Truth about family planning

As if a big blow had hit her, Bolanle Ogunsakin was
devastated when she found out that she was pregnant six
months after she had another baby boy.
Instead of rejoicing when the nurse broke the ‘good news’ to
her, Ogunsakin began wailing such that she had to be taken
to the doctor on duty at the Oshodi-Isolo General Hospital,
Lagos.
After much probing from the physician, Bola opened up on
her dilemma. Her husband had just lost his job as a teacher
in a primary school and her three kids were sent home from
school because they had not yet gathered enough funds to
pay their fees.
The mother of four, who narrated her ordeal to our
correspondent while (Ogunsakin) on admission at the
Obstetrics and Gynaecology unit at the Lagos University
Teaching Hospital , Idi-Araba, for post-abortion
complications, said she asked the doctor for what many
would consider unthinkable.
‘I told him I wanted to abort the pregnancy. There was no
way I was going to tell my husband that I was pregnant
again, being the only one that remained employed.”
When the doctor refused to grant this request, Ogunsakin,
who earns a living from washing clothes for residents in her
neighbourhood, confided in her neighbour who took her to a
‘tested and trusted’ herbal doctor in Ikorodu, Lagos.
The native doctor gave her a herbal potion that would abort
the pregnancy before the end of the week.
According to her, the concoction worked as she began
bleeding profusely on the third day, which led to her being
admitted for three weeks for acute anaemia.
To avoid recurrence, Ogunsakin’s physician advised her to
try one of the family planning methods that were available
at the hospital. In spite of her predicament, she refused to
be placed on any contraceptive.
According to her, she had been told by a traditional birth
attendant who delivered her last baby that such methods
could lead to cancer or make her bleed to death.
Ogunsakin is not the only woman who has reservations
about various family planning methods.
Our correspondent, who was accompanied by officials from
the Federal Ministry of Health in February, who had gone to
distribute birth control pills and other contraceptives to
market women at the popular Tipper Garage in Ketu, Lagos,
got the same cold response from the women in the locality.
In spite of the fact that the contraceptives were going to be
given freely, a majority of them refused to take them.
One of them, Mrs. Shekina Aderoju, explained to the health
officials that a fellow trader who took the birth control had
not been able to conceive even after she stopped taking the
pill.
She said, “That was how they gave my friend some tablets
two years after her first child. Do you know that she has not
conceived till now? Her husband just got married to another
woman.
“I have just three kids and I don’t want my in-laws to start
saying I am barren when they want more children. It is not
by force, if am pregnant I am pregnant.”
Between myths and spreading ill health
Further investigations by our correspondent, who spoke to
some mothers in Lagos, revealed that more than 70 per
cent of Nigerian women do not accept any birth control
measures due to misconceptions about the safety not the
efficacy of contraceptives.
Another petty trader, Mrs. Omolara Odunfarin, said after
much pressure from her husband, she tried one of the
family planning methods at a primary health centre in
Oshodi-Isolo, Lagos but discontinued such due to excessive
bleeding some days after.
She said, “After my third child, my husband insisted that I
should do family planning. I was given one of the
‘injectables’ but I had to stop it when I kept seeing blood for
three days. I confided in my sister, who told me to stop
because she had a similar experience. I did not bleed again
when I stopped using it.”
On her part, Chinyere Ekeocha stopped the progesterone
vaginal ring, a popular and free family planning method in
Nigeria, because it halted her menstruation.
The mother of four said she was scared that the vaginal
ring had disrupted some natural processes in her body,
which could lead to ill health.
Ekeocha said, “It was the nurses that said I should take it
after giving birth to my third child but I when I did not see
my menses for four months , I was afraid. I was growing
fat, even my husband who initially supported me said I
should remove the ring because it could be that it had
shifted or turned to cancer.
“Three weeks after I removed it, I saw my menstrual flow
began to reduce. All the blood that was not coming out was
making me fat and storing in my body to cause cancer. My
doctor fixed it for me at the clinic but when I did not use it
again, I started my menses again. I won’t advise any
woman to use it.”
A new survey conducted in 20 local government areas in
Lagos in 2014 revealed that 57 per cent of women who
need these essential services, which are widely available in
health care facilities, shy away from it due to the fear of
cancer, infertility and other health-related challenges.
