Seeking to better women’s health through the use of contraceptives

By: ELIZABETH MERAB

As she rocks her six-month-old child to sleep, leaning against the wall of her house in Eastleigh, Grace Nthenya recalls that as a young girl, she had sworn to have six children only.

She wanted a manageable family so that, unlike her mother, who had eight children, she would not have to struggle to provide for them.

However, her plans were derailed when she had her first child when she was just 17, and before completing primary school.

“Life was already difficult enough, without adding another child to our family,” she says. “Besides, I never expected to have a child at such a young age.”

But then she had two more children in quick succession, while still single and jobless.

Back then, she says, there wasn’t as much talk about contraceptives as there is today.

Besides, she had only three children while the country’s fertility rate stood at five children per woman at the time (1998).

Then, at the age of 20, Ms Nthenya got married and went on to have more children.

“With five children and no job, I had to make decisions that would either see me survive or have my children end up on the streets.”

Data from 1977 show that Kenya had one of the highest fertility rates in the world, with eight children per woman.

It was these statistics that made the government start paying greater attention to the issue of fertility and also reinvigorate the population policy by developing a vigorous national family planning programme.

MODERN METHODS

And it is thanks to such programmes that Ms Nthenya and other women started using contraceptives, despite her husband’s opposition to it.

“He would not agree to the idea. In fact, he had warned me against it (contraception),” she says.

“But when you are 26 and have five children you can hardly fend for, you realise that contraceptives should become part of your survival tactics.”

However, it wasn’t long before she stopped using the injectable contraceptive that she had been advised to use.

The side effects, she says, outweighed the benefits.

“As soon as I got the injection, which I would faithfully go for on a quarterly basis, I would bleed so heavily that I could hardly do anything. I, therefore, opted out.”

Globally, more than 40 million women use injectable contraceptives. But of these, 40 per cent (6.4 million) discontinue the injection either due to its side-effects or missed appointments for re-injection.

Despite the challenges she had with her first contraceptive method, Nthenya was determined to explore other family planning methods.

Now 32, she has six children and has undergone female sterilisation (bilateral tubal ligation), a surgical procedure that involved clamping her fallopian tubes to prevent the ovum from being reaching the uterus for fertilization.

Bilateral tubal ligation is one of the modern contraceptive methods women opt for. However, only 4.8 per cent of women in Kenya and 19 per cent globally have opted for it.

Ms Nthenya represents only a fraction of the 660 million women globally who have access to modern contraceptives.

She portrays the face of a changing country which, through the use of contraceptives, has managed to lower its fertility rate to an average of four children per woman.

This has mainly been attributed to the development of a vigorous national family planning programme, which has seen the fertility rate decline from 8.1 children per woman in 1977 to 6.7, 4.7 and 4.6 in 1989, 1998 and 2008 respectively.

The latest demographic health survey indicates that more than half of married Kenyan women (58 per cent) use some method of contraception.

And most of them use modern family planning methods (53 per cent) than traditional methods (5 per cent), with injectable contraceptives being the most widely used (26 per cent), followed by implants (10 per cent) and the pill (8 per cent).

Although the total fertility rate has declined significantly, there is still a major gap in the unmet need for family planning, a topic which was the highlight of a global conference on innovations in contraception held in Finland last month.

RISK FACTORS

During the conference, reproductive health experts and manufacturers of contraceptives raised concerns about the high number of women with unmet needs for contraceptives.

Although use of family planning has been known to cut maternal deaths by one third, the experts said that more than 225 million women in developing countries who do not want to get pregnant lack access to contraceptives.

“We acknowledge that availability of contraceptives has improved globally. However, to meet the set targets of reducing maternal deaths, we have to address the unmet need,” Dr Kai Haldre, a member of the European Society of Contraception and Reproductive Health, said.

While seeking ways to address the gap, the experts also looked at the possible causes of the unmet need.

Ms Emmah Kariuki, a midwife, said one of the reasons the world is still talking about unmet needs, especially in Africa, was partly attributable to myths and misconceptions among women.

“Many think that contraceptives could be among the risk factors of emerging non-communicable diseases like cancer. Others say that it correlates with promiscuity,” Ms Kariuki explained.

But despite such hurdles, the experts say they are not fighting a losing battle. During a summit in London in 2012, they deliberated on ways to reach an additional 120 million women with contraceptives by 2020.

As part of a project dubbed PMA2020 launched in London, the Bill and Melinda Gates Foundation signed a deal with pharmaceutical company Bayer to make Jadelle, a long-acting contraceptive implant that lasts up to five years, available to 27 million women in the world’s poorest countries over the next six years.

The summit hoped that the project would result in 200,000 fewer women dying in pregnancy and childbirth, more than 110 million fewer unintended pregnancies, more than 50 million fewer abortions, and nearly three million fewer babies dying in their first year of life.

1 Combined oral contraceptives (COCs) or “the pill”

2 Implants (Small, flexible rods or capsules placed under the skin of the upper arm; they contain the hormone progestogen only)

3 Progestogen-only injectables (Injected into the muscle every 2 or 3 months, depending on the product).

4 Monthly injectables or combined injectable contraceptives (CIC).

5 Combined contraceptive patch and combined contraceptive vaginal ring (CVR)

6 Intrauterine copper-containing device (IUD)

7 Male condoms

8 Female condoms

9 Male sterilisation (vasectomy)

10 Female sterilisation (tubal ligation)

TIMELINES

1960

The Food and Drug Administration Agency (FDA) approves of Enovid, the first hormonal birth control pill (almost half a million American women are already taking it for “therapeutic purposes”).

1965

In Griswold v. Connecticut US, the Supreme Court strikes out state laws prohibiting contraception for married couples; 6.5 million American women are on the Pill.

1970

Concerns about the Pill’s safety and side effects prompt Senate hearings.

1980s

Lower-dose Pills dominate the market; 10.5 million American women are taking the Pill.

GLOBALLY

More than 40 million women use injectable contraceptives.

Of this, 40 per cent (16 million) discontinue the injection either due to its side effects or missed appointments for reinjection.

Only 4.8 per cent of women in Kenya and 19 per cent globally have undergone Bilateral Tubal Ligation (Female Sterilisation).

By: 1967, nearly 13 million women in the world were using the pill.

In 2010, 100 million women use the pill.

SOURCE: DAILY NATION