With recent talks of Nigeria overtaking the United States of America in population by 2050 and the call on citizens by population experts and government to embrace family planning, a few women who have undergone one family planning method or the other and have one unpalatable experience to show for it are calling for caution. They fear that many female folks may not be aware of the side-effects since they are hardly highlighted; but experts have debunked these claims saying that although all family planning methods have side effects, they don’t outweigh the consequences of not choosing any method at all.
Mrs. Franca Chijioke was lucky; after having her first child, she went to a health care centre to give her baby the Bacillus Calmette-Guerin (BCG) Vaccine. Whilst waiting for her turn, a nurse walked up to her and asked if she had done any family planning. She replied in the negative, so the nurse who became excited, told her about the available family planning methods. She also told her that the method that would suit her most was the implant.She explained that all she had to do was pay a sum of N7, 500 and she’d be secured for five years.
But Mrs. Chijioke didn’t have the money at the time, plus the fact that she didn’t plan it, so she told her she’d come back during the week and left after her baby had been attended to.
She told The Nation: “Yes, I had the mind of going back that week but I didn’t have the time and looking back, I thank God I didn’t because the following week when I went to my hospital to see my doctor for a check-up and told him how I hadn’t had the time to go for the implant, what he said shocked me.”
“He said implants are not given to women who just put to bed. That it is advisably given 2 weeks after delivery or thereafter.”
Mrs. Chijioke, who kept thanking God, told The Nation she could imagine the number of women ‘uneducated’ nurses have advised wrongly to insert an implant just days after delivery.
But Mrs. Grace Olumide was not lucky. Although a journalist, she had adopted the intrauterine device IUD method after her last child and started to bleed months after. She bled for 10 months non-stop and yet didn’t tell anyone or visit any hospital.
It was beginning to affect her life and marriage but she still didn’t talk until one day when she attended a seminar on family planning and realised that it may be the family planning method she was using. According to her: “As soon as the IUD was removed, the bleeding stopped.”
Mrs Obehi Iyagbatan was over 72 years old when she began to fall ill and her children took her to a hospital for treatment. After listening to her complains, the doctor requested that a scan and X-ray be done.
It was discovered that she had used the IUD method for more than 20 years and never bothered to remove it, because according to her, she didn’t know that she was supposed to remove it.
While speaking to The Nation, one of her children said: “My mother used the method about 20 years ago. A friend took her to the facility where it was inserted and she didn’t have any information about it or whether it should be removed, so she forgot about it until she started falling ill and it was discovered that a little piece of it still remaining inside her was the cause.
Mrs. Fatima Lucky’s case is different. She claimed she started having acnes and boils on her vagina after using a method in April. “My sister, I sometimes have up to eleven boils on my labia and pimples on my face. The boils also come out on my laps and back side. I can swear that since I was born I have never had a boil or pimples, so it is easy for me to conclude that it is the implant, even though I have not visited the hospital to find out.”
Most family planning methods have side effects
Dr Edun Omasanjuwa, state team leader for the Nigerian Urban Reproductive Health Initiative, NUHRI who spoke with The Nation said most of the family planning methods have side effects, which are not unique to a particular person. As a result, not everybody will experience the same side effects.
“At the time of receiving the method, if you go to a qualified practitioner, they first do what we call a balanced counseling, where you are told of all the methods available and then you will pick your best preferred method.
“After that, the provider (a nurse, a doctor or someone who is trained to provide the service) will give you details of how the method works. Part of the details they will give you is the possible side effects. So for some women who use implants, also called ‘Jadelle the side effect is bleeding’. What happens is that for some women, in the first three weeks of taking it, they will have spotting, where they will have a little blood for about two to three weeks, which eventually stops.
“We usually tell the women that they shouldn’t be alarmed but if it becomes heavy, they should come back to the provider or go to a nearby provider because there is a drug that can be given for a period of time to regularise the menstrual cycle. But if it doesn’t regularise after two months, we tell them to come back and remove it.”
“Another thing” Dr. Omasanjuwa said, “is that there is no test to find out which method will suit you, so what WHO has come up with is the Medical Eligibility Criteria, MEC Wheel that has all of the possible scenarios that will make you not to be able to use a particular method.
