Birth control practices

Written by Dr Sylvester Ikhisemojie - The Punch, Nigeria.

Sylvester Ikhisemojie

In much of Africa today, there is a burgeoning population made possible by explosive birth rates and the endurance of a majority youthful population. This has many evident positive advantages, not the least of which is the presence of a virile population of people in the productive age group.

The obverse in the problem here is that feeding this large population and finding adequate jobs for the large population will remain a challenge well into the twenty first century. It therefore means that efforts must now be made from this time forwards, in all countries of the region, to slow the rate of population growth to more manageable, more sustainable levels.

As a result, it is incumbent on health authorities throughout the region to teach women of all socio-economic groups about the immense benefits of birth control and child spacing. It is because of all these interwoven facts that issues of contraception and other efforts at birth control must now be examined and propagated.

While birth control and contraception do not necessarily mean the same thing, both of them are geared towards controlling the appearance of unwanted pregnancies. This is because it is possible to engage in birth control without engaging any means of contraception to achieve this aim. Our focus today must therefore centre on birth control. With this clarification, it can be seen that birth control practices will not always involve the use of means, devices and medications to avoid pregnancy occurring but can in fact be achieved naturally by following the natural rhythm of the body itself.

This means that birth control and contraception make up what is known as family planning. As a result, it is important for us to examine some of these methods.

Birth control refers to the methods or devises used to prevent pregnancy. It is also known as fertility control. The planning, provision and use of birth control practices is known as family planning. People have used various birth control methods for thousands of years. Today, there are many different safe and effective birth control methods available to us in our various countries or communities. There is no best method for achieving this and it is important for people to know from the outset that any form of birth control has its peculiar advantages and disadvantages.

All men and women ought to know that they have some measure of control over what method they ultimately choose depending on their peculiar life styles, whether they intend to have children in the future (not a consideration) in Nigerian women I am sure, and how many times they have sex in a week for example or how many sexual partners they have. Above all, there must be an objective assessment of how many different side effects any of the methods chosen will have on the individual. Above all, there must be a realistic assessment of how much level of comfort or the lack of it a person will endure as a result of any particular choice.

In many Nigerian communities, and in some religious circles, it is anathema to talk about family planning. The truth of the matter, however, is that even among some of those people family planning practices have been practised in some benign form for many generations. It began in many local communities when polygamy was the rule and men would send their pregnant wives away to their mothers' in-law when the time of childbirth approached. Sometimes, this was done soon after a delivery had occurred so that such women could be adequately cared for.

The unstated reason for such forced migration, however, was that such women were considered temporarily unavailable for sexual relationships and this tended to persist all through the period of breast feeding. They also understood that breast feeding mothers were unable to get pregnant while they still actively breastfed. In the years to come, the relationship between the flow of breast milk and the inability to get pregnant was proven by science to have a "cause and effect" relationship. In that entire period, attention turned to one of the other wives in the family. As a man's wealth was then measured by the number of wives he had, so it reflected in the number of children he sired. The women in the household took turns to have their children.

More recently though, as attention moved away from polygamy to the true nuclear family, there evolved many different types of birth control practices some of which we shall have to deal with here.

1) Continuous abstinence: This means that a person will not have sex under any form of sexual intercourse for the period they desire. This is the only guaranteed way to avoid a pregnancy and to prevent contracting sexually transmitted diseases. At the moment, monks, Roman Catholic fathers and sisters and people incapacitated by disease are known to practice this form of birth control.

2) The natural method: This is also known as the rhythm method or the Billings's method. By this is meant that a woman will have to be certain about the peculiarities of her menstrual cycle and also know how her ovulation period is demonstrated. When she knows this, she will then have to note that for a period of five days before the date and for two or three days after ovulation has occurred, she can get pregnant. That means pregnancy is possible for about six to eight days in each cycle. To stay safe, those days will be marked as sex free days while the remaining days in the monthly cycle will obviously be free of any risk of getting pregnant.

3) The male condom: This is widely available in most kinds of shops in Nigeria. They are made of various materials like latex, polyurethrane or lamb skin and in essence, they are a thin sheathe of material placed over an erect penis to prevent ejaculated semen from getting into a woman's vagina. They are more effective when used together with a spermicide that can kill off the sperms should the condom tear. Condoms must be changed with each sexual act.

4) The female condom: This has never been a very popular means of contraception because of the fact that is not so handy to put in place. It is made of lubricated rubber and worn by a woman inside her vagina to prevent the sperm from getting into her body. However, it can be inserted for up to eight hours before having sex but a new one must be worn with each act and it should not be used together with the male condom.

5) The oral contraceptive; the combined pill: This contains the two female hormones of oestrogen and progesterone. It has to be taken every day and acts to prevent the ovaries from releasing their eggs. It is not suitable for use by women who are older than 35 years or have a history of blood clots or a history of previous breast, liver or uterine disease, specifically, cancer. It is also not advisable for use by smoking women. The use of antibiotics, which many Nigerian women take without prescription, can reduce the effectiveness of the oral pill.

6) The intrauterine contraceptive device (IUCD): It is also called the IUD, which simply does away with the word contraceptive but may often be confused with intrauterine death. However, it is shaped like a "T" and made of copper. The device releases a small amount of copper into the womb at a time which prevents the sperm from reaching and fertilising the egg. It is a device usually inserted by a family planning nurse or a doctor and can be left in place for five to ten years. There is also the hormonal IUD which releases a hormone into the womb to achieve the same purpose as above. It can stay for up to five years. The Lippes loop, essentially a plastic coil, is no longer in use in many countries.

