After giving birth to four unspaced children in four consecutive years, she wanted to stop but her husband did not care. Coming from a Muslim family and being married to a Muslim husband brought little options of using family planning because they were against it.
Aisha Nalumansi, 35, knew she would be more productive if she stopped giving birth but how would she do this without offending her husband? He had cautioned her against signing up for any family planning method, even when the doctors had recommended her to do so.
Nalumansi says, “I come from a Muslim family but I don’t mind using family planning. I thought about taking pills but I knew I would easily forget. I decided to go for an injection.”
Months later, she overbled. “My husband asked what was happening because the bleeding became so intense. I opened up to him. He took me to hospital where I was given some pills that stopped the bleeding.”
Dr Peter Ddungu, a public health specialist at Marie Stopes Uganda, warns that, “Some women have irregular or prolonged bleeding as a side effect of using the injectable birth control. It is more common to first time users of Depo Provera, but often improves with time.
After three months, Nalumansi managed to convince her husband about the importance of family planning. She then opted for an implant, a long term method, since they had plans of having their last child after three years.
The need for family planning
According to Carole Sekimpi, the country director for Marie Stopes Uganda, if many women would use family planning, maternal mortality would reduce a great deal. She adds that many women are reluctant about family planning services because of the side effects, unsupportive partners, cultural and religious beliefs.
She says safe sex practices are important for the sexual and reproductive health of sexually active women of all ages but the battle cannot be won without male involvement.
“Traditionally, the burden of raising children is for women. It is about time women started having children by choice, not by chance. Empowering women through innovative approaches to social protection is very important,” she says.
Reducing fertility rates
“Reduction in fertility rates improves the uptake of modern contraceptives, impacts on the sexual reproductive health services and enhances economic growth. Good sexual and reproductive health is important for women’s general health and wellbeing. It is central to their ability to make choices and decisions about their lives, including when to have children,” she says.
“Sexual and reproductive health includes the right to health services that are inclusive, safe and appropriate, access to accurate information, effective and affordable methods of contraception and access to timely support and services in relation to unplanned pregnancy,” says Dr Ddungu.
There are hormonal and non-hormonal methods of family planning that a couple can always choose from, according to Dr Ddungu.Barrier methods are the commonest type of non-hormonal birth control methods where the sperms are physically prevented from reaching the egg. These include condoms and diaphragm which are short term.
The intrauterine devices (IUD) are a reversible form of contraception and available as hormonal birth control method as well as the hormone-free birth control method. The IUD can be used for up to 10 years, can be removed anytime to return to fertility and has a failure rate of less than one per cent.
Common side effects of the IUD include cramps and heavy bleeding, but these decrease with time.
You may choose tubal ligation (for females) or vasectomy (for males) which are permanent procedures for birth control without hormones.
“Birth control pills, injections and implants contain a combination of estrogen and progesterone hormones that prevent you from getting pregnant. Generally, lesser hormones are associated with fewer side effects of birth control pills like headaches, nausea, and breast tenderness, “says Dr Ddungu.
Doctors advise that different family planning methods suit different people. Plan to have proper consultation with a doctor to make an informed choice before signing up for a particular method.