Family planning by Dr Rotimi Adesanya

Nigeria has the world highest burden of maternal mortality in the world. The country is investing in family planning programs in order to save our women from preventable maternal-pregnancy related deaths.

However, religious beliefs in Africa are associated with some reservations about family planning services.

With limited access to family planning, one third of Nigerian women have experienced an unwanted pregnancy and many may undergo illegal abortions. Even government health plan and other forms of insurance policy normally states that such plans covers parents and four biological children.

I have always pondered who takes care of the remaining children of the couples with more than four children. But this is a clear message from the government, the providers and the society that we need to plan our family by spacing the children and putting a stop to child bearing after three or four children.

All sexually active adults must consider family planning options. Family planning is not just about preventing pregnancy. It is about timing conception so that every baby is wanted and planned, while contraception is just prevention of pregnancy. The advantages are numerous to the family and they include health, emotional, physical, economic and social stability. The contraceptive chosen must take into consideration personal preference, habits and health concerns. Complete abstinence is the only method that prevents pregnancy 100 percent of the time, but most contraceptive methods have a very high success rate when practice correctly.

Recently I became a certified family services provider by USAID and the SHOPS programme. But, part of the requirement then was for me to attend to 10 client from selected public hospital/family planning clinics where i completed my certification.

One of the first things I learnt is that in the context of family planning, the woman or man seeking counseling is a client and not a patient, while the health worker is a provider.

I have this con with one of my clients at the public hospital:

Doctor: Good morning ma, I am Dr. A, I am here to counsel you on the family planning i.e.the need to space you chil. I will like to ask you about your knowl of family planning.

Client: I don’t know the detail about fa olann.I was scared because I was told it caused diseases, cancer and infertility.
Doctor: No, madam. Family planning does not cause infertility, cancer or any diseases.

Client: OK, noted.

Doctor: How many babies do you have?

Client: Eight 

( I was amazed to see a couple with eight children in present day Lagos)

Doctor: Hay you ever heard of any family planning methods before?

Client: No. Before now,I thought family planning was meant for prostitutes. I thank God for the opportunity to know more about family planning.

The client was counselled on the family planning methods available, the requirements and she made an informed choice. She passed the medical examination and test ( pregnancy test), she had the implant on her arm and this will protect her from getting pregnant for the next five years. There are different methods and it is important to choose one that best meets the needs and circumstances of the client. When choosing family planning services considerations should include accurate information about: effectiveness in pregnancy choices, ease of use, side effects ( change in monthly cycle), cost and availability, reversibility, protection against sexually transmissible infections ( STIs)

Types

When one is deciding which type of contraception is right, it is important to think about how each options works to prevent pregnancy and how reliable it is. There are many types to choose from and each of them works in a different way. Contraception options are:

. Pills that you need to tay every day

. Fit and forget methods that are long lasting.

. Barriers that you will need to use every time you have sex.

. No method is 100 per cent effective

The most effective reversible methods are the ” fit and forget” long-acting reversible contraceptives( LARCs)- intrauterine devices ( IUDs) and contraceptive implants. It includes counseling and education, preconception care, screening and laboratory tests, approved method of contraceptives and not just preventing pregnancy.

With limited access to family planning, one third of Nigerian women have experienced an unwanted pregnancy and turn to illegal abortions. Some methods are temporary, while some are permanent. The temporary method is used when spacing pregnancies. It can be discontinued anytime one wishes get pregnant, while the permanent methods are irreversible and indicated for women who don’t want to get pregnant again or men who don’t want to impregnate any woman again in their lifetime.

Natural family planning: This include abstinence- including periodic abstinence, calendar calculations, cervical secretions, basal body temperature, feel of cervix, lactational amenorrhea method for mothers feeding their babies on exclusive breast milk.

Male condom: The condom is put on the erect penis. The condom prevents pregnancy. It also prevents sexually transmitted diseases such as HIV. The condom can be used at anytime even by breastfeeding mothers. Side effects are rare and this may be allergy or rash. It is 86-97 percent effective.

Famale condom: The woman inserts a female condom in her vagina before sexual intercourse. The female condom also prevents STDS and HIV. It must be used during each acts of sexual intercourse. It is 79 to 95 percent effective.

Diaphragm: The diaphragm is a shall rubber cup that acts as a collection and blocks the sperm and prevents if from making contact with the vagina.

Spermicide: This includes cream, jelly pessaries inserted by the female into the vagina prior to sexual in. Spermicides kill sperm by Preventing it from making contact with eggs.

Injectable contraceptive: They are given through a shot in the arm or buttocks . The injection is made from hormones. The hormone stop the body from releasing an egg every month.

Oral contraceptives: They are  called the pills. To use either of these pills, one tablet is taken every day. It is important to take the tablet every day even if there is no sexual intercourse.

Implant: The implant is a set of two small capsules. The capsules contain hormone and are safe if you are breastfeeding. The capsules are put under the arm and are used for long term.

Intrauterine contraceptive device: The IUCDs are made of flexible plastic or metal inserted in  woman’s vagina. The IUCDs stops the sperm from fertilizer egg or it also stops an egg from attaching  to the uterus.

Fit and forget method: The most reversible methods are the ” fit and forget” long acting reversible contraceptive (LARCs)- intrauterine device an contraceptive implants.

IUCDs and implants: These suitable for women of any age, and can be used by most women, even if they have any significant health issues. They can be removed easily at anytime by a trained  health professional and are immediately reversible on removal.They have the disadvantages of not protecting against STIs.

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