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Posted by African Press International on June 10, 2013

  • By Maurice Alal, API Kenya

THE level of awareness on proper use of emergency contraceptive pills (E-pills) among the university and college students in Nyanza region is still low, health officials say.

They are worried that despite the increasing popularity of the drugs among the sexually active group, there was little understanding on their working and side effects, so much so that most users had turned them into a family planning tool.

As such, the medics are now demanding that aggressive sensitization on the drugs, popularly referred to as the Morning-After-Pills, be mounted in the region to raise the level of awareness.

“It is important for this sensitization because these people do not know,” says Dr Paul Mitei, a Gynecologist and Deputy Director for Medical Services,Kisumu County. He suggests that schools, colleges and other public places should be targeted with the awareness creation information on the availability and correct usage of these pills.

“We must use all the forums and platforms available to educate our women about these drugs,” he says, expressing the need for a regulated wider availability of the drugs.”But this should not be seen or interpreted to mean someone is trying to encourage promiscuity,” he says.

Rising Demand

His comments come against the backdrop of chilling statistics that indicate a huge rise in demand of these pills among an increasingly sexually active group of Nyanza’s populace.

At a Chemist outlet located in Maseno township in the vicinity of Maseno University the owner tells African Press(API) that in less than two weeks, they sell over 1000 doses of emergency contraceptive pill called Postinor 2 that is popular among the students eager not to conceive after having unprotected sex.

“We have booming business especially when the students are here,” says

Lamek Otieno. Demand for the E-pills starts from Thursdays towards the weekends but peaks on Mondays after the weekend.

“They come apprehensive that they might have conceived so they demand for the pills as a cautionary measure,” she says.Asked whether they give instruction on the E pills usage, Lamek says that most of the ladies do not have that time for guidance. They come for specific pills with fixed amount of money.

Most of these ladies are in the age bracket of 18 and above, therefore they prefer going to local chemist which most of them are operated by those who are not qualified health providers.

This shows that a lot of sex happens towards weekends, from Friday to Saturday especially in night clubs, mostly attended by the students.

In Kisumu City, the same story replays. A spot check shows that the pills are increasing getting popular among the sexually active age group.

The interesting aspect of this demand is that although the emergency pills are offered free of charge at government hospitals, not many of these users choose to get them from there and instead settle for the over-the-counter self prescription purchases from, drugs shops some of which are run by unqualified personnel.

A nurse at Jaramogi Oginga Odinga Teaching and Referral Hospital Mrs. Mary Ngoya laments that the rate at which E-pills are used in hospitals is very low.”We have established that these users will rarely come to hospitals to get the pills, but instead prefer buying them from the local chemists and backstreet shops,” she says.

Perhaps this has to do with the stringent check measures attached on those seeking the pills from the public hospitals so much so that they would rather go where no questions are asked.

E- Pills are given for free in public hospitals after the users are interviewed and counseled. The pills are mostly used in rape and defilement clinics.

“We interview and counsel the victim be¬cause ethically we have to ascertain that the victim qualifies to use the pills. We have to be careful and follow professional guidelines because the pills can be helpful or cause harm if carelessly used,” Ngoya explains.But while the intents of such ‘stringent’ measures might be good, the would-be users of the emergency contraceptives especially those in the low age bracket are left out “Young girls are scared and feel uncomfortable being interviewed about sex hence they prefer to buy the pills from the many local chemists,” Ngoya says.

The concern at this trend lies in the fact that most of the people dispensing the drugs do not have knowledge and offer the users no counseling before dispensing them.A high school teacher, Margaret Benswell, says time was ripe when Nyanza parents encouraged an open debate on the usage of the contraceptive pills among their teenagers “We cannot pretend that our children are not having sex.

The easy availability of the pills means they can easily get carried away to have unprotected sex,” she posits. She suggests that parents should be frank and advise their children on the dangers of early sex and the need for proper protection.

It cannot be over emphasized that one of the toughest decisions faced by teenagers in today’s era is whether to have sex and the appropriate time. Health workers therefore advance that teenagers should take responsibility to protect themselves from unplanned pregnancies and Sexually Transmitted Diseases (STDs).
In the recent years, the usage of E-pills has shot countrywide. Basically E-pills are medically and legally considered forms of contraception measures that if taken after unprotected sex may prevent pregnancy.They can also be used in rape cases so as to prevent a victim from undergoing the trauma of carrying an unwanted child as a result of the cruel act.

The now popular e-pill is recommended to be taken within 120 hours of having unprotected sex, but is most effective if taken within 72 hours. But in Nyanza there is a thin line between its proper usage and abuse.

The most popular E-pill, Postinor 2 (P2) should to be taken within 120 hours of having unprotected sex, but is most effective if taken within 72 hours.

The pills prevent ovulation from taking place. The hormones contained in the pill prevent pregnancy by suppressing the pituary glands which stops^ development and release of the egg in the ovary, medics say.
How¬ever, in cases where ovulation has already taken place, the pills change the lining of the uterus to prevent implantation from taking place.

