More awareness is needed to increase contraceptives uptake

Contraceptives have for long been surrounded by myriad myths and misconceptions that have, to some extent, influenced their uptake.

Research has proven that women are most comfortable and likely to continue longer with contraceptives suggested by specialists, as long as they are well informed and can make their own choices.

Contraceptives are either non-hormonal or hormonal. The Non-hormonal include male and female condoms, cervical cap, or diaphragm, copper IUD (coil), natural birth control and sterilization.

Sterilisation is tubal ligation in women and vasectomy in men. Among hormonal methods of birth control are pills, injections, contraceptive patches, implants and the hormonal IUD or coil.

The level of effectiveness, health, age, side effects, cost and lifestyle are some of the basic concerns looked into before deciding on a contraceptive. In line with the 2018 theme for World Contraceptive Day “It’s your life, it’s your responsibility” family planning is a personal affair.

A major concern among women is weight gain for those considering a hormonal birth control.  Truth is that there is no consistent effect of contraceptives on weight gain. Other factors such as genetic potential, variation in activity level, alteration in diet or change in metabolism are more likely to result in variations in weight.

Contraceptive methods are safe, provide good protection against pregnancy but nothing is perfect; failure rates are very low and depend on the method used. Another common myth is that women using coils are more prone to pelvic infections.

Used e-pill

Research evidence confirms that insertion of a coil does not increase the risk of acquiring pelvic infections. However, if a coil is inserted into a womb with ongoing, often asymptomatic infection, the infection will flare.

Emergency contraceptive pills (e-pills) are among the most misunderstood and hence abused in Kenya. The most commonly used e-pill contains the hormone Levonorgestrel. It is 98 per cent effective in preventing pregnancy if taken at the earliest, but within 72 hours of sexual activity.

Unknown to majority of people, the copper coil is an alternative emergency contraceptive that is more than 99 per cent effective and works if fitted up to five days after unprotected intercourse. Whether inserted as an emergency contraceptive or at a regular visit the copper coil continues to offer long-term reversible contraception.

Natural birth control methods is a group of methods that work primarily based on understanding the female reproductive cycle and the fertile window. They offer a choice for couples not willing or able to use other contraceptive options.

Because these methods require a very predictable, regular cycle, partner co-operation and a lot of consistency, their typical failure rate fluctuates significantly and can be quite high. Condoms have the advantage of being widely available, especially for the male condom, as well as being able to help prevent both pregnancy and sexually transmitted infections (STIs).

Less effective

Implants are small flexible plastic rods about the size of a matchstick embedded with hormones that are implanted under the arm skin. They can last 3 or 5 years. They are among the most effective contraceptive methods, preventing pregnancy more than 99.9 per cent of times.

The commonest contraceptive injection is the three  monthly ‘depo’ injection. It is related to the implants in hormone content but is slightly less effective.

The contraceptive patch is a good substitute for those who may wish to take contraceptive pills but are unable to sustain daily taking. The woman sticks the small adhesive patch on her skin and changes it every seven days. If fixed on dry skin it will withstand taking a bath and even swimming.

Male and female sterilization are permanent birth control options for couples who do not wish to have more children. They entail a small cut to block the fallopian tubes in women or semen passages in men.

Sterilization if fraught with many misconceptions. The commonest are that tubal ligation diminishes a woman’s libido, causes excessive lubrication during sex or causes menopause. For vasectomy, men express fear that it will diminish their ‘maleness’ and libido. None of these is true.

To conclude, there is need for policy and implementation dialogues to address these issues to increase uptake of contraceptives.

Dr Mwaniki is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital, Nairobi