When Ella Akins, an Instagram content creator posted a video of herself dancing in very high spirits and captioned it ‘Mood when you successfully prevent pregnancy without using medical or invasive contraceptives’, about 11, 600 users liked the post.
Her comment log was flooded by tales of many who said they could relate with that constant struggle with birth control methods and the horrific side effects of some modern contraceptives on their health.
Akins’ selling point was that an unproven natural solution packaged as neem oil and neem capsule by one of her clients has a high proficiency that has helped many women achieve family planning without the hassle of hormonal imbalance and extreme weight gain and fibroid in some cases.
“With all the IUDs complications I’ve heard about, no way! It’s natural methods plus prayers for me…,” she wrote.
“Comment section is filled with over 98 percent of women either saying how BC was bad for them or saying they only do natural methods. The remaining 2 percent still want to shove IUD down their throat…”
What was clear from the interactions on the post was that horrific tales of lived experiences of side effects of contraceptive use and sometimes misconceptions have a huge impact on women’s decision and the uptake of contraceptives in Nigeria.
A woman who identified herself simply as Mirabel said she decided to cancel all methods after a long-acting reversible contraception led to a two-month non-stop bleeding.
Alimot Kolapo, a mother of one in her 30s, told BusinessDay she was unwilling to try any birth control method after an injection that promised only three months prevention seized her menstrual flow for three more months. When it came, it took the intervention of a doctor to stop the flow.
Although health experts say the rate of adoption of modern contraceptives have increased to an extent and have lowered the rate of abortions, tales of side effects still travel far to influence the decisions of women.
About 78.3 percent of women aged 15-49 years currently married or in union do not use any contraceptive method, according to the 2021 Multiple Indicator Cluster Survey & National Immunisation Coverage Survey.
Among the poorest, 90.7 percent do not use any method. In the middle class and richest class, 78.6 and 63.3 percent fail to adopt any method.
An analysis by the Bill and Melinda Gates Foundation shows that current methods don’t meet the needs of women in most cases. Nearly 40 percent of women who begin using contraceptives stop within the first year because they’re dissatisfied with the method, the foundation said, adding that the development of new contraceptive technologies is chronically underfunded, and investments have remained stagnant for years.
Appropriate contraceptive use is a key tool to the health of women, preventing pregnancies that are too early or too late, extending the period between births, and limiting the total number of children.
Elizabeth Abimbola, South-West regional coordinator for Planned Parenthood Federation of Nigeria, said the level of knowledge of family planning in the southern part of the country is very high but the uptake has not matched that level of knowledge.
“The issue I see we are facing in the southern part of the region is more of a low uptake versus a very high rate of knowledge among women of reproductive age,” she said.
“From field experience and different interventions that we have done, what we have seen, first, is issues with providers’ attitude. The attitude of some providers put off clients. How do they counsel? What responses were given? Were clients’ questions answered? We find that some providers today still coerce clients to take specific methods, probably because an appropriate method is unavailable.”
Abimbola said the myths and misconception around contraception also make nothing of the knowledge that people have.
She pointed out that clients’ failure to keep appointments at hospitals for proper review of responses that may deviate from the norm also creates unintended consequences. “And in other instances they go to the wrong hands for care.”
She said: “Most people take a method and are gone until the day they are due for another one or when they want to remove it. I’ve seen so many women that when I’m doing cervical screening for them and I discover they have IUD on, they have forgotten for more than 8 or 10 years. Even some will be already aged before recalling they took that action.
“In my clinic last week, there was a client that came in. She was referred from one private facility. They did an implant for her in the upper arm. They couldn’t find it. She went for an x-ray, and the result shows that the rod of the implant was lying very close to her bone. This is something that needs to be under the skin that should be figured out at a mere glance. There is no way we can remove that easily. We have to cut the arm into the muscle to go and bring those things out. Somebody provided that incompetence.”
Khadijat Hassan, consultant obstetrician and gynaecologist at Maternity and Child Centre, Eti-Osa, said recently that the use of implants is on the rise, contributing to the side effects that most women dread.
However, not everyone will experience the bad side of it, she said.
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Ejike Oji, former country director at Ipas, an international NGO that seeks to increase access to safe abortions and contraception, said family planning should be more individualised in the healthcare profession, adding that the failure of uptake is mostly due to bad counselling.
“The most important thing is to counsel very well and make sure that the method suits the person. There are another 19 percent who want to get family planning but are not getting it despite this,” he said.
Enabling girls and women to avoid unwanted pregnancy can unlock progress on a wide range of issues, from gender equality and maternal health to girls’ education, according to the Gates Foundation.
“It’s also a smart investment as fully meeting the need for contraception and maternal and newborn health care would cost $600 million less than only meeting the need for maternal and newborn health care,” it said.
The foundation has committed $280 million per year from 2021 to 2030 to develop and improve contraceptive technologies, support family planning programmes that reflect the preferences of local communities, and ensure women and girls are in control of their own reproductive health.