To use or not to use contraceptives

Not long ago I found myself circled by three women who are at least a decade into their marriages. They wanted to know if I had seen a gynaecologist and what form of contraception my spouse and I had settled on. It is expected that one makes this decision before walking down the aisle.

One mentioned “the pill”, a tablet that comes in two different colours and contains chemicals that trick the body into thinking that it’s pregnant, another piqued that I should go for non-hormonal birth control and soon after, the chat morphed into the side effects of the various contraceptives and what they felt about them. Contraceptive is an emotive subject.

In Kenya, 52 percent of women of reproductive age are eligible for family planning methods, according to a report launched by the Ministry of Health early this week. This represents 5.2 million women using modern family planning methods.

Still, reports show Kenya is characterised by a high unmet need for family planning (FP) and high unplanned pregnancy, in the context of urban population explosion and increased urban poverty. But there is progress. 

As a newly married young woman, I started researching and talking to gynaecologists on the suitable family planning method for my body, and I have found myself in provinces of women where the question of the safety of modern contraceptives is paramount in the minds of many. There are those who also want to know how they can naturally prevent pregnancy without using artificial forms of contraception. 

It’s little wonder content on contraception and family planning is trending on social media. On Tiktok, a platform favoured by those in their 20s and below, content related to techniques that avoid unplanned pregnancies by abstaining from sex or using other forms of contraception has racked up more than four million views while videos related to rhythm method have been viewed almost one billion times.

This clearly shows there is a hunger for information and a knowledge gap. According to a March 2022 UNFPA report, globally around 257 million women who want to avoid pregnancy are not using safe, modern methods of contraception. Of these women, 172 million use no method at all. 

Statistics show that 48 percent of young women the world over unintentionally become pregnant. Myths and misconceptions surrounding contraception have been cited as a major barrier to the modern use of contraceptives. This was noted by Dr Andrew Mulwa the Head of Promotive and Preventive Services at the Ministry of Health as he officiated the World Contraception Day, on 26 September in Nairobi. This year’s theme ‘breaking family planning myths’ called on governments, policymakers, educators, corporations and even medical professionals to offer sustained efforts to ensure information and knowledge on voluntary family planning, is universally accessible to all women of reproductive age in retaining and managing their desired families.

Boycott

Unlike decades ago when lack of awareness and access to contraception were commonly cited as reasons for non-use, the UNFPA report indicates that this is one of the least reasons why some women are boycotting family planning methods today.

“One of the most common reasons I get from women is that they don’t have a partner. You find someone has ended a relationship and getting rid of the contraceptives is one of their ways to heal. Then there are those who suffer from side effects and instead of following up on them and seeking medical attention, they decide to get off them,” says Dr Nelly Bosire, an obstetric and gynaecologist practising privately in Nairobi.

Dr Bosire also adds that there are those whose religious beliefs bar them from using contraceptives and not forgetting those who just want to conceive. Another reason why some women will want to stay is tied to morality. “I am not dating anyone, what will people say of me when they discover that I am using contraceptives?” 

Attitudes

The misgivings, myths and misconceptions have given rise to more women opting for natural family planning methods. 

Natural family planning (or "fertility awareness") is a method of contraception where a woman monitors and records different fertility signals during her menstrual cycle to work out when she's likely to get pregnant. If natural family planning is followed consistently and correctly, it can be up to 99 percent effective. However, studies show one to nine women in 100 who use natural family planning will get pregnant in one year as the method is less effective if the instructions are not carefully followed.

Doreen Keziah, a mobile hairdresser opted to go the natural method way. By the time Keziah was getting married three years ago, she knew that she did not want anything to do with contraceptives whether hormonal or non-hormonal. “I previously had a very bad experience with pills and had heard from friends about their bad experiences with contraceptives. I discussed this with my husband and we are three years into our marriage using a natural family planning method. “I use a period tracker to track when I am fertile or infertile. We have also adopted a withdrawal method,” she says.

Other natural methods that women use to track their fertility and ovulation include the calendar method, cervical mucus method, and basal body temperature and ovulation predictor kits.

“The most accurate one in my experience is the billings method, which is centred on observation of mucus patterns during one’s menstrual cycle,” says Magdalene Kamau, a nurse working with the Catholic Archdiocese of Nairobi.

Magdalene, 53, has been married for the past 23 years and has never used any form of contraceptive.

“I got married at a time when the use of contraceptives was very common. However, my experiences as a nurse exposed me to the side effects of both hormonal and non-hormonal forms of contraceptives. This ties to the harrowing experiences of some of the people I interacted which informed my decision,” she offers.

Months before her marriage in 1999, she enrolled in a training course, which, according to her, was being offered by the Mater hospital at the time.

“We were taught about the cervical secretions and changes in our bodies during that time. Now I train other women on the method,” says the mother-of-two.

Moods and Feelings

A 2016 Danish Study found a correlation between depression and hormonal birth control usage, noting that women on the pill were 23 percent more likely to go on antidepressants. There are also quarters who say that some methods such as the pill drains their libido. Although there is not much scientific data to support this study, it is tempting to be swayed by the accounts of many women who narrate their scary experiences on social media. Nowadays, it is not uncommon to come across such stories on individual posts on Facebook groups.

Misinformation

Doris Kathia, a sexual reproductive health rights expert with Naya Kenya warns about choosing a contraception method based on other people’s opinions.

