Family Planning in West Africa
Poku Adaa
A survey conducted by our correspondent has shown that most young women have "gone off the pill'. They are suspicious of most of the contraceptives on the market because of the reported side-effects of one "wonder drug". The controversy sparked by this drug rages on.It has taken a long time for family planning methods to be accepted in traditional West African societies, and this has been attributed to illiteracy in the sub-region.
In Ghana, Togo, Nigeria and the Ivory Coast, for instance, many interpretations were put forward by women on their respective governments' intro- duction of family planning program- mes. Traditionally, African societies have been dependent on large families for their farming, fishing and as a form of insurance for old age. And apart from being a great asset to have many children, it was seen as confirming fertility and thus raising one's social status.
It was, therefore, no wonder that family planning methods initiated some 20 years ago did not find favour with West Africans. But following intensive public educational campaigns by government agencies assisted by the International Planned Parenthood Federation (IPPF), young women are getting over their inhibitions and suspicion about contraceptives.
The educational campaigns made women understand that the contraceptives were only to prevent unwanted pregnancies and to ensure their uninterrupted education in schools and colleges. The programme also aimed at allowing married couples to space their children and have only those they could maintain.
But recently, the United States Food and Drug Administration (USFDA) renewed its earlier campaign against the use of the contraceptive injection, Depo-Provera, which is still prescribed by government or state family planning clinics in some countries despite world- wide controversy about its safety. Depo-Provera is said to prevent pregnancy for up to three months.
An investigation by this writer has revealed that the USFDA was influenced in its decision by findings made during a long study of the contraceptive, which indicated a link between the drug and increased incidence of cancer in certain animals.
This generated controversy in the African sub-region. However, other medical and family planning organis- ations such as the IPPF, which is a government supplier of Depo-Provera judged the results as insufficient evidence against its use by human beings.
Depo-Provera is also said to have certain side effects, including the pro- gressive or sudden cessation of menstruation in some women, weight gain or loss and prolonged period of infertility after its use is stopped. This period can last up to 18 months. Various other symptoms connected with its use have also been reported. They include headaches, nervousness, abdominal pains, nausea, menstrual cramp and backache.
But thousands of Ghanaian women continue to receive this contraceptive at their local family planning clinics. Justifying the continued use of Depo Provera in the government's family planning programme, the executive director of Ghana's National Family Planning Programme, Dr A A Armar, said the drug's use is acceptable in countries where medical services are generally inadequate.
In such countries, he said, pregnancy and childbirth constitute a greater danger to certain women than the contraceptive itself. "It has its problems but so long as it is being used by people who know what they are about, it has its place in the national family planning programme", he said.
Mrs D G Azu, executive secretary of the Planned Parenthood Association of Ghana, said it was PPAG's policy to inform prospective users of the drug's possible side-effects. But it is not clear how many of the users of Depo Provera in Ghana are fully aware of the possible implications of its use.
Alternatives
Mrs Azu said Depo-Provera was popular with Ghanaian women, particularly rural ones, because they found the three monthly injections a convenient method of contraception. "For method than taking a pill daily". But she added that because of side-effects attached to the drug, notably temporary infertility after cessation of use, PPAG clinics tried to limit it to mothers who had no intention of having more children.Other family planning alternatives are the pill, which many Ghanaian women consider inconvenient, the "loop", which they feel has too high a failure rate, and sterilisation, which is still unpopular in Ghana.
The Depo-Provera controversy flared up when the USFDA withdrew approval for the marketing of the drug in the United States, while supporting its continued use in countries with poor maternal and child-care facilities.
This action prompted the accusation of "double standards" from consumer groups in the United States and Europe. The USFDA, in response, decided to set up a board of inquiry to take another look at available information
Cervical cancer in Nigeria
A MOST distressing news for African women has emerged from the discovery by researchers in Nigeria of the were married. ravaging spread of cervical cancer (carcinoma of the cervix) among Nigerian women.A report in the Nigerian Guardian quoting researchers F. A. Durosinmi Etti and T. A. Ajeigbe, radiologists with the Lagos University Teaching Hospital (LUTH) who examined 108 cases, carcinoma of the cervix is the commonest female gynaecological tumour being seen at the radiotherapy unit of the hospital.
Although it has always been known to be common in women over 40, its incidence is rising. The mean age of their patients was just 25 and about 92.6 percent were married.
While 80 (71 percent) of cases of cervical cancer were out of reach of any curative hope, there was a frightful drop in the survival rate of sufferers. At the end of the first year, for instance, 32 had died. By the end of the second year, 44 had died.
Mr Durosinmi-Etti also disclosed that at least six out of every 20 patients visiting his department each day have cervical cancer. What makes this "terrible disease" so depressing is not just that it is spreading so fast, but that like other varieties of cancer, it has no easy cure or treatment.
