BY KATE HALIM

Mrs. Josephine Ekanem is not a happy woman at the moment. She just discovered she is pregnant with her fifth child. For someone else, this news would have been a sweet one, but with the present economic situation in the country, Mrs. Ekanem is heartbroken.

Mrs. Ekanem got married 11 years ago and has four children between the ages of four and 10. She also had an implant done to prevent getting pregnant again, but it seems this fifth child just wants to come into the world by all means. It was no good news to her already large family.

Her husband does not even want to hear the word baby in their home.

Lamenting her fate, she said: “God should have given this child to those fruitless couples who have been crying tears and blood and spending money in different hospitals just to have one child. I don’t know why this implant that the nurses told me was the safest method failed.”

Mrs. Ekanem is not alone in this predicament. Many Nigerian women have had sad experiences as a result of failed or failing family planning methods.

Besides unwanted pregnancies, many are contending with unpleasant side effects associated with these contraceptive methods.

Now, the women are regretting their desire to keep their families small, blaming health care professionals for not educating them well enough on the side effects of these family planning methods.

Mrs. Chinwendu Jude was wise to go for an implant three weeks after having her second child, barely 18 months after the first, or so she thought. But, she was shocked when she was told she was pregnant even while her first child was still suckling. “Initially, I thought I had malaria because I was still having my monthly periods. But, when the doctor asked me to go for a pregnancy test, I laughed. When I discovered I was pregnant again, I was crushed. I had wanted to space my children well,” she said.In her own case, Mrs. Jude went for the implant that cost her N10, 000 at a hospital at Satellite Town, Lagos after her second child. The implant kept her safe for three years.

But Mrs. Uju Okolo wasn’t so lucky. Okolo went for the intrauterine device IUD method after her last child who is two years old and started to bleed some months later. She bled for a month non-stop and when she visited the hospital, her doctor told her the device wasn’t well placed and she did well by seeking for help.

She told Saturday Sun: “As soon as the IUD was removed, the bleeding stopped. I got myself, my peace and my life back. I didn’t know it was this painful to plan my family. I think our medical personnel are not doing enough to educate women on the advantages and disadvantages of these methods.”

For Mrs. Lucky Usifo, planning her family came with pains and embarrassment. She started having acnes and boils on her vagina after using a method last month. “I have up to five boils on my labia. I have more on my laps and backside. I know I am reacting to the implant. I have three children and I don’t want more. I will remove it when I have money to do another method. My husband refused to use condom with me,” she said.

Doctors shed light on contraceptives

Although experts have debunk claims that these methods are life threatening, they admit that they do  have side effects. However, they insist these do not outweigh the consequences of not choosing any method at all.

Dr. Gabriel Omonaiye who spoke with Saturday Sun explains that the side effects are peculiar to particular persons and may have absolutely no effect on others.

“At the time of receiving the method, if you go to a qualified practitioner, they first do what we call a balanced counselling, where you are told of all the methods available and then you will pick your best preferred method.”

Omonaiye added that after this step, the provider (a nurse, a doctor or someone who is trained to provide the service) will provide details of how the method works. Part of the details is the possible side effects. So for some women who use implants, also called ‘Jadelle’ the side effect is bleeding. For some women, for the first three weeks of taking it, they will have little blood spotting for about three weeks, but this eventually stops.”

Women are told not to be alarmed by this spotting, but if it becomes heavy, Omonaiye advise, they should go back to the provider to get a drug that will tide them over for a period for their menstrual cycle to regularise. But if this does not happen after two months, the device would have to be removed.

On the possibility of IUD use causing infection, he said: “If a woman is having recurrent urinary tract infection (infection around the perennial region) and she is using an IUD, it is because she is having multiple sexual partners or her hygiene level is low, so, if you cannot keep up a high hygiene level, it is advised that you remove the IUD because IUD will increase your risk of UTI; it doesn’t cause it though.”

Dr. Frank Aneke advises against the use of implant by hypertensive patients. “A woman who is hypertensive should not use the implant because one of the side effects of implant is water retention. When your body retains water, it will increase your blood volume, which worsens the hypertension.”

Asked if implants can cause boils on the vagina labia, as complained by some women, Dr. Aneke says it is definitely not the implant. The women who complain about boils after using the implants should check their hygiene because there is no connection between the two, he says.

He notes that there are lots of hearsays out there about contraceptive methods and so, advises women to get the correct information from the family planning providers at the health centres. “We have heard lies about how the implant moved from the hand to the head or to the other hand. To be honest, the benefit of family planning outweighs whatever side effects many women experience after going for one or more methods,” Aneke says.

Also, the doctor told Saturday Sun that “weight gain after going for family planning varies from woman to woman. While some women lose weight after the method, some others add weight. For implant, there is a tendency to add weight, because of water retention, so if you were a size eight, you may move to size 10 in a space of three years.”

He lists among some things to consider when choosing a birth control method, the individual’s health status, the desire for children in the future, frequency of sexual contact and number of sex partners, safety and efficacy of chosen method and level of personal comfort with the chosen method.

Dr. Aneke revealed that hormonal contraception can be administered in a variety of ways, including pills, patches, injections, intrauterine devices, and vaginal rings.