Different methods for different women
According to the Co-Principal Investigator of the PMA2020
family planning survey sponsored by the Bill and Melinda
Gates Foundation, Dr. Funmilola Olaolorun, only 19.5 per
cent of the female population in Lagos use one form of
modern contraception or the other.
Olaolorun stated, “We found out that 25.6 per cent had
fears and unfounded perceptions about the side effect such
as cancer and bleeding. About 6.5 per cent stopped
because it interfered with natural processes in their bodies,
that is, they stopped menstruating while another 5.1 per
cent felt they would become infertile.
“Those who took family planning implants feared that the
implants had migrated and entered their stomach and
turned into cancers.”
Olaolorun , however, erased these women’s fears.
According to her, no research or evidence has shown that
any modern birth control method causes cancer, infertility
or other serious medical complications.
She stated, “There is no single method that works for every
woman. It is not a one-size-fits-all. It is the doctor that will
determine which method best suits you but we know that
no scientific evidence has showed that modern
contraceptives lead to cancer.
“Some of the methods however have their side effects but
they are not life-threatening. For instance, we would not
want to give a woman who has not given birth an
intrauterine device popularly known as coil because it can
cause infection in her vagina which can lead to pelvic
inflammation. Yet, this is also very rare.
“If a woman is using ‘injectables’, she may not see her
menses for years till she stops but it does not mean that the
blood that is not coming out is stored somewhere in the
stomach. Yet, for a woman who has reached menopause
and does not see her menses again, it does not mean that
she would have cancer.”
Family planning and maternal mortality rates
In Nigeria, birth control is widely stigmatised and
misunderstood by women who need it the most.
According to the United Nations Population Funds, globally
Nigeria has one of the lowest contraceptive prevalence
rates after India.
The global body also stated that countries with the lowest
contraceptive prevalence rate often record the highest
maternal and infant mortality rates as women in such
countries are more likely to die of child birth complications
as a result of unwanted pregnancies and unsafe abortions.
Corroborating this view, consultant gynaecologist and
former country director of Ipas, a sexual reproductive health
organisation, Dr. Ejike Oji, stated that the low contraceptive
prevalence rate in Nigeria ( 11 per cent) is the major reason
why the country has the highest maternal mortality rate in
the world.
Oji said it was high time government at all levels recognised
that family planning was the magic bullet that could
decrease the number of women dying from child birth
complications and unsafe abortions, which are often the
outcomes of an unwanted pregnancy.
He noted that studies had shown that regions with low
contraceptive prevalence usually recorded the highest
maternal rate in the world.
“Unwanted pregnancies, unsafe abortions and maternal
deaths are like sisters. More than 90 per cent of women
who have more children than they can cater for will seek an
abortion when they get pregnant again.
‘Statistics also show that about 33 per cent of all maternal
deaths that occur in Nigeria have been linked to women
who sought unsafe abortions because of an unwanted
pregnancy.
“Every pregnancy can be prevented or planned for if more
women who should be using this family planning methods
use them.”
Apart from reducing maternal deaths, Olaolorun posited,
improved uptake and awareness on family planning can
also reduce the infant mortality rate in the country.
According to the scientist, mothers who adopt modern
family planning, which she said are 99 per cent-efficient in
preventing conception, are better positioned to do exclusive
breastfeeding.
“The breast milk is the best immunity that you can give your
child to survive his/her first five years. A child that is
breastfed exclusively is less likely to have problems of
diarrhoeal diseases that kill over 90,000 Nigerian children.
“There would be less likelihood of upper and lower
respiratory tract infections, pneumonia and other infections
that can lead to a baby’s untimely death.
“The mother also stands to benefit as recent evidence have
shown that mothers who breastfeed have at least 50 per
cent protection against cancer of the breast.
“Breastfeeding helps the bond between the mother and a
child such that the child is less likely to end up with
behavioural problems.
But if you don’t take family planning to space your children,
you won’t be able to breastfeed any of them for the six to
one year period that you should – because once you are
pregnant, you can’t breastfeed again.”
It will reduce poverty – Experts
Oji said apart from reducing infant and maternal deaths,
increased uptake of family planning methods among
Nigerian women could significantly reduce the poverty rate
in the country as more women would be able to contribute
their economic quota to the development of the country.
