Contraception misconceptions

Last week I gave a talk to a group of mothers who have children in the hospital.  They gather twice a week for a talk given by a visiting med student, resident or attending.  I chose to talk about contraception.  I kept the talk pretty basic, covering the health benefits of contraception, the varieties of contraception, and how they work.  I knew there would be plenty of questions to take up the rest of the time.  What I didn't know was how much I would learn from the experience.

When I was preparing for the talk, I came across a number of interesting statistics, as well as a lot of mis-information.  I learned that the average number of children for women in Subsaharan Africa is 5.  (This reminded me of a woman who was being cared for by my team in the hospital - she broke into tears as she told us that her husband had recently passed away and she is now a single mother with 9 children.  She had just had a stroke and might not return to her full strength.)  I also learned that appropriate birth-spacing (18 months between pregnancies) decreases maternal complications during child birth.  The misinformation that I found was about the supposed malicious intent that the Western world has when it provides contraception to Kenya, written by an local Ob-gyn doctor.  There were also web pages citing numerous side effects from contraception, most of which were hyperbole or simply false.

After reading through some of these sources, I knew I would get some interesting questions during my talk. I was not disappointed.  Some of the questions seemed to be derived from male-centric social culture, with an emphasis on women's role as child bearer:

 "Is it true that if a women takes birth control pills before she has children, she will never be able to have children?"

"I heard that when a woman uses birth control she uses up all her eggs and can't have children.  Is it true?"

Other questions related to potential side effects of contraception.  Some were at least partially based on reality, while others were not.

 "My friend was told she can't take OCPs because she has varicose veins.  Why is that?"

 "I heard that the copper IUD will give you cervical cancer.  Is it true?"

"When you get the contraceptive implant taken out, I heard that your next period is really heavy.  Is that because all the blood builds up inside you when you use the implant? 

A couple questions seemed to come out of left field.  They reminded me that there are a wealth of myths that exist about birth control, many of which paint contraception as scary and dangerous.

 "I heard that if you use birth control pills, they will all collect in one area in your body, and you will eventually need to have a major operation to remove all the pills.  Is it true?"

" I heard that the IUD can leave your uterus and travel to your heart.  Is it true?"

These women were very engaged with the talk and had numerous questions.  They all took the handout that I had made, and many requested one or two extras to give to a friend.  The interest in contraception is definitely present, but they have little to no access to accurate information or to the contraception itself.  Kenya is fairly advanced when compared to its peers in Subsaharan Africa, but it continues to foster a society that values men above women and relegates women to the role of child-bearer and mother.  I learned from a Kenyan med student that even among progressive families, a dowery is still paid by the man when he marries a woman - an act that, even if ceremonial, defines women as property.  Today the husband of a patient on our team refused to consent for a biopsy of a liver mass for his wife, stating that a relative of his died from a biopsy and he "doesn't want to lose her and the money."  Why does he mention the loss of his wife and the loss of money as if they are of equal value?  As we tried to explain to him the risks and benefits of the biopsy and the risks and benefits of doing nothing, and as he continued to interrupt us and refuse our explanation, I couldn't help but think that if this was his son or his brother, he would have consented in a heartbeat.  I felt anger and frustration at the injustice I was witnessing.  Yes, there are women in more progressive (and likely more wealthy) families who are loved and supported and encouraged to pursue their dreams.  There are quite a few female physicians and med students, and I see women around town who run little street-stands and seem quite independent.  But there are still many women here who live within a constrained set of societal rules that value men over women.

Witnessing this sexism and the second-rate status of many women here has been challenging.  It also added yet another item to the growing list of things I am grateful for: the fact that I am a 26 year old unmarried woman without children who is supported and loved by her family and friends.