At the last clinic of my nonprofit, Helping Hand Medical Outreach (HHMO) we attended to over 600 patrons. Understandably, most of these were children, because they were the focus of the clinic. Curiously though, the multitude was made up of a disproportionately small number of families. Initially I thought some kids were joining some parents just so they would be attended to, because we needed parental consent to attend to the children. However, when children with the same last name came in fours, fives and even sevens, I realized the problem of contraception and family planning is bigger than we want to believe.
[contextly_sidebar id=”5lszAvcQ6qBBtacIFnr4uMjEAguAg1Tq”]I interviewed a few of the mothers and their responses summarized the problem into two broad categories; side effects and other issues.
Issues like access, cost, spousal disapproval, religious and cultural impediments and lack of knowledge all came up in the discussion, but the most pertinent commentary came from the issue of side effects.
The benefits of contraception extends well beyond a woman’s decision whether and when to conceive. It plays an important role in the physical, economic, and emotional health of children and has been shown to make parents happier and marriages last longer. The benefits are too compelling to be detracted by fear of side effects and I’m going to do my best to address these fears.
There are about 12 distinct modern family planning methods available in Ghana. Some work by altering the body’s hormonal balance, others work as a physical barrier and others work by changing the chemical environment in the womb to make conception unlikely.
The issue of side effects is one that seems to bother a lot of women. Some are real, others are imagined. There are some side effects that are unique to particular types of contraception, while others are shared by a number of them.
The commonly mentioned real side effects are headaches, nausea, dizziness, weight gain and mood swings. These side effects are not present in every user nor with every method. Headaches, dizziness and nausea are experienced on commencement of certain hormone based methods. These side effects are usually short-lived and resolve after about a week to a few months of using the method.
Weight gain and mood swings may last a tad longer. The hormonal methods high in estrogen are the chief culprits. Sometimes switching brands helps with controlling these effects. Switching between methods, especially from a hormone based to a non-hormonal method also helps in certain cases.
Then there are the peculiar side effects like allergic reactions to certain kinds of condoms and an increase in the frequency of urinary tract infections with diaphragms. For these situations an immediate switch of methods should be made.
The imagined side effects include barrenness, accelerated aging and death.
The return to fertility may be delayed with some long term methods in a few women, but fertility usually returns by the sixth month after cessation of the method. The only exception is tubal ligation (tying the fallopian tubes) and vasectomy (tying the sperm duct). These are permanent methods and there is thus no return to fertility. Your provider will counsel you well before you opt for them.
Accelerated aging has not been documented as a side effect of contraception and it is actually counter-intuitive to think so, considering that hormone replacement in the menopause is known to somewhat slow down the aging process.
Death as a complication is simply an unfounded fabrication.
While on the issue of side effects of contraception it is important to make a note on an emerging trend. This trend, particularly popular among young unmarried women is the “abuse” of emergency contraception. As the name suggests, it is for those few occasions when you suspect your preferred method may fail you. E.g. you have missed many doses of your pill or you have messed up the calculation of your safe period, or the condom broke.
Emergency contraception cannot be your regular preferred method. It shouldn’t be taken after every bout of unprotected sexual intercourse. Frequent use will throw your menstrual cycle out of synch and will produce unpleasant side effects like nausea, vomiting and bloating almost every time.
If you find that you have to use emergency contraception very frequently (e.g. more than once per cycle) it indicates a need to obtain a more reliable and lasting method of contraception.
Ghana’s revised population policy (1994) aims to achieve a contraception prevalence rate of 50% by 2020. With just 5 years to go and the figure currently hovering around 24%, achieving the target looks more and more unlikely. However, we can improve on the statistic significantly if we make contraception not just accessible, but also acceptable, especially with respect to side effects. More women need to take control of their reproductive health. It helps everyone.
This discussion continues on the Citi Health Chat on Wednesday, 25th February, at 1pm.
By: K.T. Nimako (MB ChB)
Dr. Kojo Nimako is a private medical practitioner with an interest in public health. He is also the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.
E-mail: [email protected]