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| Sunday, 11 July 2004 |
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Compiled by Carol Aloysius Today is World Population Day : Unwanted pregnancies The sharp increase of unwanted pregnancies in Sri Lanka in recent years has posed a major challenge to the Reproductive Health of young adults. Dr Sriyani Basnayake, Medical Director, Family Planning Association talks to Carol Aloysius how unwanted pregnancies can be prevented. Q: The Family Planning Association has been in the front line for most of the activities promoting the concept of planned families. How successful have these activities been in limiting the size of families and bringing down our population growth figures? A: Our population has now reached replacement fertility level i.e. zero population growth, which is a major achievement in this part of the world. Q: What factors contributed towards achieving this goal? A: The high contraceptive prevalence of over 70 percent would be largely responsible for having reached this goal. Q: Did any other factors outside the purview of the FPA play a role in this decline in population growth? A: The large number of illegal abortions taking place in our country may also be a contributory factor. Q: How many such illegal abortions do you estimate to take place each day? A: I'm told there are about one thousand illegal abortions a day. Q: What are the health consequences of these abortions on women? A: Because they are illegal, many of these abortions are performed in unsafe conditions. Many of these backstreet abortions are performed by quacks or semi trained persons. Even if women do not actually die of these abortions there can still be a high level of maternal morbidity that could last for life. Q: What specific illnesses can a woman be susceptible to after an unsafe abortions? A: There can be serious damage to her reproductive system. It can result in sub fertility, infertility, pelvic inflammatory disease and have an adverse impact on her reproductive organs for life. She could also suffer from emotional trauma. Q: Can we prevent this by making abortions legal? A: By making abortions legal, women who opt for abortions could have pre and post abortion counselling which is very important for a woman opting for an abortion. She could also have the procedure performed in safe sterile conditions by trained doctors. Q: The FPA has recently introduced the Emergency Contraceptive Pill, also known as Morning After Pill, to prevent unwanted pregnancy. How good is the response for this Pill from women in the reproductive age? A: Very good. We are now selling an average of 35,000 Postinor packets a month. Q: Is this Pill effective if you are already pregnant? A: No. The Pill is to prevent pregnancy and not to cause an abortion. It will be of no use if the woman is already pregnant. Q: Where are they available? A: In pharmacies throughout the island and at the FPA. Q: What is the reason for the high incidence of unwanted pregnancies? A: Several reasons. The first and most important reason is the nonuse of reliable family planning methods which are freely available in this country. Other reasons include changes in one's life style, the shift from rural to urban areas which has deprived young women of parental guidance and care. And most importantly, the lack of knowledge about Reproductive health and how they should take care of their sexual health. Q: From your experience as a medical director at the FPA, what is your opinion about the extent of knowledge that young people have today on reproductive health? A: Their knowledge about reproductive health is still very poor. I have found that many of them lack in the knowledge of important scientific aspects on Reproductive Health i.e.knowledge about their body and how it functions. It is this gap in their education that has often resulted in young women getting pregnant without intending to do so, since they did not know how to take the proper precautions. Ideally they should be taught these basic facts of life from the time they are in school. Q: But isn't sex education already in the school curriculum? A: Yes, but it is not dealt with comprehensively because of the dearth of properly trained teachers in reproductive health education. Hence many young people who leave school still have wrong ideas about sex. Teaching this sensitive subject requires a special skill and training. Q: So in other words, what you are saying is that a proper education in reproductive health can prevent unwanted pregnancies (apart from sexually transmitted diseases like HIV/AIDS) and help to prevent any further rise in our population by a knowledge of the importance of family spacing. A: Yes. Although our teenage pregnancies are still low when compared to other countries, they still do take place. Such pregnancies can result in low weight babies besides harming the mother's health as she herself is still growing. Most illegal abortions are, as I said before the result of unwanted babies, and their consequences on the health of the mother are grave and long lasting. If short, if young people were better equipped with knowledge about how to take care of their bodies and were taught how to be sexually responsible; if young married couples were encouraged to use more scientific methods of contraception rather than the traditional methods they largely prefer at present,we could prevent illegal abortions and preserve the health of our mothers and children in future. ########## Too early, too many,too soon Ten years ago, 179 governments met in Cairo and agreed that population
