Lack information, services for youth cause abuse of E-Pill

Woman in bed with medicine

Beatrice, a pharmacist sells drugs at a chemist shop  in Kiserian, a fast growing town in the outskirts of Nairobi.

For most of the week, business is slow, and she mainly serves the steady stream of patients who visit the adjacent clinic.

But on weekends and Mondays, her weekly sales spike, thanks to a new crop of customers who buy emergency contraceptives.

Even for such a small town, she can manage to sell as much as 30 doses of morning-after pill on a Monday.

Most of the customers are teenagers, some looking as young as 14. More troubling for her is the fact that a number of them are regular customers, buying morning-after pills as many as three times a month.

Mondays for many in formal employment bring an end to a weekend of fun and sexual escapades. But it is all a stark reminder of the real possibility of a pregnancy for those who did not use protection during sex.

The joke that Kenyans fear pregnancy more than sexually transmitted diseases it seems, is a reality.

It is a reflection of risky sexual behaviours among young people that can expose them to sexually transmitted infections, says Dr John Nyamu, a consultant gynaecologist and Executive Director at Reproductive Health Services.

DRUGS OF LAST RESORT

Morning-after pills are drugs of the last resort but most customers seem oblivious of the health risks associated with their abuse.

Irregular breathing, hormonal imbalance and headaches resulting from progesterone contained in the emergency contraceptives are some of the side effects. Hormonal imbalance, in the long term, can affect the reproductive health of women, says Dr Nyamu.

“If somebody develops hormonal imbalance, then they will have to be given other medicines before they can conceive again.”

Dr Nyamu treats many women with hormonal imbalance but it is hard to link them with emergency contraceptives.

HIGH SALES ON WEEKENDS

However he notes that abuse of drugs is commonplace with chemist shops recording high sales during weekends and on Mondays and may well be the reason in some cases.

Manufacturers recommend that morning-after pills should not be used more than twice a month.

“Emergency pills should only be taken when women feel they have ovulated and they might conceive and this (ovulation) only happens once in a month,” he says. “But most of the women, especially college and university students, ingest morning-after pills whenever they have unprotected sex.”

He adds that most of them are not married and do not have reliable contraceptive methods, thus, they use morning-after pills as emergency back-up.

The problem, according to him is the lack of awareness among young people on where they can get reliable contraceptive (methods.)

“The government does not have youth-friendly services for provision of contraceptives to young people, more so teenagers and adolescents,” he observes.

“Government facilities do not have clinics where youth can get advice, and even the contraceptives.”

For him, society is yet to come to terms with the fact that sexual activity starts between 12-15 years for both boys and girls.

“It has been like that for many years and it is a fact that we cannot deny,” he says.

“Also, the government has no policy regarding provision of these services to the unmarried youth.

“In public hospitals and clinics, family planning services are mainly provided for married couples, and it is never thought that the unmarried youth need them too.”

But even where these facilities are available, young women will most likely stay away due to societal attitudes that girls should not be having sex.

“The society is also to blame since it feels that young people should not be engaging in sex while they feel they are mature enough and should be having relationships, “Dr Nyamu says.

Other contraceptives  like condoms are more effective and can prevent sexually transmitted infections, but pressure from religious groups against the latex sheaths could be limiting the number of users.

PREVENT STIs

Emergency contraception is not however a guarantee that a one will not conceive.

Manufacturers of Postinor 2, the most popular morning-after pill put its efficacy at 75 per cent meaning there is still a 25 per cent chance of one getting pregnant.

Male and female condoms have a failure rate of 18 per cent and 21 per cent respectively, under typical use but can also prevent sexually transmitted diseases.

For Beatrice and other pharmacists, there is little to dissuade some of their regular customers from buying emergency contraception.

After all, chemist shops are in business, says Dr Nyamu.

“They cannot turn away such customers but they also have no time to counsel these women, which could have been the best thing.”

“If one is sexually active then she should use long term but reversible methods but not rely on the emergency pill, Dr Nyamu advises.