Med­i­cal Bytes with Dr. K

It’s your life; it’s your re­spon­si­bil­ity

mailife - - Contents - with Dr. K

Seini was an 18 year old high school stu­dent. She had many friends who were sex­u­ally active. They in­sisted that she also ex­per­i­ment with this be­fore leav­ing school. It was al­most the end of the year and Seini was at­tend­ing the prom with her class­mate. The evening went well, Seini had a lot of al­co­holic drinks and be­came quite drunk. Lit­tle did she re­alise that she did not get home that night. She ended up with her date and could not re­mem­ber what had hap­pened. Next month Seini missed her men­strual pe­riod. She took a preg­nancy test, which to her great dis­ap­point­ment came back pos­i­tive. Rita, 24, is adamant about us­ing con­doms for con­tra­cep­tion, as she does not want to get preg­nant. One night, how­ever, the con­dom broke dur­ing in­ter­course. Rita was un­aware that the emer­gency con­tra­cep­tive pill ex­isted (morn­ing af­ter pill). Rita and her hus­band were not ready to have a baby yet as they both had very de­mand­ing jobs, but Rita fell preg­nant. They did not have a choice but to have the baby, as abor­tion is not le­gal in Fiji. Shelly, aged 30, was on the oral con­tra­cep­tive pill and was care­ful to take it at the same time ev­ery day. She had been with a new part­ner for two months. Since that time she re­alised that she was hav­ing an ab­nor­mal vagi­nal dis­charge and lower ab­dom­i­nal pain. Shelly vis­ited her doctor who did the ap­pro­pri­ate tests and ad­vised her that she had gon­or­rhea, a sex­u­ally trans­mit­ted in­fec­tion. Shelly was us­ing the con­tra­cep­tive pill so she did not get preg­nant, but got a sex­u­ally trans­mit­ted in­fec­tion be­cause her in­fected part­ner was not us­ing a con­dom. All th­ese women were dif­fer­ent ages and in dif­fer­ent si­t­u­a­tions, but they had one thing in com­mon – con­tra­cep­tive is­sues. World Con­tra­cep­tive Day takes place on 26 Septem­ber ev­ery year. The an­nual world­wide cam­paign cen­tres around a vi­sion where ev­ery preg­nancy is wanted. Launched in 2007, World Con­tra­cep­tive Day’s mis­sion is to im­prove aware­ness of con­tra­cep­tion and to en­able young peo­ple to make in­formed choices on their sex­ual and re­pro­duc­tive health. Fam­ily plan­ning in­for­ma­tion and ac­cess to pre­ferred con­tra­cep­tive meth­ods for women and cou­ples is es­sen­tial for the well-be­ing and au­ton­omy of women, while sup­port­ing the health and de­vel­op­ment of com­mu­ni­ties. Al­low­ing women to choose whether, when, and how many chil­dren to have achieves progress on global health goals. It also helps break the cy­cle of poverty and puts fam­i­lies, com­mu­ni­ties, and coun­tries on a stronger, more pros­per­ous and sus­tain­able path (World Health Or­ga­ni­za­tion). Over the past 25 years, con­sid­er­able progress has been made in women’s sex­ual and re­pro­duc­tive health, in­clud­ing in­creased con­tra­cep­tive use spurred by the Mil­len­nium De­vel­op­ment