October 26, 2016

Family planning, maternal health imperative: Much ado about fears, myths of contraceptives

*Different types of contraceptives

No doubt, contraceptives or methods of  Family Planning, have become well known in the society. However, this knowledge is still relatively low in Nigeria with only 15 per cent of Nigerian women using any method. Today, common claims   among Nigerian women   is that   family planning interferes with the natural process, while others say their spouses are totally opposed to the use of contraceptives.

Professor Isaac Adewole

Professor Isaac Adewole

Features writer, Chioma Obinna, examines the implication of the myths, misconceptions and challenges surrounding contraceptives and their use.

ALTHOUGH the global campaign on contraceptives centres around a vision where every pregnancy is desired, sadly millions of Nigerian women of reproductive age, may not benefit from this on the long run.  One of such is Ijeoma Ehiri, who witnessed the death of her senior sister, Nkiru, at childbirth. Ijeoma was right there when Nkiru bled to death while giving birth to her seventh child.

Ever since, Ijeoma, who is a mother of three, vowed never to go back to the labour room. Ijeoma had wanted to have as many babies as possible before the incident, but today, she has decided to put a stop to childbearing.

Controllingher fertility

At 29, Ijeoma is still very much attractive and fertile.   Though determined to control her fertility, she could not because her husband was opposed to the use of contraceptives following unfounded claims that they cause infertility and that one contraceptive method, the Inter Uterine Device, IUD, can migrate into the woman’s body.

“My husband refused my use of contraceptives, saying he heard that they cause cancer. I tried to convince him that the claim was only a myth and not true.”

As a result, Ijeoma resorted to the age-long method known as “withdrawal” which is not 100 per cent reliable. She continued to battle the problem and within three years, had carried out three abortions.

*Different types of contraceptives

*Different types of contraceptives

After the last abortion, her doctor warned that further attempt would be a risk to her life. But, today, Ijeoma is pregnant with her fourth child.

Ijeoma is  one out of many  in a similar dilemma. Bola Opeyemi, 25, is in the same boat. Travelling that path after an unsafe abortion could mean suicide.   But her religion does not permit her to maintain her stance.   Married into a Catholic home, use of contraceptives is forbidden.   There is enough trouble merely mentioning the word contraceptive, not to talk of actually using any one of the different contraceptives available, including condoms.

Bola’s religion considers the use of any contraceptive as obstructing the work of nature or amounting to   playing God.  This belief, among other cultural reasons, make it difficult for her to use contraceptives.

But she soon paid a dear price for having another abortion: a damaged womb.   Today, Bola is without a womb.     She has become one out of Nigeria’s 190 women faced with unwanted pregnancy every minute and one of the 40 women who had unsafe abortion.

But for 37-year-old Rose Efuru, a bank executive, life has been what it should be for her as a mother and professional.

This she attributes to the power of understanding the importance of contraceptives. But thanks to the free family planning services in one of the primary health centres in her area. If Rose who married at a tender age had not been informed about contraceptives, she would have had more than five children today.

“My babies came in quick succession. I had my third baby at the age of 24.   If not for contraceptives I would still be having babies,” she noted. Rose is one of the 33 percent of women whose lives were saved due to the use of contraceptives.

Findings have shown that despite the availability of free family planning services in some public and private health facilities, the uptake of contraceptives in Nigeria still remains low and is stagnated for about 17 years now. A number of reasons have been adduced why women shun the services. These include cultural practice, issues of acceptability, accessibility and affordability.

Also myth that contraceptives damage a women’s health plays a huge role.   Fortunately, the opposite is that contraceptives improve the health of women and children.

According to the Nigeria Demographic & Health Survey 2013, the percentage of married women using modern contraception is only 9.8. The figure according to experts, hardly changed from the 9.7 percent recorded five years previously.

From available statistics, the figure is also lower than all countries in West Africa when compared with the 2016 World Population Data Sheet except Gambia, Guinea and Mauritania.   The average for all of West Africa is 13 per cent.

It is no longer news that family planning can save the lives of over 1.2 million women of reproductive age annually.   Unfortunately, as contained in the 2013 NDHS Report, Nigeria has one of the highest maternal mortality rates of 576 deaths per 100,000 live births.

Family planning

Despite the fact that family planning through the use of contraceptives alone can reduce maternal deaths by more than 33 per cent, yet only 15 percent of Nigerian women are using any method of family planning for spacing or limiting pregnancies, while 10 percent use modern family planning methods.

In the view of a Senior Technical Advisor, Advocacy for Nigeria Urban Reproductive Health Initiative, NURHI, Mrs Charity Ibeawuchi, the health of the women, particularly those of reproductive age (15 – 49 years) in Nigeria is at risk with the silent epidemic of poor maternal mortality and morbidity.

“Twenty-three percent of our teenage girls (ages 15-19) are already mothers or pregnant with their first child. Half of our teenage girl population are already married by age 18, while 61 percent are married by age 20. Women in Nigeria have an average of six children. Studies have shown the strong linkage between high fertility, high risk births, poor access to modern family planning/child birth spacing methods and high maternal mortality ratio.

