The unsolved puzzle on family planning choice

We tend to imagine our future families coming on the heels of a well-laid plan, but the reality is that plenty of us become parents entirely by accident.

In fact, in Tanzania, an estimated one million pregnancies are unintended.

And while some women inevitably decide not to keep their unplanned pregnancies through unsafe abortion, many decide to go with the flow — or the lack of flow, as it were. A brief survey done by Woman Magazine revealed that myths, misconceptions still discourage use of family planning method among majority of women who were interviewed. They live in fear and dilemma of unwanted pregnancies as they fail to decide on the right family planning method for them.

Below, women tell us the stories of their unplanned bundles of joy and the myths, dilemma in choosing the right family planning method.

Health risks; real or imagined?

35-year-old Advera Mwaleja is a stay-at-home mother and has been married for eight years now. Fear of health side effects and risks, both real and imagined, is a major reason why Advera discontinued using contraception.

“I don’t know which method is best for me. I have heard so many women complain of health complications using various modern contraceptive methods,” says Advera.

For Advera, a mother of four children, dilemma on which is the best family planning method has always been a nightmare as both her and her husband agreed on not to use any but just the traditional calendar method, of which has failed them four times.

She says, all of her children were not planned which is never a problem, however, she wished she would be able to better plan on spacing between their children.

“My life is all about counting on which the safest day is and which is not but it always ended up with an unexpected pregnancy. Now that we have four children already, my husband and I still live in fear of what might be next,” says Advera.

She relies on the traditional rhythm method by monitoring her pattern of menstrual cycle but there comes a point where she gets confused when she experiences irregular period cycles.

Failed methods

Rumours about contraceptives are spread by and among women themselves, often through their social networks. Many of their decisions on family planning are influenced by peers. One among is 38-year-old Halima Seleman who cannot decide on the right family planning method despite trying one or two.

Halima tells Woman Magazine that through stories from other women who have used family planning methods, they have had various health challenges which includes irregular monthly periods, nausea, mood swings, losing weight and in some gaining, heavy flow of blood during menstruation, and much more.

Halima is a mother of four children and just like Advera she wished she had the opportunity or knowledge on deciding to plan her births. “The fact that there are so many rumours on the side effects of family planning methods, I and my husband decided not to use any modern contraception,” says Halima.

But when traditional contraceptive methods failed, Halima and her husband decided to seek a health professional’s advice on family planning after their second child. Halima opted for the loop [an intra-uterine device]. The loop as explained by Halima is a small, T-shaped object that goes inside your uterus. It is put in your uterus by an experienced nurse or doctor and the procedure itself takes about 5 to 10 minutes, but your appointment will take about 30 minutes. During this time the nurse or doctor will explain how the insertion is done and will give you instructions about what to expect once your loop is in place. “My gynaecologist informed me about some discomfort but assured it will get back to normal in few months,” Halima says.

Halima experienced heavier periods during the first three months and they appeared twice in a month. On the fourth month, she experienced a sharp pain around the area where the loop was placed. “We had to rush to the hospital and the doctor removed the loop the very same day. I never wanted to try another method from that day on,” Halima reveals.

Unmet need of contraception

Health experts warn that clandestine abortion is common due to unintended pregnancies and is a major contributor to maternal death and injury.

According to Tanzania Health Policy, reduction of maternal mortality is given high priority. It is addressed in various national commitments including Tanzania’s vision 2025, National Strategy for growth and reduction of poverty and health sector strategic plan

Dr Anna Temba from Population Service International (PSI) confirms unsafe abortion is the second leading direct cause of maternal mortality rate which stands at 13 per cent. According to the current National representative study conducted by Guttmacher, Tanzania Association of OBGYN (AGOTA) and National Institute for medical research (NIMR), 1 in 5 women in Tanzania have an unmet need for contraception. The study shows 405,000 Tanzanian women have abortions almost all clandestine and 40 per cent result into complications that require medical treatment.

Commenting on the importance of family planning Dr Temba says, it is important to use family planning to give women space to rest at least two years before she gets another child. She needs to get back to normal and gain enough blood and that is where family planning comes in.

Adding to that she says, family planning methods reduces up to 40 per cent of martenal mortality deaths and other health risks that comes along with giving birth. And for children it gives them enough time to breastfeed and a mother will be able to involve herself in income generating activities to support her family.

“Family Planning also helps in the development of the country as it helps a nation to have people according to the resources the country has. Tanzania is one among the countries that needs to invest in family planning and education to be in the middle income economy list,” says Dr Temba.

The dilemma women have in family planning is that majority of people think it is a western agenda. Majority of men are not supportive to allow their wives to use family planning methods as they think women will be free to have extra-marital affairs. For women the fear lies in giving birth to deformed babies while on contraception.

Adding to this, Dr Temba says, there is no enough education in the community. Different opinions from different health experts on family planning methods also contradict women on who and what to believe.

Dr Temba suggests on the best way to avoid unwanted pregnancies is abstinence, delay sex until marriage, family/sexual reproductive health education, use of contraceptive family planning methods to prevent pregnancy etc.

Commenting on how they advise women on family planning she says they advise women according to their reproductive goals towards family planning. Some women do it secretly, so they advise on the best ways so that their family will not notice.

Dr Temba says that most women whom she consults prefers intra-uterine device as it has less side effects and it takes long for a woman to wait until she decides on having another child unlike injection which a woman has to go for it after every three months.

A man’s point of view

Benjamin Lutanjuka, 36, is a banker. He is a father of a two-year-old and a husband to Bahati Isdory. He says, soon as they started dating six years ago they agreed on using a family planning method just to avoid stress of getting unwanted pregnancies.

His wife Bahati is currently using implants despite rumours surrounding family planning methods. He says his wife gained about 25 kilograms in six months since she put the implant.

“There are times I want to believe my wife’s sudden weight gain is because of the implants but blind-siding it, the fact is that this is the method which helps us maintain a proper number of the children we want. We don’t want more than just two children and family planning is the only solution,” Benjamin says.

Modesta Masala, a Counselor at the Sengerema District Hospital said efforts to reduce Maternal Mortality Rates (MMR) in the country will be successful if right education on maternal health that includes family planning will be reach out to the society even before a woman gets pregnant.

Majority of women are not getting enough information on how to stop from having unwanted pregnancies which force them to find improper ways to terminate pregnancies and lead to an increase in MMR in the country.

“In my line of work, I have come across different cases where women want to terminate pregnancies but they don’t know how to go about it since Tanzania restricts abortion until approved in medical grounds. Majority shun away from hospitals and try to do it unsafely at home where it poses death risks among women,” says Modesta.

“All I do is to encourage them from not going for abortion but educating them on the dangers that comes along with unsafe abortion as well as encouraging them to keep their pregnancies and after delivery educating them on how to protect themselves with family planning methods,” she adds.

The choice of a contraceptive method is a complex decision am leaving most women and couples in a dilemma.

Medical providers have an important role in providing information and supporting patients’ decision making about contraceptive methods through contraceptive counseling.