This week, You! talks to Dr Sadia Ahsan Pal, a renowned gynaecologist and Dr Azmat Wasim Director Population Welfare Sindh, regarding emergency contraception...
This week, You! talks to Dr Sadia Ahsan Pal, a renowned gynaecologist and Dr Azmat Wasim Director Population Welfare Sindh, regarding emergency contraception...
With a population growth rate of 2.1%, high fertility and poverty, and with a young population comprising 41% of children under age fifteen years, Pakistan needs effective contraception methods to prevent unwanted pregnancies. Unfortunately, the family planning programme receives minimum share in the overall government budget, i.e., only 1% of the total funding, if it is compared with other public sector programmes.
Emergency contraception pills (ECP) can control fertility; however, limited knowledge about the use and availability of emergency contraception (or EC) hampers its efficacy for women. Experts suggest that every couple should determine their family size, according to their financial conditions, age and stage of marriage. In case of late marriages, there should be less child spacing while in young age marriage, child spacing is a must. And once the family is completed, proper family planning should be done under the guidance of a specialist. Similarly, young girls should have institutionalised learning about their reproductive health rights instead of falling victim to misinformation.
Sometimes referred to as ‘Morning after, or post coital contraception’, emergency contraception is the use of drugs or devices (such as Intra Uterine Contraceptive Device or IUCD) to prevent pregnancy after having an unprotected intercourse. These methods of contraception are considered to be a safe and effective means of post coital treatment, and have been estimated to prevent at least 75% of expected pregnancies resulting from an ‘accident’. The drug prevents the implantation of a fertilised egg in the uterus if taken within a prescribed period after a sexual intercourse.
The knowledge parameters about ECP are barely there. A study conducted by Aga Khan University in 2009, to assess the knowledge and attitudes about EC among women of childbearing age in Karachi, found out that 88 % of women were not aware of the method among which 83% were housewives. It was recorded that only a small number (around 11.5%) ever used EC to prevent pregnancy, out of those, the correct timing of effectiveness of post-coital pill was known to only 40% of women. Also, none of them were aware of the existence of Intra Uterine Contraceptive Device (IUCD) insertion as an option for EC. The study also suggested that about 50% of women identified general practitioners or family clinics as their main sources of knowledge about EC. Increased advertising was consi ered desirable by 72% while 37% considered over-the-counter availability of EC pill, and only 36 % of women were uncomfortable to use EC because of religious reasons.
Another study was carried out in 2015 by Ayub Medical College, Abbotabad, at Combined Military Hospital (CMH) Khuzdar, on the same subject, for which 200 married women of reproductive age group were interviewed. Though 77% of the women were practicing some contraceptive method at the time of study, only 7.5% were aware about ECP.
“Not only married women but even the primary healthcare staff like doctors, nurses don’t know about contraception as the subject isn’t taught in the medical colleges; the reason being the embarrassment to discuss it. Even the teachers are not properly trained to take patients’ history, recording their sexual life, contraception methods they use, etc. As a matter of fact, young doctors only get to know about contraception once they join professional field and undergo training,” laments Dr Sadia Ahsan Pal, a renowned gynaecologist based in Karachi.
Citing the reason as to why ECP isn’t prescribed by doctors, Dr Sadia explains, “If someone needs contraception then ECP is not the first thing we tell them about. Rather we prescribe regular contraception which is reliable. ECP, as the acronym indicates is an emergency pill which should only be taken in case of any unprotected sex, rape, abuses and mishaps like, a condom breaking.
While accepting the low level of awareness among healthcare staff and lack of attention paid to the subject, Dr Azmat Wasim, Director Population Welfare Sindh tells, “Things are changing for the better. I admit that there is only one chapter on Family Planning (FP) in the curriculum of the medical colleges, but all undergrads undergo training sessions on FP, conducted at the teaching hospitals by senior doctors. Even the students at Aga Khan do a two-week rotation at our facilities. Similarly, house officers have attachments in the FP department and post graduate students study the subject during their course work.”
Dr Wasim informs that the College of Physicians and Surgeons has introduced the subject in the curriculum and a two-week attachment is mandatory for those who are specialising in Obstetrics & Gynaecology. All Post Partum Haemorrhage (PPH) doctors have been trained in the subject. Now we are also conducting trainings for Lady Health Visitors (LHVs) and Community Midwives (CMWs) in IUCD (implants) and while teaching all contraceptive methods to them.
Schools in the developed countries of the world impart sex education, which not only reduces child abuse there but also encourages contraceptive use at later stage. “Early marriage is a norm in our part of the world, and we are being unfair to both - the boys and the girls - by not discussing such matters with them. This leads to the couples not being equipped with knowledge to plan their families or take informed decisions about the number and time of their pregnancies. Also, around 50% of the pregnancies are unplanned because people don’t discuss contraception due to religious reasons,” explains Dr Sadia.
In this connection, the Population Welfare Department has also planned to include some information about FP in the school curriculum. Dr Wasim notifies that the Education Department has almost developed the curriculum and the new books that will include this chapter in the near future. It is expected that the subject will also be introduced at college and university level soon.
“Currently, we also do sessions in different schools and colleges about small family norms, reproductive health, etc through our Family Welfare Assistants (male and female) and Social Mobilisers (male). Our Taluqa Population Welfare officers first talk to schools’ principals and parents for their consent before conducting these sessions just to avoid any misinformation about the subject,” shares Dr Azmat Wasim.
Ghazunfer Abbas, a reputable family planning expert, speaking on the challenges of marketing ECP says that, “FP empowers women to decide about their families. ECP cannot be marketed due to regulatory restrictions. Theoretically it can only be prescribed by the doctor, but practically these are sold as over-the-counter medicine. People either get to know about it through Indian channels’ ads on emergency contraception or directly from chemists and pharmacists who tell people approaching them. Only the private health professionals who are connected through some networks are better informed.
Contraception is a careful choice and women need to make informed decisions regarding family planning. Better to be more informed about the ECP and be safe than sorry.
