Under the theme “Family Planning is a Human Right”, Rwanda joined the rest of the world to commemorate World Population Day, an annual event observed on July 11 every year that seeks to raise awareness of global population issues. Also, preparations are underway for Rwanda to host the 2018 International Conference on Family Planning (ICFP2018) in November. However, when it comes to family planning, many women are still not sure about the method that suits them best, and many have had to cope with the side effects that come with these methods. Medics believe that with close supervision and analysis, one can find a suitable family planning method with minimal to no side effects. John Muganda, a gynaecologist at Harmony Clinic in Kigali, says when it comes to family planning methods, it is important to note that people are different and what works well for one person might not do the same for another. When choosing a method, Muganda says not to listen to what others say because one will end up with false information which can lead to unexpected pregnancy. HOW TO CHOOSE THE RIGHT METHOD He says birth control is a medical option of planning the family size, as well as spacing. The available options are many, including hormonal and non-hormonal options. When it comes to choosing, Muganda says it depends on an individual, but follow-up is required. However, it’s important to explain to a health expert which methods you have been using, and what worked or not. This, he says, will help one figure out what methods might work best. Birth control pills. /Net photos “It might be a trial and error situation when finding the right method. For instance, all those types of combined birth control pills contain different doses of estrogen and different kinds of progestin. And the way these two hormones work together in the body may differ from person to person,” he says. If one has a medical condition, like high blood pressure, it’s advisable to avoid hormonal methods. Also, people with diabetes or breast cancer should not use family planning methods that contain these hormones, such as the pill or injection. He says for such people, the intrauterine device (IUD) method is ideal as it doesn’t contain any hormones. Dr Theodomir Sebazungu, a gynaecologist at University Teaching Hospital (CHUK) explains that this is so because some cancers are very sensitive and can bring about health complications. Sebazungu says people with these illnesses should also avoid oral contraceptives (those that are swallowed). For people who experience headaches or migraines every month during their period, Sebazungu says opting for birth control methods with estrogen may be ideal because they give relief by regulating the cycle. On the other hand, he notes that if one has experienced a blood clot (deep venous thrombosis) or pulmonary embolism in the past, they should discuss with the gynaecologist so that they can avoid combined hormonal birth control, as it’s not recommended for someone with a history of blood clots. “If there is no illness, it’s good for a gynaecologist/obstetrician to suggest the method which they believe can work better for the individual,” he says. IUD, Sebazungu says, is the best method for any woman; this is because the non-hormonal IUD can last for up to 14 years. Birth control consultation at a clinic in Rwanda. Courtesy SIDE EFFECTS AND HOW TO MANAGE Side effects of family planning methods, Muganda says, are rare and when they do occur, they are easy to manage as long as one seeks help from a physician. He adds that if the side effects are serious, a woman is advised to use another method. He advises that in case of any problem, stopping family planning is not the solution, rather, women should talk to their gynaecologist so that they are able to be given the family planning method that is suitable for them. The main side effects, he says, women normally experience are spotting — which is consistent for a month, over bleeding (the amount of blood can increase), headaches and in some cases, weight gain. Iba Mayale, a gynaecologist at Clinic Galien, Kimironko, notes that there are other minor side effects that can be handled by treatment instead of changing the method, and that is after thorough analysis. However, he says that there is no direct association of these side effects with the family methods used; therefore analysing these effects well is ideal to be able to handle such cases. For management, Mayale says depending on the family method used, it’s easier to manage. For instance, he points out that for the case of the coil, when being placed, one is required to go after one month (after the monthly period), to check if the coil is still in place and get feedback from the user if there is any problem. “Generally, we normally expect that after a period of six months, one should be in a position to know if the method used is working well for them. After the insertion, the first period can change but with time, if the method suits your body, one will have no problem even later on,” he says. After six months, in case of no problem, the person is required to go for check-ups every one year, says Mayale. Emmanuel Ssemwaga, a gynaecologist/obstetrician at La Croix Du Sud Hospital in Kigali, points out that the advantage of this kind of family planning method is that when one uses it, it’s easier for a gynaecologist to asses other health problems. He explains that because women are supposed to be checked (screening of cervical cancer) regularly, when they come for service on family planning, it’s easier to be screened and followed up on their health as far as keeping them away from cervical cancer is concerned. This is very difficult to remember when other family planning methods are used, especially to assess the cervix. A lady gets the birth control injection. /File photo Other methods, such as hormonal methods, he says, are pills which are supposed to be taken every day. He says they are two kinds of pills, those with estrogen and progesterone (combined), and those with progesterone only. Regarding these pills, he says, after delivery, a healthcare professional should find out if the mother is breastfeeding or not. In case they are, they should be given pills with progesterone alone, and after five months, they can be changed and given combined pills. “Most methods of birth control are safe during breastfeeding, but those that contain estrogen can lower the milk production. Birth control pills usually contain estrogen and progesterone, taking estrogen which is naturally low when a woman is breastfeeding can reduce milk production,” he says. Muganda says there are also some long lasting methods, for instance, the implant which can last for three to five years. Also, there are permanent methods, especially for those who have stopped giving birth or don’t want more children. He says these permanent methods include tubal ligation or tubectomy — also known as having one’s “tubes tied”. He says it is a surgical procedure for sterilisation in which a woman’s fallopian tubes are clamped, block and sealed, which prevents eggs from reaching the uterus for implantation, thus stopping one from getting pregnant. Another important aspect when it comes to family planning methods, Muganda says, is that the partner should be involved. They should accompany their partners when getting these methods done and learn how they work. “Family planning is meant for the couple, if men are not ready for male methods, they should at least be there for their partners. In case of a problem or side effect, they can be able to understand their spouse and work together as a couple,” he advises. Experts share their views If a woman is not breastfeeding her baby for various reasons, they can start using family planning methods of their choice. However, if the baby is taking nothing but breast milk, it’s ideal to start family planning at least after six weeks. Christian Bahati, Paediatrician ************************ Traditional family planning methods are not effective, because the chances of not getting pregnant are rare. Women should shun them and embrace the available modern methods to avoid any inconveniences. Francis Kazungu, General practitioner ************************ Women who use oral methods of family planning like pills should ensure they take them daily. In case they forget to take them as instructed, they should start all over again, but in the meantime, using condoms as this will keep them from getting pregnant. Yves Iraguha, Gynaecologist ************************ It’s advisable for women who are forgetful to opt for other family planning methods, not the pill. Those who smoke should avoid contraceptives such as the combined pill or vaginal ring. Health experts should recommend the suitable method for them. John Muganda, Gynaecologist editorial@newtimes.co.rw
