Family planning: Why are women shunning contraceptives?

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Some contraceptives are administered through injections. / Internet photo.

Although most Rwandans have embraced family planning to ensure healthy and manageable families, it is not yet time to celebrate.

From 13,497 women aged 15-49 and 5,585 men aged 15-59 from 12,793 households around the country; there was an unmet need of 19 per cent use of modern family planning methods among married women, according to the latest demographic health survey.

While many women understand the value of contraceptives towards birth control and family planning, many still fear because of misconceptions within society about contraceptives. Others give up just a few weeks or months after using them.

Georgette Uwineza started using birth control pills following a recommendation from her friend. After a week, Uwineza complained of discomfort and side effects like headache, small body swellings on the legs and fatigue.

“I consulted my friend again. She told me that I should always expect such side effects with the pills except if I rely on natural birth control-the safe period,” she explains.

Unfortunately, Uwineza could not reliably establish days when it was safe for her and she ended up with an un planned pregnancy. She is now three months into her third pregnancy.

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Intake of pills should follow recommendations to reduce side effects. / Internet photo.

As Rwanda joins the rest of the world today to mark World Contraception day, many women like Uwineza still fall victim of misconceptions regarding the use of contraceptives.

Some think that contraceptives always bring about serious side effects while others shun them because they fear becoming barren.

According to professionals in the health sector most of these issues arise from misconceptions.

Pushing sensitization campaigns to households

Nonetheless, actors in the health sector are not sitting back just to watch figures of unwanted births escalate. Both government and private players are applying interventions to solve the problem.

Through sensitization campaigns, women have been educated about advantages of contraceptive for birth control.

Dr Jean Claude Nyirinkwaya, a specialist in obstetrics and gynecology at La Croix du Sud Hospital in Remera, believes that once each individual and household are informed about the right approach towards birth control, then planning can improve at all levels.

“Many come for consultations, but those who don’t can only be reached through sensitization campaigns. We are currently reaching out to as many as we can, but it is something that requires engagement of all the actors,” he explains.

He however maintains that much as such communication is useful not everyone in the community will welcome the gospel of contraceptives.

“There those who wont just listen in especially among the uneducated. Because of several hearsays, thorough convincing is needed to ensure that when it comes to birth control, individuals take on the right choice of contraceptives,” he adds.

A stumbling block of unreliable advice

Within various health facilities, fertility departments have established clinics to provide proper counseling over issues that include contraceptive use and other inquiries. However, most people only turn up to these clinics for antenatal consultations.

It is a challenge, Dr Iba Mayele, explains that friends or relatives have played a big role in transposing false information that would otherwise be offered by trained health workers.

“It passes on from one woman to another. Well your friend could recommend a method and it works for you, but there is no guarantee that it will work for the third person. The moment this person tries it out and realizes the side effects, chances are high that they will never take on contraceptives again,” he explains.

On a similar note Dr Mayele warns that contraceptives should not be abused because this could result into grave side effects.

“They have been scientifically tested and proven to be safe. But they should not be abused because this is the first step towards complications. It is important for individuals to always consult medical professionals before reaching out for a certain method,” he says.

Social pressure

Although some married women are willing to use contraceptives, the other problem many face is when their husbands are against it.

According to Dr Rachna Pande, a specialist in internal medicine at Butaro Hospital, the fear against contraceptives is a social problem that needs to be addressed starting at the household level.

“It is a social problem. Pressure by the husband or the family to have a child early or other children makes it hard for a woman to accept contraception. Other women may be ignorant about contraception and hesitate to come forward and discuss it with a health care provider,” explains Pande.

She is also fast to point out that some societies have labeled contraceptives a channel towards infertility.

“Then there is a fear of adverse effects or worse still infertility caused by contraceptives. She may have used some contraceptive for a short time, then given it up because of some side effects,” she adds.

Following the right procedure

Currently, about 15 contraceptives methods are available, however the oral contraceptive pill and female sterilization are the most commonly used methods.

In the event that an individual decides to start contraception, Dr Nyirinkwaya advises that after receiving the necessary prescription from a trained health worker, they need to observe certain regulations to overcome likely discomfort.

