Yemeni men support the use of contraceptives to help plan families [Archives:2008/1146/Health]

Hamed Thabet
Most Yemenis believe they should abstain from sex until married, but afterward, they think it's their duty to have as many babies as they can, no matter if they are poor, unhealthy or their wives are too weak to bear many children within a short period. However, other Yemeni families practice family planning using the available forms of contraceptives on the market.

Yemen's population is growing 3.1 percent annually and will double in 23 years. “Yemen has one of the world's highest fertility rates, so this is where we look for solutions,” says Hans Obdeijn of the United Nations Population Fund (UNFPA).

According to UNFPA studies, the average Yemeni woman has six children, and if growth and fertility rates remain as they are, Yemen's population will reach 60 million by 2050.

“No one is of the opinion that Yemen should stop growing, but it should be slow and controlled,” Obdeijn said, explaining, “Birth control is a term and a method to help women avoid becoming pregnant. It includes a wide range of methods ranging from contraceptives to avoiding intimacy.”

Some Yemeni men do believe that it's not a matter of quantity, but quality, according to Nadim Al-Saqqaf, who has two sons. Although he has the ability to have more children, he prefers to keep his family smaller and well cared for. “I don't want 10 children playing in my house if I can't raise or educate them well,” he said, “Hence, I've decided to have fewer, but well-educated and well-behaved children.”

Hassan Al-Auodi, 26, says that because he's poor and doesn't have enough money to raise a child, he uses condoms whenever he's intimate with his wife, claiming that this helps him avoid a financial debacle which would affect his child's future.

Other Yemeni men promote using birth control pills in order to space out births. For example, Hani Al-Harazi, who has two wives, supports their decision to use the pill. “Of course I want children, but not until later because at the present time, I want to be happy with them and enjoy life,” he says, adding, “Imagine my two wives being pregnant at the same time!

“If you don't want to have a baby, there are two main options: either abstain or use contraceptives,” Al-Harazi says, “I advise all men to enjoy their life before having children.”

Sana'a pharmacist Ahmed Thabet says that in the past, men used to be very embarrassed when they would come in to buy condoms; however, in the past two years, things have changed and buying condoms is something normal.

“I sell 15 boxes of condoms a day, with each box containing three condoms,” he says, “Most of my customers are between the ages of 18 to 35, but particularly 25 to 30. These days, even the number of women coming in by themselves to purchase contraceptives has increased.”

Married for five years, 28-year-old Ali Al-Naqib already has three children and has begun using condoms to help plan his family, worrying about his wife who has become weak due to giving birth every year. Additionally, he decided to begin using contraception when he realized that due to her annual deliveries, his wife has been subjected to sub-par services and treatment at public hospitals in Yemen.

Some Yemenis use birth control to cope with residential space problems because their homes aren't big enough to accommodate many children. With five children living in a three-room house, Ali Al-Maznaei explains, “I don't have enough money to move. My house is too crowded now, so this is why I won't have any more children until I become wealthy.”

Al-Maznaei uses the “rhythm” or “pull-out” method where he doesn't ejaculate inside of his wife; however, this is the least reliable form of contraception because women also may conceive from pre-ejaculation fluids, which contain a small amount of sperm, emitted during intercourse.

Miriam Ali, 23, vows that she'll have no more than four children after she marries, explaining, “I want a rest and it's not good for my health to have many children. If my husband forced me to have children, for sure, I would use contraceptives.”

Na'isa'a Mohammed, 25, says she'll ensure that any prospective husband will agree – before marrying – to have only the three or four children she desires. “And it must be during a spaced out time period over four to five years,” she said, adding, “I'll use methods myself in order not to have children because I have to ensure that I can raise my children well.”

Dr. Faezah Sanai, a gynecological specialist working in Yemen, says, “Most women in Yemen deliver a child every year, which obviously is dangerous for both the health of the mother and the child.”

When a woman delivers many children within a short time, she faces health problems such as anemia, calcium deficiency, exhaustion and loss of blood in the womb because when a woman delivers children within such a short period, her womb weakens, which can cause bleeding. Having no rest from childbearing also causes the same problem, as Sanai notes, “Many women have died in my clinic because of these problems.”

He points out that a major problem in Yemen is that there's no awareness about the availability of contraception, with even women themselves having no knowledge about family planning.

Sanai says, “I advise them not to have children every year, but many tell me that it's not in their hands because their husbands want children, so they must obey. However, I advise them to use contraception in order to have a rest.”

Many products helping to prevent pregnancy are available in Yemen, such as condoms for men, female condoms, intra-uterine devices or IUDs, diaphragms, Depo-Provera, spermicides and the contraceptive pill and loop, which is a metal object used to prevent pregnancy.



Condoms for men

The male condom is one of the best methods of contraception that couples can use. It's a rubber prophylactic closed at one end like the finger of a glove so that when a man uses one, it stops the sperm from entering the woman. One advantage of using male condoms is that a husband can take an active part in family planning and it's not just left to the woman to worry about.

A condom should be used only once. Most condoms are made of rubber latex, although others are made from lamb intestines, called lambskins.



Female condom

The female condom is a fairly new barrier method; thus, it's not as widely available as the male condom and is more expensive. However, it's very useful when a man either won't or can't use a male condom. It's like a male condom, except it's bigger and worn inside the vagina.

It's a good idea to try practicing using the female condom before having sex, getting used to touching it, etc., as it may help one feel more confident about using it during sex. To use, insert the condom into the vagina right before sex and use it only once, like a male condom.



Spermicides

Spermicides are chemical agents that kill sperm and stop it from traveling up into the cervix, which is the lower part of the uterus, or womb, where babies develop. Spermicide comes in different forms, including the sponge, vaginal pessaries (which melt in the vagina), gels and foam, which are squirted into the vagina using an aerosol. Young people who use spermicide mostly choose foam.

To use, put the spermicide into the vagina at least 10 minutes before having sex. One dose of spermicide usually works for one hour. Spermicide is recommended for use in tandem with other methods of contraception, such as condoms or diaphragms.



Diaphragm

A diaphragm is a rubber disk inserted into the vagina before sex so that it covers the cervix, or neck of the womb. To protect against conception, place a spermicide into the dome of the diaphragm before inserting it.

Women must be fitted for a diaphragm at a doctor's office or clinic because diaphragms come in several different sizes.

A diaphragm must remain in place at least six hours after intercourse before it can be safely removed, but shouldn't remain in place for more than 24 hours.



Cervical cap

The cervical cap is a soft rubber cup with a round rim that is placed into the vagina to fit over the cervix, or neck of the womb. A cap is smaller than a diaphragm, but sometimes more difficult to insert.

A woman must go to a doctor or clinic to be fitted for a cervical cap, as it too comes in several different sizes.



Depo-Provera

Depo-Provera is a form of progestin, similar to the hormone in the birth conrtol pill. A doctor must inject Depo-Provera with a needle into a woman's buttocks or arm muscle and she must receive an injection every three months for this method to continue working.



IUD

An intra-uterine device or IUD is inserted into the womb by a doctor. Some IUDs release copper and others release progesterone, a form of progestin. An IUD must be replaced annually by a doctor.



Contraceptive pill

Birth control pills are a synthetic form of the hormones progesterone and estrogen. They prevent ovulation by maintaining more consistent hormone levels. With no peak in estrogen, the ovary receives no signal to release an egg; thus, no egg means no possibility of fertilization and pregnancy.

The pill also thickens the cervical mucus so that sperm can't reach the egg and makes the lining of the uterus unreceptive to the implantation of a fertilized egg.
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