Lack of proper training on Long Acting Reversible Contraceptives (LARC) leads to a high rate of accidental pregnancies within the first year of use. In South Africa as many as 600 000 women experience unwanted pregnancies due to contraceptive failure. Globally the rated of accidental pregnancies is 40%. This should not have to be.
'Fit and forget' methods
Speaking during a contraceptive round-table discussion, Dr Gregory Petro, Chief Specialist in Obstetrics and Gynaecology at New Somerset Hospital says one of the common reasons why women are not on long acting birth control methods is because of the lack of knowledge. Dr Petro also urged health workers not to have myths on contraceptives, as this further discourages people from using them.
Other common factors that minimise the effectiveness of birth control methods are incorrect insertions and drug interaction. Some medication such as Efavirenz based antiretroviral therapy (ARV), have been fingered as culprits that weakens a contraceptive's effectiveness. In cases where patients are on other medications Dr Petro advises the use of barrier methods of pregnancy prevention such as condoms.
Despite some challenges associated with the various types of LARC, Dr Petro says with the right use to their specific function they do work. “With correct administration and insertions LARC have a high rate of effectiveness. And we generally refer to them as the fit and forget methods because they are long term,” says Dr Petro.
The panel also addressed myths associated with the implants, a controversial long acting contraceptive which was introduced in the country in 2014. Specialists in Obstetrics and Gynaecology were unequivocal in their call for more training of health workers on how to correctly insert and remove implants to prevent severe side effects.
Inadequate training of health workers especially in the public sector has been pointed out as one of the reasons behind the implants being an infamous pregnancy prevention choice.
Counselling and education
Obstetrician Gynaecologist in KwaZulu Natal, Dr Mala Panday, says the side effects of implants can vary from abnormal bleeding to implants inserted too deep. “About 1 in 5 women who had implants inserted experience excessive bleeding after the procedure, this makes about 20 % of all patients on this method,” she explained. Dr Panday also mentioned that 1 in 3 women have indicated that they experienced no bleeding at all while others have reported to have normal menstrual cycles.
Another specialist in Obstetrics & Gynaecology at the University of Pretoria and Steve Biko Academic Hospital, Dr Zozo Nene, says there needs to be a protocol to manage bleeding caused by contraceptives at all public clinics.
“There should be protocols of bleeding on walls at every clinics, ” says Dr Nene. She mentioned that women not being advised properly on the choices they have available is a cause for concern. Dr Nene also urged for health workers to give special attention to counselling women and educating them on the options they have available for effective family planning.
“Women should be told that if they experience any problems with the implants, they need to go back to the person who has made the insertion in the first place”, she advices.
However, there have been concerns that most nurses are given training on implant insertions only and not trained on removal of such devices. In cases like this, Dr Petro has urged for up referrals to be made for patients.