Contraceptives: The failure in birth spacing

Linda Atieno sits down on her belly at home not knowing what kind of future her child holds.

Atieno who is in her 30’s has been using family planning procedures to prevent her from conceiving but then an ‘Oops’ took place as most people would put it.

In particular, she used a copper coil.

Her worries are not new as many women have fallen victim of unplanned pregnancy even with the use of these family Planning procedures.

“I use the non-hormonal coil, also known as the IUD or ‘copper coil’. A friend advised me to use it because of its nature. The doctor inserted the coil that takes five years,” she tells the Star.

Atieno decided to use this kind of FP after she gave birth to her firstborn son Ethan in 2018.

“I have been married for five years, so I decided to use the coil for better spacing only to get pregnant midway,” she says.

She says that she became pregnant after a year of inserting the coil in her womb.

A coil is a small T-shaped device that sits in your womb. It is long-acting but can be easily removed if you decide you want to become pregnant or use alternative contraception.

It is also very effective emergency contraception and it is particularly popular among 20-34-year-olds.

About 10 per cent of women choose this type of birth control because the risk of pregnancy is so low – less than 1 per cent per year.

Many women have an IUD placed right after delivery so they go home from the hospital with an established birth control method.

However, no form of birth control is 100 per cent effective.

“It happened that one morning I woke up and was nauseated and I had morning sickness. I got worried and decided to do a pregnancy test though I was sure that I could not get pregnant after all, I had the coil as my shield,” she says.

“I was shocked when the results turned out positive. How could I get pregnant in a span of one year? Was I going to carry this shame with me forever?”.

But Atieno notes that she had to accept the situation that she had found herself in.

“Since then, I became sceptical about family planning and instead tried using a condom, something that was quite uncomfortable for me,” she says.

Atieno is among 174,142 Kenyans who were registered in 2019 as new clients who used the Copper insertion methods.

This is according to the Economic Survey that was released last month.

The data indicated that in that year alone there were 78,366 re-visits from people who are used to the method.

But most women go for the coil since it is non-hormonal.

“I have the coil. Opted for it because I fear hormonal stuff. I’ve had bad experiences with pills like Primolut so I figured anything hormonal will definitely mess me up,” Marry Anne* tells the Star.

Married with three children, she says that the coil has been working for her without any fears of being pregnant.

“For me, it’s been great, only the first three months were hectic, painful periods and heavy bleeding. Then my body adjusted,” she says.

“But I also have a friend who had to have hers removed because it was causing her to much pain to heavy bleeding, cramps even while ovulating.”

Moraa* says that she has used copper T for two years.

“It was perfect. I prefer non-hormonal methods. My menses were heavy at first but my body adjusted. No other side effects. The insertion process isn’t so fun but it’s over quickly,” she says.

“My only worry is when I hear people who’ve gotten pregnant while with the coil, but that also happens with other contraceptives I guess.”

Some modern contraceptives include; Progestogen-only pills (POPs) or “the minipill, Implants, Progestogen-only injectables, Monthly injectables or combined injectable contraceptives (CIC), Combined contraceptive patch and combined contraceptive vaginal ring (CVR), Intrauterine device (IUD) among others.

Chief Medical Specialist in Obstetrics and Gynecology John Ong’ech told the Star that every person has a family planning that suits them.

“There are some who are fat and would not go for FP that has progesterone because they will make them fatter. There those who are breastfeeding, this category of people cannot take pills because it will make the milk to decline,” Ong’ech said.

Speaking to the Star on Tuesday, Ong’ech said there is no Family planning that does not have a failure rate.

“There is nothing like 100 per cent. If you don’t take the pills on time, you will get pregnant, if you fail to go for injections on time, you will be pregnant,” he said.

Ong’ech noted that if the doctor puts a coil on an individual and does not do an ultrasound to check if it is well inserted, it would fail.

“If the doctor does not check that it is well put, then chances that the coil moved is likely. This increases the rate of a person getting pregnant. Also, if a person does not go for a yearly check-up, this may lead to pregnancies,” he said.

Unplanned pregnancies in Kenya are on the rise as access to family planning services and reproductive health care is declining, according to a study from Performance Monitoring for Action.

The 2019 study revealed that unplanned pregnancies have increased to 44 per cent within the last two years, and the use of contraceptives among married women has declined from 62 per cent to 56 per cent.

The traditional ways of family planning are also failing unless you exercise high discipline.

WITHDRAWAL

The withdrawal method of contraception (coitus interruptus) is the practice of withdrawing the penis from the vagina and away from a woman’s external genitals before ejaculation to prevent pregnancy.

This process is used by people who do not like the use of modern contraceptives and would rather do the pull-out.

“This is the method I have used for the longest time possible. It is good when your partner knows exactly how and when to pull out. If not you can really mess up,” Jane* says.

Jane notes that with this kind of method, it is not easy to space your children in your liking.

“At times it works really well, but sometimes, you get pregnant unknowingly. Like for the last pregnancy. I did not plan for it. I just gave birth nine months ago. Why then should I get pregnant now?” she poses.

Withdrawal like any other contraceptive for men can backfire. A man might pull out when it is too late thereby depositing sperms into a woman’s vagina.

CALENDAR DAYS

Before relying on this method, a woman records the number of days in each menstrual cycle for at least six months. The first day of monthly bleeding is always counted as day 1.

The woman subtracts 18 from the length of her shortest recorded cycle.

This tells her the estimated first day of her fertile time. Then she subtracts 11 days from the length of her longest recorded cycle.

This tells her the estimated last day of her fertile time.

The couple can use CycleBeads, a colour-coded string of beads that indicates fertile and non-fertile days of a cycle, or they can mark a calendar or use some other memory aid.

The couple avoids vaginal sex, or uses condoms or a diaphragm, during the fertile time.

They can also use withdrawal or spermicides, but these are less effective.

“Even traditional methods have a high failure rate. Take an example of calendar methods. It needs you to have a regular period and get advice from doctors. If you do not count properly, you get pregnant,” Ongech said.

SO WHAT NEXT?

Experts say that the only way out is for men to engage in vasectomy.

In medical parlance, a vasectomy is a surgical procedure for male sterilisation or permanent contraception.

During the procedure, the male vas deferens (a tube which conveys sperm from the testicle) is cut and tied or sealed to prevent sperm from entering into the urethra.

This thereby prevents fertilisation of a female through sexual intercourse. The cost of vasectomy in Kenya differs.

It ranges from Sh15,000 to Sh150,000. The Economic Survey 2020 indicates that many men in the country are yet to embrace vasectomy as an alternative family planning method.

According to the survey, only 658 men underwent the procedure during the year 2019. The number is lower compared to women who go for other methods of family planning in the country.

The number is however slightly higher compared to 646 who underwent the process in 2018. The highest figure was recorded in 2016 where 919 men went through sterilization vasectomy.

Family Health Options Kenya’s Dr Charles Ochieng, 46, told the Star that vasectomies are shrouded in myths.

These deter men from opting for the family planning method, yet many desire to limit the number of children they sire.

The doctor, who has worked at Kakamega General Hospital and Kenyatta National Hospital, agreed with the viewpoint that most men from rural areas have a bad view of the procedure and prefer that their wives bear the contraceptive burden.