by Olutayo Irantiola
The World Contraception Day takes place on September 26th, but ahead of the 2019 edition, our team decided to engage a Community Health Profession on the adoption of Contraceptives in Nigeria. We spoke to Dr. Davies Adeloye, MBBS, PhD, the Research Lead, RcDavies Evidence-Based Medicine, Lagos, Nigeria; he is also Editor-in-Chief, Journal of Global Health Reports; & Honorary Research Fellow, Centre for Global Health Research, Usher Institute, University of Edinburgh, UK. Herein below is an excerpt of the interview that we had with him.
PDC: Can a woman move from one form of contraceptive to another, for instance can they use pills at some point before moving to cervical cap, Intrauterine device amongst others?
DDA: Yes, a woman can switch from one birth control method to another. However, it is important you seek advice from your doctor or nurse before doing this. It is recommended that there should be no gap between methods, ie. you start a new method before stopping the old one. This helps reduce chances of being pregnant, as the new method has adequate time to start working while the new one gradually wears off.
PDC: What are the beliefs of Nigerian women about contraceptives that stop them for adopting any of the types of contraceptives?
DDA: There are several myths and misconceptions, mostly inaccurate. The fear of side effects, health problems (eg. cancer), and return to fertility, are among leading reasons. Religious and sociocultural issues, partner’s disapproval, stigma, and discrimination further contribute to these in some settings.
PDC: Many women complain of perennial headache after taking up contraceptives, what are the various examinations that are carried out on women so as to know the best contraceptive for their body?
DDA: Really, there are no clinical tests to know which contraceptive method best suits a client. However, your past medical, obstetric/gynaecological, family and social history will be taken at family planning centre as part of normal clinical practice. Research has even shown that relative over-medicalization placed on choice of contraceptive methods in some Nigerian settings has been counter-productive, with many clients eventually not taking any method.
PDC: What are the other side effects of the use of contraceptives?
DDA: Persons could experience some side effects with contraceptives, just like any other medicine. Headaches, irregular bleeding, abdominal pains, weight changes, and breast tenderness have been reported in the first few weeks or months of starting family planning. These side effects usually disappear with time. However, if they get worse or you are bothered, please see your doctor, nurse or relevant health worker for appropriate advice or care.
PDC: One of the phobia of many women about the take up of contraceptive is that it delays conception when they desire to have a baby, how can they guard against this?
DDA: This is not true. There could be other factors for delayed conception. Normally, it takes some time for the natural hormones in the body to fully take over after stopping contraception, which implies menstrual cycles may take some few months to return to normal. However, most women conceive within a year of stopping hormonal contraceptive. Studies have shown that chances of getting pregnant are almost the same, or even better for women one year after discontinuing hormonal contraceptives compared to other women that are not on any method. In fact, pills have been reported to contribute to preservation of women’s fertility as it reduces occurrence of some conditions (eg. fibroids and ectopic pregnancies) that affect fertility.
PDC: Stories have been heard of many women whose contraceptive method failed and they had unplanned pregnancy, what are the ways of ensuring that contraceptives don’t fail?
DDA: Consistent and appropriate use of any contraceptive is the key. Long acting reversible methods (implants and IUD) are very reliable.
PDC: With the series of intervention by global bodies about the John Hopkins University, Bill & Melinda Gate Foundation, has there been a significant increase in the adoption of contraceptives?
DDA: Efforts of these international donors, partnering, local NGOs, and the federal ministry of health must be commended. Indeed, awareness on contraceptives has increased in Nigeria, but not yet translated to a desired uptake. Modern Contraceptive Prevalence Rate (mCPR) in Nigeria is 13.8% (according to FP 2020 reports), with current projection indicating we can only hit 15.1% mCPR by 2020, which is still far from the year 2020 target. Several married women (25%) still have unmet need for family planning. A Nigerian woman currently gives birth to an average of 5.5 children.
PDC: Recently, the Federal Government of Nigeria was of the opinion that families should not have more than 2 children, what are the various steps that can be taken to make this a reality in a country where many of the predominant cultures love having many children?
DDA: Controlling the number of children in a family (like in China) may be difficult to achieve in Nigeria, given the diverse socio-cultural and ethnoreligious tenets. Education (using contextually acceptable means), advocacy (targeting community heads, religious leaders, trade and union leaders), and measures to increase supply and demand of contraceptives across the country (eg. media) have been shown to be helpful. The government can also assist by providing an enabling environment in which women and girls make informed choices about their health. Monitoring, evaluation, and relevant research may inform better approaches and strategies.
PDC: Women too are also advocating that men should also be involved in taking up contraceptives other than the male condom, what are the various contraceptive methods available for men?
DDA: Currently, the contraceptive methods available to men are condoms and vasectomy (a minor surgical procedure, usually permanent, that prevents sperm from being released). However, research on male contraception are ongoing in two main areas—hormonal, and non-hormonal methods. As noted, media campaigns, advocacy and education targeting men have been helpful.
PDC: Kindly share some statistics to show the improvement in the sales of contraceptives?
To the best of my knowledge, across most government-owned health facilities, FP services are relatively free or subsidized. Thanks to efforts of the FMoH, BMGF, and several donors and NGOs. Private centres, chemists and vendors do charge for FP services—I cannot provide accurate data on their sales. However, beyond sales, I think the question is: are we making any progress in contraceptives’ uptake in the country? According to FP 2020, mCPR increased from 11.8% to 13.8% between 2012 and 2018, with additional users of contraceptives consistently increasing during this period (over 1.7 million additional users between 2017 and 2018 alone). So, I think the efforts are yielding some results, albeit not desired.
PDC: Is it true that contraceptives lead to early attainment of menopause in women?
DDA: No. Menopause is a natural process for every woman. A woman’s age, her mother’s age, smoking, chemotherapy, ovarian cancer and ethnicity are key determinants of onset. Being on birth control does not affect this, but may mask some symptoms of menopause, sometimes making it difficult to tell if a woman has attained menopause. For women who think they are peri-menopausal, we advise they stay on their contraceptives during the transition process.
To know more about Dr. Davies Adeloye, MBBS, PhD, visit www.daviesadeloye.com