Family planning adoption rates remain low among Nigerian women despite growing campaign as fears and misconceptions linger, writes SOLA ABE
“There is nothing anybody can tell me about family planning that will make me do it,” Patience Onyinke said, with her mouth tilted to one side as she shook her head in disapproval.
Onyinke, a mother of four and a petty trader, lives in a one-room apartment, with a curtain dividing it into two – one space for ‘bedroom’ and the other for sitting. A huge cupboard used to store kitchen materials and a refrigerator sit at the right side of the bedroom.
She narrated to this reporter the story of her sister-in-law, who did family planning and almost bled to death.
Onyinke, who was warned by her sister-in-law never to do family planning because “anything can happen,” said she had been using the calendar method her pastor taught her.
She said even though she was very scared that she could mistakenly get pregnant, it was safer than injecting something into her body.
“Everything is in God’s hands. Mistakes can happen but I prefer it. The only reason I’m scared of getting pregnant now is because I’m not happy with our standard of living.”
The story of Onyinke portrays the views of the average Nigerian woman, whose knowledge about family planning revolves around what she has been told by family and friends.
Damilola Adelakun, a mother of two, would like to do family planning but she is scared because a neighbour who did it bled until she changed to another method.
“Some people told me it would delay having another child. My mother told me not to do it, that it is not good. So, I use salt and water and it is 100 per cent effective,” she said.
Even though the advocacy for family planning has gathered some momentum in recent years, not many Nigerian women subscribe to it for the fear of being a victim of its side-effects.
“My sister-in-law was tested at the hospital before they decided on which one would be the best for her but she almost died due to bleeding,” Onyinke said.
The women interested in doing it are not sure they would get the perfect method at the first trial because they have been told stories of family and friends who were tested before settling for the one that would be suitable for their body, only to later experience some complications.
The effect of this attitude to family planning can be seen in the nation’s population, which has been estimated by the National Population Commission and the National Bureau of Statistics to be 193,392,517.
A 2017 United Nations report also predicts that Nigeria will be the third most populous nation in the world after China and India in 2050.
Unfortunately, Nigeria does not have the capacity to cater for its growing population and the result of this is high rate of poverty, unemployment, environmental pollution, depletion of resources and weather change.
Unhygienic living conditions, high crime rate, conflicts, political instability, scarce resources, hunger and high rates of disease spread are also some consequences of the population explosion. Thus, family planning has been considered a major solution to the population growth caused by increased birth rates.
Helen Edet, a mother of five, said her sister told her about family planning two years ago but she was not ready for it because she wanted to have more children.
Even though Edet’s family is struggling to live a comfortable life, she believes that family planning methods may prevent her from having the desired number of children.
Family planning explained
Family planning is the process where parents or couples are given the choice to determine the number of children they want and when they want them, by the spacing of pregnancies, which is achieved through the use of contraceptive methods.
Asides from helping to control population growth, the World Health Organisation states that family planning helps women take charge of their lives. It helps to prevent pregnancy-related health risks; it reduces infant mortality, and it prevents HIV/AIDS.
It also helps women to pursue additional education and participate in public life and reduces adolescent pregnancies, among other things.
Despite the benefits of family planning, not many Nigerian women are interested in the procedure, while many subscribe to the traditional method, which may not be as effective as the modern method.
The 2015 United Nations report on the trends in contraceptive use worldwide states that, contraceptive use is 40 per cent lower in the least developed countries and 33 per cent low particularly in Africa.
According to WHO, one of the reasons why women who want to avoid pregnancy are not using modern contraceptive method is because of the fear or experience of side-effects.
“It is after my second child that I can do the implant method because family planning causes secondary fertility or delay. But for now, I will do the withdrawal or calendar method,” Seyi Fatoki, a new mother, said.
Fatoki had been told about the types of family planning at the hospital but the side-effects of the procedures were explained to her by ‘advanced mothers.’
Omolara Aluko, a family planning and contraception educator, explained that family planning, among other things, is to safeguard the health of the woman as she is supposed to rest for at least two years after pregnancy, according to the recommendation by WHO.
This is to make sure that her body recovers from the toils of carrying a child for nine months and breastfeeding the child for the next one year, according to her.
“All that takes a lot on the health of the woman; so, for you to be well-rested in between giving birth, there’s a need for you to put in a method of family planning,” she said.
Types of family planning methods
Family planning methods can be classified into two: traditional and modern.
The traditional methods include the calendar method, which has to do with a woman counting her safe period; the withdrawal method, where the man does not release into the woman; and the breastfeeding method, where the hormones-aiding lactation in the system of the woman is not so compatible with the hormones that produce the egg that makes reproductive very easy.
The modern methods of family planning include pills, injectables, intrauterine device, diaphragms, implants, and condoms.
According to Aluko, the modern methods are more effective because they have been tested and found to have higher percentage in terms of protection rates over the traditional methods.