Dr Mitei explains that E-pills make the lining of the uterus not responsive to implantation. He says women in their reproductive age can use E-pills to prevent un-wanted pregnancies on instructions from a certified medical practitioner since fertility starts as early as the age of nine.

The medic explains that women who take birth control pills can use E-pills in case they engage in unprotected sex and forget to take the birth control pills.
“When an Inter Uterine Device (1UD) comes out and the woman does not want to get pregnant, she can use E-pills,” he says.Caution

However, Dr Mitei warns that people with hypertension, obesity and people of varicose veins (abnormally swollen veins) are not advised to use these pills. He explains that if one makes it a habit of using E pills, they suppress the work of the ovum which later on may forget its work and this might cause infertility in a woman.

On her part, nurse Ngoya asserts that E pills were not a method of family planning as presumed by a number of women.”These pills safe only supposed to be used to prevent unwanted pregnancies in cases of emergency”, she emphasized. One sensitive and important issue that people using these pills ignore is that E pills do not prevent AIDS and STDs.

“As much as one would want to use them, they should bear in mind that they have a high chance of contracting STDs and HIV/AIDS unless one uses a condom,” she says.

Conversely, there is a misconception that by using E pills one will be carrying out an abortion. The medics discount this saying E pill is used to prevent the pregnancy from occurring and will not have an effect once the pregnancy has already taken place.

Even so, Dr Mitei explains that misuse of E pills is bound to lead to menstrual problems that might include feeling nausea, headaches and disruption of the menstrual cycle, “Sometimes, the user might experience heavy menses.”Roseline Adhiambo, a student from Jomo Kenyatta, does not advocate for the use of pills because she believes they do not work. In contrast, Becky Akinyi, a student at University of Nairobi advocates for the use of E pills on condition that the users do not misuse them.

“People using them should follow instructions and be careful not to damage their reproductive system,” she says. A Kisumu resident,

Mathayo Amonde begs to differ. “To prevent unwanted pregnancy, I would rather advocate for people to use a condom than these pills,” he says.Kisumu County has various institutions such as Kenyatta University, University of Nairobi, Maseno, Bondo, Jomo Kenyatta, Catholic University, Uzima University and Moi University. Other institutions include Kisumu Polytechnic and Nairobi Aviation among others.

Unfriendly health services to blame on misuse of E pills

Lack of youth friendly integrated health services in most Kenyan medical facilities has been blamed for the increase of contraceptive abuse among high school girls.

Medical practitioners say school girls abuse family planning methods because they lack proper information on how and by whom the contraceptives are used.

Most hospitals in the country do not have Sexual Reproductive Health experts to ensure the youth are well guided on the dangers of contraceptive use in their young age.

The 2008 /2009 Kenya Demographic Health Survey (KDHS) indicates that the use of modern contraceptives among adolescents aged between 15 and 19 is at 36.5 percent with majority 39 percent using the injectable.

The survey showed that Central region was leading with 57.5 % of the adolescents using modern contraceptive method while Rift Valley was the lowest at 24 percent in all the provinces nationwide.

The survey further indicated that more educated adolescents who are more educated, richer, living in the urban areas and married have higher use compared to their counterpart.

Researchers points out that most hospitals lack that facility where the youth can freely obtain information. “Lack of information has led the girls and their mothers to buy the contraceptives from across the counter,” they say.

A Reproductive Health consultant with the United Nations Population Fund, Dr Dan Okoro says although the KDHS showed that public, health facilities were the major source of the contraceptives, the emergency pills are mostly provided by the private sector, especially pharmacies.

He points out that 80 per cent of the adolescents have knowledge about contraceptives, adding that the survey showed that most of them 

had got the information from radio stations.
He however, observes that this may change, especially with the advert of ICT use of mobile technology that includes m health, Facebook and twitter.The existing family planning facilities seemingly are unfriendly to young girls because of the stigma involved and the advertisement pictures on the walls.

“Even if a girl wanted counseling on a SRH-related issue, she may lack confidence because the facility environment favours married women,” says Mary Okiya, a high school student in Homabay County.

She observes that even the pictures in the family planning facility discourage young girls from sitting in the queue to be attended to.
“They are pictures of pregnant mothers, mothers carrying their babies or accompanied by their spouses.

Because of this young are discouraged from seeking for guidance and counseling session with health providers. The medics now call for the government to improve family planning services to adolescents saying that they need information on the subject.

However, health providers have also called upon Nyanza residents to embrace family planning methods to enable them have children they are able to educate and provide for.

“Family planning methods enable the government to budget well for her people,” researchers say adding that if the rate of birth is not controlled then the country will not meet the demands of the populace.

They add that family planning services are offered free of charge in public health facility and called upon residents to take advantage of that to improve their living standards.

All Kenyans are affected by the nation’s rapid population growth, which has nearly doubled to 38.6 million people over the last two decades and is estimated to grow to 71.5 by 2030.

Without Family planning methods a decrease in the number of births per woman, this level of growth will push the country’s economy, social services and natural resources past their limit and threaten the achievement of the national goals outlined in the Kenya’s vision 2030.



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