“The medication should be taken with a heavy meal or after eating to prevent stomach upset. On a regular basis, individuals need to follow a similar pattern to prevent incoherencies in the cycle,” he advises.

Statistics from the world health organization indicate that in less developed countries, modern contraceptive methods are used by only 43 per cent of women.

While modern contraceptives continue to face a ban from the Catholic Church on grounds that they are ungodly, a big impact towards birth control in Rwanda has been realized over the last decade. Births fell from 6.1 per cent births per woman in 2005 to 4.2 births per woman in 2014/2015.

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WOMEN SPEAK OUT

Lionel Mukashema, a mother of two
I have two children who are well spaced. This is because after my first child, I went for the implant. It later took me three years to get the second pregnancy but at least I achieved the spacing I needed. But for now, my husband and I have agreed not to use such methods any more until our third child. Then we shall move for a more permanent method.

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Daniela Kayitesi, a newly married
Although I was using contraceptive pills before I got married, I don’t think I will ever use them again. When I first started using them, I experienced a lot of discomfort and side effects which included fever and loss of appetite. Besides, I don’t see the point of continuing with them before having children.

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Patricia Uwamahoro, a mother of one
My husband is always against any method of family planning because he thinks, they would interfere with our sexual life. I think more awareness is needed by the health departments to inform the entire community about family planning. Also, people should embrace family planning to recover well after birth.

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Marie Uwihoreye, a Kigali resident
I started on injecta plan of three months but it always came with side effects. After consulting my gynecologist, it was found that my hormones and the kind of family planning did not rhyme. I was advised to switch to pills, which I also find slightly uncomfortable. On my behalf, birth control pills are good but the problem lies in the side effects.

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Marie Chantal Tuyishimire, a parent
The only methods of family planning I have used are birth control pills. Prior to going on these pills, my friends warned me about the side effects. In fact one of them was hospitalized after getting problems with pills. Currently, I prefer using the natural method because I believe it has limited interferences with my body system.

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WHAT BIRTH CONTROL OPTIONS ARE AVAILABLE?

Among your birth control options are:

• Barrier methods. Examples include male and female condoms, as well as the diaphragm, cervical cap and contraceptive sponge.

• Hormonal methods. Examples include birth control pills, as well as the vaginal ring (NuvaRing), contraceptive implant (Nexplanon), contraceptive injection (Depo-Provera) and contraceptive patch (Ortho Evra).

• Intrauterine devices (IUDs). Examples include the copper IUD (ParaGard) and the hormonal IUD (Mirena).

• Sterilization. Examples include tubal ligation or the Essure system for women, and vasectomy for men.

• Natural family planning. Examples include the rhythm, basal body temperature and cervical mucus methods.

It’s also important to be aware of emergency contraception – such as the morning-after pill (Plan B One-Step, Next Choice One Dose, ella) – which can be used to prevent pregnancy after unprotected sex.

How do the different birth control options work?

Various types of birth control work in different ways. Birth control methods may:

 Prevent sperm from reaching the egg

 Inactivate or damage sperm

 Prevent an egg from being released each month

 Alter the lining of the uterus so that a fertilized egg doesn’t attach to it

Thicken cervical mucus so that sperm can’t easily pass through it

What is the method’s effectiveness?

To be effective, any method of contraception must be used consistently and correctly. Contraceptives that require little effort on your part, such as IUDs, contraceptive implants and sterilization, are associated with lower pregnancy rates. In contrast, methods that require monitoring fertility or periodic abstinence are associated with higher pregnancy rates. The bottom line is that the right method is the one that you are comfortable with and willing and able to use.

Is it reversible?

The method of contraception you choose depends on your reproductive goals. If you’re planning pregnancy in the near future, you may want a method that’s easily stopped or quickly reversible, such as an oral contraceptive or a barrier method. If you’d like to become pregnant – but not in the near future – you may want to consider an IUD. An IUD has a quick return to fertility, but it is expensive if you are going to use it only for a short time period. If you’re certain that you don’t ever want to have children, you may prefer a permanent method, such as sterilization. You may find that different contraceptive options work for you at different stages of your life.

Is it compatible with your religious beliefs or cultural practices?

Some forms of birth control are considered a violation of certain religious laws or cultural traditions. Weigh the risks and benefits of a birth control method against your personal convictions.

Agencies