“So for example, if a woman were to be hypertensive, she is advised not to use implant; if she has breast cancer, she is advised not to use a particular method. If a woman has just put to bed, she cannot use a particular method.
“All of these things have to be found out to determine which one will be good for her.
On whether IUD causes 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.
“Some people also tend to bleed a lot from IUD. Once you see that you are bleeding a lot, all you have to do is come back to the care provide, remove it and then try another method.
“If a woman uses the implant and she is spotting for two weeks in a month, it will regularize, as long as it is not a heavy bleeding.
“Like I said, 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,” Omasanjuwa said.
Asked if implants can cause boils on the vagina labia, as complained by Mrs Lucky, Dr Omasanjuwa said it is definitely not the implant. She needs to go and check her hygiene because there is no connection.
He said there are lots of hearsays out there, so women should try to get the correct information from the family planning provider at the health centres.”
He also said: “There are lots of myths and misconceptions about family planning by people out of fear and they are trying to transfer that fear to others; and if out of fear you begin to bring forth children that you cannot take care of, the burden to take care of the children is worse.
“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 there may be.”
On whether family planning makes people add weight, he said “Not really, as it 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 ten in a space of three years.
The doctor said if a woman carries her implant or IUD for more than the number of years she should have ordinarily carried it, nothing will happen except that the method will stop working at the set years.
Another Doctor Akinkunmi of Life Font Hospital, Igando who also spoke with The Nation said for every drug there is always a leaflet that tells you what the chemical composition of the drugs are, what the indications for the drugs are. The things you should not use while taking the drug, the side effects and everything.
So like wise family planning methods; the injections, the drugs and everything. They all have side effects but for every methods there are precaustions that need to be taken to ensure that the particular method is used effectivly and one gets benefit from it. If people don’t use it as it is supposed to be used o if they don’t take it the percautiosn that has been prescribed then it will not work for them or it will not do what they expect it to do but the point is that the family planning thing is so flexible, there are different methods, so if somebody os using a particular method and the method is giving him or her a problem, they can change to another method.
Family planning is not rigid, for instance, when a woman is breastfeeding, it is expected that she does not see her period, however we have discovered that there are women who see there period four to six weeks after delivery whether they are brestfeeding or not and once they start menstruating there is a high possibility that they can get pregnant.
There are some family planning methods that cannot be used while a woman is breastfeeding, there are some that can be used. There are those that can be started almost immediately after she delivers and some cannot be started immediately so it depends on the particular method that she is taking.
Asked if there are family planning methods that can expose one to Urinary Track Infection, he said yes, “The coil also called copact T or IUD can predispose a woman to having infections and if a woman is using the coil once she suspects that she is having infections, the coil must be removed, the infection treated and then another one can be inserted.”
On how long a woman can carry an IUD, he said there are different types of IUD, “We have what is called the copact T and for each method there are expiry date. For the copact T, there are usually for about four to five years even if the woman has entered menopause or for any reason she is not sexually active, she must go and remove it.
If she doesn’t go to remove it, after a while the IUD will start causing problems. Similarly for the implant, the implants are of teo types – the one for five years which is the Jadelle and the one for three yars which is the implano. Once the expiry date is due, the person must go and remove it whether they are sexually active or not so if people use the methods according to the way it has been prescribed, then it will not give them any problem.
On what caused Mrs Lucky to bleed for 10 months, he said IUD is not known to cause bleeding per say, however, in medicine we say never say never. So it is god for any woman that wants to start family planning to go to a place where she can receive correct information because it is based on those information that she will be able to make a choice and if she has made her choice and she is having any probems with it, she can go back and make her complains to know whether whatever family planning she has done is the cause of her problem or if it is something else that is causing it.
But you find out that a lot of people do family planning from quacks who knows little or nothing about the methods and when they run into trouble they begin to seek professional medical assistance.
When a patient comes to us what we do first before we carry ut any method on them is cunselling. We first counsel them, telling them about all the different methods that are available; their advantages and disadvantages. As a healthcare provider you provide all information that will assiat the patient to make a choice. The providers don’t make a choice, the patients do. They are told that if for any reason the choice they have made is not compartible with their system they can choose another method and discontinue the other one.
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