Angelique Uwamaye, 37, a mother of five from Masaka Sector in Kicukiro District, says she has had enough children since supporting a big family would be challenging. But one question remained niggling: how would she effectively avoid pregnancy?
The obvious answer would be by use of contraceptives. However, Uwamaye is not comfortable with birth control methods, claiming that contraceptives, one after the other, all give her “strange ailments.”
“I have tried out pills, injections, implants and many others, but they all have terrible side effects ranging from head ache, back pain, nausea, and irregular menstrual periods. All this has forced my husband and i to return to condoms, whose use we sometimes also find inconveniencing,” she says.
Dr Jeanne Nyiransabimana, a gynaecologist and head of maternity department at Kibagabaga Hospital, says where as it’s hard to find a birth control method that is 100 per cent effective, some methods work better than others.
The methods can be permanent, long or short term.
The contraceptives range from, injectables, condoms, pills and intrauterine device (IUD) to implants.
Each work differently and the effectiveness varies either according to use or from person to person, depending on the type of contraceptive.
The national census of 2012 in Rwanda showed that contraceptive prevalence increased from 10 per cent in 1990 to 45 per cent in 2012.
The census result showed that women in rural areas have 4.8 children on average, compared with 3.4 children on average per woman in urban areas.
According to information from the United Nations Population Fund (UNFPA) Rwanda, 19% of women in the country would want to have fewer children than they have now but they don’t because of limited access to contraceptives.
This is a small rod about the size of a matchstick that is put under the skin on the inside of the upper-arm. The implant slowly releases a hormone called progestogen. It lasts between three and five years.
This can stop the body from ovulating each month. It also thickens the mucus in the cervix so that sperm cannot travel up to meet an egg.
”If inserted well, an implants is at least 99 per cent effective in preventing pregnancy,” says Dr Karine Zaninka, a gynaecologist with Ubuzima Clinic in Gatsata, a Kigali City suburb.
Dr Zaninka, however, warns that implants can cause irregular bleeding or periods that last longer. This is quite common, especially in the first six months and may last for the entire duration of usage.
While the irregular periods and bleeding can be inconveniencing, it is not harmful and does not mean the implant is less effective, the doctor adds.
Almost every woman can use implants whatever age. It is suitable for women who might forget pills, injection appointments or who may have a medical reason that stops them from using the combined pill, Dr Zaninka says.
The obstetric gynaecologist also warns that the inserting and removal can only be done by trained medical personnel.
The pill contains a small amount of man-made estrogen and progestin hormones. These hormones work to inhibit the body’s natural cyclical hormones to prevent pregnancy. Pregnancy is prevented by a combination of factors. The hormonal contraceptive usually stops the body from ovulating. Hormonal contraceptives also change the cervical mucus to make it difficult for the sperm to find an egg. Hormonal contraceptives can also prevent pregnancy by making the lining of the womb inhospitable for the eggs to implant themselves.
“Studies show that less than one out of 100 women will get pregnant each year if they always take the pill each day as directed. About nine out of 100 women will get pregnant each year if they don’t always take the pill each day as directed,” Dr Zaninka said.
Dr Nyiransabimana, however, admits that the method may have side effects ranging from head ache, back ache, and vaginal bleeding, depending on the individual.
Dr Zaninka says the time spent taking the pills depends on the type one is using, pointing out that most combination pills come in 21 or 28-day packs.
“There are various measures to contain some of these side effects, and one of them is giving pain killers,” she says.
However, pills do not prevent one from catching HIV infection and other sexually transmitted diseases.
Also known as tubal ligation, it is a surgical operation to seal the fallopian tubes which carry eggs from the ovary to the womb. When the tubes are sealed, the sperm and egg do not meet.
The egg then dissolves and is absorbed by the body. This method is permanent and effective in preventing pregnancy.
However, Dr Zaninka says there have been rare cases where a woman gets pregnant after undergoing a tubal ligation. This operation is usually preferred by women who are sure they will not want any more children. There are no long-term side effects to using this method.
There are two types of condoms designed to be used by men and women. According to Dr Alphonse Butoyi, a gynaecologist at Rwanda Military Hospital, both types work the same way by preventing sperms from reaching the egg, although the female condom is not as commonly used as the male condom. When used correctly, condoms help prevent pregnancy and sexually transmitted diseases such as HIV. Each condom should be used only once.
Going permanent with vasectomy
Dr Jeanne Nyiransabimana, a gynecologist at Kibagabaga Hospital, says some people are allergic to latex, which makes it hard for them to use condoms.
A vasectomy is a permanent method of birth control. It prevents the release of sperm when a man ejaculates.
During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen.
An egg cannot be fertilised when there are no sperms in the semen. The testicles continue to produce sperm, but the sperms are reabsorbed by the body.
Dr Butoyi says one should take two to four weeks without having sex after the vasectomy to allow the semen trapped in the tubes to get ejaculated, otherwise they can end up impregnating a partner. Or they could turn to another method of birth control meanwhile, he adds.
The gynaecologist says adds that access to the service countrywide is quite easy, as all district hospitals offer it.
An intrauterine device (IUD) is a small T-shaped plastic device that is placed in the uterus to prevent pregnancy. A plastic string is attached to the end to ensure correct placement and for removal. IUDs are an easily reversible form of birth control, and they can be easily removed.
However, an IUD should only be removed by a medical professional.
Dr Butoyi cautions a woman on IUD should maintain hygiene to avoid catching infections, and that they should go back after every two to three months for check up by their doctor.
“In case of pain in the spot where the intrauterine device was inserted or an abnormal vaginal discharge, one should always consult their doctor,” Dr Butoyi says.
Lactational Amenorrhea method is based on the natural effect of breastfeeding. The act of exclusive breastfeeding suppresses the release of hormones that are necessary for ovulation. This method should only be used by women who exclusively breastfeed their babies every day. It is usually recommended in the first six months after childbirth.
Myths about contraceptives
The withdraw method
Gynaecologists say pulling out before a man ejaculates, known as the withdrawal method, is not a method for contraception. Some semen might be released before a man begins to climax. In addition, it is practically impossible to withdraw in time.
Vasectomy is castration
Dr Butoyi dismisses this as misinformation. “Many people think this system leads to impotence, but it’s wrong. They need to know that the operation is done by professionals,” he says.
Pill makes you gain weight
Some women seem to gain weight on the pill, but research has shown that it isn’t due to pill use. The estrogen in the pill can make some women feel bloated, but this typically goes away.
The progestin found in the pill may increase appetite, resulting in weight gain. Also, some women may experience water retention; it can often be reduced by switching to a lower dose pill.
Pill causes cancer
This is a common myth that has been proved to be baseless by repeated research. Generally, using the pill does not increase your overall cancer risk. The pill actually has a protective effect against certain types of cancers.