Jamila, a part time domestic help in Mirpur was feeling helpless. She became unable to do heavy works like mopping floor and could not bear any jerk while traveling, since she took an Intra-Uterine Contraceptive Device (IUD), a long-term contraception method from a nearby health centre.
"I am having severe pain in my lower abdomen. Earlier I had my menstruation stopped and gained weight when I took injections. All these things (contraception method) are bad for health. I would go to the centre again and ask them to remove it," grumbled Jamila.
Not only Jamila, but also a fair number of women complain about and then cease using IUD, a small device inserted in the uterus to prevent pregnancy. According to the report of Bangladesh Demographic Health Service (BDHS) 1999-2000, 53.8 percent eligible couple in the country use contraception
mmedpur.
Some of the women in the city commented that IUD, being a cheaper method is promoted in private and public health centres, where mostly the women from lower income group opt for health facilities. "One IUD costs less than one dollar and provides protection for ten years. This becomes cheaper for the organisations and they offer it to people more," commented Tahmina Begum, a housewife in Elephant Road.
When asked one of the higher officials of Department of Family Planning strongly denied the allegation. "No government health centre ever persuade a client to use IUD," he said. He said, if government had designed to promote IUD, there would have been high referral fee. "Do the centre provide huge amount of money to clients or service providers? Why would someone opt for IUD for Taka 20 only?," he said clarifying Tk 20 is given as a token money or conveyance when a client inserts IUD.
However, he admitted the
methods and only 1.2 pent of them use IUD. It also said that more than 34 per cent users discontinued using IUD within first year due to several reason and 30 per cent discontinued for side effects.
Some of the doctors working in private and public sector said, sometimes it cause some disadvantages. They expressed it causes lower abdominal pain, irregular bleeding, heavy menstrual bleeding, inter-menstrual bleeding and also severe infection.
However, the doctors stressed that IUD could not be termed as 'harmful' to female health. "The method itself is not harmful but its success depends on quality of care and technical skills of service provider," explained one of the doctors.
Also the doctors said that each individual has body functioning and body response that differs from person to person. Therefore, nobody can predict how a person's body would react to IUD. "Sometimes the uterus pushes out the IUD considering it as a foreign body," said Dr. Helena Begum, working in family planning sector for long. "But that only happens in two percent of cases," she said.
"In fact, sometimes the IUD users confront some disadvantages due to lack of appropriate screening," said Dr. Syed A.K.M. Hasan Alam, Director, Mohammedpur Fertility Services and Training Centre. He said that service providers should be skilled in history taking and physical examination. "They should know the thumb rule of IUD insertion like not using it incase the client suffers from infection," he clarified.
Moreover, the doctors said it is necessary to give the client satisfactory information about the method. Both precounselling and postcounselling are essential, they said. "A client should be given all information regarding the advantages and disadvantages of all methods so that she can decide which one to take," said Dr. Helena. She added that no family planning method is absolutely free of side effects and if the client is given precounseling, she can deal with it. "Had they told me before that I may have sever bleeding, I would not have got scared this much," said Amina, wife of a rickshawpuller in Moha-
recent lot of IUD used in family planning centres was brought from India that is not of good quality and may have caused complications in users. When asked about skilled providers, the official of the department said around 23,000 skilled fieldworkers working in public sectors. They work in 76 district hospitals, 93 Mother and Child Welfare Centres, 467 Thana and Upazila Health Complex and 4500 Union Parishad Health and Family Planning centers. "Our Family Welfare Visitors go through 18 months of basic training," he said. He also added sometimes private or NGO run health centres lack of skilled service providers, as they leave the job if got a better offer in government organisations.
Now let us know some facts about IUD.
Indication of IUD
l Multiparous (who have child more than one) women for birth spacing
l Women who cannot use hormonal contraceptive method l For lactating mother
l Unreliable, illiterate woman when patient compliance is not good to pill
l Post coital contraception when IUD is inserted within 5 days of unprotected sex
Absolute contraindications
l Suspected pregnancy
l Pelvic Inflammatory Disease (PID)
l Vaginal bleeding of unknown origin of unknown aetiology
l Cancer of uterus or other pelvic tumors
l Previous ectopic pregnancy
Side effects and complication
l Fainting and collapse of the patient
l Bleeding
l Pain
l Pelvic infection
l Uterine perforation
Ideal candidate for IUD
l Who has borne at least one child
l Has no history of pelvic diseases
l Has normal menstrual period l Is willing to check IUD tail l Has access to follow-up and treatment of potential problems