7) The patch: This is a skin patch worn on the buttocks, outer arm, abdomen or upper body to release oestrogen and progestin into the blood stream in tiny amounts which prevents conception. It achieves this by preventing the eggs from being released by the ovaries. This is fairly popular among Nigerian women.

8) The shot or injection: This is a hormonal injection made up of progestin alone. It is called Depo-Provera and is also popular among women here. It is given on the buttocks or arm once every three months. It acts similarly to the other hormonal preparations above. There is a similar "oestrogen only" injectable given every two months and called Noristherat. This is much less popular than Depo-Provera.

9) Vaginal ring: This is a thin flexible ring that releases oestrogen and progestin and is worn in the vagina for three weeks and then taken out for a week so that the woman wearing it can have her period, before being replaced with a new one.

10) Vasectomy: This is a permanent means of birth control in which the spermatic cord is cut and the ends tied separately by an operation. Amazingly, even women do not want their husbands to have this procedure done.

11) Bilateral tubal ligation (BTL): This is also achieved by an operation but it is seldom the sole reason for carrying out the operation. Usually, it may be a part of some other operation like a caesarean section. It is regarded as a permanent means of birth control.

12) Emergency sterilisation: This is done usually with hormonal drugs in situations in which an unplanned sexual encounter has occurred or as in rape. Medications like "the morning after pill" (not the real name) are taken up to 72 hours after such an encounter in order to prevent a pregnancy from occurring.

13) Contraceptive sponge: This is a barrier method of birth control made of polyurethrane. It is thus a soft, thin material resembling rubber and has a handle for removing it from the vagina. It also contains a spermicide that can kill off the sperm. It is useful for up to 24 hours and can thus be used for multiple rounds of sex. It should be left in place for at least 6 hours after all sex has ceased in order to reliably kill off all the available sperm.

14) The diaphragm, cervical cap or cervical shield: These are other barrier methods of female contraception made from various materials. All of them act by preventing sperm from crossing from the vagina into the uterus.

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Ask the doctor

Dear doctor, I noticed a single pimple-like rash (just one) in my abdomen recently. I do not have any itching or pain there even when I have scratched it open. I had sex with a girl eight months ago and I remember seeing a similar spot on her abdomen which she told me was just a result of shaving. Please is this an infection?

It could be an infection. You must see a dermatologist as soon as possible to have it examined and properly diagnosed. That is the only way to get good treatment.

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Dear Doctor, I am 46 years old. Some weeks ago, I noticed that I have difficulties getting an erection. When it does get up, it is not firm and strong like before. My blood pressure and fasting blood sugar are normal. A friend suggested that I use Viagra but I am scared of having to rely on it for the rest of my life. My desire and appetite for sex is very high. Thanks.

There are is nothing to fret about at this stage. It could just be a temporary lull in the activity level of your penis and so might yet recover. However, you should see a urologist for a routine examination and treatment options instead of having to rely on the suggestion of your friends.

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Dear doctor, please what can a woman who is experiencing serious menstrual pains do? The woman cannot even stand up. She is around 28 years old and has two kids.

She should see a gynaecologist without delay for a proper examination and the determination of the possible cause. If that is successful, treatment should be possible.

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Dear doctor, I have a small penis and I am not happy about it. Is penis enlargement real and what can I use? Thanks.

Penile enlargement is possible within certain limits. In order to get the very best result, you should see a Urologist who will examine you for any possible cause and offer you the best treatment for the predisposing condition. Good luck.

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Dear doctor, I think I have gonorrhoea. Please how do I treat it? What drugs do I take? Please reply.

Well, the diagnosis you have made out must first be confirmed in a laboratory so that the treatment you eventually get will be accurate and curative. So you must see a gynaecologist if you are a woman or a urologist if you are man. Whatever result is obtained will have to be used to treat you and your partner also.

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Dear doctor, what can I do about continuous sneezing for more than five years now?

You will have to see an ENT surgeon for a proper examination of your nose, ears and throat. However, if there is a history of allergic disease in your family, you could visit a dermatologist instead.

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Dear doctor, well done. I read the January 24 column. I tested positive to E.coli after my wife tested positive to "Gono" bacteria. Can the E.coli in me cause the "gono" she had? Where did I get E.coli? I was asked to use Ciprotab. She was also treated but she still complained of experiencing itching and a peppery feeling after I met her without a condom.

Both organisms are separate types of bacteria. The E.coli you had could not have caused the gonorrhoea she had. While gonorrhoea is a sexually transmitted disease, E.coli is more likely to be contracted from food and from eating or drinking anything contaminated with faeces. It is a good thing that you have had treatment for the E.coli infection but both of you must now have treatment for gonorrhoea. Until that is done, the treatment cannot be regarded as complete. So please see your doctor for the necessary follow up on this.

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Dear doctor, with reference to your article of January, 24 2016. Please, how do I get rid of gonorrhoea because I have some of the symptoms in my private part? Please I am a lady in my early 30's. Please what should I do or how do I contact you sir?

Having some of the symptoms is not the same thing as having the disease. However, what is clear is that there is a problem which you are not comfortable with. You should try to see your doctor for the required examination and swabs for culture. The result obtained will determine what treatment you get. As part of the treatment, you must ensure that your spouse or partner gets equally treated.