TOUGH CHOICE: WHEN HORMONAL CONTRACEPTIVES DON’T WORK FOR YOU
CAROLINE NJUNG’E talked to two professionals who took alternative but still unpopular routes
Recently, tens of panic-stricken women gathered at the closed doors of a family planning clinic in a Nairobi city estate that was dispensing “herbal contraceptives”.
The women interviewed said they preferred the “herbal” contraceptive because it had no side effects. Although the Ministry of Health has since issued an alert against the use of these contraceptives, this just goes to show how desperate women are to find a contraceptive that works for them.
June Ndegwa, 31*, is one such woman. She has four children. The last two, which she and her husband had not planned for, were conceived while she was on hormonal contraceptives. She was on the pill when she conceived her third born, and on an injectable contraceptive when she conceived the fourth.
“My husband and I had planned to have just two children, so it took us a while to get over the news that I was pregnant a third time,” she says.
But her fourth pregnancy nearly wrecked her marriage when her husband accused her of being “careless”, which nearly drove her to seek an abortion.
“I was so devastated, I nearly went mad,” she recalls.
Though the marriage weathered the storm, June knew she could not afford to have another child. After consulting with friends, she had a tubal ligation, which has finally given her peace of mind.
Phoebe Akoth has a similar story. She, too, was on the pill when she conceived her second born just eight months after having her first child. “I actually considered having an abortion because the last thing I expected was to conceive so soon after giving birth. I was worried about what people would think when the pregnancy started showing and whether my body could handle another pregnancy so soon,” she says.
Fortunately, her husband was supportive and with time, she started coming round to the idea of being pregnant once again.
Lucy Thang’a, the executive director of Carita Nurses Association of Kenya, a professional organisation of Catholic nurses, says women would be better off using natural birth control, where couples abstain from sex during the woman’s fertile period.
“Contrary to what many think, the abstinence period is a maximum of just seven days per cycle. The rest of the time, the couple can enjoy intimacy without the fear of pregnancy,” says Thang’a, a mother of four who adopted the method soon after having her first child more than 30 years ago.
When she got married, her doctor put her on the pill but within three months, she had to discontinue due to its side effects. “I was sickly and experienced mood swings. My libido also dropped drastically and I felt as if I was pregnant, which is ironical because the pill was supposed to prevent pregnancy,” recalls Thang’a, then 21 and still in college.
Thereafter, her doctor recommended the coil, but it was no better. “Not long after I started using the coil, I developed a serious infection and alarmed, I went to my doctor to find out what the problem was,” she recalls.
After performing some tests, the doctor announced that either she or her husband had been unfaithful. “I cannot explain how devastated I was, especially because I had been faithful to my husband,” she says.
When she went home and told her husband what the doctor had insinuated, he also went for a medical test to prove to her that he had not cheated on her. The couple would later learn that some pelvic infections sometimes present symptoms similar to sexually transmitted diseases and unless tests are carried out, it is difficult to tell whether it is just an infection or an STD.
“It was a difficult phase in our young marriage and although we eventually overcame it, we decided that we were done with contraceptives when I conceived our first born,” says Thang’a, who, later in the course of her nursing career, came across many women on hormonal contraceptives and intrauterine devices with symptoms like the ones she had had.
After weighing the remaining options, Thang’a and her husband settled for natural birth control, which she says is 100 per cent effective if applied properly. They spaced their last three children using it.
“Most women have no idea how the contraceptives they’re using work or how they affect their bodies, so they suffer quietly. Their husbands, too, are in the dark, and the poor couple watches as their marriage crumbles since they have no idea how to solve the problem.”
She believes the information about contraceptives as well as the counselling offered at health institutions is not enough to enable couples to make informed choices.
For instance, she says, women are rarely told that none of the hormonal contraceptive methods is completely safe and effective, or that it takes six months to a year — sometimes even longer — before a woman who has been using these methods can conceive. They are also ill-informed about how natural contraception works.
“If you ask women how natural family planning works, most will tell you that as long as you have a regular cycle, all you need to do is consult your calendar to pin-point your fertile and non-fertile days,” she says, adding that this is not true.
