Once one of my fellow lady health workers went to a house and the old mother said to her that my son is having a headache, find a solution for it. The lady health worker took out a headache pill from her bag, gave it to Amma, and started walking.
A few days later, when the lady health worker went to that house again, the mother started shouting at her. You are not ashamed. What kind of family planning do you want me to do at this age?
The lady health worker said, “Mother, I gave you a headache pill.”
Amma’s anger did not subside, and she said indignantly, ‘Thankfully my son saw and stopped me.’
The mother’s son came and he also attacked the lady health worker saying, ‘Shame on you, my mother, you are doing family planning.’
The lady health worker said, “You see, I have given you a pill for headache.” The son said, “The mark of the Lady Health Worker program is printed on this pill, which is on family planning pills.”
The lady health worker said, ‘You open it and see, there is paracetamol in it. The mark is so that no one can sell this pill for money in the market.”
This story is not new for Balqis Alam, who has been associated with the Lady Health Worker Program for 23 years.
She says that she has heard a lot of things that have defamed her and questioned her ‘intentions’. Family planning is not their only job, but family planning is definitely a part of it.
And the biggest challenge for them in this is to remove misconceptions among people regarding family planning methods.
1. Misunderstandings about Contraception in Pakistan?
Pakistan has become the fifth largest country in the world in terms of population. The government has long initiated a family planning program to control the health and population of its citizens.
According to the official data of 2018-2019 in Pakistan, 34 percent of married women aged 15 to 49 in the country use some form of contraception.
And 43 percent have used a contraceptive method at least once.
In this regard, the trend of using such methods is slightly higher among educated women.
30% of women who are illiterate, use some form of contraception, 34% of those with first or second grade education, 36% of those with 3rd to 7th grade education, and 36% of 8th graders. 39% of women with up to or more education use some method.
2. Which method is more popular?
When looking at which method is more popular, the most commonly used methods are male abstinence (27 percent), condoms (26 percent), sterilization (23 percent), pregnancy. Cush injections (10 percent), IUDs (five percent) and contraceptive pills are used by five percent.
But interestingly, among married women aged 15 to 49, whether in rural or urban areas, overall 99% of them know at least one contraceptive method.
But despite this, there are still many misconceptions about contraceptives and methods in Pakistan.
We asked Bilqis Alam what kind of misinformation he has encountered during his years of experience.
She says that Pakistani women believe many things they hear.
There are many misconceptions about birth control pills. Some women believe that if they take birth control pills for too long, they will get cancer of the uterus, or they will not be able to breastfeed another child.
In this regard, well-known gynecologist Dr. Salma Kafeel, says that “contraceptive pills are made for the hormones that our body produces”. The hormones our bodies naturally produce are intended to drive a regular menstrual cycle and then an ovulation cycle.
She said that the same hormones that we use to prevent pregnancy, i.e. estrogen and progesterone in the form of pills, affect the timing of the menstrual cycle and thus the patient. Given that ovulation stops and there is no problem.
She said about a common misconception that cancer is not directly related to these pills.
She says, “When it comes to breast cancer, there are not enough cases that we can say that they are related to pills.”
Uterine cancers are also not linked to these pills. When we advise a family to use a contraceptive method, we first assess their health, i.e. no family history of cancer or irregular periods. We directly say that cancer occurs is not such a thing.
3. Do these pills have any effect on Breast Milk?
Dr. Salma says that this is not entirely true, because the process of producing milk is completely separate. It has nothing to do with the second pregnancy. There may be other reasons for low milk supply, but it is not caused by pills.
But these are not the only misconceptions about birth control pills. Bilqis Alam says that many women say that if I eat more of this, I will gain a lot of weight.
In this regard, Dr. Salma says that there is no such thing.
I would say that it has to do with lifestyle. Women who want to stay slim are slim even with pills. Those who want to be fat become fat, even if they don’t take pills. For this reason, I would say that there can be a very slight difference, like an excess of one or two kilos, but not such that the weight increases too much.
Another question that Balqis Alam frequently faces is that women develop facial hair due to taking birth control pills.
In this context, Dr. Salma says that the reality is completely opposite.
Most pills are made of estrogen and progesterone. Due to them there is no hair on the face. It occurs due to excess of testosterone in the body. In such cases, women have a problem called ‘polycystic ovary‘ in which hair grows on the face. We give pills to reduce it. It doesn’t happen because of pills.’
4. Copper T (IUD)
Another method of preventing pregnancy in Pakistan is the IUD, commonly known as ‘Copper T’. In this method, a very small device is placed in the woman’s fallopian tube, which prevents pregnancy.
Bilqis Alam says that there is a surprising misunderstanding about this method in Pakistan.
“Women say that if you keep it, it might go into your heart and give you a heart attack.” I heard that so-and-so kept it and it went to her heart!’
Bilqis Alam says that when she hears such a thing, she has to explain to the woman that look, if the baby in your womb cannot reach the heart by tearing the ovary, where will this little thing go?
Dr. Salma explains the possibilities in detail. It is possible for the IUD to move out of place and move near the abdomen or in the pelvic area. Due to this, one can sometimes get an infection. But it can never go into the heart.
The heart is separate from the lower body. But yes it can move from its place and then we check whether it is inside the body or has fallen out. But its shaking is not normal. In my many years of experience, I must have seen five or six such cases.
5. Contraceptive Injection
Another way to prevent pregnancy is through injections. Bilqis Alam explains that women believe that the implantation will make them completely sterile and they have many examples to justify this idea.
But Dr. Salma says that is not the case. The injections or implants are long-acting contraceptives and are made of progesterone. You get injections for three months or implants for different periods of time. The problem with them is that some women have very little or no menstruation during this period.
She said that very few women have little difficulty in conceiving after this. But most people don’t get it here, and even those who do have some problems. In such a case then we have to follow fertility protocols and it takes time for these people to recover their fertility.”
6. Use of Condoms
The most popular artificial method of contraception in Pakistan is the use of condoms. About 26 percent of family planning people in the country use condoms.
Balqis Alam says that the condom method is also not free from rumours. Some women think that using a condom will make my stomach bloated and then my husband will start liking another woman.
Dr. Salma understands only one reason for this idea.
“If you take a large population and one of them has this problem, it becomes a rumour. 99 percent, if not 99.9 percent, of couples who use condoms do nothing. In very rare cases, it may be possible for a person to be allergic to the material the condom is made of. In such a case, it may happen that some part of their body gets swollen. It is so rare that as a doctor I cannot discourage its use in people”.
But apart from women, men also have some concerns regarding contraceptives. Some men find that any method with hormones, whether it’s the injection or birth control pills, can cause a woman’s mood swings.
Dr. Salma says, “Because of the pills, the mood of women starts to improve.” But in very few cases, a very small number of women say they have depression. But this number is so small that you cannot say that all other women should be removed from pills.
7. Most Effective Contraceptive Method?
Dr. Salma says that the most effective way to interrupt pregnancy is pills. They are most effective if taken correctly. Second is the injection and third is the IUD.
According to Dr. Salma, ‘it is important to assess the health of the couple before using any method. This is not just a matter of a couple, but of the whole nation. If you don’t control your population, your population is badly affected, and rumors start to fly.’
She said that the countries that have family planning programs are on a large scale and every couple that comes there is regularly counseled and given a thorough health check-up after which they are offered contraceptives.’
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