaderin-Agarau says. "Ten percent of the world's maternal mortality deaths occur in Nigeria, and 50 percent of these among adolescents."
Conservative beliefs are also a major roadblock for teenage girls, who need these services the most. The My Questions and Answer is used slightly more by males (46 percent of females use the service vs. 54 percent of males), so girls are clearly still gun-shy aboutreaching out for support. Compare this to Planned Parenthood in the United States, whose users are 90 percent women. But there is good news. According to Akinfaderin-Agarau, the My Question and Answer Service has seen a 5 percent increase of female participation over the last year.
EVA is focused on closing the gap between the number of young women and men reaching out for help.
"We make sure that social stigma doesn't affect our services. We also don't provide textbook answers but true medically accurate responses," explains Akinfaderin-Agarau. "A lot of sex education in Nigeria is focused on disease prevention which can be sex-negative and fails to address the real concerns young people have."
Akinfaderin-Agarau also explains that sexual orientation and gender violence are taboo topics in Nigerian society, which makes it even harder for young people to get the answers they need from their parents, teachers and health administrators. "Consensual sex between same-sex partners is prohibited but we get questions about sexual orientation and same sex practices all the time."
Young people experiencing gender violence and sexual abuse also contact the service, and in these cases, the counselors try their best to connect them to local safe spaces and health organizations.
"In case of abuse or danger, we ask if we can contact them on their cell phone which we ordinarily never do. If they give us permission, we follow up with them to see what steps they took. We also follow up with the organizations that we connected them to make sure the caller received appropriate help," explains Akinfaderin-Agarau.
EVA is able to provide all the resources and information it does because the organization has cleverly forged ties with the government and national health agencies. Akinfaderin-Agarau is a part of the Nigerian Minister of Health's Technical Advisory Committee on Adolescent and Young People's Health and Development and the National Agency for Control of AIDS technical working group on HIV Prevention.
"We hide under umbrellas such as the National AIDs commission, which has a vested interest in reaching underserved groups such as LGBT youth, to get them the information and services they need," she says. "Since we've been a part of developing a lot of these policies, we can push the envelope a little."
EVA has also weaved its way through the system to provide information on abortion, even though abortion is illegal in Nigeria unless performed to save a mother's life (approximately 1.25 million abortions occurred there in 2012, according to research from the Guttmacher Institute). Under Nigerian law, it's legal to provide information on post-abortion care, but not to abortion services themselves. But the organizations that provide post-abortion care for women that are legally allowed to obtain abortions (for life-threatening reasons) are more often than not the same places that provide abortion services.
EVA has figured out a way to be resourceful and make a tremendous impact on the sexual rights and health of young Nigerians. Next stop: enforcing that the needs of adolescents, especially girls are reflected under the recently passed National Health Act. Most notably dismissing user fees for young girls and women when accessing health services.
Pushing for greater changes in sex education and policy-making is a constant battle for EVA. While they've tried to work within the system as much as possible, it's time to take it to the next level. EVA's next big battle: Contending with the damaging results of the government's abstinence-only attitude and policies.
"We've just written a proposal to conduct an analysis of the questions young people ask by age to show the government that implementing an abstinence-heavy program is not realistic because young people within a certain age are asking very specific questions," says Akinfaderin-Agarau.
It won't be an easy fight, but it's one worth waging.