“The enormity of the current high maternal mortality and morbidity in Nigeria is staggering. The social and economic costs due to the complications and deaths to the family and the nation are enormous and should be resolved as a national priority,” she said.

In a survey carried out in Lagos in 2015, it was found that over 67 percent of women in the state are not accessing family planning services due to health – related concerns.

Excessive bleeding

Also in that survey tagged PMA2014/Lagos conducted by the Performance, Monitoring and Accountability 2020, PMA2020, with grant from Bill & Melinda Gates Foundation, it was discovered that despite the availability of free family planning services in public and private health facilities, many women boycott the services for a number of reasons.

A Co-Principal Investigator, PMA2020, Dr. Funmilola Olaolorun in the study listed some method-related problems that hindered access to include excessive bleeding, mixed and misconceptions regarding using long active method.

Olaolorun who is also a lecturer at the Department of Preventive Medicine & Primary Care, University of Ibadan, further stated that some other women claimed family planning could cause infertility even though it is not a permanent contraceptive method while some say the Inter Uterine Device, IUD, can migrate. “Some people also believe that these devices can cause cancer. It is actually a mix of what they think; it is just their perception. It is not that they have actually experienced any of them.”

Debunking these fears, Olaolorun explained that family planning does not cause infertility or cancer. “We found that about 19.3 percent are using modern contraception in Lagos State which is higher than the national average. We also found that women are now initiating sex at about 20.0 – 24.5 years and that is about the age of first birth as well. Also they are not using contraception until about 26.5 years which is roughly six years after they have initiated sex and roughly two years after they have got married and roughly after two children”.

Myths and Misconceptions: Dispelling the confusion on link between excessive bleeding and contraceptives, Olaolorun said: “When there is excessive bleeding the woman definitely needs to go to the hospital for assessment because it is not impossible that she may have some other underlying conditions. Bleeding could just happen and may not actually be related to the family planning method.       Some women   on injectables don’t even see their menses for years and once they stop the injectables, their menses come back.

“There are side effects for every drug, not just the family planning methods. But the few people who experience it make a lot of noise about it. We need to take all these information in context because only a few people experience excessive bleeding. For instance with the IUD, but it is not enough to lead to death,” she explained.

In the views of a Professor of Obstetrics and Gynaecology, Prof Oladosu Ojengbede, the wide knowledge of family planning methods is yet to be translated to its uptake.

“Religious connotation seems to draw us back just like cultural issues such as the men not supporting family planning, community misconceptions about family planning, religious undertone to family planning and also the failure to build enough confidence in the people to access quality services needed for family planning”.

Ojengbede, however, recommended working with traditional-religious structures in which the people have confidence, trust and the will to believe and obey. This, he said, would help dispel the myths, misconceptions, traditional and religious biases that people have against the use of contraceptives.

“The traditional rulers have a role to play; we should not think that these traditional and cultural structures will not support family planning. We’ve seen traditional rulers who are talking about family planning. We need to bring them in far more than we have done,” he added.

Why contraceptives: Contraceptives available in the form of drugs and devices, not only take care of unwanted pregnancy but prevent sexually transmitted infections and unintentional pregnancy. It is segmented into oral contraceptive pills, topical contraceptives, and contraceptive injectable.

The devices segment is sub-segmented into male contraceptive devices and female contraceptive devices. Low cost and ease of use make the female contraceptives the dominant segment in the global market. The growing number of unintended pregnancies, especially in rural areas, has propelled the demand for various contraceptives.

Apart from enabling couples to space their children, modern contraception has multiple benefits for both the mother and the child.

A Reproductive Health/Family Planning, Adviser to Fistula Care Plus, Mrs. Amina Umma Bala said: “When a woman is using modern contraception, she is able to go back to the labour force and that means increased income for the family because if she is having a child every one and half years, she probably will not be able to maintain a job.

She pointed out that if women are having only the children they want, they are not likely to have more children than they can care for, and there will be fewer street children and homeless children.

Apart from spacing, Bala explained that when a couple is ready to stop bearing children, they can utilise the more permanent methods so that a woman is not getting pregnant in her late 40s and early 50s.

Again, decades of research have shown that modest investments in family planning can save lives and improve maternal and child health. On the global stage, there is a growing effort to emphasize family planning because of the cross-cutting role it plays in contributing to most of the broader development goals.   It has also been proven to be one of the most cost-effective health interventions. In short, family planning improves the economic well-being of families, communities and nations.

Campaign for contraceptives use

However, despite these challenges and more, experts say the good news is that 16.1 percent of married women in Nigeria want to use family planning but are not using it now. The figure is even higher among sexually active unmarried women: 21.8 percent of them want to use contraception. This provides the country with a huge opportunity for reaching these women who are already convinced about the value of contraception and how it can help their families.

Health watchers believe that there is need for the Federal Government to intensify the campaign for contraceptives use by ensuring that the services are in all PHCs across the 774 local government areas of the country free of charge.     There is also the need for the men to be carried along in this campaign in line with the mission of the World Contraceptives Day to improve awareness of contraception and enable women to make informed decisions on their sexual and reproductive rights – in essence plan the timing and spacing of their births.