“There is a lot of misinformation online when it comes to the use of birth control. Sometimes, the people that are telling you not to use are actually using the same or have some products that they want to sell to you. This can hinder women from accessing contraceptives and one might end up with an unplanned pregnancy which could predispose one to unsafe abortions thus developing health issues,” she says.

Mary Mukami, 32, is one of the women who fault social media for her decision to get rid of the IUD coil.  She was one year into her marriage and they were not ready for a baby.

 “When I decided to remove it, I didn't tell my husband because according to some social media users, all I need was to keep track of my periods and know my safe and unsafe days. It didn't work. I got pregnant right after and it almost ruined my marriage. I am currently on the same IUD coil and though I would prefer being free of it because of heavy menses, the risk and cost of another unplanned pregnancy is a bigger burden,” she says.

Unlike Mukami, natural birth control has worked for Jacinta Nkonge, an Isiolo-based Kindergarten teacher who has been off the pill for the past two years.

“I am not a regular social media user but whenever I went online, I would chance upon posts from women who were decrying contraception. I had a share of the side effects myself from the pills such as feeling moody and lethargic so I thought to myself, “If other women are managing, what is so difficult about it?” She had talked to specialists but she says that her concerns were downplayed. She decided to talk it out with her husband but confesses that it was not easy starting that conversation.

“Surprisingly when I told my spouse of my intention to go off the pills, he was totally supportive of the idea and we went to see a gynaecologist together. I felt stupid for mulling over the issue for days,” says Nkonge adding that women should not make assumptions that their partners will not embrace the idea.

Culture Expectations

Even though the birth control methods have given many women some freedom, as they don’t have to worry about unplanned pregnancies, it is also largely because society expects women to bear the burden of preventing pregnancy. For some men, the decision of birth control solely lies with the woman hence he expects that their partner has totally figured out the effectiveness of the plan. Most do not tolerate any surprises.

When Magdalene gets a call from a woman who wants to learn about the natural method, she highly recommends that her partner tags along for at least the first session.

“I offer the classes in six sessions of about 30 minutes each. The first class is where we lay out the guidelines for the method to work. One’s partner needs to know when they can have sexual contact and days they can’t. They also become each other’s, accountability partners. It is also great to understand the effectiveness of the method and how the body functions when ovulation is about to happen,” she says.

When Satmag asked if married men would be supportive of their wives going off artificial birth control, there were varying responses. However, all of them were concerned about an unplanned pregnancy.

“I don’t have a problem using a method like withdrawal but I am worried about the failure rate. In the current tough economy, this would rock our financial boat and I am not sure if we’d survive the waves. After we have one more child, I have committed to her that I will go for vasectomy,” says Morris Chege, a Nairobi-based artist.

In 2016, a clinical trial of a promising hormonal contraceptive pill for men was halted for safety reasons. The report showed that some of the men in the test trial had complained of familiar side effects such as mood swings and acne.

Feminist Wave 

When it comes to getting off pills and long-term birth control, it is not all about preventing pregnancies. For some women, it is about asking the right questions and making informed decisions about one’s future. Some of the questions women pose are, “why has it taken this long to have birth control for men? Or “why are women’s concerns about the side effects of birth control methods not being keenly looked into?

The build-up of all this partly stems from the Covid-19 vaccines that altered the menstrual cycles of a number of women. A study by Oregon Health & Science University clinician-scientist Alison Edelman, M.D., M.P.H., and published in the journal BMJ Medicine early this week identified an association between COVID-19 vaccines and menstrual cycle changes.

“Menstruation is woefully understudied, which is troubling considering it is a key indicator of fertility and overall health,” said Edelman, the study’s lead investigator and professor of obstetrics and gynaecology and division director of Complex Family Planning in the OHSU School of Medicine.

Information and Classes 

Dr John Ongech, a Nairobi-based gynaecologist and obstetrician who sees at least 20 women every day looking for birth control options emphasises giving women the right information so they can make an informed decision. 

“Our clients come with varied concerns, especially health-related ones. You realise that some people get a lot of information from family or friends but not from a specialist. As such, we start by explaining to them about the various birth control methods and their side effects,” he says.

For Dr Bosire, her worry is that many women choose natural birth control without any guidance or understanding of how the menstrual cycle works.

“The same way that people seek counselling services, they should do the same with choosing birth control options. If a couple opts for natural contraceptive methods such as withdrawal, cervical mucus or period tracking, an important question on whether they are comfortable with the failure rate. Are you ready for any eventuality?” she poses.

 Side Bar

High alert on dangerous Chinese Contraceptive pill

Early this week, the Ministry of Health warned against a Chinese contraceptive pill “Sofia” that was banned in Kenya 10 years ago.According to Dr Albert Ndwiga, the manager of the Ministry of Health’s National Family Planning Programme, the said drug is being sold as a natural herbal product with no side effects and as a convenience as a woman only needs to take it just once a month.

“If you see somebody distributing these kinds of pills, please warn them; they are very dangerous. They have severe side effects even on unborn children,” he warned, adding that half of the women using the method end up getting pregnant.

The MOH found that children born to women on the pill had early breasts and uterus enlargement. It also leads to early puberty for men.Babies who are breastfeeding are also exposed to the chemicals in the drug and carry the risk of developing secondary sexual features.

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