issues must be addressed if development policies are to Family Planning (FP) is often thought of as a means controlling the 'population explosion', but its importance as a method of improving the health of the mother and child and also of the family cannot be overemphasised. It is accepted that too many and too closely spaced pregnancies cause depletion of nutritional reserves of the mother, resulting in an increase of the risks to both mother and child. It has been shown that; Children born to mothers below 18 years of age are more likely to die during their infancy than those born to women between 20 to 30 years; The incidence of still births, birth defects and, infant deaths in the first month, all increase with maternal age over 35 years. Children born with a birth interval of less than 2 years are more likely to die before they reach their 5th birthday than children born with a birth interval of more than 2 years; The chance of a mother dying during pregnancy and childbirth increases with the age of the mother under 18 years or over 35 years, number of children over 4, and birth interval of less than 2 years - i.e. too early, too late, too many, too soon. There is also a strong relationship between insufficient spacing and low birth weight. Rapid succession of pregnancies and periods of nursing cause a nutritional drain on the mother. Low birth weight babies often have an initial retardation of growth. Lower level of academic achievement is sometimes seen in children whose birthweight has been low. Low birthweight babies are more liable to sickness, which may even be fatal. Insufficient birth spacing affects not only the newborn but also the other children. A new pregnancy occurring too early causes abrupt stopping of breast feeding which leads to malnutrition and more infections in the elder child. Hence timing and spacing of births is very important. Benefits of FP, and FP Methods The timing, spacing and limiting of births through FP enables women to have children when they are best prepared. This results in maximum health benefits to both the mother and the child by preventing the hazards mentioned earlier. A wide range of FP methods, both temporary and permanent, are available from state institutions and also from several Non Governmental Organisations such as the Family Planning Association of Sri Lanka (FPASL), Sri Lanka Association for Voluntary Surgical Contraception and Reproductive Health (SLAVSC and RH), Community Development Services (CDS) and Population Services Lanka (PSL). Methods Temporary FP methods include condoms, oral 'pills', injectable hormone preparations, subdermal hormone implants, intrauterine contraceptive devices ('loops') and spermicidal preparations, in addition to traditional natural methods. Permanent methods are male and female sterilisation. Traditional and Natural Methods, and local applications - these are simple but not always reliable. Coitus interruptus or withdrawal has a high failure rate. Safe period or rhythm method (calendar method) This is a natural method which is based on the fact that the ovum is released from the ovary once a month, 12 to 16 days (average 14 days) before the beginning of the next menstrual cycle. Mucus method This natural method depends on changes that take place in the mucus produced by the glands at the mouth of the uterus (womb) is not fool proof and is suitable only for those who dislike the more reliable artificial methods. Artificial Methods The Condom is a thin rubber sheath worn by the male to prevent sperms entering the vagina during sexual intercourse. In Sri Lanka, condoms are available at a nominal price from field health personnel, FP clinics, and estate health personnel and from sales points in hospitals. Non Governmental Organisations also market the condom. The condom is 97% effective if used properly. Incorrect use contributes to failure of this method. A female condom, now available, prevents sperms from entering the uterus and prevent conception; it also prevents sexually transmitted diseases. Oral pills The popular oral pills contain oestrogen and progestogen, synthetic preparations of hormones that occur naturally in the body. The main action of contraception by the pill is by prevention of release of the ovum from the ovary. Oral pills are nearly 100 per cent effective if taken daily without interruption. Side effects of using oral pills are minimal. It must be emphasized that the oral contraceptive pill should always be prescribed by a doctor or a trained health worker and no woman should start the pill on her own. Emergency contraception pill (ECP)- also called the "Morning After Pill" is a high dose hormone preparation of oestrogen if a woman has had sex without using an effective method of contraception. It has to be taken (by mouth) within 24-72 hours after intercourse. It has to be repeated once more exactly after 12 hours. The success rate is reported to be 98% if taken within 24 hours and a little less if taken between 24 to 72 hours. These pills are now available at clinics of the Family Planning Association. It must be cautioned that ECP is useless if a woman is already Pregnant. Also, it must not be used as an alternative method of contraception, as it may not be effective if used frequently. As mentioned above it is only for use in an emergency situation. Injectable hormonal contraceptives These preparations contain a long acting progestogen and they act in the same way as the oral contraceptive pill, to prevent pregnancy. The injection used in Sri Lanka is Depot Medroxyprogesterone Acetate (DMPA) and it is generally known as `Depo Provera'. DMPA is popular as a method of spacing pregnancies but it can also be used as a method to limit the family size if permanent methods are not acceptable. Subdermal Implants This is contraceptive-`Norplant'-used in