By: Melissa Garcia, Technical Adviser, International Consortium for Emergency Contraception
For this year’s World Population Day on 11 July, our community celebrates and affirms the right to family planning. On this day, the United Nations Population Fund (UNFPA) is also calling attention to the many people around the world unable to realize this right. The Guttmacher Institute’s analysis, Adding it Up, estimates that 214 million women of reproductive age in developing regions want to avoid pregnancy but are not using a modern method of contraception. One hundred and fifty five million of these women are not using a contraceptive method. Some 59 million women use traditional practices and remedies for pregnancy prevention. UNFPA has listed some of these practices in this article and accompanying photo essay. They are cause for concern because the users of such “pseudo” contraceptive practices act in the belief that they are protecting themselves from the risk of unintended pregnancy. But in fact they are exposing themselves to that risk, and potentially to further health consequences.
This phenomenon affects emergency contraception (EC) as well. The majority of women are not aware that a contraceptive option after sex exists, in most countries that capture EC knowledge in their most recent Demographic and Health Survey (DHS) data. Most women have never heard of the dedicated, safe and effective pill, and copper- IUD, regimens that are the only effective post-cotial methods.
Yet, research in one country context reveals that the same phenomenon of folk or traditional contraceptive behaviors and practices also exist after sex. Although levels of awareness of dedicated ECPs in the Democratic Republic of the Congo (DRC) are low at 18.8% (DHS 2013-14), only about a third of respondents in ICEC’s recent qualitative study believed that nothing could be done to prevent pregnancy after sex. In structured focus groups, Kinshasa women and girl participants discussed in detail the arsenal of potential post-coital “emergency” behaviors and practices that they, and other women and girls in their communities, were familiar with. They described a range of folk remedy treatments, such as douching, drinking very salty water or sodas, using a herbal concoctions of avocado leaves, and “jumping really hard to make the sperm come out”. In other cases, they described the use of non-contraceptive drugs, such as antibiotics, deworming medications (Décaris, Tanzol) and antimalarial medications (quinine, tetracycline). Describing some of these behaviors, participants detailed very complex regimens and timeframes for use.
The focus group discussion participants offered several explanations for these practices. For one, they explained that most women had never benefited from a family planning counseling information session, and relied on the “handed-down” ingrained beliefs and practices that could be observed among their mothers, sisters, aunts, and others in their communities. Compounding that is their self-admitted generally poor knowledge of reproductive biology, including the fertile period.
In their calculation, the risks of these behaviors amounted to less than what they perceived to be the high and numerous “costs” of using modern contraceptive methods, citing their fears and concerns about these, including rumored health risks. Participants also explained the high financial cost of paying for a contraceptive method, saying that, in comparison, the relatively lower cost of non-contraceptive drugs made them more appealing. In addition, focus group participants referenced the anticipated “social” cost, in terms of embarrassment and stigma, of asking for a contraceptive out loud to a pharmacist or store clerk (potentially male, potentially older) at a pharmacy counter, for anyone to hear. For these and other reasons, women and girls in Kinshasa who participated in our research revealed that post-coital contraceptive behaviors were in fact being practiced within their communities, albeit using ineffective and unreliable treatments.
The recourse to unsafe behaviors and practices to prevent pregnancy highlights the great imperative of improving awareness, through training for providers and counseling for clients on the full and diverse range of high-quality, safe, effective contraceptive methods, including on EC. They must be made available, acceptable, accessible and affordable for all women and girls, then enabled and empowered to make free and informed choice and realize their rights to family planning.
To read the full article referenced above, please see “Awareness and Perceptions of Emergency Contraceptive Pills Among Women in Kinshasa, Democratic Republic of the Congo”, co-authored by Tulane University, the DRC Ministry of Health’s National Program for Adolescent Health and the National Program for Reproductive Health, and by the International Consortium for Emergency Contraception, hosted by Management Sciences for Health.