Space your children, the benefits are many

After Mrs. Folu Emmanuel had her baby and was discharged from the hospital, she was able to adjust to her new role without any stress, even as a first-time mother. This is because, while the antenatal period lasted, her care givers took time to teach all the pregnant women in her ‘class’ how to go about it.

About five weeks after delivery, her husband started making demands for sex. Again, she was prepared, simply because she had also been tutored at the antenatal clinic that one of the advantages of active and exclusive breastfeeding was that it also prevents pregnancy.

So, she went to work. Not long after, she started feeling sick. She made quite some visits to her doctor, and, each time, she was diagnosed as being in perfect health.

Folu recalls that most times, she was nauseated; and sometimes, she felt some pains that seemed to suggest that she had peptic ulcer. With this complaint, her physician prescribed Zantax for her. She took it but her discomfort persisted.

It was when ‘something’ kicked in her womb about five months into her initial complaint that she suspected she might be pregnant. A pregnancy test was positive. She was distraught because her baby was barely seven months old.

What went wrong, considering that her antenatal nurses had assured her that if she breastfed exclusively for the first six months of her pregnancy, she needed not to be worried each time she ‘met’ with her husband?

What Folu did not realise is that exclusively breastfeeding does not always work for everybody. Indeed, according to Dr. Akin Olugbade of Sinai Clinics, most women don’t commence their monthly period until some months after child delivery. He, however, warns that when a woman actively breastfeeds her infant, she is less fertile but definitely not infertile because her ovulation is still ongoing quietly and she could fall pregnant if she doesn’t apply caution.

Indeed, experts warn that “although you may not menstruate for months after giving birth, your body usually releases its first postpartum egg before you get your first period. So, you won’t know you’ve ovulated until two weeks later — when you menstruate.”

Again, physicians warn that though breastfeeding curbs the hormones that trigger ovulation, “remember that you could start ovulating again at any time after three months of lactation, and you probably won’t know when it happens.”

They, therefore, caution that in order to guard against unwanted pregnancy, you must adopt a birth control method.

The Senior Programme Manager on Reproductive Health at the Population Council, Dr. Salisu Ishaku, notes that there are various birth control measures such as the diaphragm, condom, and the pill. He, however, notes that while some women are able to tolerate some of these methods favourably, others react to them; while some men would not be dragged into using the condom.

He discloses that since one of the aims of the Millennium Development Goals is to enhance maternal and child health; and to also reduce maternal and child deaths — which are likely to occur when births are not well-spaced — a new, long-lasting, user-controlled natural progesterone hormone contraceptive for breastfeeding women is being introduced in Sub-Saharan Africa — Nigeria inclusive — and it has 98.5 per cent effectiveness for preventing pregnancy. It is called the Progesterone Vaginal Ring.

Ishaku notes that though breastfeeding may provide contraception for new mothers, “once her infant is six months old or a woman begins supplementing her infant’s diet or has her first postpartum period, the contraceptive protection of lactation decreases.”

He advises that a woman who does not want to get pregnant accidentally must consider safe contraceptive alternatives such as the PVR to avoid unintended pregnancy.

“The contraceptive releases by diffusion a continuous flow of the natural hormone (progesterone) from the ring outward to the vaginal walls. Progesterone enters the blood stream and regulates fertility, mainly by suppressing ovulation in lactating women,” Ishaku explains

In his presentation at a workshop on the introduction of the PVR, Consultant Obstetrician and Gynaecologist, Prof. Adeyemi Adekunle, explains that the contraceptive has been formulated to especially meet the needs of women who have just had babies, and therefore have considerable unmet need, especially during lactation (breastfeeding).

The fertility expert explains that progesterone is a naturally occurring female sex hormone and it is essential for the function of the female reproductive system. He says that is why the PVR has high acceptability among the subjects of the clinical trials in terms of safety and very low (if any) side effects.

Ishaku explains that the PVR is made of silicone rubber, and this enables the ring to slowly release the natural hormone progesterone, which is absorbed into the bloodstream to regulate a women’s fertility. “An individual ring lasts for up to three months, and a woman can use the method for one year,” he enthuses.

Adekunle adds that the PVR’s contraceptive effectiveness is ensured as long as the woman continues to breastfeed at least four times per day.

Better still, the physicians enthuse, while many contraceptive methods sometimes affect a woman’s ability to produce milk, PVR does not interfere with the breastfeeding process, nor does it affect the health of the breastfeeding baby.

Ishaku says a woman can insert and remove the ring herself, thus eliminating the need for a skilled health provider’s involvement. He however warns that though the PVR is worn in the vagina, it does not protect women from sexually-transmitted infections, including HIV. As such, he says, users must use appropriate protections against STIs.