Prevention is better than abortion

Dr. Godakandage explains how family planning options put women in control :

by Carol Aloysius

With abortions often being used to end unwanted pregnancies, across the world and in Sri Lanka, concerned health authorities and pro life activists have devised awareness raising programmes to let women know there are safer and easier options that will allow them more control over their Reproductive Health.

This global concern on the number of women who die due to unsafe abortions and mothers and babies who die as a result of unsafe deliveries due largely to the lack of knowledge about safer options available to the women, has prompted world health authorities to declare a separate day, September 26 as World Contraceptives Day.

Sunday Observer spoke to Dr Sanjeeva Godakandage, Consultant Community Physician, Family Planning Unit, Family Health Bureau, Ministry of Health, Nutrition and Indigenous Medicine, about contraceptive use and availability in Sri Lanka, why women should use them and why the world needs a Contraceptive Day

Excerpts…

Q: How do you define contraceptives? Why has it been necessary to declare a special Contraceptives Day at global level?

A. Contraceptives are methods used to prevent a pregnancy. Abortion is not a contraceptive method.

Even though the world has enough resources and technology to ensure ‘every pregnancy is wanted’, many women in mostly developing countries run the risk of several health risks due to the non-use of contraceptives.

The list of such tragic outcomes is long, starting with abortions and maternal deaths.

The objective of a Contraceptives Day is to draw world attention on how these health risks could be minimized.

Q: In what part of the world are contraceptives most used? Are these methods also available in Sri Lanka?

A: Contraceptive prevalence is highest in developed countries. There are different types of contraceptives used: Modern and traditional; permanent and temporary; hormonal and non-hormonal. Most of the effective methods are provided in the government programme in Sri Lanka.

Q: Who needs them and what are their age groups?

A: Everyone who engages or is likely to engage in sex must use them, unless they are planning a pregnancy. The younger age groups are at a higher risk, but it has to be stressed that every woman is at risk of getting pregnant till she reaches menopause.

Q: As young people in the reproductive age are most at risk, how knowledgeable are they about contraceptives? Has there been a survey either by an NGO like the FPA or a medical team from the government sector or university?

A: According to the Demographic and Health Survey 2006/2007, conducted by the Department of Census and Statistics, 99.7% of married women in the reproductive age group were knowledgeable about at least one contraceptive method, and it did not vary by age. However, that does not mean all of them are effectively using contraceptive methods.

Q: What are the myths that surround this subject?

A: One of the biggest myths heard these days, is that contraception is aimed at controlling population. At present the only objective of contraceptive services is to help women and couples to avoid unwanted pregnancies.

This is part of the Family Planning Programme, where the objective is to assist women and couples to have the desired number of children, with right timing. It includes management of subfertility as well.

Q: When were contraceptives first introduced to Sri Lanka?

A: The existing services were first introduced by FPA in 1953 and the earliest methods included diaphragm and cervical cap, and spermicidal substances. It was recognized as a government responsibility in 1965, and is responsible for most of our health achievements.

Q: What are the most widely used contraceptives now? Have they changed over the past decade or more?

A: At present the most prevalent method is the female sterilization. A few years back, the most prevalent method was the injectable. However, the trend observed during past few decades is that modern temporary methods are gradually increasing in popularity.

Q: Do women who have started menopause need contraceptives? What are their chances of getting pregnant, especially those who have gone into early menopause?

A: If you are confirmed as having reached menopause, you can stop contraceptives. However, you need to consult your healthcare worker regarding this. You will be asked to continue contraceptives for some time after your last menstrual bleeding.

Q: What are the adverse effects of contraceptives - e.g. a common fear is that the Pill could lead to cancer when used for a long period?

A: As with any other medication, there are adverse effects associated with contraceptives as well. Only a minority of clients will experience them, and the advantageous far outweigh these adverse effects. However, none of the methods would cause cancer or infertility. Also you don’t get immune to a contraceptive, if used over a long period.

Q: What is an Emergency Pill?

A: It is a pill that should be taken as early as possible following a sexual encounter, if you are not practicing a regular contraceptive method. However, it has a higher failure rate and should be used only for an ‘emergency’, such as following a rape incident, or a burst condom. You are always encouraged to practice a regular family planning method. Apart from the pill, an IUD (loop) can also be used as an emergency method.

Q: Natural birth spacing was what was practiced by our grandparents. How effective is it when compared to scientific techniques developed later?

A: Modern methods are far superior to natural methods when it comes to effectiveness.

Q: Some girls believe they won’t get pregnant when they have sexual relations for the first time, or if withdrawal takes place at the last minute. Your comments?

A: A girl can get pregnant in her very first sexual encounter. This can also happen even without proper vaginal penetration. So we always recommend they use a regular method. The method you described, i.e. coitus interruptus, is a traditional method of contraception. However, this carries a high risk of failure.

Q: Some women believe that using a contraceptive can turn them off sex…..?

A: This is all psychological. They need careful counseling.

Q: How soon should a woman who has delivered a baby start using a contraceptive to avoid another pregnancy?

A: Some methods can be started immediately after delivery. However, she must start a method within six weeks of delivery, even if she is breastfeeding. A woman without other complications and who does not belong to a higher age group is advised to practice a reliable method for at least two years, as delivering another baby within three years carries a higher risk, both for the baby and the mother. This can vary (e.g. higher maternal age), and you can get advice from healthcare workers.

Q: Is there such a thing as a best method when it comes to contraceptives?

A: No method can be described as the best method for everybody. It depends on the individual requirements and circumstances. The client is offered suitable methods to select from. This is called the ‘cafeteria approach’.

Q: What are the new breakthroughs in contraceptives abroad? How practical and cost effective are they for countries like Sri Lanka?

A: One of the methods we are frequently asked about is the IUS (LNG IUD). However, any additional benefit cannot justify the exorbitant cost, unless there are specific indications.

Q: If a couple wants to prevent an unplanned pregnancy, where can they go for help? What are some of the NGO’s and state hospitals that have birth control units?

A: The easiest option is your Public Health Midwife. They are available in all parts of the country, and one of their prime duties is to provide contraceptive services. They provide pills and condoms, and refer you to the appropriate place for other services. Health Ministry has instructed hospitals to provide family planning services, and bigger hospitals have dedicated family planning clinics, free of charge. The main NGOs providing contraceptive services include FPA, PSL and SLAVSC.

Q: What are the gaps in Reproductive Health in Sri Lanka?

A: Reproductive Health is a vast subject, and I will narrow down to family planning. Our strategy at present is to further improve the capacity of healthcare workers to provide family planning services. This year a new training programme on family planning counseling targeting healthcare workers was introduced.

Q: Have you programs to educate young people?

A: A number of awareness programs have been undertaken to educate this category, as fertility amongst adolescents has significantly increased in the recent past.

Q: What is the main objective of your programs for youth?

A: At present the national recommendation is to delay the first pregnancy till 20 years of age. Teenage pregnancies are associated with significantly higher risks. Contraceptive services are essential for this category, if they are engaged or are likely to engage in sex. As mentioned earlier, population control is not an objective of current family planning services.

Q: Your message to the public regarding contraceptives?

A: To make every pregnancy wanted. For this, it is important that all those in the reproductive age, should have good knowledge of contraceptives, and use them appropriately to avoid abortions and the large number of risks they carry.