The survey used a cross-sectional design. Both qualitative (key informant interviews [KIIs]) and quantitative (structured questionnaires) research methods were employed for the survey. The research team conducted a desk review of existing FP data in the state and Calabar Municipal LGA (Local Government Area).

The literature review revealed an increasing trend in the uptake of modern contraceptive methods among women of reproductive age in Cross River State. Between 2012 and 2014, uptake rose dramatically, from 10,790 to 66,364. However, this study revealed a decline in the rate at which men of reproductive age used modern contraceptives between 2012 and 2014, from 4,375 to 2,529. This can be attributed to misconceptions about FP and to religious or cultural barriers, which also play a negative role in the acceptance of modern FP methods both by men and women (Federal Ministry of Health [FMOH], n.d.).
The health budgetary allocation in Cross River State is based on available funds. The confirmed 2014 Cross River State government’s budgetary allocation for the health sector was 9.8 billion naira (approximately US$6 million), of which just 10 million naira (about US$61,000) was earmarked for the FP subunit to cover a population of nearly 4 million people. Not all of the funds were spent and were therefore rolled over in 2015. In 2015, 7 billion naira was allocated for the health sector. This represents a 16.7 percent decrease in allocation between 2014 and 2015 for the health sector. The consequence is that fewer
RH and FP programs and activities are implemented in the state.

The budget process in Cross River State involves budget drafting by the executive arm, budget review and approval by the legislative arm, budget implementation, and auditing and evaluation. Inquiries revealed that only the officers of the state government, local government, and the Budget Transparency and Accountability Initiative Nigeria (BTAN) have good knowledge of the budget process and allocations. Because civil society organizations (CSOs) and nongovernmental organizations (NGOs) are not included in the budgeting process, they have only a fair knowledge of the budget process and budgetary allocation to RH and FP. A good understanding and use of the current health management information system (HMIS) contributes to good-quality data; however, a large proportion of respondents (68% of males and 83% of females) have never received any formal training in HMIS and planning.

Based on our findings, our recommendations are as follows:
• Intensify stakeholders’ knowledge of and access to RH- and FP-related policies to enhance policy implementation, monitoring, and evaluation of the policies.
• Develop advocacy messages that will motivate the government to take action in support of FP and provide a budget line for FP at the LGA level.
• Ensure that allocated funds for FP are released and used for the right purposes.
• Create advocacy messages targeting policymakers on the importance of investing in capacity building for monitoring and evaluation (M&E) staff at the facility, LGA, and state levels. This cadre of staff need to be trained and retrained on M&E harmonized data capturing tools, data analysis, and data quality assurance. This approach is important for achieving the sensitivity and reliability of the FP system and achieving the health goals and objectives for Cross River State.