Yemeni women and the Pill [Archives:2009/1222/Health]

January 5 2009

Jamal Al-Najjar
and Almigdad Dahesh Mojalli

Yemeni women increasingly make an effort to make informed choices about their reproductive health and make use of family planning methods, also known as birth control. Although many women choose the hormonal pill as their contraception method, several complain about the side effects.

The side effects include breast tenderness, headaches, dizziness and fatigue. And they often push women to quit the pill and seek alternative contraception methods. Other women are driven to forsake birth control all together as they are discouraged and mistakenly believe that other options will not work for them.

Doctors agree that to compound the troubles associated with the side effects of pills, wrong practices like their irregular use can trigger a number of health problems. To further add to the problem in Yemen, many prescription contraceptives are sold over-the-counter, so many women don't consult gynecologists to conduct the necessary check-ups and get the appropriate contraceptive method prescribed to them.

Dr. Arwa Al-Rabe'e, the deputy of the Health Ministry for the population sector stated the ministry announced in the beginning of in 2006 free birth control services, available to 85% of the country. However, there are still many obstacles against the effective implementation of this service.

Afraid that alternative contraception methods may have the same side effects as the pill Najat Saleh Ali, 25 of Sana'a said, “I began to use contraceptive pills a year ago but I don't think I can continue anymore because they constantly cause me stress, dizziness and migraine,” said. “I went to the doctor to seek other alternatives such as intrauterine device; she told me that it doesn't fit me as I have uterus inflammation. I am now hesitant to use other kinds of contraception,” she added.

A study conducted by Mari Stops in 2007 revealed that only 32% of Yemeni married women use some method of birth control, though 96% of both men and women are aware of at least one type of birth control.

Women reported that the major reasons why women stop using FP is either because of the adverse health effects of FP (37%), or because they want more children (28%), and 11% were told to stop by their spouse. Others noted that the cost of methods was also an issue. One woman put it succinctly that the woman stops: “When her husband asks her to because he is the decision-maker”. Women also stop FP to protect their marriage “when her husband wants to marry another woman because his financial status becomes better”.

The report, which covered 1,400 men and women ranging from 15-49, aimed to know the background, education and usage of both women and men regarding birth control methods and sexual transmitted diseases, particularly HIV and AIDS. The report revealed that 34% of women in urban areas use birth control, in contrast to 14% of rural women. Contraceptive pills are the most commonly used method with 13%, followed by the IUD with 6% and injections with 4%. 7% of married women use traditional methods of contraception such as periodic abstinence, withdrawal and breastfeeding.

The main reasons given by women for discontinuing contraceptive use was: it is bad for their health (37%), they wanted to get pregnant (28%) and they were told to stop by their spouse (11%). The reasons for non-use were: not wanting to use family planning (FP) (36%), their spouse not agreeing with family planning (24%), not knowing family planning exists (10%) and perceived bad side effects (6%).

Belief in myths and lack of awareness about birth control also hinders women from making informed choices. Najla Ali Musleh, 30 of Ibb governorate, said that she and her husband decided to control childbirth for health reasons and also to raise their three children with more resources. However, she suddenly stopped taking the pill after two-days because she suffered from a constant migraine. She was surprised that she conceived although she had been using pills for five months. “Apart from their negative effects on health, I believe that pills are not safe because if a woman forgets them for a day or two, she may conceive. I don't want to use the other ways of contraception because they may be unhealthy,” said Musleh.

Some women prefer to conceive despite doctors' warnings that their health cannot tolerate a pregnancy. “Since my wife has heart problems and hypertension, doctors advised her against getting pregnant. However, she used pills for two years and then refused to continue,” said Sa'ad Al-Raimi. “As soon as she stopped pills, she conceived. When she was in her sixth month of pregnancy, doctors had to conduct an operation to expel the fetus to save her life as she suffered from pregnancy complications,” added Al-Raimi.

Dr. Arwa Al-Musbahi, a gynecologist working at her private clinic in Sana'a, said that around 60 percent of women opt to use the pill for contraception. She said that although there are different side effects, the main reason of most health problems that result from using contraception is associated with a lack of education and awareness with regard to the importance of consulting doctors. She pointed out that some women who suffer from certain diseases may endanger their lives if they use contraceptive pills randomly. In addition, these effects vary based on the quality of pills.

“People should be aware that using any kind of birth control method should be based on a consultancy of the gynecologist who determines the most suitable contraceptive method,” said Dr. Al-Musbahi. “For example, if a woman suffers from hypertension, anemia or a cardiac stroke, then she cannot use hormonal pills as they may endanger her life. However, other methods of contraception can work such as intrauterine device but in all cases, women should consult doctors.”

Dr. Al-Musbahi said that there are more advanced types of contraceptive pills that cause fewer side effects. However, because they are expensive, not many people can afford them. “The newer pills are better for women's health but they are unaffordable if we consider the living standard of Yemeni people. The price of 30 pills is around YR 2500, which is too much compared to the other kinds of pills that are sold at only one hundred riyals,” she said.

While some Yemeni women believe that contraceptive pills cause infertility, Dr Al-Musbahi said that pills never cause infertility, noting that society should be made aware of the means of family planning and the importance of consulting gynecologists before and during the use of any contraception to avoid potential health risks. “There are rumors that pills cause infertility. On the contrary, pills help to organize menstruation due to the hormones they contain,” she said.

The reasons stated in the mentioned study for not using a method was 36% not wanting to use family planning, 24% because of spouse not agreeing with family planning, 10% not knowing about family planning and 6% not using because of negative side effects of FP in the past.

Dr. Mohamed Al-Obaidi, a medical specialist working in Al-Aqsa Medical Center in Sana'a, said that in addition to the side effects that pills cause to women, some doctors don't conduct medical checks-up before they prescribe these pills, which may bring about health problems. “Women suffer from side effects of pills because they are of poor quality,” he adds.