The good and the bad of contraceptives

Siwema Juma, in her 30s tied the knot in 2001 and was blessed with a baby girl the following year. Before her daughter turned one, Siwema realised she was pregnant again.

With a child that was hardly a year old, Siwema wondered what people would say when they found out she was pregnant. She had no choice but to take care of the pregnancy because she believes children are a gift from God.

Soon after she delivered, the mother -of-two decided to seek advice on birth control. She did not want what had happened to happen again. After discussion with medical experts, Siwema chose the implant. It was removed five years later. For five years now, Siwema has been unsuccessfully trying to conceive.

She was diagnosed with uterine fibroids a few years back and says her menstrual cycle has changed. She blames contraceptives. Population Reference Bureau (PRB)’s August 2011 Policy Brief on Integrating Family Planning and Maternal and Child Health Care: Saving Lives, Money and Time, has it that 35 per cent of recent mothers in developing countries become pregnant again within 15 months- most unintentionally.

Globally, about 222 million women do not want to become pregnant but are not using a family planning method. In Tanzania, 25 per cent of women who do not want to become pregnant are not using contraception. Maua Makene, 37, a mother of three used the pill after she delivered her twins and claims the pills interfered with her system. She says when she stopped taking them, she started experiencing a non-stop menstrual flow.

“My husband and I consulted the nurse at the family planning clinic and she told us the problem would end after a short time. My menstrual cycle got back to normal two years later,” narrates Maua.

No sooner had her periods normalised than she conceived again. After delivery, the mother of three went for the implant, which she says did not work well with her. She tried the intrauterine device (IUD) but it also didn’t work.

“I tried several other methods but some made me dizzy. None of the methods I tried worked. I don’t advise any woman to use these methods for as I speak, I have been diagnosed with fibroids,” says Maua.

While Siwema and Maua have had bad experiences with contraceptives, or so they believe, Monica James, an entrepreneur at Mwenge and a mother of three is full of praise for contraceptives.

Monica says she has been able to plan when to have children, thanks to contraceptives. Unlike the two women, she has never experienced any side effects and is still using the intrauterine device to-date. Like Monica, Anna, a mother of four who is now permanently sterilised never experienced problems with contraceptives. She had chosen the pill and the nurse had told her to expect some discomfort for three months after which things returned to normal.

“I decided I would bear the short time discomfort rather than become pregnant before I was ready,” says Anna

Controlling population growth

Although some women complain about contraceptives and others talk negatively about them from hearsay, the government of Tanzania is doing all it can to ensure women use birth control.

President Jakaya Kikwete has on several occasions stressed the importance of controlling birth to bring down the high population growth rate, standing at 2.6 per cent per annum. He has also talked about the importance of controlling population growth for the country’s economic development. The country’s population stands at 45 million.

According to recently released statistics from the 2012 Population and Housing Census, half of the country’s population is made up of children. The percentage of children however has slightly dropped from 50.6 in 2002 to 50.1 as of 2012. This means about 22.5 million Tanzanians are under 18. It is projected that if the country maintains the current birth rate, Tanzania will have a population of 52 million by 2016.

“This means a lot to not only our government but our development partners and the civil society in planning our work in the service of the people of Tanzania. I have appealed to my fellow Tanzanians to take family planning more seriously. We in government will give more attention to this matter this year and the years ahead,” President Kikwete was quoted as saying early this year.

On September 26 every year, the world celebrates World Contraception Day, a worldwide campaign with a vision for a world where every pregnancy is wanted. The only way to make sure children are born by choice is using contraception. Because of the negative attitude towards contraceptives, only 27 per cent of the women in Tanzania use contraceptives. The government’s target is to increase the number of women using contraceptives from 2.4 million to 6.6 million by 2015.

Saving women’s lives

Ulla Muller, Marie Stope’s Country Director says if everyone uses modern contraceptives, many women’s lives could be saved. Tanzania is one of the countries with a high maternal death rate where 454 women die in every 100,000 live births. Unsafe abortions, which result from unplanned and unwanted pregnancies, account for 19 per cent of these deaths. Such deaths are preventable through the use of family planning methods.

Ulla does not agree with those who claim contraceptives are bad. On the contrary, she says contraceptives give women and children quality life. She says young women in Tanzania face a lot of challenges. Girls are expelled from school because of pregnancy. Contraception helps them to avoid unwanted pregnancies and gives them the opportunity to finish their education and fulfill their dreams.

“Last year 8,000 girls were expelled from school due to pregnancy and almost 2,000 of these girls were in primary school. These young girls never get a second chance to go back to school after delivery,” says Ulla. She says contraception offers girls protection against unwanted pregnancies and allows the young women to live their dreams.

Also when these young women get pregnant, they are likely to seek unsafe abortion where terrible things are done to them. Those who survive the unsafe abortions could end up being unable to have children later in life.

Cyril Masawe, a gynaecologist at the Muhimbili National Hospital says most people have the wrong information about contraceptives. The truth is that contraceptives have been in use since the 1960s and are safe.

“Family planning helps people plan the number of children they want. It is also important for the health of both mothers and children. It also improves the family’s economic status,” says the doctor.

Without family planning, women can have children almost every year and failure to space children affects the health of both the mother and the child. A woman needs time to recover after delivery.

Religion and contraception

Rev. James Mlali, Programme Manager – Advocacy, at Health Promotion Tanzania (HDT) supports the use of contraceptives. He says contraceptives help couples decide when to have children, the number of children to have and when to stop having children.

The pastor says child spacing enables a woman to recover and be healthy to carry subsequent pregnancies. It also enables her to give the children the best care they need in terms of breast feeding, nutrition, and parental attention. “Many religions teach that health is a blessing from God and it is something that believers are encouraged to desire and pray for. Family planning is one of the ways to ensure good health for both women and children,” says the pastor. Quoting verses from the Bible, Pastor James says the Bible clearly shows that it is not God’s plan for people to die at an early age such as in childhood or during delivery. This, he says shows how it is necessary to avoid preventable maternal and child deaths.

He says there are people who misinterpret religious books and apply the readings incorrectly in defence of their arguments against the use of modern family planning methods. Some cite God’s command for people to be fruitful and multiply and fill the earth. However, sometimes they just read part of it. The command says:

“Be fruitful, multiply, fill the earth, and subdue it...” (Genesis 1:28).

The pastor says it needs planning in order to fulfill what is said here. It is not just being many and filling the earth, but also subduing the earth, which implies having control, power, or dominion over the earth. Also, God commands in Genesis 2:15 that human beings should take care of not only their lives, but also of the environment.

Surah 25: Al-Furqan: 74 of the Holy Quran refers to children as being a gift from God.

“In Islamic religion we practise family planning but we don’t use modern contraceptives. Couples need to plan their families using natural methods as God directs,” says the Muslim Council of Tanzania (Bakwata) Information Director, Simba Shabani.

Simba believes modern contraceptives are meant to control birth for economic purposes and says religion “doesn’t allow us to stop reproducing for economic reasons.”

The Tanzania Episcopal Conference, Vice President Severin Niwemugizi, says it is good to use family planning but the question is which methods? He says the holy book allows married couples to space children and plan the size of their families by using natural methods.

“In the Catholic Church, we believe that artificial contraception is sinful and immoral and may frustrate the divine plan to bring new life into the world.”