Dr. Sanjeewa Godakandage- Consultant Physician in Community Medicine Family Health Bureau - HealthNutrition and Indigenous Medicine Ministry
Myth 1 : Family planning is for population control
According to a recent declaration by the World Health Organization (2018), ‘Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through the use of contraceptive methods and the treatment of involuntary infertility’.
The objective of the National Family Planning Programme in Sri Lanka is to assist couples to have a desired number of children with optimal timing and spacing. Neither the local nor global family planning concepts are aimed at population control. Current Sri Lankan statistics on contraceptive and fertility rates also do not show any clear association.
It should also be highlighted that assisting couples who have difficulties in conceiving (i.e. subfertile) is also an important part of family planning.
Myth 2 : The intra-uterine device (IUD or loop) can migrate
This is one of the biggest myths associated with family planning. The IUD is a T-shaped device which is made to tightly fit into the uterine cavity, taken into consideration the shape of the non-pregnant uterus. The IUD can never travel to the heart, brain, or any other part of the body outside the abdomen.
In extremely rare situations, following a difficult insertion, the IUD may come through the wall of the uterus into the abdominal cavity. Doctors and public health nursing sisters in Sri Lanka are given a special training on the correct insertion technique to prevent this type of complication. Correct insertion technique also helps in minimising premature expulsion of the IUD.
Myth 3 : Hormonal methods can lead to subfertility
This myth is mostly prevalent amongst females in younger age groups. Hormonal methods of family planning, i.e. the pill, the injectable and the implant contain progestogens, alone or in combination with oestrogen. These are similar to the hormones naturally found in the body of a female. The small doses of female hormones released by these family planning methods do not cause subfertility.
Some women who have used family planning methods for longer durations complain of subfertility and attribute it to the method used. However, the real reason is decreased fertility due to ageing, and not the family planning method.
There may be a delay in regaining fertility after stopping progestin-only injectable (DMPA or depo injection). Women who stop using DMPA will take about four months longer on average to become pregnant compared to women who have used other methods. This means they become pregnant on average 10 months after their last injection. These are averages and a woman should not be worried if she does not become pregnant even as much as 12 months after she stops using it.
The length of time a woman has used the injectable is not related to how quickly she becomes pregnant, once she stops having injections.
After a woman stops the use of progestin-only injectable, she may ovulate before her monthly bleeding returns, and thus can become pregnant. If she wants to continue avoiding pregnancy, she should start on another family planning method before her monthly bleeding returns.
Women who switch methods need to consult their healthcare worker to avoid an unwanted pregnancy.
Myth 4 : The pill can cause cancers
As mentioned earlier, the pill contains oestrogen and progestogen which are similar to the hormones naturally found in the female body. There is no conclusive scientific evidence that the pill can cause breast cancer. However, in some studies, breast cancer was slightly more common among women using the pill and those who had used the pill in the preceding 10 years than other women. It is possible that the cancers were already there before starting on the pill but diagnosed sooner.
On the other hand, scientific evidence suggests a decreased risk of ovarian and endometrial (lining of the uterus) cancers amongst pill users.
There is no increased risk of cancer amongst other hormonal or non-hormonal family planning method users.
Myth 5 : The intra-uterine device (IUD or loop) can cause abortion
The IUD (or the loop) is an extremely effective way of preventing unwanted pregnancies. It is a small plastic device with a tiny copper wire wound around it. It acts primarily by causing a chemical change that affects the ability of the sperm to swim through the female genital tract and fertilise an ovum. In the rare occasion of a sperm somehow fertilising an ovum, it prevents the fertilised ovum from implanting in the uterus and starting a pregnancy.
However, the IUD cannot terminate an established pregnancy i.e. an embryo implanted in the uterus. On the other hand, an IUD should not be used to terminate an unwanted pregnancy, because it cannot cause an abortion.
In fact, the IUD is an extremely good option to prevent women resorting to illegal abortions due to unwanted pregnancies.
Myth 6 : Hormonal methods should not be used for long periods
As mentioned earlier, hormonal methods of family planning contain substances similar to the hormones found naturally in the body of females. The World Health Organization guidelines confirm the ability to use them for long periods unless there are certain medical conditions like very high blood pressure or complicated diabetes mellitus.
On the other hand, stopping them abruptly or failure to use them regularly can lead to far greater adverse consequences. Your healthcare worker will screen you for any medical condition that makes you an unsuitable candidate for the IUD or any other family planning method before and during the use of the particular method.
Myth 7 : Failure of family planning methods can lead to birth defects
All family planning methods have a very small chance of failure. There are rare incidents where family planning methods have failed and women have ended up with pregnancies. However, birth defects or any other adverse outcomes have not been reported in any of those instances.
Similarly, there are instances where women have unknowingly started family planning methods while they were already pregnant. In such instances also birth defects or other adverse outcomes have not been reported.
Myth 8 : The intra-uterine device (IUD or loop) can cause ectopic pregnancies
On the contrary, IUDs greatly reduce the risk of ectopic pregnancy (i.e. pregnancy outside the uterus) due to the overall reduction of pregnancies. The rate of ectopic pregnancy among women with IUDs is 12 per 10,000 women per year. The rate of ectopic pregnancy among women in the United States using no family planning method is 65 per 10,000 women per year.
However, on rare occasions that the IUD fails and pregnancy occurs, the chance of it being an ectopic pregnancy is high compared to pregnancies among females who are not on family planning methods. Amongst women with IUD failures, six to eight out of every 100 pregnancies are ectopic. Thus, the great majority of pregnancies even after IUD failures are not ectopic.
Myth 9 : Infrequent monthly bleeding following the family planning injection (DMPA injection) is harmful
Users of the DMPA injection sometimes get alarmed when their monthly bleeding becomes infrequent or stops altogether. This is based on the misguided belief that it would lead to the collection of ‘impure’ blood inside the body causing complications. However, it is not impure blood, and there is no need to shed blood every month. A good example is pregnant women.
At the same time, if there is any suspicion of family planning method failure leading to pregnancy, it is advisable to discuss with a healthcare worker.
The bleeding pattern a woman had before she started using DMPA injections generally returns several months after the last injection, even if she had no monthly bleeding while using the method.
Myth 10 : Natural/ traditional methods are safer than modern family planning methods
There is nothing natural about these natural or traditional methods of family planning as they interfere with natural sexual behaviours. It is true that some of these methods have been used for centuries, but we need to make use of the developments in science and technology, just like other medical treatment options.
Natural or traditional methods of family planning carry a higher risk of failure. According to available scientific evidence, a large proportion of abortion seekers had been using these natural or traditional family planning methods. Adopting more reliable modern family planning methods can minimise women resorting to illegal abortions due to unwanted pregnancies.