the national FP program. It is a long acting contraceptive containing only progestogen, with duration of action of five years. The main contraceptive action is by an increase in the viscosity of the cervical mucus inhibiting the penetrating capacity of the sperms. The capsules are inserted under the skin preferably in the inner aspect of the upper arm within the first five days from the onset of menstruation. The contraceptive action starts within twenty-four hours of insertion and lasts for five years if the capsules remain in place. If at anytime the woman wishes to conceive the implant should be removed at that time. Fertility returns immediately after removal of the capsules. This method can be used to provide continuous contraception by replacing the capsules every five years. This method has a low failure rate of less than 1 per cent side effects are few. Intra Uterine Contraceptive Devise-IUCD, `Loop'This is a small devise usually made of plastic which is inserted into the cavity of the uterus. The IUCD used widely at present in Sri Lanka is the CuT 380A containing copper. The best time for their insertion is during the first five days of the menstrual cycle. However, if pregnancy can be excluded an IUCD can be inserted anytime during the cycle. The contraceptive effect starts immediately after its insertion, and no backup method is necessary. Permanent contraceptive methods Male and female sterilization are the permanent contraceptive methods available for those who wish to limit their family size. Sterilization is available free of charge at many state medical institutions. Male sterilisation- Vasectomy Male sterilization is a simple and safe procedure done under local anaesthesia and it takes only a few minutes to perform. No admission to a hospital is required. Female sterilisation-Tubectomy, LRT (Ligation & Resection of Tubes) The Fallopian tubes through which the ovum travels is cut and the ends tied or clipped. This procedure can be done in two ways, either by the minilap or the laparoscopic technique. Both operations are simple and safe. Laparoscopic sterilisation is done at the Family Health Bureau in Colombo and in some state hospitals and some NGOs, both in Colombo and in the outstations. The advantage of this method is that it does not need hospitalisation and the woman can go home the same day. Minilaparotomy (minilap) is also done under local anaesthesia but the patient may have to stay a day or two in hospital. Female sterilisation has a success rate of almost 100 per cent. From 'Your child, your Family' by Dr. H.A. Aponso et al. ########## Message Statement by Thoraya A. Obaid Executive Director of UNFPA, United Nations Population Fund On the occasion of World Population Day
Ten years later, we can say that significant progress has been achieved. A girl born today in the developing world faces better prospects than a girl who was born ten years ago. School enrolment rates are increasing and life expectancy is on the rise. More and more women and couples are able to choose the number and spacing of their children, and many countries are taking steps to confront HIV/AIDS. But much more needs to be done. Nothing demonstrates the urgent need for greater action than the issue of safe motherhood. Today, each and every minute a mother goes missing. She perishes in childbirth or from complications of pregnancy. And the tragedy is compounded by the fact that nearly all of these deaths are preventable. This tragedy adds up to 529,000 deaths every year, leaving a devastating void in families, communities, entire regions. Imagine life without your mother's countless acts of love and support. The emotional, social and economic consequences are catastrophic. They affect every one of us. Safe motherhood also means protecting women from violence and abuse and from HIV/AIDS. We must ensure that all women and adolescent girls have the knowledge and means to prevent HIV infection, and that men are supportive partners. We must reduce the vulnerability of women and girls by increasing respect for their human rights and confronting gender discrimination and violence. And we must do more to get life saving drugs to people who are living with HIV/AIDS. Not only do women deserve treatment in their own right, they also need it to prevent HIV transmission to their children. HIV prevention and treatment services should be available in all health care settings, especially in places where medical services are limited. There is a solution. Ten years ago, 179 governments committed to it when they signed the ICPD Programme of Action. The ICPD prescribes the steps that will not only save millions of women's lives but empower individuals to achieve a better future. Universal access to education and sexual and reproductive health services are the primary goals. These goals complement and reinforce those set by world leaders at the Millennium Summit to secure a more equitable and sustainable world in the 21st century. |
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succeed. Today as
a result of that commitment, many people enjoy increased longevity,
reduced mortality and broader opportunities. Yet too many people have
still to experience their gains. Greater commitment and action is urgently
needed especially in promoting women's rights and investments in their
reproductive health and family planning, says the Secretary-General UN.
Today as we celebrate World Population Day, we also celebrate the 10th
anniversary of the historic International Conference on Population and
Development. Ten years ago, 179 governments promised to improve the
quality of life for women and families with access to health care,
education, a clean environment and reproductive rights.