He said, “The regions in Nigeria that have the lowest
contraceptive rate such as the North East and the West
have the highest poverty indicators in the country. In fact,
there is almost a direct correlation between poverty, high
fertility rate, low contraception and low standard of living.
“It will be difficult for a woman who is having children every
one and a half years to maintain a job or become a tangible
employer of labour. It will be more difficult for her to
improve her standard of living and it will be much more
difficult for her to establish a viable business.
“Poverty continues to thrive in Nigeria because the women
who form about 50 per cent of the population are not able
to deliver their full potential because of the many challenges
they face – which include unwanted pregnancies.”
Olaolorun pointed out that women who use modern family
planning methods were not likely to have more children
than they can cater for, which would help them build a
tangible family life.
She said, “There will be fewer street children and homeless
ones. The regions with the lowest family planning rate in the
world often has the highest population of street children. A
child that is not well catered for is not likely to get a good
education
“Family planning helps couples to plan their finances
around the number of children they can afford to educate.”
To encourage more women to embrace family planning,
Consultant Gynaecologist and Obstetrician, Lagos
University Teaching Hospital, Idi-Araba, Dr. Ayodeji
Oluwole, noted that there was a need to correct the
perception that the modern methods were not available for
all.
According to him, many women in rural areas would rather
use local and traditional contraceptives such as traditional
rings and concoctions which pose a greater danger to their
health even when the modern methods are readily available
and are given free of charge in primary health centres in the
country.
He stated, “Many women are ignorant about these
methods. We also need to talk to mothers, especially those
living in the rural areas, who are not benefitting from these
methods and who will only listen and do what their friends
tell them without consulting the right people.
“Women are dying daily from unsafe abortions they engage
in when they have unwanted and unplanned pregnancies.”
Oluwole listed birth control measures that are available in
Nigeria to include the use of condoms and the pills.
“We have the hormonal methods, which are oral pills, to be
taken once every day. It is 99 per cent efficient. We have
the ‘injectables’, which are divided into three parts, and
there is a dose for every two or three months depending on
the woman. But women who are over-weight are not
supposed to use the hormonal methods,” he said.
According to him, there are implants that are inserted
underneath the skin, examples of which are the implanon or
jadelle.
“They last for about two to five years, depending on the
type one chooses. There is the tubal ligation. It is like a
tube and is usually prepared for those who do not want
babies again. This is done during the Caesarian section or
laproscopy. It is a permanent contraceptive.”
It is against our tradition- Faith-based institutions
While stakeholders continue to call on the Federal
Government to enlighten more women on the benefits
inherent in using modern family planning methods, some
religious organisations are against the practice.
In fact, women who fellowship in these institutions are
often chastised by their religious leaders for daring to
interfere with the natural process of conception – as
ordained from ‘above’.
Ada Obinna , a devout catholic, said it would be a sin for her
to use any of the birth control methods to space her
children.
The 26-year- old- mother of three, who sells food
condiments in Ketu market, Lagos, told our correspondent
that instead of using birth control pills or other devices, she
uses the calendar method popularly known as the Natural
Family Planning method.
She said, “It is not even allowed in the Catholic Church for a
woman or man to use contraceptives. I usually calculate
my period to ensure that I have sex only when I am safe.
Even my husband and I have agreed and it is working for
us.”
Obinna is not exaggerating. In some faith-based
organisations, artificial contraception is regarded as a sin.
For instance, the Catholic Church condemns the use of
contraceptives such as tubal ligations, vasectomies and
pills.
Indeed, Pope Paul VI, in his landmark encyclical letter
tagged Humanae Vitae (Latin, “Human Life”), re-
emphasised the church’s constant teaching that it is always
intrinsically wrong to use contraception to prevent new
human beings from coming into existence.
The letter, which is still an integral part of the church’s
doctrine, states, “Contraception is any action which, either
in anticipation of the conjugal act (sexual intercourse), or in
its accomplishment, or in the development of its natural
consequences, proposes, whether as an end or as a means,
to render procreation impossible.
“This includes sterilisation, condoms and other barrier
methods, spermicides, coitus interruptus (withdrawal
method), and all other such methods.”