But serious risks associated with hormonal contraception include heart attack, stroke, blood clots, high blood pressure, and liver tumours. He said that “these risks are higher in some women, including women who are 35 years or older, who are overweight, have high blood pressure and high cholesterol as wells smokers.”

Aneke noted that hormonal methods do not protect against sexually transmitted disease and a condom will need to be used as well if either partner has had intercourse before.

Dr. Omonaiye, on his part, advises that when choosing permanent sterilization, it is important for men and women to be sure that they are done with child bearing and do not desire becoming pregnant in the future. “Permanent sterilization in women can be achieved by surgery, such as getting your tubes tied or the non-surgical approach using an implant. Men can undergo a vasectomy,” he explains.

He says that benefits of female sterilization include its permanency and the fact that it is accomplished without disturbing natural hormones. Its permanency and limited reversibility can also be seen as disadvantages if the individual changes her mind following sterilization.

“Types of female sterilization include tubal ligation where the fallopian tubes are surgically severed. This can be achieved in a number of ways, including tying and cutting, sealing, clamping, or removing a portion of the tube itself. Tubal ligation is highly effective with less than 1 percent of women experiencing an unintended pregnancy.”

There is tubal implant also known as Essure. This non-surgical method of sterilization involves the placement of a coiled implant into the fallopian tube which will scar over – blocking the tubes – approximately 3 months after insertion. Less than 1 percent of women experience an unintended pregnancy.

According to Omonaiye, the risks associated with this form of sterilization include incorrect placement, implant dislodgement, incomplete scarring within the expected timeframe. Women rarely experience menstrual changes, infection, pain, and fluid build-up in the blood.

Dr. Aneke said that contraceptive pills contain either a combination of the hormones estrogen and progestin or just progestin. Contraceptive pills are an extremely effective method of pregnancy prevention, however, as with all other methods, they are not foolproof and must be used correctly. With correct use, only one percent of women will experience an unintended pregnancy. The pill works less well in women who are taking certain antibiotics, anti-seizure medications and some HIV drugs. It can also work less well in women who are overweight or experiencing diarrhea and vomiting, he says.

According to Aneke, common side effects of taking pills include bleeding between periods, breast tenderness, nausea or vomiting, dizziness, weight gain, mood changes and visual problems.

Benefits of taking the pill are improved menstrual cramps, lighter periods, improved acne, protection against certain cancers, ectopic pregnancy and benign breast growths.

Given every three months, DepoProvera is an injectable form of birth control that uses the hormone progestin to prevent pregnancy. When used correctly, it is an effective method of birth control with less than 1 percent of women experiencing an unintended pregnancy. “Benefits of injectable birth control include its safety and convenience, uterine cancer prevention, safety with breastfeeding, and lack of estrogen. Side effects vary from woman to woman and they are irregular bleeding, heavy periods, libido changes, weight gain, abnormal hair growth as well as periodic headaches,” Omonaiye adds.

But, risks associated with DepoProvera include bone thinning, with an increased risk of fracture, osteoporosis and ectopic pregnancy.

NuvaRing is a flexible plastic ring that is inserted and left in the vagina for three weeks out of each four-week menstrual cycle. Estrogen and progestin are released into the vagina, providing effective birth control.

Mrs. Ifeyinwa Obinwa, a gynaecologist at His Strips Hospital, Lagos, identifies benefits of using the vaginal ring to include its safety and convenience, as well as quick restoration of fertility, lighter periods, some pelvic inflammatory disease (PID) protection, reduced bone thinning, improved acne, protection against certain cancers, ectopic pregnancy, and benign breast growths.

On the other hand, the side effects are minimal and include, breast tenderness, vaginal discharge, irritation and bleeding between periods.

Obinwa reveals that another method of contraception women go for is the cervical cap. Cervical cap is a silicone cup fitted by a doctor, which sits in the vagina and covers the cervix. Benefits of cervical cap use include safety, convenience, it can be used when breastfeeding, and it does not affect hormones. She says: “the disadvantages include inability to use when menstruating, insertion challenges, timing of placement, potential for dislodging, abnormal pap smears, allergic reactions, potential need for size change following pregnancy, and risk of toxic shock syndrome.”

She advises women to adhere to the instructions so as not to record failure or injure themselves. According to her, the cervical cap must remain in the vagina for 6-8 hours following sex and removed within 48 hours.

However, Dr. Obinwa says that it is not only women who should be concerned about planning their families. According to her, men can undergo permanent sterilization by having a vasectomy. During this procedure, a man’s vas deferens, which transports sperm, are blocked or closed to prevent conception. “After 3 months, there should be no sperm in the fluid a man ejaculates during orgasm. He will need to undergo a semen analysis to ensure that there is no sperm present to ejaculate,” she says, describing vasectomy as a very effective form of birth control with a nearly 100 percent success rate; less than 1 percent of men will experience their vas deferens re-connecting.

  “But as with any procedure, there are some risks, including infection, bruising, hematoma, and decreased libido or inability to have an erection. At times, male sterilization can be reversed, however, there is no guarantee that there will be successful restoration of fertility,” she adds.