17-year-old Olayemi Adelani* has been sexually active since she was 15 years old and has had an abortion. Adelani doesn’t mind engaging in unprotected sex because of the ‘contraception hack’ she uses. “After sex, I go to the bathroom and try to wash the semen out of my vagina then I drink a mixture of lime and Alabukun.”
In developing countries, approximately 50% of pregnancies among adolescent girls are unplanned. In Africa, about 46% of these pregnancies end in unsafe abortion. The rate of unplanned pregnancy is high among young people in Nigeria.
Unwanted pregnancies can be prevented by emergency contraception such as birth control pills or devices after unprotected sex, failed contraceptive or rape. Emergency contraception helps to prevent a pregnancy, not end one. It does not protect against sexually transmitted diseases. Pill form and IUD are the two types of emergency contraception. The most common side effects of emergency contraception pills include nausea, abdominal pain, fatigue, headache and menstrual changes. Emergency contraception is recommended for use within 5 days but are more effective the earlier it is used after sex.
The intrauterine device (IUD) is the most effective form of emergency contraception. It prevents fertilization by causing a chemical change in sperm and egg before they meet. This method is great for women who desire a durable and reversible contraceptive method.
Challenges with emergency contraception use
Amongst the major barriers to the use of emergency contraception are inadequate information, dependence on unproven contraceptive methods, and misconception about modern contraception. In Nigeria, the knowledge of contraception is really poor, hence why its use is strikingly low. Cultural beliefs also play a role, reinforcing biases such as contraceptives lowers sexual urge, contraceptives cause infertility and health problems among women. Unfortunately, progress has not been made towards improving the use of contraceptives over the last 10 years.
While a large number of young people are aware of the benefits of using contraception, the rate of utilization is still low. Rather many young girls use unconventional and unproven contraception methods known as ‘concoctions’. These concoctions involve a mixture of substances such as Alabukun, an analgesic drug and lime, Alabukun and 7Up drink to wash the womb. Other methods include salt and hot water, vaginal douching, and a combination of antibiotics and non-emergency contraception pills. Though some people are knowledgeable about approved emergency contraception pills (Postinor), they still preferred a combination of ECPs and concoctions like saltwater solutions, lime and potash.
While Adelani believes that medically approved emergency contraception like Postinor is effective in preventing unwanted pregnancy, she scared to use it because of certain claims about its side effects. “I heard that too much of Postinor can damage somebody’s womb, and the person may not be able to fall pregnant again. That is why I prefer condom, it is better than taking drugs.”
It is clearly evident that there is a sweeping knowledge gap regarding emergency contraception among young adults in Nigeria. The need for a comprehensive sexuality education that starts early cannot be overemphasized. The cycle of silence, shame and stigma over sexual and reproductive health-related matters continues to put many people at risk of STDs and life-threatening situations.
The government has a role to play in improving how young people in Nigeria access information on sexual health. It is also crucial to consider a more inclusive language for sexual health-related subjects. The word commonly used to describe pregnancy prevention methods is ‘Family planning’ instead of words like ‘Contraceptives’ or ‘Preventing pregnancy’. What is the essence of communicating in a way that excludes half of the people who need these services? 50% of the people who need to prevent pregnancy are young, unmarried and definitely not planning a family anytime soon.
According to Morenike Fajemisin, a Sexual and Reproductive health Innovator, “Sex education in Nigeria is still in the ‘do not talk about it’ phase and what is available is abstinence-only sex-education, such that when it comes to the matter of sexual and reproductive health, so many young women and men end up making so many wrong decisions or going to the wrong sources for answers.”