“The success rate of this method is based on daily observation of one’s body, which includes observing changes in the vaginal mucus and measuring the basal body temperature,” she explains, adding that this applies to all women, regardless of whether they have a regular or irregular menstrual cycle.
Thang’a stresses that the method should be taught by competent individuals. At her organisation, they encourage women to be accompanied by their partners for at least three sessions since the method requires joint efforts to succeed.
It is notable that some scientific reports say it is possible to pre-select the sex of your baby using natural birth control.
“This is normally the last thing I teach since I would want couples to have the children God gives them. However, if the couple’s marriage is on the verge of breakdown because they desperately want a certain sex, we are ready to help,” she explains.
Besides Caritas Nurses Association, The Mater Hospital and other Catholic institutions also offer sessions on natural family planning.
Family planning is largely a one-sided affair in our society, with women entirely responsibile for ensuring that they have only the number of children they and their partners agree on. A number of women we talked to confessed that their husbands have no idea what contraception method they were using.
Not so Dr Charles Ochieng, who took charge and had a vasectomy, a step many men would not consider, thanks to the myths surrounding it. Ochieng’ had watched his wife of seven years, Evelyn Wekesa, battle severe side effects triggered by the contraceptives she was using. She experienced irregular and heavy bleeding, severe headaches, and low libido.
“I could no longer bear to see her suffer any more so after she conceived our second child, we decided to consider a permanent method of family planning,” he says. The couple eventually settled on a vasectomy, which Ochieng’ underwent in May last year.
“The procedure took just 20 minutes and after that, I simply walked out and went about my business,” he says, explaining that a vasectomy is a minor surgical procedure.
“There are so many misconceptions about vasectomy that the majority of men cringe at the mere mention of the word. The fact is that besides some slight bleeding which occurs soon after the procedure, vasectomy is extremely safe and has no side effects,” assures Ochieng’, a reproductive health doctor with Marie Stopes Kenya.
Contrary to what many men believe, he clarifies, vasectomy is not castration. And it does not interfere with the man’s libido, meaning his sexual pleasure does not diminish. Indeed, a man can safely have sex just 72 hours after the procedure.
“With vasectomy, our love life has improved because there’s no longer fear of pregnancy and, more importantly, we have peace of mind since my wife is in good health,” offers Ochieng’.
He believes it is the best way a man can show commitment to his partner and family if hormonal contraceptives affect his wife’s health. “It is an investment because it gives you an opportunity to focus on your family and career and also allows your wife to blossom and enjoy good health,” he explains.
He, however, cautions that the procedure is for men who have had the number of children they want since it cannot be reversed easily.
“For me, one child is good enough; if the second comes along, it is okay. However, three’s a crowd, says Ochieng, who believes a marriage is complete with or without children.
He says it is time men started playing a more active role in family planning. “Men should start showing some social justice when it comes to family planning.
Many women are adversely affected by the contraceptives they are using yet there are other safer methods couples can explore,” he says.
At his place of work, at the Marie Stopes Kisumu family planning centre, Ochieng says most of his clients are women, and they are rarely accompanied by their spouses. “Women come for consultations alone and those who are lucky are dropped off by their partners at the gate before they zoom off,” he says.
“It is important for men to accompany their wives because that way, they are informed about the possible side effects of contraceptives,” he adds, pointing out that this can prevent the common misunderstandings that couples experience when say, the wife suddenly puts on or loses weight, or starts experiencing an unexplained low sex drive.
The female equivalent of vasectomy is tubal ligation, which is basically surgery that blocks a woman’s fallopian tubes. “There are many providers in the country so access to it is better compared with vasectomy. Besides, medical students are exposed to it much more than vasectomy.”
Ochieng’ adds that compared with vasectomy, tubal ligation is more invasive and, therefore, more risky and given that it has a failure rate of one per cent, is not foolproof.
“There is a safer, non-invasive method for performing this procedure known as Essure. It involves introducing an adhesive mesh into the opening of the fallopian tubes through the uterus. However, it has yet to reach developing countries like ours,” says Ochieng.
Tubal ligation is best for the woman who has decided she doesn’t want any more children. So, there you have it; the choice is yours.