After her first child, Aisha Nakanja made a decision not to use contraceptives. Besides her religious restrictions, she was scared of the consequences of modern contraceptive methods. “I had seen how some of these family planning methods had affected my friends and did not want to be like them,” she says.
Her husband had also warned her against spacing her children. However, after five pregnancies, the 30-year-old visited a health centre to learn about natural family planning methods.
According to a Family Planning 2020 (FP2020) Progress Report, Momentum at the Midpoint, 2015-2016, released on November 1, 2016, the demand for family planning in Uganda is growing and contraceptive use is becoming more common. As of 2016, Uganda had added 613,000 modern contraceptive users since 2012.
However, there is also a growing section of women, especially in rural areas, who find it more convenient to use natural family planning methods. According to Josephine Nawampande, a midwife at Pigeon General Medical Centre in Namwendwa, Kamuli District, few women are adhering to the call for family planning.
“There is lack of information to allay the fears of women in rural areas regarding the myths associated with contraceptive methods. Most use herbs to space their children yet some of these herbs can be harmful to their reproductive systems in the long run.”
In an earlier interview, Dr Aggrey Batesaaki, the Kamuli District health officer, said the uptake of family planning in the district is low – about 23.2 per cent. “We have a high fertility rate of 6.7 per cent. Deep in the villages, every woman is expected to produce at least seven children.”
Besides herbs, whose potency one can never be sure of, there other natural methods of family planning that a woman can use.
This is a temporary contraceptive method that relies on exclusive breast feeding. It usually lasts for only six months after giving birth. Sister Mary Nakakaawa, a midwife at Kamuli Mission Hospital, says, “This is a method for mothers who have just delivered. For it to be effective, the baby must be less than six months old. The mother has to breastfeed often, exclusively, and should not have resumed menstruation.” All three conditions have to work together. If one of them is breached, then the method stops working, and the mother has to be put on another family planning method.
Two Day method
This method involves a woman checking the type, colour, and consistency of her vaginal discharge as an indicator of her fertility. There is even an App available on Google store to help women in this endeavor. If you do not have a smartphone, there is an easier way to track your discharge.
“We teach the woman about her secretions,” Sister Nakakaawa says, continuing, “In the fertile days, her secretions are like raw egg white and they stretch.
A few days after menstruation, the secretions begin, in small amounts and then, go on increasing until they peak, then decrease as the menstrual cycle ends. A woman can see these secretions on toilet paper, underwear, or feel them with her fingers.”
A midwife should teach the mother how to examine herself every day, before bedtime and what she sees is recorded on a special calendar. Two days are added to each particular record. “If she sees a secretion today, and none tomorrow, or vice versa, then she can get pregnant. If there are no secretions for two consecutive days, then she cannot get pregnant.”
This type of natural family planning method can only be used by women who have regular menstrual cycles of 26–32 days. A woman who menstruates twice a month or has irregular periods cannot use cycle beads. “The white beads show the fertile days, which are 12,” Sister Nakakaawa says, adding, “The brown beads show the days when a woman is not fertile. When you start menstruating, put the black ring on the red bead and mark that day on a calendar.
Then, every day, keep on moving the ring onto another bead.” When the ring reaches the white beads, a woman should abstain from having sex because that is when she is most fertile. “If you finish all the beads without menstruating, then this method is not for you because your cycle is too long,” Sister Nakakaawa advises, adding, “If you begin menstruating immediately after completing the white beads, this method is also not good for you because your cycle is less than 26 days.”
Natural family planning is more acceptable to women in rural areas because this is something they can do without the fear of being detected by their husbands.
According to the midwife, many women are trying out the natural family planning methods. For instance, from November 2016 to March 2017, the hospital taught 500 women how to use these methods. “The problem with artificial family planning is the side effects, the worst of which is excessive bleeding. Some women bleed for two months after going off the method, painful legs, backaches, and nausea,” says sister Nakakaawa. With drug shortages plaguing health centres in rural areas, the supply of family planning commodities might be sporadic. Natural family planning methods may be the answer to helping women manage their families and sexuality much more effectively.
Questions to ask
• Are there any health conditions that may prevent me from using natural family planning?
• What should my cervical mucus look and feel like when I’m not ovulating compared to when I am?
• How long should it take for me to rely on natural family planning?
• Do you recommend working with an natural planning teacher?