Goals (MDGs) and the 1994 In­ter­na­tional Con­fer­ence on Pop­u­la­tion and De­vel­op­ment (ICPD). De­spite the pos­i­tive global trends there are large dif­fer­ences among and within coun­tries. More than 200 mil­lion women world­wide would like to avoid a preg­nancy but are not us­ing an ef­fec­tive method of con­tra­cep­tion. Two very sig­nif­i­cant rea­sons for this in­clude lim­ited choice of meth­ods and lim­ited ac­cess to con­tra­cep­tion par­tic­u­larly amongst young peo­ple, and poorer seg­ments of pop­u­la­tions or un­mar­ried peo­ple. There may also be a fear of side ef­fects, cul­tural or re­li­gious op­po­si­tion, poor qual­ity of avail­able ser­vices, users and providers bias and gen­der based bar­ri­ers. A woman’s abil­ity to choose if and when to be­come preg­nant has a di­rect im­pact on her health and well­be­ing. Fam­ily plan­ning al­lows spac­ing of preg­nan­cies and can de­lay preg­nan­cies in young women at in­creased risk of health prob­lems and death from early child­bear­ing. It pre­vents un­in­tended preg­nan­cies, in­clud­ing those of older women who face in­creased risks re­lated to preg­nancy. Fam­ily plan­ning en­ables women who wish to limit the size of their fam­i­lies to do so. Ev­i­dence sug­gests that women who have more than 4 chil­dren are at in­creased risk of ma­ter­nal mor­tal­ity. By re­duc­ing rates of un­in­tended preg­nan­cies, fam­ily plan­ning also re­duces the need for un­safe abor­tion. Fam­ily plan­ning al­lows peo­ple to make in­formed choices about their sex­ual and re­pro­duc­tive health. It rep­re­sents an op­por­tu­nity for women to pur­sue ad­di­tional ed­u­ca­tion and par­tic­i­pate in public life, in­clud­ing paid em­ploy­ment. Ad­di­tion­ally, hav­ing smaller fam­i­lies al­lows par­ents to in­vest more in each child. Chil­dren with fewer sib­lings tend to stay in school longer than those with many sib­lings. Fam­ily plan­ning is key to slow­ing un­sus­tain­able pop­u­la­tion growth and the re­sult­ing neg­a­tive im­pacts on the econ­omy, en­vi­ron­ment, and na­tional and re­gional de­vel­op­ment ef­forts. There are many dif­fer­ent meth­ods of con­tra­cep­tion. The most ef­fec­tive rev­ersible meth­ods are the “fit and for­get” long-act­ing rev­ersible con­tra­cep­tives (LARCS) - in­trauter­ine de­vices and con­tra­cep­tive im­plants. Th­ese are suit­able for women of any age and can be used by most women even if they have any sig­nif­i­cant health is­sues. They can be re­moved eas­ily at any time by a trained health pro­fes­sional and are im­me­di­ately rev­ersible on re­moval. How­ever, they in­volve an in­ser­tion and re­moval pro­ce­dure by a doctor or nurse and do not pro­vide pro­tec­tion against sex­u­ally trans­mit­ted in­fec­tions (STI’s). In­trauter­ine de­vices in­clude a hor­mone re­leas­ing de­vice or cop­per de­vices. The hor­monal IUD is a small T-shaped de­vice that is fit­ted in­side the uterus (womb). Over five years it slowly re­leases a very low dose of pro­gesto­gen hor­mone

