‘MATEBOHO Mohase could not hide her fear as she expressed concerns over an implant contraceptive she wanted immediately removed at the Lesotho Planned Parenthood Association (LPPA) clinic in Maseru on Monday this week.
Minutes later, after receiving some information on the benefits of the method from the LPPA Service Delivery Coordinator, Nthabiseng Phatsoane, Ms Mohase (27), changed her mind and decided to remain on the Implanon contraceptive.
She later told the Lesotho Times that she had initially decided to have the implant removed after her friend had recently fallen pregnant while using the same method.
However, Ms Phatsoane explained there were some few isolated cases of failure, which were reported among women with certain health conditions, and the matter was under investigation.
“The method remains safe, but we have received concerns from a few women with certain health conditions. We urge all women using the Implanon and may be concerned, to seek the right information from their nearest health facility,” Ms Phatsoane said.
The Implanon is a rod inserted in a woman’s arm to prevent pregnancy for three years. It can be removed any time. The rod releases a steady dose of progestin into the body, which is a synthetic (artificial) hormone that prevents the release of the egg for fertilisation by the sperm.
Mangose Sithole, the Family Planning Programme Officer in the Ministry of Health also confirmed they have received some complaints with regards to the implant and investigations were underway to further inform action to be taken by service providers.
However, Ms Mohase represents many women of child-bearing age who struggle to identify an ideal contraceptive method to use and rely on what friends or relatives say about certain methods. In some cases, information shared is inaccurate and can negatively affect choices of methods to use, depending on need.
Family planning and sexual reproductive health and rights service providers have for years struggled to demystify the myths associated with mainly long-acting contraceptive methods including the Intra-Uterine Device (IUD), commonly known as the loop and implants. Some of these myths are associated with the side-effects some users experience, which can be managed through treatment and other actions.
Speaking to the Lesotho Times this week, Ms Sithole said women of child-bearing age should demand assistance from appropriate service providers to learn about contraceptives and whenever they experience some discomfort.
She further explained that currently the methods less used in Lesotho such as the loop, used by only three-percent of women, and implants at six-percent, are long-acting and reversible methods suitable for child-spacing, for women no longer in need of children and women not ready to have children.
“We introduced implants in 2014, which is not a long time considering the difficulties associated with change of practices, behaviour and acceptance of new methods. We hope that with continued advocacy support from our partners, we will strengthen awareness on the benefits of the implants and begin to see more women opting for methods such as the Jadelle and the Implanon. As for the loop, although it is very good and readily available, a significant number of women are still not comfortable with it,” Ms Sithole said.
A total 60 percent of women in Lesotho prefer injectables while 31 percent use the pill. Lesotho has an 18 percent unmet need for family planning among married women, looking at disruptions in use of certain methods and effectively addressing the needs of women who no longer want to have more children and for child-spacing.
In addition, men do not feature prominently when it comes to sharing the family planning responsibility.
Lesotho’s current contraceptive prevalence rate is at 60 percent and the Ministry of Health is working with partners to increase it to 80 percent by next year. Focusing on the unmet needs can help Lesotho to achieve some quick gains.
However, this could be a difficult task if the government and partners do not address inaccessibility of integrated and youth-friendly services, particularly in the hard to reach areas where fertility rate is even higher than in the urban areas.
But also, according to Ms Sithole, Lesotho’s 3.3 percent fertility rate is not evenly distributed with indications showing that, among other factors, some women do not start having children at the right time.
“The challenge in our situation is that as a country we are not properly planning families by ensuring that we start and end at the right time. Some women start to have children either too early or very late. If you start late it means you are likely to experience a limit in the number of children you are going to have and if you are too early, there are chances that you will have more children than you need,” Ms Sithole said.
The need to also involve men, she further explained, was critical in ensuring effective planning of families’ and also protection against sexually transmitted infections (STIs).
“There are a number of factors if you look at the role of men in issues of contraceptives and sexual reproductive health and rights. Their understanding is key because we then prevent situations where some do not want their partners to use contraceptives, mainly because of the myths. We also need to work towards ensuring that men too can use male-contraceptives such as the condom and vasectomy, which is a safe and permanent family planning method,” Ms Sithole said.
LPPA’s Ms Phatsoane also indicated the importance of strengthening the empowerment of men, particularly adolescents and young men to increase the effectiveness of prevention of unintended pregnancies and STIs.
A peer educator working with the LPPA, Bahlakoana Malelu, 25, said a high STI prevalence among males age 15-24, show a disturbing trend of irregular use of condoms.
“A significant number of young men who describe their relationships as steady, do not regularly use condoms. Through our work, we have learnt that most young men are mainly concerned about preventing pregnancy than STIs, including HIV,” Mr Malelu said. Lesotho has a worrisome HIV prevalence rate at 25 percent, the second highest in the world.
He explained the need to strengthen education on the importance of dual protection (condom-use and another form of contraceptive) among young partners not ready to have children and to help prevent STIs.
“In relationships involving young women and much older men, which we do not encourage, we also promote dual protection. Usually in such relationships, the danger comes when young women lack knowledge of contraceptives, and the assertiveness to demand safe sex. That then place them at the risk of having unintended pregnancies. Through desperation, some may end up resorting to backyard abortion,” Mr Malelu said.
These rampant backyard abortions are also attributed to a significant number of maternal deaths in Lesotho, which are also among the highest in Africa at 1,024 deaths per 100,000 live births (2014). Although abortion remains illegal in Lesotho, the government bears the cost of post-abortion care, which is provided by public health facilities.
In some cases, women in Lesotho seek clinical abortion services in the neighbouring South Africa, where it is legal.