“Some women can’t count or monitor their ovulation period. Some men in the process of withdrawing drop a little sperm, which is enough for an egg to be fertilised; some will even be breastfeeding and be pregnant. That was why the modern family planning came into place,” she said.
Types of modern methods of contraception
Emergency pills: The dose in the emergency pills is a bit high because they are meant for emergency sex. Taken immediately after sex for high effectiveness, it only delays ovulation until the sperm are dead. It can still be taken five days after sex but the more you delay, the more you’re open to chances of pregnancies.
Daily pill: The daily pill is a preventive taken every day and it is low dose. It does not delay fertility because once you stop taking them, your system returns to normal.
Injectables: It is of two types, one taken every two months called, noristerat, and the other every three months called, depo provera. It is injected into the muscle or under the skin.
Implants: They are inserted under the skin of the upper arm of the less dominant hand, which means that if you are left-handed, it is inserted on your right hand and vice versa.
Intrauterine device: It is placed in a woman’s womb and it is non-hormonal. It contains a safe natural copper and it is popular in Nigeria as coil.
Diagphram: It is used to cover the cervix before sex. After sex, you wait for six to eight hours before removing to clean until the next use.
Vaginal rings: it is placed in the vaginal
Aluko noted that the only modern contraception that prevents sex transmitted infections and pregnancy is condom. She explained that the other types of contraception only prevents pregnancy and they are not 100 per cent assured.
“No method is 100 per cent. You have 95 or 97 percent. The only method that is 100 per cent is abstinence. Meaning that in a thousand women, you will have one that will use and will fail.”
However, Lilian Ugammadu, matron of the Blue Cross Hospital, explained that women interested in having more children should not go for the depo provera injectable method because it takes time for the body of the woman to adjust, but does not happen to all women.
Ugammadu explained that another type of family planning is the tubal ligation in women and vasectomy in men, which is permanent and many couples do not do it because it is non-reversible.
Allaying fears of family planning
A major cause of worry for many women who would like to adopt a modern family planning method is the side effects, but Aluko explained that not all women experience side-effects, depending on the body type.
According to her, the period where a woman usually complains about a side-effect is when the body is adjusting itself to the introduction of the contraception as it was not part of it before.
Noting that one of the side-effects of modern contraception is headache, she said, “A woman should be sure it is not due to stress or hunger pangs; however, if it is because of the family planning method, she should take some pain relief medicine.”
Another side effect, according to Aluko, is menstrual change.
“If it is bleeding or spotting, it is manageable,” she said, adding that, “the woman is advised to see her doctor, who will give her drugs to regulate it or take her off that method.”
She described heavy bleeding as a situation in which one pad gets filled with blood in an hour or two.
“However, there are some other causes that may make the woman bleed, like fibroid,” she said.
For women complaining about not seeing their periods, Aluko said some hormonal contraceptions inhibit ovulation – that is the womb lining does not shed after an egg is fertilised.
Ugammadu also noted that there is no family planning method that will make a woman bleed to the point of death but women should check themselves for any diseases or infections before blaming the procedure.
Another side-effect of contraception is breast tenderness, which is often caused by emergency pills.
Aluko said, the tenderness stops within days but a doctor should be consulted if it persists to ensure that one is not already pregnant.
Weight change, which could be a weight gain or a loss, is another side-effect that many women complained of.
Aluko said it was normal to add weight but it shouldn’t be more than 3kg, especially for the hormonal method.In a situation where the weight is more than 3kg, Aluko said the woman should check her lifestyle and diet.
Ugammadu advised women to reduce fat intake, desist from heavy or late night food and exercise regularly.
For women who react to condoms and diaphragms, Aluko said it is because they are made from latex.
“The side effects do not stay with you permanently; they last within a period of time – the period when your system is trying to adjust to the new element that has been introduced into it. When your body gets adjusted, then you are fine.”
Aluko explained that a woman should see a doctor before adopting a family planning method and not take on a method because a friend or a family member did the same.
According to her, this is to know which method would be suitable for her, adding that one of the things a doctor would demand is a pregnancy test.
Ugammadu explained that there is no testing per se, but to get the blood pressure and weight, while salient questions on her health are asked before she is advised to adopt a method.
“For example, hormonals are not good for people that are hypertensive, diabetic or already on the big side. If someone that is hypertensive is coming to tell me that I want implants, I won’t give it to her because I know that implant will make her BP worse. Instead, I will ask her to go for IUD as it is not hormonal. So, it depends on the family planning provider,” she said.
She added, “If your weight is above 70 and you take a family planning method that should stay up to five years, it will only stay up to three years.”
On the misconceptions women have about family planning, Aluko explained that family planning does not cause infertility, contrary to the belief in some quarters.
“It is when the contraceptive is still in the system that it prevents pregnancy but when it is removed, a woman can get pregnant again,” Aluko said. “Family planning does not encourage promiscuity as it is believed by some men,” she added.
She also noted that it does not travel to other parts of the body, neither does it make a baby have defects.