into the uterus. Pe­ri­ods usu­ally be­come lighter or may stop when us­ing a hor­monal IUD. The hor­monal IUD is about 99.8% ef­fec­tive. The cop­per in­trauter­ine de­vice is made from plas­tic and cop­per and is fit­ted in­side the uterus. It stops sperm from reach­ing the egg and any fer­tilised egg from stick­ing to the wall of the uterus and is 99.2% ef­fec­tive. They have no hor­mones and there­fore have no ef­fect on the nor­mal fe­male cy­cle but pe­ri­ods may be­come heav­ier when us­ing a cop­per IUD. IUDs need to be re­placed ev­ery 5-10 years de­pend­ing on their type or can be re­moved eas­ily at any time. The con­tra­cep­tive im­plant is in­serted di­rectly un­der the skin, on the in­ner arm above the el­bow, where it con­tin­u­ously re­leases a low dose of a pro­gesto­gen hor­mone into the blood stream over three years. The im­plant works by pre­vent­ing ovu­la­tion (egg re­lease from the ovary). De­vices need to be re­placed ev­ery three years or can be re­moved ear­lier if re­quired. Us­ing an im­plant will change a woman’s usual bleed­ing pat­tern: for some women this will mean lit­tle or no bleed­ing at all but about 1 in 5 women have ir­reg­u­lar or per­sis­tent bleed­ing. Im­plants are 99.9% ef­fec­tive. The con­tra­cep­tive in­jec­tion – De­pot medrox­ypro­ges­terone ac­etate (DMPA) – is given by in­jec­tion into a mus­cle ev­ery 12 weeks. It pre­vents preg­nancy by stop­ping ovu­la­tion. Pe­ri­ods may stop while us­ing DMPA and there may be a short de­lay in re­turn to usual fer­til­ity. DMPA is 94-99.8% ef­fec­tive. Shorter act­ing hor­monal meth­ods in­clude the com­bined oral con­tra­cep­tive pill and the pro­ges­terone only pill (minip­ill). A reg­u­lar pre­scrip­tion from your doctor is re­quired and th­ese do not pro­vide pro­tec­tion against sex­u­ally trans­mit­ted in­fec­tions. The com­bined oral con­tra­cep­tive pill, com­monly re­ferred to as ‘The Pill’, is taken daily and con­tains the hor­mones oe­stro­gen and a pro­gesto­gen. Th­ese hor­mones are sim­i­lar to those nat­u­rally pro­duced by the fe­male body. The pill may help with acne or heavy pe­ri­ods. The pro­gesto­gen-only pill can be used by most women, even if they have any sig­nif­i­cant health is­sues. Pills rely on reg­u­lar and con­sis­tent daily use to be ef­fec­tive. Bar­rier meth­ods are con­doms and the di­aphragm. They pre­vent se­men from en­ter­ing the uterus and can be an ef­fec­tive method of con­tra­cep­tion when used con­sis­tently and cor­rectly. Con­doms are the only method that pro­vide pro­tec­tion against preg­nancy and sex­u­ally trans­mit­ted in­fec­tion. The male con­dom is a sheath made of la­tex or polyurethane, which is rolled onto the erect pe­nis be­fore sex. The male con­dom is 82-98% ef­fec­tive for preg­nancy pre­ven­tion and con­sis­tent use is very im­por­tant if they are the sole method of con­tra­cep­tion. Con­doms can be used in con­junc­tion with other meth­ods to in­crease con­tra­cep­tive ef­fec­tive­ness. Emer­gency con­tra­cep­tion (EC) can re­duce the risk of un­in­tended preg­nancy af­ter un­pro­tected sex. There are two types of EC - the emer­gency con­tra­cep­tion pill (ECP), a pill con­tain­ing a pro­gesto­gen hor­mone and the Cu-IUD. Per­ma­nent con­tra­cep­tion (ster­il­i­sa­tion) for men or women in­volves a small op­er­a­tion by a sur­gi­cal doctor with gen­eral or lo­cal anaes­the­sia. As you can see, there are so many avail­able op­tions for con­tra­cep­tion. I urge you to make an appointment with your doctor to dis­cuss the best pos­si­ble op­tion for you and your part­ner. Knowl­edge is power and we all need to em­power our­selves so that we can make the best de­ci­sions. Wise words by Dr.Ba­batunde Oso­time­hin, Ex­ec­u­tive di­rec­tor of UNFPA“Fam­ily plan­ning is not a priv­i­lege but a ba­sic hu­man right. By en­abling women par­tic­u­larly the most dis­ad­van­taged and hard­est to reach, to make in­formed choices about the num­ber, tim­ing, and spac­ing of their chil­dren, we help them ex­er­cise this right.”

“Knowl­edge is power and we all need to em­power our­selves so that we can make the best de­ci­sions.”

DR. KRUPALI RATHOD TAPPOO is an Aus­tralian qual­i­fied Gen­eral Prac­ti­tioner, a Fel­low of the Royal Aus­tralian Col­lege of Gen­eral Prac­ti­tion­ers and the Med­i­cal Co­or­di­na­tor for Fiji-based NGO Sai Prema Foun­da­tion. Dr. Krupali is based at Mitchells Clinic in Tap­pooc­ity Suva and has a special in­ter­est in women and chil­dren’s health.

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