Why some women abandon contraceptive methods

Health workers are calling for better provider training, male involvement, reliable contraceptive supplies and personalised counselling to help women make informed reproductive health choices.[iStockphoto]

For many women, choosing a contraceptive method marks the beginning of a journey towards reproductive autonomy. Yet for thousands, that journey ends prematurely due to a myriad of changes.

They include side effects, misinformation, partner hostility, stigma, cultural beliefs, and limited access to quality counselling.

At Mechimeru Health Centre, nurses and family planning providers regularly encounter women seeking to discontinue contraceptive methods they had previously abandoned.

Kenya Demographic and Health Survey (KDHS) 2022 report shows in Kenya, 70 percent of sexually active unmarried women use any method of family planning; 59 per cent use a modern method. The most popular type of family planning method for sexually active unmarried women is the male condom.

The report says use of implants is higher in rural areas (16 per cent) than in urban areas (7 per cent).  According to the survey, at least 63 per cent of married women aged 15-49 use any method of family planning, with 57 per cent using a modern method and 6 per cent using a traditional method.

 Commonly used methods among married women are injectables, at 20 per cent, implants at 19 per cent and pills at 8 per cent.

 Lydia Kitui, a nurse and family planning expert at the facility, says women discontinue contraceptive use for a variety of reasons, ranging from the desire to have children to adverse effects, lack of partner support, stigma, contraceptive stock-outs, myths and misconceptions.

 She says some women arrive at the facility convinced that a contraceptive method is harmful after hearing stories from friends, relatives or other members of the community.

 Kitui says that inadequate information and counselling before a woman begins using a method makes it difficult for her to understand and manage expected side effects.

“Lack of training among healthcare providers may make some women not get enough information about the effects of the type of contraceptive they need to use,” she said.

Healthcare workers need adequate training to enable them to provide comprehensive counselling, assess a client's eligibility for a particular method and explain possible side effects before the client makes an informed choice.

 Kitui observed that a shortage of healthcare workers in some facilities is making it difficult for providers to dedicate enough time to individual clients seeking family planning services.

“There is excessive workload in the facilities; for instance, in a dispensary only one healthcare provider is working all over, and he or she will not get time to sit down with clients for 30 minutes explaining about the effects of the commodity they have chosen and assessing the eligibility of the commodity,” she says.

She called for more investment in training healthcare providers in family planning  to ensure women receive accurate information and appropriate counselling before and after choosing a contraceptive method.

 Kitui urged Marie Stopes to support the training of more family planning experts who can help bridge the gap in reproductive health services by helping women understand that experiencing challenges with one contraceptive method does not necessarily mean they have to abandon family planning altogether.

Women experiencing adverse effects could be assisted to explore alternative methods depending on their individual circumstances and availability of the preferred contraceptive at the facility, according to the nurse.

“Mothers using certain contraceptive methods are allowed to switch to others if the methods they are supposed to use are available,” she said.

Kitui says contraceptive stock-outs can complicate the situation, particularly when a client needs to change to another method urgently. 

 “If the commodity they wish to switch to is available, then they will be able to get it.  In circumstances where a given commodity poses a risk to the client, we would be forced to discontinue the method without giving them a replacement,” she said.

The situation, she adds, can leave women without an immediate alternative and may increase the likelihood of discontinuing family planning altogether.

Further, Kitui identifies myths and misconceptions as some of the major barriers to sustained contraceptive use.  Women often receive information about family planning from friends, relatives, and other community members, some of which may not be accurate.

“A woman may have been using a certain type of contraceptive without a hitch but when they start listening to myths and misconceptions from the community, they begin to develop fear about the contraceptive, and they come to the facility to have it removed,” she reported.

Kitui says such clients require patience and accurate counselling from trained healthcare providers to address their concerns and help them make informed decisions.

 Kitui also points to a lack of male involvement as another factor influencing contraceptive decisions.

 “Family planning should not always be viewed as a woman's responsibility, but couples need to communicate and make informed decisions together.”

“The use of a contraceptive should never be a one-person decision. When two people come together for counselling sessions concerning contraception, they will be able to come up with a contraceptive that favours all of them,” she said.

 She says involving men in family planning counselling can help address misconceptions, improve communication between couples and reduce opposition to contraceptive use.

 At Mechimeru Health Centre, healthcare providers conduct follow-ups to monitor women who have adopted different family planning methods, says Kitui.

She lauds Marie Stopes, saying the facility has been supporting clients who experience severe side effects and require additional care.

“Marie Stopes plays an important role in ensuring that those who face challenges with contraceptives are helped to come back to their normalcy,” she stated.

She says such partnerships are important in strengthening family planning services, particularly in facilities that face shortages of healthcare workers and other resources.

At Mechimeru Health Centre, which serves an estimated 7,000 women of reproductive age, Kitui says the facility receives more than 150 mothers seeking family planning services monthly.

It also works with Community Health Promoters (CHPs), who have been trained to identify clients who require family planning services and refer them to health facilities for skilled care.

“Mostly, we talk to our CHPs to monitor pregnant mothers in their catchment population areas and follow them up after giving birth. They come to our family planning clinics after six weeks, which is the best time to begin contraceptives,” she said.

The facility has also established youth-friendly days where young people can access information and counselling on sexual and reproductive health.

Kitui says the sessions provide an opportunity to discuss contraception, sexually transmitted infections and unintended pregnancies with young people in a safe environment.

“Young girls who feel they cannot abstain from sex are usually guided on contraception to cushion them from a high risk of contracting not only STIs and HIV but also experiencing unwanted pregnancies when they engage in unprotected sex,” she said.

According to her, providing young people with accurate, age-appropriate information can help them make informed decisions about their reproductive health and seek services when necessary.

Kitui says the three-month injectable contraceptive is among the most commonly used methods at the facility, alongside implants that protect for three and five years.

Nonetheless, there is no single contraceptive method that is suitable for every woman.

 “The choice should be guided by an individual's health status, reproductive intentions, preferences, possible side effects and access to a trained healthcare provider for counselling,” she said.

Nellie Masava confided that she started falling sick unaware that a baby that had not been planned for was forming inside her. It later turned out that she had an ectopic pregnancy, which occurs when a fertilised egg grows outside of the uterus.

Masava says she had to take an emergency pill to terminate the pregnancy. Mercy Miruka had an implant but was shocked to learn she was five months pregnant.

She recounted how she bled on many occasions, experienced dizziness, backache and headache all at once. At some point, she was forced to seek treatment only to learn she had conceived.

"I don't know how it happened, but they had to immediately remove the implant and I started antenatal appointments. Despite being on family planning, I conceived, and my baby is now two years old. More research needs to be done so that we don't have such inconveniences in the future," she argued.

According to the two mothers, family planning has a lot of side effects which may be confused for pregnancy symptoms.